Clinical Medicine 2 2 20 5 - 3 4 8 9 53

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 nevertheless 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 environmental 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 effective 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, since special studies and reviews of avai lable data indicate relative Zy low uti lization rates. Indonesia is also enlarging its newly established Planning Unit for more effective and improved planning.

Bangladesh, Nepal and Thailand are increasingly making use of the services of architects for the planning and location of health institutions and for improving the quality of medical care at the periphery. SEA/RC26/2 Page ix

In Bangladesh, India, Indonesia, Nepal and Thailand staff from specialized campaigns are being utilized to provide comprehensive health services and effect wider coverage. In order further to assist Member Govements, the Regional Office, together with Headquarters, is developing and testing new approaches to the strengthening of health services. The project systems analysis methodology exercise has been completed in Inhnesia and Thailand, and the Regional Office will take part in an evaluation of experiences in the use of this methodology with the Western Pacific Regional Office later this year (December 1973). A country programme exercise is to be conducted in Bangla- desh jointly by Headquarters, the Regional Office and the Government. This is a new venture which, it is hoped, will benefit not only Banglad@sh but other countries and WHO as well.

An operations research seminar, the first of its kind, was held in Bangkok, and the report has been widely circulated. Major attention is bdng paid to reviewing the health information systems in order to establish a more rational basis for WHO progme planning. Modifications have also been made in the monitoring of WHO'S delivery of planned projects, in order to provide for effective management and planning.

A revised format and new guidelines to assist governments and WHO in preparing plans of operation for projects have already been completed, based on a systems approach to project formulation and inplementation.

A meeting of senior national staff was convened early this year to advise the Regional Office on the development of its assistance to govements in the field of medical care. This group recommended that WHO programmes shouZd be directed mainly to four specific areas, viz., the planning, organization and management of medical care; evolving a referral system; education and training in medical care administration, md the conduct of research and training in research methodology. These recomnenda- tias, together with those likely to emanate from a review of WHO assistance in this field by the Programme and Budget Sub-Conurrittee of the Regional Conurrittee, should be of great value in developing new projects.

A Sub-committee appointed by the Regional Conswittee which was caven- ed early in 1973 made suggestions on further developments for the Asian Charter. It recommended that priority be given to comnicable diseases, family health, nutrition, and provision and maintenance of water supply and drainage, for imnediate action, and outlined the specific components of the proposed charter. It also reconmended continuing the collection of information on activities related to long-term plming. A plan of work along the lines suggested is under preparation.

With the appointment of an economist in the Regional Office, a start has been made toward planning a programme in health economics. It is hoped to initiate specific activities in this field after the meeting on health economics to be cnnvened by Headquarters in July 1973, which will be attended by the tuo emnomists fmm this region. SEA/RC26/2 Page x

I am glad to report the progress in the development of projects in family health as a part of comity health progrmes. The progrme proposals for 1973 include a total of 33 projects for the Region as a whole, 25 of which are continuing projects and 8 new ones.

Recent deveZopments include the successful conclusion of plans of operation for four new projects in Thailand, fomalizing an assistance of about $2.9 million over the next three years. FoZZming the conclusion of a project agreement between the Government of Sri Lanka and UNFPA, requests for five projects for which h7HO will be the executing agency have been prepared, in coZZaboration with the national staff concerned, and submitted to UNFPA. Should the present negotiations for UNFPA funding for these projects be successfil, another $4.7 million worth of assistance will be provided to Sri Lanka in the field of fami& health in projects to be carried out over the next three to four years.

In addition, proposals for assistance in the development of an Institute of Medicine cmd for the training of workers for expanding family health activities in Nepal are under negotiation. In Bangladesh, also, great interest has been shown by a nwnber of agencies in assisting in the development of sound maternal and child health and family planning services. WHO participated in a recent IBRD Mission and also assisted earlier in a UNFPA Mission to Bangladesh. It is hoped that these negotiations will lead to the development of the urgently required expansion of the services in that country, where high priority has been given to family health as part of the national plan for socio-economic development. Preparations are also being made by the Government of India for expanded UNPA assistance to famiZy health as part ofthe comnity health services in areas where health personnel are being trained, with special reference to the wider utilization of recent techniques in termination of pregnancies, in strengthening research and development and with expansion of peripheral health services, especially in rural areas. In response to a request from the Maldivian Government, WHO undertook a preliminq survey, the findings of which, it is hoped, wit2 be of assistance eventuaZly in developing a planned project for the strengthening of the maternal and child health services in that country. In Indonesia, WHO assistance has been given to the development of family health services in areas other than those in Java and Bali which are at present covered by the IBRD/UNFE'A Agreement.

If all these efforts succeed in obtaining UlVFPA funds, it is visua- lized that assistance to the family health projects in the Region as a whole will amount to about $5 million in 1973, excluding the expected, but yet unspecified, assistance to Bangladesh and Nepal and expanded assistance to India.

Preparations for this substantial addition to the Regional Office's budget have been undertaken jointly by WHO staff in the Regional Office and in the field along with the national staff. In this joint venture, I should like to express our gratitude to the government and the national staff concerned. SEA/RCZS/Z Page xi

Our activities in programmes for maternal and child health and nutrition have continued to gain strength. Assistance has been given to the development of training facilities wikhin the Region, which are nm quite capable of meeting the major needs of countries in this regard. Studies in nutrition were undertaken in Burma, India, Maldives, Nepal and Sri Lanka and have formed the basis for the development of expanded services in the countries concerned.

As a result of an assessment in Bangladesh of the nutritionat status of rural chiZdren, a country-wide programme for the prevention of xerophthalmia was initiated mong pre-school children, using a high dose vitamin A concentrate. The resourves of the various specialized programmes, especialty those of the mataria programme, have been utiZized for this carrpaign, which is one of the largest und most important of its kind ever to be undertaken.

Governments' concern regarding the shortages and maldistribution of heatth manpower and their desire to improve the quality and to attain self- sufficiency in training resources have aZreaLZy been emphasized. Assistance from WHO has been directed towards ensuring a (:omunity orientation and incorporating a comnunity approach into the trcrining progrmes for heatth personnet. In addition, the application of recent advances in educationat technology and pedagogy has been made possibte through the establishment of two training centres for medical teachers within the Region. This year, possibilities of setting up m institute of educational technozogy within the Region have been further expZored; such an institute, together with the documentation centre that has been created in the Regional Office, should further assist countries in training teachers in the use of modem educational technology.

A series of inter-comtq courses is being introduced this year to provide continuing education for members of the medicat and nursing profes- sions in countries of the Region. The first such course will take glace in Indonesia, and, if it is successfut, further short courses wilt be developed on relevant topics in other countr.ies.

Group educational activities, arranged sequentiatly with built-in evaluation md fotlm-up, are being undertaken at country-level, and assist- mce has been given in ctinical areas such as orthopaedic patient care and rehabilitation. This attempt at evatuating the teaching of techniques in management by objectives wiZl be further developed, and it is hoped that such training courses wit2 help to improve the services of medical care institutions and wi ZZ prove useful as models for national teaching programmes.

Severat countries are undertaking re-training programmes, especially for auxiliary health workers, and are arranging to increase the admission of such workers into their training institutions. The training of such large nwnbers of staff members, whose services are urgently required, can no longer be undertaken by the traditional means and the Leisurety methods hitherto

resources tn L L conrznue zone eswu ~zsneu. -~ ~-~- -. - - SEA/RC26/2 Page xii

SEA/RC26/2 Page xiv

Cancer control programmes have been developed in a nder of countries, some with the assistance of bilateraZ agencies such as NORAD. They include the establishment of studies on the cancer of specific organs, the training of cytopathologists in early diagnosis, and a survey of the morbidity and mortazity patterns in South-East Asia. A seminar on the epidemiology of cancer with special reference to the problems of the Region is being planned jointly with the Indian Council of Medical Research and the International Agency for Research on Cancer, to be held in November 1973. At this seminar it is hoped to draw up proposals for assistance in the establishment of cancer registries, for the further training of personnel in cancer control, and for the establishment of control services within the framework of health services in the countries of the Region. In addition to xerophthalmia, which is a leading cause of blindness, the problem of cataract alone is estimated to afflict 4-5 million people in the Region. This is an area where further studies are likely to be fruitful.

The problem of the human environment still continues to require the urgent provision of basic sanitary measures on a national basis. Although large-scale assistance is available from several bilateral and multilateral sources, I must confess that progress in this field has been limited and needs to be accelerated if we are to be able to cope with the expmding demands of both urban and rural populations. Although responsibility for programmes to meet these needs often does not lie with ministries of health, I feel it incumbent to emphasize again that they will have to exercise increasing leadership in order to bring about substantial improvements in the environment. Progrannnes in Nepal and possibly the Maldives are likely to be expanded with assistance from bilateral sources.

The interest of the WorZd Bank in financing projects in this field is indeed welcome, and WHO wiZZ be glad to assist, along with the UNDP, in the preinvestment planning required by national governments to obtain further finances for such progrmes. This year a beginning has been made in supporting programmes for the improvement of environmentaZ health in areas with specific health problems such as cholera, guinea-won infestation and, in one country, fluorosis. If these programmes prove successful, they will be expanded and extended to other countries.

Assistrmce has been rendered during the year under review to 294 projects, of which 49 were inter-country and 245 country projects. In addi- twn, the Regional Office participated in 7 inter-regional projects sponsored by WHO Headquarters. !l'he projects covered many importrmt health areas, namely, public health administration and basic health services 1211, family health, including maternal md child health 1231, nursing (311, enwironmentaZ health, water supply and water rmd air poZZution(221, health education(l41, nutrition 17), dental health 16), mental health 141, radiation health 1151, quality control of drugs (61, malaria (131, tuberculosis (101, srnallpox17), Zeprosy(6), SEA/RCZ~/Z Page xiii is lmer even thrm the total rider of deaths attributed to malaria two decades ago. This year, in one country, in order to prevent deterioration of a situation that may prove serious, I om exploring the possibility of assisting by providing supplies of DM' as an exceptional measure.

Urban malaria continues to be a problem, and WHO has assisted the Govenvnent of India in a pilot project for the trial of a newer technique, which, if successful, may provide economical and reliable methods for use in such areas. The coverage of large populations in the outer islands of Indonesia shouZd bring a stiZl larger population into the consolidation phase in the Region in the near future.

WHO also hopes to stimulate the expansion of national training resources for malaria progrmes so that the Region will soon be self-sufficient in this respect. Dengue/haemorrhagic fever has again proved a problem and has reached a very high rate of incidence in Thailand, Burma and Indonesia. In a situation of this complexity, it is difficult to establish the co-ordinated multi-disciplinary action which is required for the ultimate oontrol of this disease. WHO is planning to provide assistance in preparing a plan of action on a long-term basis to replace the emergency measures hitherto used to deal with the increased outbreaks.

Programmes on zoonosis control are progressing, through the establishment of training facilities in veterinary public health in the Region. This year it is planned to hold, in Bangkok, a Headquarters/Regional Office inter- regional seminar which will review the further requirements for service and training progrmes in this field.

@idemioZogical surveilhce of comnunicable diseases and training the health staff in surveillance techniques are likely to be among the priority concerns of national governments and of WHO, if existing gains are to be consolidated and further progress achieved. Together with the establishment of an organized system of health laboratory services at all levels of the adninistratwn, to provide reliable diagnoses and epidemiological infonation, surveiZlance will require the increasing attention of national governments. WHO'S resources to assist governments in this respect have alrearpl been strengthened, and it is hoped that greater use will be made of the inter-country team which has been established for this purpose.

Assistance to programmes in non-connnunicab le diseases continues, especially in prevention and control of cardiovascular diseases, epidemiological studies on such conditions as rheumatic fevers, hypertension and ischaemic heart diseases, and the promotion of progrmes for mental health. Education and training facilities to provide the necessary manpower resources will continue to be established. SEA/RC26/2 Page xiv

Cancer control pmgrmes have been developed in a nunher of countries, some with the assistance of bilateral agencies such as NORAD. They include the establishment of studies on the cancer of specific organs, the training of cytopathologists in early diagnosis, and a survey of the morbidity and mortality patterns in South-East Asia. A seminar on the epidemiology of cancer with special reference to the problems of the Region is being p2-d jdntZg with the India CounciZ of Medical Research md the International Agency for Research on Cancer, to be held in November 1973. At this seminar it is hoped to draw up proposals for assistance in the establishment of cancer registries, for the further training of personnel in cancer control, and for the establishment of control services within the frmewo& of health services in the countries of the Region.

In addition to xerophthahia, which is a Leading case of bZindxess, the probZem of cataract alone is estimated to afflict 4-5 million people in the Region. This is an area where further studies are Likely to be fruitful.

The problem of the human environment still continues to require the urgent provision of basic sanitary measures on a national basis. Although large-scale assistance is available from several bilateral and muZtiZateraZ sources, I mt confess that progress in this field has been limited and needs to be accelerated ifwe are to be able to cope with the expanding demands of both urban and ma2 populations. Although responsibility for programmes to meet these needs often does not lie with ministries of health, I fee2 it incumbent to emphasize again that they will have to exercise increasing Leadership in order to bring about substantial improvements in the environment. Pmgramnes in Nepal and possibly the Maldives are likely to be expanded with assistance from bilateral sources.

The interest of the World Bank in financing projects in this field is indeed welcome, and WHO will be glad to assist, along with the UNDP, in the pre-investment planning required by national governments to obtain further finances for such progrmes. This year a beginning has been made in supporting programnes for the improvement of environmental health in areas with specific health problems such as cholera, guinea-wom infestation and, in one country, fluorosis. If these programmes prove successful, they will be expanded and extended to other countries.

Assistance has been rendered during the year under review to 294 projects, of which 49 were inter-country and 245 country projects. In addition, the RegionaZ Office participated in 7 inter-regional projects sponsored by WHO Headquarters. !The projects covered many important health areas, namely, public heaZth administration and bmic heatth services (211, fdZy heaZth, including maternal and child health (231, nursing (311, environmental health, water suppZy and water and air poZZution(221, health education(l41, nutrition (71, dental health (61, mental heatth 141, radiation health (151, quality control of drugs (61, malaria (131, tuberculosis (101, smallpx(7/, lepmsy(61, SEA/RCZS/Z Page xu

other comicable diseases (27/, health laboratory sermices and production of vaccine (201, health statistics(71, direct assistance to medical institutions (21) and other activities (41). Brief descriptions of all these projects are given in Part III of this report.

As in the past, in the year under review, there has been close co- operation with the United Nations and its related specialized agencies as we22 as with bilateral and voluntarg organizations. This co-operation has been especially close with UNICEF, UNDP, UNFPA, UNESCO, the World Bank, ILO and FAO. I look forward to the further strengthening of this relationship in future.

It is with profound sorrm that I have to record the untimely deaths of three of our valued colleagues during the period under review: the first was that of Professor J.J. MacSJeeney, Sanitary Engineer,who was stationed in the Regional Office; the second that of Dr J.N. Pradhan, MalarioZogist, who was attached to our malaria eradication project in Sri Lanka, and the third, that of Dr C.W. Chacko, WHO Consultant,who had served the Organization several times in its programme for the control of venereal diseases.

The Regional Office has continued to receive the utmost support from all our Menber countries, and this understanding has in no small measure contributed to the progpess made during the year. On behalf of coZ2eagues in the Regional Office as well as in the field, I should like to express my sincere appreciation to all the governments in the Region for the confidence they have placed in us and for their co-operation.

V.T.H. Gmaratne, F.R.C.P., D.P.H., D.T.M. & H. Regional Director PART I

GENERAL REVIEW OF ACTIVITIES SEA/RC26/2 Page 3

1. PUBLIC HEALTH ADMINISTRATION

1.1 Planning and Strengthening of Health Services

As in previous years, the planning and strengthening of health services have received emphasis in several ways. Health finds an important place in the overall socio-economic development plans of the countries in the Region. Integration of curative and preventive services and of specialized programmes into the general health services has continued to make progress, and greater attention is being paid to the training of auxiliary health personnel and the conversion of workers in specialized programes into multipurpose workers to man the peripheral health services. There has been increasing awareness among governments of the desirability of improving the health information system for better monitoring, evaluation and management of the services, of taking inventories of the existing health resources, carrying out studies on health manpower, investigating the possibility of making the optimum use of auxiliary staff, developing some of the newer tools such as systems analysis and management science, and conducting operations research into community health organization for more effective delivery of the health services. WHO has assisted with all these activities at both national and regional levels.

1.1.1 National Health Planning

The development of national health planning units in Sri Lanka and Thailand made further progress. WHO assisted in these efforts and also helped to establish a similar unit in Bangladesh.

In Thailand, the Division of Health Planning at the Ministry of Public Health, with assistance from a WHO public health administrator and a statistician, has prepared a health plan within the provincial development plan for Chonburi, in collaboration with the WHO Headquarters Project Systems Analysis Unit and the Regional Office.

A WHO consultant assigned to Indonesia twice during the period under review advised on the drafting of the second five-year health plan (1974-1979). Another consultant (senior public health administrator) and a management expert from the Regional Office visited Indonesia in March to advise on the re-organization and strengthening of the health service structure and the development of the Bureau of Health Planning. In Nepal, assistance was given in working out the health component of the regional economic development plan for the Gandaki/Lumbini region.

The MPH course at the Faculty of Public Health, Mahidol University, and at Ramathibodi Hospital in Bangkok continued to receive assistance from the WHO staff attached to the United Nations Asian Institute for Economic Development and Planning, Bangkok. The WHO staff also participated in the various courses at the Institute and helped in the conduct of a national course on national health planning in Rangoon in February. SEA/RC26/2 Page 4

Plans were made by the Ministry of Health in Indonesia to establish a Centre for Ecological Investigations at the National Institute of Medical Research, with the objective of planning ecologically-oriented health programmes, and, in support of this scheme, WHO is recruiting a human ecologist to undertake ecological studies to determine the major determinants contri- buting to the distortion of the ecological equilibrium.

1.1.2 Organization of Basic Health Services

Developments during the year in individual countries are described below.

In Bangladesh, the first National Training Seminar for Health and Family Planning Personnel to strengthen rural health services was held at the Institute of Post-graduate Medicine, Dacca, in December 1972-January 1973, with 500 participants. A one-month "re-training" workshop for lady health visitors and lady family planning visitors was organized for the same purpose. Training was given to 300 new doctors to be assigned to the thana health centre complex for the implementation of integrated health services.

In Burma, a second addendum to the master plan of operation for the strengthening of health services was drawn up, relating to the plan of action for 1973 in respect of WHO/UNICEF-assisted projects, including basic health services, tuberculosis, leprosy, trachoma,goitre and nutrition.

A National Seminar for the Training of Medical Officers in Rural Areas was held at Najafgarh (near Delhi) in October, with 18 participants from the different States of India. The objectives were to enable these medical officers to exchange ideas and experience on problems in the rural health establishment with community health personnel, to develop an orientation programme for medical officers in the rural health services, and to draw up a curriculum outline for short training progrannnes for the use of those who train basic health workers. Assistance continued to be given to the Directorates of Health of Haryana and Punjab States in a project for strengthening the rural health services and conducting training courses.

In Indonesia, a wide range of activities was carried out with WHO assistance. The preparation of a manual for health centre staff is under way. A course for provincial medical officers in charge of health planning was planned and given, and a number of training activities were conducted: a one-week workshop on the community and family health team, a course for the upgrading of health centre medical officers (held at the Cilandak National Training Centre), an upgrading course for nurse-midwife teachers, and a post-graduate course in community medicine for medical officers of the armed forces. A study to evaluate teacher training in school health was also planned, and basic information on school health programmes collected.

Two WHO consultants were assigned to Indonesia during the year - one to write the study protocol for research projects in public health practice, and the other to conduct and evaluate a workshop on health management. In STRENGTHENING OF HEALTH SERVICES

In an attempt to bring health care to all segments of the population, health services are being strengthened. In Nepal (1) an auxiliary health worker makes home visits. This young Indian doctor (2) is checking up on the health of an elderly member of a rural community. Rural health centres such as those shown here. in Indonesia (3) and in Sri Lanka (4). are being strengthened and expanded, since it is they who have the closest contact with the majority of the population in developing countries. In Burma (5) a public health nurse. with two student lady health visitors, is shown on her round of house-to-house visits. TRAINING OF HEALTH WORKERS

Strengthen~ngor nealtn servlces also means 1111~1oving hospital care. Th~simprovement is possible if all memhers of the health team receive the necessary instruction, as in this clinical hospital in Mongolia (1). A Thai nurse (2) receiving advanced training is writing up a case history. and young students in Bangladesh (3) are undergoing basic nursing training. SEA/RC26/2 Page 5

addition, a team consisting of senior staff members from WHO Headquarters and the Regional Office paid a visit in July 1972 to review the programme for the delivery of health services, research and feasibility of development; also, towards the end of the period under review, a similar team visited the country to review and co-ordinate the activities of the I, Strengthening of National Health Services" project and to assess progress in research and development of health services under a project based at the National Institute of Public Health at Surabaya.

The composition of the WHO team which is assisting with the strengthening of national health services underwent a change, in that it was decided to replace the public health nurse administrator and the health educator by a systems analyst and a management expert. The systems analyst joined the team in May 1973 and the management expert was expected in September. WHO continued to provide assistance in the development of health services in the Province of Irian Jaya: a draft proposal for this development during Indonesia's Second Five-Year Health Plan and the basic minimum curricula for various categories of staff in the health centres were drawn up. A draft summary description and proposals concerning further technical and pre-investment requirements in Irian Jaya also were prepared.

A WHO medical officer has been working since October at the National Institute of Public Health, Surabaya, on the preparation of a manual on the maternal and child health "package". This manual will have sections on child care, nutrition, maternity care and administrative procedures.

In the Maldives, the strengthening of health services and the control of communicable diseases, together with the training of auxiliary health workers, constituted the main activities. A WHO consultant advised on the various aspects of the training of these personnel and helped to draft a syllabus.

Several Mongolian health administrators received training abroad under the WHO fellowship programme, and eight physicians were awarded fellowships for training and orientation in community health services. A national seminar on health service management and planning was held in Ulan Bator from 26 February to 3 March 1973 with WHO assistance.

The organization of intensive in-service training courses for auxiliary health workers, field supervisors and junior auxiliary health workers was the main feature of the work in Nepal, and the curricula for such training were further developed. Special reviews were made of the nursing component of the health services and of the integration of maternal and child healthlfamily planning services and public health nursing into the basic health services. Detailed job descriptions for auxiliary nurse-midwives were prepared in relation to their work in maternity and child health/ family planning and other tasks to be performed in a health post.

Considerable progress was made with regard to the comprehensive national health manpower study in Sri Lanka (see Section 1.1.3 below). SEA/RC26/2 Page 6

Medical Care

An important event took place in April, when, in the Regional Office, a three-day Discussion Group Meeting on Medical Care was held. It was attended by 15 senior national health administrators and/or planners in health and planning ministries of the countries in the Region. The purpose of this meeting was to help in identifying the magnitude of the need in the field of medical care in the Region and the resources available to explore ways and means of strengthening it. Participants considered priorities in the provision of medical care and formulated guidelines for future planning and for WHO assistance (for details, see SEARO 0104 in Part 111).

1.1.3 Operational Studies and Health Manpower

The National Health Manpower Study which has been under way in Sri Lanka since February 1971 is continuing. A tight schedule has been prepared, according to which the study is expected to be completed by 31 December 1973. Data have been collected for all the eleven areas covered by the sub- studies, and interim reports prepared for six of the sub-studies. It is expected that all of these reports will be completed by September in preparation for the final phase of the project, in which various alternatives for health delivery and health manpower systems will be designed.

The research project in district health administration in India (Rohtak District), undertaken by the National Institute of Health Adminis- tration and Education, New Delhi, continued. It is now in its second phase of work in one primary health centre of the District. Based on the study findings, certain operational changes are being made which are likely to improve the effectiveness and efficiency of the programmes within the resources available. In July 1972, a staff member from Headquarters assisted in making a review of the project as a whole.

In Indonesia, a study on "Research in the Health Service Delivery System" was carried out with the help of WHO.

In Nepal, the integration of five "vertical" programmes, viz., malaria, smallpox, tuberculosis, leprosy and maternal and child health/ family planning, is being tested in two pilot projects under way in Bara and Kaski Districts, to develop a pattern for the feasible and efficient delivery of integrated health services. As a part of these projects, the type of personnel needed by the integrated health services will be determined, and the activities of the auxiliary health worker, which are being subjected to a time-and-motion study and an activityltime study, will be measured qualitatively and quantitatively. Information is also being collected on the costs of operating the health centres and district and zonal offices.

A WHO-sponsored inter-country Meeting on the Role of Operational Studies in Health Services and Education for These Services was held in Bangkok in December, with participants from six countries. (For details see Chapter 6 and project SEARO 0116 in Part IV.) The former WHO-assisted medical education project (SEARO 0096) has now been converted into a project on "Regional Health Manpower Development" and is being evaluated(see Chapter 6). SEAIRC2612 Page 7

1.2 Family Health

Maternal and child health and family planning

In WHO'S assistance to maternal and child health services in the Region, the policy of according high priority to family health has been maintained, with a bias towards family planning. The added support of funds from UNFPh has made it possible to undertake an extensive regional family planning programme.

Also, in its activities WHO has continued to help countries such as Burma and Mongolia to increase the coverage as well as improve the quality of their maternal and child health services, including school health services, in both urban and rural areas.

Much of the work in this important field is, of course, carried out in the closest collaboration with UNICEF,LlNDP and other interested agencies. The various meetings and other educational activities, which formed a significant part of WHO'S work in maternal and child health and family planning, are described elsewhere in this report (see Chapter 6).

The work done in the different countries during the year is briefly described below.

As a follow-up of the WHO "task force" which visited Bangladesh in July 1972, a draft submission for UNFPA assistance in family health was formulated. WHO also participated in the UNFPA mission which visited Dacca in January-February 1973.

In Burma, the pressing problems in respect of maternal and child health services and the methodology of improving the service aspects of the maternal and child health programme were reviewed in preparation for plans for further WHO/UNICEF assistance to the Government in the development and expansion of the services, and especially in upgrading the paediatric and obstetric departments of divisional hospitals and large township hospitals.

In India, as part of continuing efforts to formulate WHO assistance to family health programmes, a Workshop on the Methodology of In-service Training in the Integration of Maternal and Child Health Services, including Family Planning Services, into the General Health Services was organized in the Regional Office towards the end of 1972. The findings emanating from this workshop, as well as subsequent discussions with the Ministry of Health and Family Planning, will be the basis for possible WHO assistance in reviewing the whole maternal and child health and family planning service delivery system. This review will be carried out by a national body, as a basis for developing guidelines for framing in-service training curricula and field teaching manuals for health workers.

Early in 1973, a WHO consultant carried out an evaluation and survey of a new delivery system of maternal and child health and family planning services undergoing field test at the ICMR Rural Research Centre at Narangwal. sEA/~C26/2 Page 8

Furthermore, to support the new Indian Abortion Act, which became a law in April 1972, plans were made, as part of the 1973 inter-regional programme, to award 60 fellowships to enable senior obstetricians to study abortion care,on the understanding that they would return to India to assist in developing training centres for the management of cases. In relation to this topic, an important inter-country Seminar on the Application of Surgi- cal Procedures to Family Planning, the first of its kind, was held in the Regional Office early in 1973.

Discussions with the Government of India culminated, toward the end of 1972, in a working paper formulating a large-scale programme of maternity-centred family planning activities in semi-rural and rural India. As a prelude to preparing a more detailed submission to this scheme to UNFPA, assistance was given in setting up a special planning cell within the Ministry of Health.

As a main activity in Indonesia, preparations were made for implementing the national post-partum programme, which forms an important element of the National Population Programme. Inventories are now complete in respect of the 26 hospitals included in this year's phase of the post-partum programme, but the search for an agreed plan of action continues. Due attention was given to the studies of the activities of health workers with relation to family health and also to the training of ancillary and paramedical personnel in this regard.

In Indonesia also, a national training course on the planning and evaluation of family planning programmes with special reference to the integration of family planning and community health services was organized in November-December 1972 with WHO assistance.

The Organization is exploring the possibilities of merging all of its activities related to family health in Indonesia into a smaller number of projects,which would be more comprehensive.

A review undertaken in Mongolia revealed that the country had made satisfactory progress in the development of its maternal and child health services. There was, however, a need for further improvement in the quality of these services. A WHO consultant assigned to Mongolia for three months from November 1972 helped in preparing draft plans of action for the maternal and child health project for the period from 1973 to 1975.

At the request of the Government, a team of consultants visited Nepal in July 1972 to assist in drawing up a programme for the accelerated development of health services in support of maternal and child health/family planning. The team also helped in building up the Institute of Nedicine, which is to train various categories of paramedical personnel, laying emphasis on family health as a part of community health services. Subsequently,assistance was provided to the Government in preparing a draft UNFPA submission for assistance in family health (see Chapter 6).

Similarly, in Sri Lanka, the framing of a draft submission for a family health programme was followed by the conclusion of agreements between S~A/Rc26/2 Page 9

the Government and UNFPA in February,naming WHO as the participating agency with primary responsibility for planning and implementing the programme. Based largely on the recommendations of a WHO-assisted national seminar on family health, which was held in January 1973,a plan of action for the four- year WHO-assisted national family health programme was prepared and was being considered by the UNFPA.

The year saw the launching of four UNFPA-assisted projects in family health in Thailand for which WHO will be the executing agency. As formulated, these projects will require constant evaluation, introduction of new methods, and additional inputs based on emerging needs, and will constitute a new approach to activities in the field of family health.

Paediatric and obstetric education

The WHO programme in these fields is described in Chapter 6, Educa- tion and Training.

Rehydrat ion therapy

A training course in the management of rehydration therapy with special emphasis on oral rehydration was held in Rangoon in March 1973,with the participation of paediatricians and other medical officers from Burma and Nepalwho are engaged in the management of diarrhoea1 cases (see also Section 2.3.2).

1.3 Nursing

Milestones for nursing,projects were established as part of a new procedure for monitoring the pqogress of WHO-assisted projects in the Region. Long-range planning for nursing activities in 1974 and 1975 was under way,and recommendations were put forward for improved programmes. The project formulation process was utilized in the preparation of a plan of operation for project Indonesia 0074, "Nursing and Midwifery Education".

Work during the year advanced,and WHO supported activities for the comprehensive training of auxiliary nursing-midwifery personne1,in line with the increasing trend in several countries of the Region towards following the integrated pattern of basic health services and the need for the rapid expansion of health services. Training programmes in the form of orientation and refresher courses for auxiliaries included content in general nursing, midwifery, public health and family planning plus simple medical care. In India, WHO assistance included the training of teachers of auxiliary nurse-midwives and planning for three workshops to be held in the latter half of 1973. In Nepal, the curricula for assistant nurse-midwives underwent an exhaustive review, and a revised curriculum was drafted in order to make the training more sensitive and practical to the country's needs and situation. In Indonesia, the syllabus for the training of auxiliary nurse-midwives was re- written and translated into Bahasa Indonesia. Initial steps were taken in Bangladesh to prepare the lady family planning visitors and lady health visitors to assume broader fun~tions~whichincluded family planning work. SEA/RC26/2 Page 10

Planning for the training of auxiliary personnel for nursingjmidwifery services was included in projects in Indonesia and the Maldives.

Assistance continued to be given to strengthening the basic, post- basic and continuing education programmes for nurses. Support for such activities was provided through the inter-country project SEAR0 0139, "Short Courses for Nurses and Other Health Personnel" (see Chapter 6). To help ensure the delivery of nursing services, consideration was given to the establishment of the necessary nursing service infrastructure (organization and personnel system) and the determination of the health manpower mix (the proportion of various categories of staff) required. Assistance in this regard included the assignment of nursing administrators, educators and clinical specialists to national nursing divisions and health and medical care institutions.

In Bangladesh, the College of Nursing was reactivated,and an educational programme to prepare nurse teachers/administrators for basic schools of nursing was implemented. The central aim of the programme is to accelerate the preparation of nurse teachers, and it is so designed that the graduates will be able to meet current as well as future government requirements in the basic schools of nursing. In Uttar Pradesh, India, the first college of nursing in the State with a post-basic degree programme was established, and the first group of students was admitted in September.

Two short courses - one on orthopaedic nursing care and one on nursing care of surgical patients - were organized in Burma.

In Indonesia various educational programmes, supported by UNICEF and UNFPA, to prepare teachers in auxiliary nurse-midwifery and nursing schools were conducted or assisted. A nursing manpower survey in Irian Jaya was completed.

The need for an organized plan for post-basic education in nursing became more important with the increase in middle medical workers in Mongolia. The decision of the Ministries of Education and Public Health that candidates for nursing should have full secondary education was implemented during the year. Short courses for local teachers, feldshers, tutor nurses and nurses in medical-surgical and paediatric wards were conducted.

In Sri Lanka, Phase I of the sequential learning activity in the "care of the paediatric patient" was conducted. An evaluation tool of paediatric patient care was developed and applied, which provided baseline data for measuring the effectiveness of the total sequential learning activity and also indicated significant areas to stress in the course content.

Thailand received assistance in the development of practice areas for basic nursing students from the Faculty of Nursing, Khon Kaen University. The activities included in-service education programmes in supervision and ward management for supervisors,for head nurses and for staff nurses. A plan SEA/RC26/2 Page 11 for an in-service education programme for chief nurses and provincial public health nurses was prepared.

The Meeting on the Role of Operational Studies in Health Services, organized for senior doctors and nurses, is described in Chapter 6.

Fourteen nurses from three countries of the Region were enrolled in the 1973 programme at the WHO-Sponsored Training Centre for Nurses in Wellington, New Zealand. As a result of the evaluat'ions carried out by the students of the 1972 programme, several changes were made. It was hoped that community health experiences would be more closely integrated into the programme. Course outlines were prepared which, together with selected reading lists, would enable the students to utilize their study time more effectively. The Centre published a prospectus and syllabus. A brochure for prospective students was also prepared.

1.4 Environmental Health

In the WHO-assisted environmental health programmes, although the major emphasis has continued to be on community water supply and sanitation and the training of personnel, other aspects such as environmental pollution and sewage disposal have also received attention.

The WHOIUNICEF-assisted rural water supply and sanitation programmes under implementation in India, Indonesia, Nepal, Sri Lanka and Thailand progressed as planned, with increasing technical and material assistance. A similar project was started in Bangladesh, and plans were under way to initiate such a programme in Mongolia. UNDP assistance to the programme in Thailand was extended for a further period of three years from July 1972.

WHO activities in Indonesia also covered assistance in conducting a project systems analysis study on rural water supply in West Java and in formulating a project in this field, as well as in carrying out studies on rural water supply in East Java for the preparation of a project document for possible assistance from bilateral sources or from UNDP.

Assistance was given in the planning and implementation of provincial water supply schemes in Thailand, and it is proposed to assign a WHO sanitary engineer to Indonesia to assist in the development of an urban water supply programme.

The UNDP-assisted project in Nepal for the preparation of a master plan for vater supply and sewerage for Greater Kathmandu and Bhaktapur continued satisfactorily according to schedule. Following the mid-term evaluation of the progress of the project in April 1972, mentioned last year, an agreement covering the additional work recommended under the water supply and sewerage sector study was concluded between the sub-contractor and WHO, and another agreement was signed between the Government and the sub-contractor in connection with the work under the Stage I (Master Plan) construction phase. Preparations were well under way for UNDP-assisted pre-investment studies in connection with a master plan and detailed designs for a water supply and sewerage scheme for Male, the capital of the Maldives. sEA/~C26/2 Page 12

In view of the growing concern among governments about problems of environmental pollution, the Regional Office organized the first Regional Seminar on Air Pollution Control to be held in this Region. It took place in NagpurCIndia) toward the end of 1972,with 15 participants from different countries. A consultant also studied water pollution activities in different parts of India and advised on the use of analytical control techniques. Action was initiated for the recruitment of a further consultant to study the various aspects of this problem in the Region and to make recommendations for the formulation of proposals for WHO assistance.

In Indonesia, assistance was provided in conducting studies on a proposed sewerage system in Djakarta, and the project document prepared in this respect was under consideration by the Government. A consultant assisted in the design aspects of marine outfalls in Gujarat State in India.

With regard to training, WHO field staff assigned to the various countries, in addition to their other activities, continued to assist in organizing and conducting in-service training courses on subjects related to their respective projects. The Institute of Technology, Rangoon, received further assistance in the development of a graduate training programme in sanitary engineering, and a professor of sanitary engineering was assigned to the Institute of Technology, Bandung, Indonesia, for the same purpose.

The UNDP approved a small-scale project for the improvement of sanitary engineering training in Chulalongkorn University. Bangkok, Thailand, with WHO as the executing agency, and a consultant was under recruitment. A consultant studied the post-graduate training programme in public health engineering at the Dacca University of Technology and Sciences in Bangladesh and made recommendations for further improvement and expansion, now under consideration by the Government. Another consultant assisted with the organization of a training course in air pollution control in India. Still another, to help with the development of in-service training courses for health controllers and sanitarians in the community water supply and sanitation programme in Indonesia,was under recruitment.

A WHO-sponsored Regional Seminar on Training and Utilization of Sani- tary Personnel (Excluding Sanitary Engineers) was held in May in Djakarta and was attended by fifteen participants from the different countries of the Region. A similar activity on training in sanitary engineering is planned to be held in Bangkok in October.

The research programme on shallow-well handpumps sponsored by WHO in collaboration with the All-India Institute of Hygiene and Public Health, Calcutta, was completed. A similar programme for the development of deepwell handpumps with financial assistance from UNICEF has been initiated in Mysore State in India.

1.5 Health Education

The need for the active involvement of community leaders, specific sections of the population and voluntary organizations in efforts to achieve the objectives of different health prbgrammes was receiving increasing SEA/RC26/2 Page 13

emphasis in all the countries of the Region. There was also a keener awareness of the fact that local and national health programmes should be planned to meet the immediate health needs of the people at the grassroots level, especially in the fields of family health,environmental health and nutrition. Health education efforts during the year were therefore directed towards enlisting community participation in different health programmes.

The year under review registered rapid progress in strengthening the several components of health education. The pressing needs of the countries of the Region, which have given high priority to health education were adequately met. Assistance was provided in the systematic development of health education manpower,in conducting studies and research in health behaviour and health education, in formulating realistic plans of operation for family health, health and family life education in schools, and in the training of health and allied personnel in health education. Preparations were made for intensive health education programmes at the community level and in specific health programmes.

In order to obtain detailed information on the rural and urban communities, their structure, leadership patterns, channels of communication, traditions, values and beliefs, so as to develop suitable plans to involve the people in individual, group and community efforts, studies and research projects were initiated in Indonesia, India, Sri Lanka and Thailand. They covered subjects such as the villagers' participation in the clinics, village-level data books for the use of health workers, village decision- making mechanisms, health-related life styles of the people, the status of health education in teaching hospitals and health centres, the adoption of modem health and family planning practices in the rural community, impact of activities of primary health centres on community health practices (including family planning) as conceived by the consumers, assessment of health education efforts in a pilot project area, and characteristics of family planning acceptors. It is hoped that the results of these studies will be available shortly and will enable the development of an effective strategy for obtaining the continued participation of the people in health programmes. Continued and considerable inputs will be necessary in the coming years to gain a proper understanding of people's behaviour in regard to health and allied matters in order to place health education on a scientific basis and to demonstrate its effectiveness. With a view to promoting family health education and social science research capabilities in the various countries, an inter-country workshop in research methodology and techniques has been planned, to be held at Bangkok in November 1973.

It was planned that the data obtained from studies and research should be incorporated into the curriculum of pre-service and in-service training programmes for health and allied field workers. In Indonesia and Sri Lanka, the duties of each member of the health team were systematically analysed in order to determine the educational components of their work and opportunities for imparting health education, and a training programme in methods of using these opportunities by means of health education efforts was prepared. For this purpose, in West Java, Indonesia, four rural and four urban health centres were taken up for study; in Sri Lanka, health SEA/RC26/2 Page 14

units and hospitals were selected; in Burma and Mongolia,continuing health education courses, as related to specific programmes and the field situation, were held,and, in Bangladesh, the current training programmes were reviewed with the aim of making them field and job-oriented.

The current field training programme in health education was criti- cally examined by country study groups, whose reports were considered at the inter-country Workshop on Field Training in Health Education, held in the Regional Office from 23 October to 4 November. The participants developed a guide and prepared plans for utilizing it in their respective countries. In the light of the experience gained at this workshop, steps have already been taken in India, Indonesia, Sri Lanka and Thailand to make the field training more practical and effective. The guide was also utilized at the Expert Group Meeting on Developing Indices for Measuring the Impact of Training on Job Performance of Field Workers in Family Planning Programmes, convened by ECAFE in Bangkok in January.

Efforts to improve university-level post-graduate training in health education in India and undergraduate training in health education in Thailand were continued. Assistance was provided to Indonesia in developing a curriculum for post-graduate training at the Master's level. To upgrade the standard of teaching of family health education and related subjects and to provide adequate local teaching resource material, a "consultation" meeting of health education faculty members in the Region is planned to be held in the Regional Office in the latter half of 1973. Health education faculties were encouraged to undertake studies which would assist in making health education programmes more effective. Plans to train the trainers in health education have been prepared in India and Indonesia.

In India, Indonesia, Nepal, Sri Lanka and Thailand plans of operation have been developed for the health education projects covering their respective plan periods. Action plans for the year 1973 were also prepared. These plans included necessary inputs for improving the technical competence of the existing manpower and for acquiring the additional strength necessary. Bangladesh also has formulated the health education component of its first five-year health plan, and proposals are under consideration for WHO assistance in its implementation. A multi-disciplinary inter-country Workshop on the Role of Social, Cultural and Educational Factors in Planning and Pro- gramming of Infant Health Care is being organized in Kathmandu in October, and a study guide was supplied to each country for use by its national study group, set up at WHO'S suggestion.

1.6 Nutrition

Activities in the field of nutrition during the period under review included studies or surveys of nutritional status, food consumption, growth, development and physical fitness, collection of data on clinical deficiency and anaemia, initiation of measures for the prevention of xerophthalmia, assistance in formulating guidelines for national food and nutrition policies, and support to training programmes. SEA/RC26/2 Page 15

More epidemiological information about the major nutritional problems in the Region is becoming available. The development of anthropometric methods for the assessment of protein-calorie malnutrition has led to the initiation of prevalence studies of various kinds in most of the countries, as described below.

In Bangladesh, a second nutritional assessment was carried out in October-November (the first had been undertaken in May-June 1972) with assistance from the United Nations Relief Operation, Dacca. The survey revealed that there had been a significant improvement in the nutritional status of rural children and a return to pre-Independence levels of malnutrition since May 1972. In Burma, preparations were made for a nation- wide study of growth, development and physical fitness, including a survey of the food intake of pre-school children. Two WHO consultants assisted with the study design, and WHO is supplying essential equipment, as recommended by the consultants in their reports. In nine States of India, nutrition monitoring bureaux were established for the surveillance of the nutrition situation and of current programmes.

In the Maldives, a WHO consultant collected data on the height and weight of children and on signs of clinical deficiency in them, as well as on anaemia in mothers; a preliminary scrutiny indicated a high prevalence of protein-calorie malnutrition. A set of guidelines for the collection of data on the height and weight of pre-school children in Mongolia was prepared in the Regional Office for use in the maternal and child health project in that country. In Nepal, a pilot study of food consumption and nutritional status was started in preparation for a national survey, to be undertaken with assistance from FA0 and DANIDA. In Sri Lanka, data on growth were collected from five thousand rural pre-school children and are awaiting analysis.

Progress with regard to the development of services for the prevention and cure of the major nutritional diseases was uneven during the year, the activities ranging from the planning of comprehensive services to specific preventive programmes and to projects on a pilot scale.

In India, an integrated child care service was included in the Fifth Five-Year Plan. The service, for which the Department of Health and several other departments will be responsible, includes health care, immunizations, food supplements and nutrition education. The applied nutrition programme will be modified to fit into the new concept. Several pilot projects (health- centre based) for the home treatment of protein-calorie malnutrition were initiated. In Burma, the nutrition rehabilitation project of the Directorate General of Health completed its pilot phase and started a rural nutrition service as a pilot project, mainly directed towards protein-calorie malnutrition. In Indonesia also, negotiations were under way for a team from the Massachusetts Institute of Technology to report on the need for comprehensive nutrition programme, highlighting the economic benefits.

A country-wide programme for the prevention of xerophthalmia in pre- school children was initiated in Bangladesh, whereby all pre-school children SEA/RC26/2 Page 16 will receive biannually a high dose of vitamin A through the network of the malaria eradication programme. WHO helped with the planning, in-service training and initial implementation, while UNICEF assists with supplies of vitamin A. A similar programme was in the planning stage in Indonesia with bilateral assistance, and one is operating on a more limited scale in India.

The pilot project in Sri Lanka for the prevention of nutritional anaemia, mentioned last year, was continued. On WHO'S advice, the Government has proposed for UNFPA assistance a scheme for regular prenatal administration of iron and folic acid as part of an extensive family health programme. ln view of the extent of the problem in most countries of the Region, it has been decided to organize a "consultation" on the prevention of nutritional anaemias in Uctober.

Programmes of goitre control by means of supply of iodated salt were operating in Burma, India and Thailand, and were receiving assistance from UIiICEF. In Burma, in an interim assessment it was found that there was a considerable reduction in the incidence of goitre among children in the project areas. Nepal reached an agreement with India for the supply of iodated salt and for subsidizing salt distribution in Nepal in areas not easily accessible. Indonesia requested assistance from UNDP for a programme of injection of iodized oil in the central highlands of Irian Jaya based on the recommendations of the WHO consultant provided in 1971.

In Thailand, an inter-ministerial working group convened by the National Committee on Food and Nutrition developed a set of guidelines for the establishment of a national food and nutrition policy. A WHO consultant assisted the group.

WHO participated in an ECAFE-organized meeting on food and nutrition in Mekong development planning, held in Bangkok in February 1973. At this meeting, the establishment of a food and nutrition monitoring unit to serve the riparian countries of the Lower Mekong Basin was recommended. The unit is to monitor trends in the health and nutritional status of populations, to predict changes in food supplies and to offer guidelines for the development of appropriate measures.

The emphasis on training continued, with WHO assisting the nutrition courses at the National Institute of Nutrition, Hyderabad (India), with guest lecturers, fellowships for faculty members, and provision of equipment. During the year, five medical officers from countries in the Region obtained the certificate in nutrition and one the master's degree, bringing the total number of persons from outside India so far trained in the two courses on WHO fellowships to 70 and 5 respectively. In addition, 97 persons within India, attending the courses on UNICEF stipends, have obtained the certificate and 30 the master's degree. (The certificate course was started in 1963 and the degree course in 1968.) In Burma, a WHO consultant and the Regional Adviser on Nutrition assisted with a nutrition course for the orientation of senior health personnel. MATERNAL AND CHILD HEALTH

All rour!f#r%rn the Rmqo- hnr 1r.d prflmcu. I I on la:ad 1 I fo1 rxarplr rwnq rro'hrf% n lndonr$-a I?)rr ;ern nr, rbau! anrlrrr. !O ponclr fan 'r h.I S:Ch~lhrlr % l43$:11~1 in urn Rrra Vo~~lnm171. trrrr% rc r 1,anntnq "atp lrl '0. :Lrr~c~rnlar! nrisrc. .n l3d.a ,?t htrIa\ rtt!~~rl~cn:t?v4e1 Ihm :J%N '.**ewe - I\,-Mnrh 'rnnlv h#m'l\ ptcprrnlr*t ran o:r.atr 1 2

CHILDREN Children require maximum protection, which may be provided through such methods as multiple vaccinations for babies. as shown here in Burma (1). or by frequent school examinations, as in Indonesia (2). where height, weight and general physical conditions are carefully examined. In Thailand (3), immunization against polio is one of the measures :i take1 child health. SEA/RC26/2 Page 17

Under WHO'S global programme of research, assistance continued to be provided to several institutions for studies on different nutritional problems. Among them were the All-India Institute of Medical Sciences, New Delhi, the Christian Medical College and Hospital, Vellore, and the National Institute of Nutrition, Hyderabad.

1.7 Mental Health

The countries of the South-East Asia Region are becoming increasingly aware of the need to provide services for the recognition and early treatment of mental illness at the cornunity level. WHO assistance in strengthening mental health services continued to receive priority consideration.

The Third WHO Seminar on the Place of Psychiatry in Medical Education was held in Colombo from 17 to 21 October. Twenty participants from five countries of the Region attended. They reiterated the need for having,in medical colleges, independent departments of psychiatry headed by psychiatrists and adequately staffed, and suggested, inter atia, detailed content and methodology of the teaching programmes, as well as qualifications for the teachers, the need for research and a co-ordinated approach.

Also, preparations were made for holding a seminar on community action for mental health care in October 1973 at the All-India Institute of Mental Health in Bangalore, India. This seminar, which will be attended by personnel working in various disciplines from seven countries of the Region, is to consider the magnitude of the mental health problem, assess the resources available and formulate a strategy for community participation in the prevention and control of mental illness.

A consultant was assigned to Sri Lanka from December 1972 to February 1973 to assist the Departments of Psychiatry in Peradeniya and Colombo in improving the teaching of psychiatry and also to advise the Government on strengthening its mental health services. In addition to making detailed recommendations for improving the teaching of psychiatry, he stressed the desirability of emphasizing the service and educational components of mental health in Sri Lanka and of continuing the present efforts towards decentralization of in-patient psychiatric services from mental to general hospitals.

Under an inter-regional project, a well-known psychiatrist was assigned as consultant for a period of nine months from March to review the development of mental health services in the Region and to prepare guidelines for WHO assistance in the further development of mental health care. It is also planned to provide consultants to Bangladesh, Burma and Mongolia to assess the problem of mental illness in those countries and to advise on psychiatric care.

The International Study Group on Schizophrenia met in Agra (India) from 11 to 15 December.

Improvement of curricula for the training of health personnel in mental health continues to receive support. Assistance is being provided sEA/~C26/2 Page 18

to Member Governments for preparing the public health services to provide mental health care at the community level. An example is the training of nurses in patient care in Bangladesh.

The Psychiatric Department of the Seth G.S. Medical College and King Edward VII Memorial Hospital, in Bombay, India, was nominated as a WHO Collaborating Centre for the Study of Psychotropic Drugs.

1.8 Dental Health

In most of the countries in the Region, a multitude of other health problems continues to overshadow those of dental health. Consequently, the development of dental health services has been slow. In the five dental health projects operating during the year under review, the main emphasis in WHO assistance was on the training of dentists. Attention was also paid to the training of school dental nurses and to the development of dental legislation.

A government request from Burma for a WHO tutor for the School of Dental Auxiliaries was under consideration in the Regional Office.

Three consultants were provided to Indonesia during the year. Two, a consultant in dental jurisprudence and one to advise on dental teaching, completed their assignments during the period,and the third,to advise on periodontology,commenced a six-month assignment in May. A further consultant on dental teaching was under recruitment.

A consultant in orthopaedic stomatology was assigned to the Medical Institute, Ulan Bator, Mongolia, from December 1972 to May 1973. Another is being provided to assist in a course on school dental health.

The WHO temporary adviser who studied the dental health situation in the Maldives in May 1972 (briefly mentioned last year) has recornended the establishment of a dental clinic in Male and the conduct of a survey of dental health needs.

The WHO dental mechanic tutor who had been assisting in the training of dental technicians at the Dental Faculty, University of Sri Lanka, Peradeniya, completed his assignment in August 1972. A consultant on preventive dentistry was under recruitment.

During August-September, a consultant visited Thailand to review the training of school dental auxiliaries and evaluate dental health programmes for school-children. His recommendations,concerning the development of a national programme of dental health, within the infrastructure of the national health services, were forwarded to the Government. A consultant to assist in the teaching of oral pathology at the Phyathai School of Dentistry, Bangkok, was recruited and was expected to take up his assignment in July.

Under the global research programme, WHO Headquarters gave grants to the Department of Dental Health in Indonesia and the School of Dentistry in Chiengmai, Thailand, for research in dental epidemiology. SEA/RC26/2 Page 19

1.9 Occupational Health and Rehabilitation

Assistance continued to be provided to occupational health services, legislation and training, and also to the development of medical rehabilitation and physiotherapy.

The Government of Indonesia was assisted in the preparation of a draft request for UNDP assistance in the development of the National Insti- tute of Occupational Health, Djakarta, and regional centres. The Chief of Occupational Health from WHO Headquarters visited Indonesia in early 1973 and held discussions with the national authorities on the request, which, based on these discussions, was re-written.

A consultant was assigned to Sri Lanka in June 1973 to suggest measures for the improvement of occupational health services in small industries and to advise on specific problems affecting the health of workers in these industries. He will also assist in framing legislation and with the conduct of courses for occupational health personnel.

Discussions were held with the National Institute of Occupational Health in Ahmedabad (India), concerning possible further WHO assistance to this institute.

In the field of rehabilitation,an important activity was the organization of an inter-regional Seminar on Planning, Organization and Administra- tion of Medical Rehabilitation Services, which was held at the All-India Institute of Medical Sciences, New Delhi, from 4 to 15 September, with 15 participants from 12 countries. The Seminar reviewed medical rehabilitation services and the facilities available in the various countries represented. The programme also included lectures on different topics and the presentation of papers on WHO'S activities in this field.

A team of three WO consultants - a medical officer, a physiotherapy tutor and a prosthetist - assisted in the conduct of two courses for medical rehabilitation personnel in Burma and a similar course in Indonesia on the integration of the various components of medical rehabilitation.

Assistance to the departments of rehabilitation at the All-India Institute of Medical Sciences and at Safdarjang Hospital, New Delhi, continued until mid-September 1972, when the WHO prosthetic tutor left on completion of his assignment.

A consultant (prosthetist) was assigned from 1 November to assist in upgrading the prosthetic and orthotic services at the Hospital for the Dis- abled,Rangoon,and in initiating and conducting training activities. Also, the WHO physiotherapist assigned to Thailand, who continued to provide help in strengthening the physiotherapy units already established in the provincial hospitals in that country, took up a short assignment in Burma at the beginning of 1973, to assist in planning, organizing and implementing occupational therapy programmes in hospitals and centres for the rehabilitation of physically or mentally ill patients. SEA/RC~~/~ Page 20

The training of physiotherapists at Baroda (India) received further assistance.

1.10 Radiation Health

The training of medical physicists,of health personnel for radiological diagnosis and radiotherapy, and of technicians in the maintenance and repair of electro-medical equipment, as well as the organization and strengthening of nuclear medicine departments and development of protection services against hazards of ionizing radiation, were the important activities in the field of radiation health which were carried out with WHO assistance during the year.

The Radiation Medicine Centre in Bombay was designated as a WHO Regional Reference Centre for Nuclear Medicine, in collaboration with the IAEA. A plan for expansion of the Centre was under preparation; in 1974, it is to have larger premises for training, services and research in nuclear medicine.

WHO participated in a joint FAO~IAEA Symposium on Radiation Preserva- tion of Food, which was held at the Bhabha Atomic Research Centre, Trombay, India. Participants discussed the physical, chemical and biological aspects of irradiation of various kinds of foodstuffs, and also considered such subjects as the wholesomeness of irradiated food, facilities and economics of food irradiation, legislation, and control and clearance of irradiated food.

The Radiation Protection Service at the Department of Medical Sciences, Bangkok, was designated as a WHO Regional Reference Centre for Secondary Standard Dosimetry, to work in collaboration with the Inter- national Atomic Energy Agency.

Personnel dosimetry services, a postal disc inter-comparison service for radiotherapy centres, the collection of data on the Strontium-90 content of the human body and advice on the siting of nuclear reactors and irradiation of food were other activities undertaken in collaboration with WHO Headquar- ters and the International Atomic Energy Agency (IAEA).

WHO maintained its support of the training of physicists at graduate and master levels in India and Thailand. Also, WHO-assisted programmes for training radiographers at the diploma, degree and post-graduate levels were continued in India, Indonesia and Thailand. In-service training of radiographers in the public health services was also organized in Indonesia. In Thailand, the year saw two projects come to a successful conclusion, when, after a number of years, WHO terminated its assistance to the School of Medical Physics and the School for the Training of Medical Radiographers, both established in Bangkok with WHO'S support.

Satisfactory progress was made in the training of X-ray and electro- medical technicians for maintenance and repair services,which WHO has promoted in Burma, India, Indonesia and Mongolia. Mongolia plans to c'over the entire SEA/RC26/2 Page 21

country by means of satellite workshops which will collaborate with the training centre in Ulan Bator.

Development of radiation protection services was promoted through consultant services and the supply of film badges and equipment in Burma, Indonesia, Nepal and Thailand. A consultant was assigned to advise and assist the Government of Bangladesh in the organization and strengthening of its radiological services.

1.11 Cancer

Based on data from hospital records, it has been observed that oropharyngeal and cervical cancer are the most common neoplasms in countries of the Region, and WHO'S programmes in this field are therefore directed mostly toward prevention and control of these conditions.

Early in 1973, a team of two consultants visited Bangladesh, Burma, Indonesia, Nepal, Sri Lanka and Thailand to assess the pattern of cancer morbidity and mortality and evaluate the existing facilities for dealing with this problem. Under the joint sponsorship of the Indian Council of Medical Research, the International Agency for Research on Cancer and WHO, a meeting has been planned for late 1973 to discuss the problem of cancer and consider measures for organizing control measures.

In India, a Cancer Assessment Comittee appointed by the Government has recommended the upgrading of the existing 11 cancer institutes to provide comprehensive cancer control services on a regional basis, the establishment of national and regional cancer registries and of a national institute of cytology for the training of cytopathologists and cytotechnicians, and the setting up of small cancer units in each medical college for the purpose of training health personnel in cancer control.

One of India's important programmes in this field is the cancer control pilot project at Kancheepuram, near Madras, which has continued to receive WHO assistance. With the completion of the building for the project, the Arignar Anna Memorial Cancer Institute has started functioning. Registration and follow-up systems have been introduced, and histological and cytological diagnostic facilities established. Health education programmes at the community level, with home visits and gynaecological examinations in the municipal maternity centres and dispensaries, have been organized. A WHO consultant assigned in April-May 1973 examined the health education component of the project. A scientific advisory committee with faculty members from Madras Medical College has been constituted to advise on the development of training and treatment facilities at the Institute, where an in-service training programme in exfoliative cytology for laboratory technicians from the District Hospital was also being planned.

With assistance from WHO, a national workshop on the establishment of cytological services and training of cytotechnicians was held in Djakarta, Indonesia, at the beginning of 1973, and, on the basis of its recomendations, SEA/RC26/2 Page 22

the first training course for cytotechnicians to be held in Indonesia was organized. With supplies and equipment made available by WHO, it is planned to develop cytological services in 11 university hospitals in Indonesia by the end of 1975. The cytopathologists and senior cytotechnicians to run these laboratories will be trained abroad on WHO fellowships. This training in exfoliative cytology is being developed as an integrated cancer control programme within the family health services in Indonesia.

Two consultants were assigned to Ulan Bator from December to February to advise on epidemiological aspects and control of cancer of the liver. It is also planned to send to Mongolia a team of three consultants in oncology to assist in the training of physicians, radiotherapists and surgeons in cancer control.

1.12 Cardiovascular Diseases

Morbidity and mortality data on cardiovascular diseases in countries of the Region indicate a rising trend. Rheumatic fever and its cardiovascular sequelae are common manifestations. Hypertension and stroke are seen to occur with a frequency of 20 to 30% in the younger age-group in India. Ischaemic heart diseases, endomyocardial fibrosis, and inflam- matory and thromboembolic lesions of peripheral vessels are other cardiovascular diseases encountered in the Region. The disabilities due to these diseases are of considerable socio-economic consequence in developing countries, necessitating the development of control and preventive measures.

Some countries in the Region have expressed an interest in setting up intensive coronary care units, organizing special services for prevention, control and rehabilitation of patients with hypertension and stroke, setting up pilot centres for the control and prevention of rheumatic fever amongst school-children, and developing voluntary and governmental institutions for training and research in cardiovascular diseases. Appropriate institutions have been stimulated to make use of the WHO compilation of electro-cardiograms of common cardiovascular conditions for promoting greater uniformity in collaborative epidemiological studies.

Consultants were assigned to advise and assist governments in the strengthening of public health services for the management of heart diseases. The cardiological centre in Ulan Bator in Mongolia received assistance in developing training programmes and research, and supplies and equipment were provided to the pilot study centre for the prevention of rheumatic fever amongst school-children.

Fellowships were awarded to the members of a team from Nepal (a sur- geon a nurse and an electro-medical technician) to enable them to go to Australia for training in the operation of intensive care units.

In India, the Institute of Cardiology in Madras reported continued progress with various sections such as diagnostic angiocardiography, the intensive coronary care unit, the laboratories and the rehabilitation unit. The organization of a stroke registry for Madras City was stimulated. Also, SEA/RC26/2 Page 23

planning was under way for a workshop for the control of stroke and rehabilitation of stroke patients, to be organized in the Institute of Neurology, Madras, in February 1974.

The problems of the incidence of hypertension among dock workers in India, which is reported to be high (23.1%), and of the frequent incidence of ischaemic disease among textile workers are engaging the attention of the National Institute of Occupational Health in Ahmedabad, India, which is receiving WHO assistance.

Candidates from Mongolia and Thailand attended the WHO-assisted Fifth Advanced Training Course in the Diagnosis, Treatment and Prevention of Major Cardiovascular Diseases,which was held in Copenhagen from 2 January to 17 June.

Documentation services in cardiology were provided to cardiologists in various countries, and plans were made for continued assistance in stimu- lating the setting up of heart and stroke registries, training of health personnel in the management of patients with cardiovascular diseases, and promotion of epidemiological investigations of problems of local importance.

1.13 Pharmacology and Toxicology

1.13.1 Quality Control of Pharmaceutical and Biological Products

In view of the importance which countries in the Region and WHO attach to this subject, assistance continued to be provided in various ways. A workshop was organized andassistance was given in the training of personnel.

A Workshop on Quality Control of Drugs, the third in.a series sponsored by WHO, was held in Djakarta from 4 to 8 June, and was attended by participants from Bangladesh, Burma, India, Indonesia, Nepal, Sri Lanka and Thailand. The purpose of the Workshop was to bring together the most knowledgeable authorities on drug control in the different countries of the Region for discussions on several aspects of drug quality control and legislation, to develop a mutually agreeable set of procedures and to make recommendations for the surveillance of marketed drugs. The workshop programme also included a field visit.

A draft request to the UNDP from the Government of India for assistance to a proposed project on quality control was processed in the Regional Office and forwarded to the Government for finalization.

In Thailand, the WHO pharmaceutical chemist continued to assist in the quality control of pharmaceutical and biological products and in training. Special attention was given to the upgrading of pharmaceutical production, the training of inspectors and development of inspection procedures, preparation of guidelines for manufacturers, and analysis of drugs and biological products. SEAIRC2612 Page 24

1.13.2 Drug Dependence

Towards the end of the period under review, consultant services were made available to India, Indonesia, Nepal, Sri Lanka and Thailand to assist with an evaluation of the drug dependence problem in these countries. The consultant being assigned for this purpose will study the extent of drug abuse, its epidemiology and etiology and the effectiveness of existing measures for control, treatment, rehabilitation and health education, and will recommend steps for prevention and control.

The Regional Adviser on Chronic and Degenerative Diseases attended an inter-disciplinary Seminar on Drug Abuse and Youth, organized by the Directorate of Social Welfare in the Delhi Administration, India, in July 1972, and presented a paper on the "Experience of other countries in combating drug abuse". The seminar advocated the conduct of epidemiological studies, establishment of treatment, rehabilitation and health education facilities, legislation and co-ordination of the administration and regula- tion of sale, as essential for the effective control of drug abuse. The Delhi School of Social Work, University of Delhi, conducted an explorative study on known drug dependants among students. Under the auspices of the Indlan Council of Medical Research, a seminar on long-term effects of the use of cannabis in India was conducted, with the participation of the Chief of Drug Dependence and Alcoholism and a medical officer from the Drug Evalua- tion and Monitoring Unit at WHO Headquarters as well as a WHO consultant.

In Indonesia, a study on drug abuse among secondary school-children in Djakarta showed an incidence of about 3.0% with 0.2% becoming addicts. This problem was found to have been growing since 1965.

A joint United ~ations/I~O/WblOplanning mission visited Thailand in 1972 and developed a plan for the treatment and rehabilitation of drug dependants, to be supported by the United Nations Fund for Drug Abuse Control (UNFDAC).

Two candidates from India and one from Thailand participated in a WHO intex-regional Seminar on Problems of Alcohol and Drug Dependence, which was held in Sweden, Switzerland and Yugoslavia from 11 to 30 September 1972.

1.13.3 Food Safety: Hazards to Man from Pesticides

A WHO consultant visited Bangladesh, Burma, Indonesia, Sri Lanka and Thailand in March t~ ascertain the position in these countries regarding the control of pesticides used in agriculture and to determine the assistance required. He held discussions with the national health authorities as well as those concerned with the control of pesticides in agricultural administrations, visited a number of laboratories and made field trips to observe the way in which pesticides were being applied. In his report, besides reviewing the situation in individual countries and making specific recommendations, he outlined general requirements for control, summarized the needs and drew up a long-term plan for assistance. SEA/RC26/2 Page 25

Another consultant was assigned to the Industrial Toxicology Research Centre, Lucknow, India, during October-December to assist the Centre in a review of the laboratory procedures of the medical toxicology unit and in the establishment and organization of an epidemiological unit. The consultant has made specific recommendations for the training of staff in pesticide residue analysis and in regard to cholinesterase assays.

1.14 Medical Stores Management

Between August 1972 and January 1973 a WHO consultant was assigned to Bangladesh to study the current methods employed by the Government in the purchase,storage and distribution of drugs, medical supplies and equipment, and to advise generally on questions of pharmaceutical and medical stores management. He recommended the addition to the Ministry of Health of a Directorate of Health Services (Pharmacy and Medical Supplies) and drew up a detailed plan for the organization of this directorate and for the complete reorganization of the medical stores throughout the country. His report also contained recommendations as to the training of pharmacists, the manufacture and quality control of pharmaceutical preparations and repair and maintenance of medical equipment.

Assistance and advice were also being provided to Nepal with regard to the organization and management of the medical stores system in the country and the training of the requisite personnel. The consultant for this purpose took up a ten-month assignment in November.

2. COMMUNICABLE DISEASES

Governments in the Region have continued to concentrate their efforts primarily on the control of such communicable diseases as smallpox, plague, cholera, malaria, tuberculosis, leprosy, dengue/haemorrhagic fever and poliomyelitis.

There has been a sharp rise in the incidence of smallpox,which is attributable to major epidemics in Bangladesh and the northern belt of India. From India, multiple exportations to neighbouring countries have been reported. Nepal is now non-endemic for smallpox, as the outbreaks which have occurred since July 1972 have been traced directly to importations. Burma, Maldives, Mongolia, Thailand and Sri Lanka have maintained their smallpox-free status. Indonesia, for the first time since the WHO- assisted programme was begun in 1967, has now joined this list of countries with zero incidence.

Cholera has continued to cause concern, showing an increase in the number as well as occurrence of cases in areas which had not reported it previously (e.g., ten provinces of Thailand). Efforts by countries to contain the spread of the disease have so far not shown significant results; however, the steady and continuing reduction of mortality resulting from better case detection and treatment has been remarkable. SEAlRC2612 Page 26

Plague continued to be reported from Burma. There have been no epidemics, but 56 detected cases and low mortality (only 3 deaths) demonstrate an effective surveillance system and timely treatment of detected human cases. India, Indonesia and Nepal - countries in which foci of endemic plague had previously existed - reported no human cases during the year. Surveillance activities continue with intensity in the known endemic foci, and are also included as an integral part of the national surveillance programme in all countries.

Most of the national tuberculosis programmes in the Region have been assessed (Burma and Sri Lanka in 1971 and Indonesia, Mongolia and Thailand in 1972) either by the Regional Training and Evaluation Team or by special WHO consultants jointly with the governments concerned. Their findings have been carefully studied and are planned to be used as the basis for future planning of the tuberculosis control programmes as an integral part of the national health services in the countries concerned.

In Burma, the tuberculosis baseline survey has shown that,in general, the control programme has been successful; it has also pointed to aspects in which improvements should be brought about.

The leprosy programmes in Burma and Nepal have also been assessed, and plans for future leprosy control activities have been under consideration.

Denguelhaemorrhagic fever has shown a high increase in Thailand and has spread to Indonesia, but the case-fatality rate has been within the known range (2-5%). It has been observed that the discrepancy between clinically diagnosed cases and those confirmed by laboratory analysis is becoming greater, and WHO is organizing a meeting of experts to review the present knowledge of the disease and to revise the technical instructions so far used as a basis for denguelhaemorrhagic fever surveillance in South- East Asia and other regions.

In the period under review, the total number of cases of malaria in the Region was the highest for many years. This set-back has made it necessary to undertake a further review of the problems involved. Research with regard to the resistance of the parasite to anti-malarial drugs,resistance of vectors to insecticides and behaviour of other vectors when under insecticidal pressure has been intensified, and the application of newer techniques for dealing with urban malaria tried out.

WHO assisted in the study of an outbreak of poliomyelitis in Delhi, and in making plans for the organization of a permanent epidemiological surveillance system in the city.

The need for the development of adequate health services once again was stressed by the Twenty-sixth World Health Assembly. This development is crucial to the systematic control of the communicable diseases prevailing in South-East Asia. SEA/RC26/2 Page 27

2.1 Malaria

The past year,like the previous year, has been marked by both gains and losses. The inclusion of Bangladesh in the South-East Asia Region auto- matically increased the total number of persons at malaria risk and also the size of the regional anti-malaria programme. Apart from the general difficulties mentioned in the last Annual Report, there has recently been a considerable loss of experienced malaria workers, both national and international, in the Region. Many key workers have retired or have been transf erred, and the number of malaria staff in countries of South-East Asia has now become dangerously low. However,despite all the set-backs and, in some cases, resurgence of malaria, it has ceased to be a serious public health problem in most areas of the Region. Many projects which had been started in hitherto malarious areas remain under the protection of the various malaria eradication programmes. The withdrawal of external bilateral assistance and the decrease in technical staff have placed a greater strain on WHO'S resources, in that it has been necessary to increase the amounts of supplies and equipment as well as to replace international staff in order to bring about improvements in certain aspects of the malaria programnes.

There still remain some difficulties in obtaining DDT, the price of which has now doubled, and in some cases the supplies have arrived too late for use where they are needed to make an impact at the beginning of the transmission season. It has been necessary, too, where technical difficulties have emerged, to switch to HCH and malathion. With the increase in the price of DDT and the decrease in that of malathion, the price differen- tial has narrowed.

In mid-1972, a strategy review of the situation in Indonesia was carried out by a joint WHO/US AID team. By June 1973, plans for the next few years had been completed in respect of all the countries, but it is likely that some of these plans will require revision in the next 24 months.

The following table shows the overall status of malaria eradication in the Region (June 1973 estimates) : Millions Population in the Region 852.3 Population in originally malarious areas 817.0 Population in areas where eradication is claimed (maintenance phase) 358.3 Population in areas under malaria eradication 328.2 In consolidation phase 165.0 In attack phase 163.2 In preparatory phase - Population in areas under malaria control measures Protected by extensive mosquito control measures 77.0 Where there is an organized effort for drug treatment 10.9 Population in areas with no specific anti-malaria measures SEAlRC2612 Page 28

The table, together with the graph, varies from similar presenta- tions in previous years owing to the steady expansion of the population under some degree of malaria control and also, as mentioned, the inclusion of Bangladesh.

Progress made throughout the Region is summarized below.

In comparing the above figures for the overall status of malaria eradication in the Region with those for 1972, an improvement is notice- able, much of which can be said to have been contributed by Bangladesh, which joined the Region in May 1972. Despite the ravages of war and natural disasters, the programme in that country has been highly satisfactory. Out of a population of 66 million, 25 million are in the maintenance phase, 33 million in consolidation and only 8 million in the attack phase. An assessment of the programme was carried out in February-March by two WHO staff members in collaboration with national staff. Following the Border Malaria Meeting between Bangladesh and India in May 1972, another meeting took place in September. These meetings have shown the necessity for collective investigation of common problems, particularly in relation to the role played by A. halahncensis and the possibility of the appearance of P. faZci- pam strains resistant to DDT.

In Burma, the plan of operation which had been under consideration by the Government was signed. The integration of the malaria programme into the general health services continues in stages, with the headquarters of the Malaria Division in charge of planning, technical direction, assessment, training and research. The ultimate aim is to have one malaria assistant and two malaria inspectors in each township, with a malaria supervisor and an adequate number of permanent spraymen assigned to each rural health centre. There are no long-term WHO staff members assigned to the malaria programme in Burma.

In India, numerous set-backs have occurred, as predicted in last year's report, because of the late arrival of DDT. It is possible that the situation may not become fully stabilized for another year. There has been a steady increase in the number of cases occurring in major towns, and efforts to control urban malaria, mainly by larviciding, have been considerably increased. In the pilot project at Jodhpur, previously mentioned, ultra-low-volume techniques of insecticide spraying have been continued, and the results of early experiments have been encouraging. The ratio of decrease in catching stations (houses) for A. stephensi and A. cuZicifacies was between 98% and 99% during the first three applications. Other anopheles species were affected equally severely. Another significant feature was a similar reduction in the case of CuZex fatigm. The usual annual independent assessment of the Indian programme was carried out in December 19721 January 1973.

In Indonesia, the Government has given more encouragement to the programme, particularly in islands other than Java. Two staff members on the WHO malaria team have been reassigned to the island of Sulawesi, and the GRAPH 1-POPULATION AT MALARIA RISK IN THE AREAS UNDER VARIOUS PHASES OF THE MALARIA ERADICATION PROGRAMME IN THE SOUTH-EAST ASIA REGION (1964-1973)

Population (in millions) SEA/RC26/2 Page 29

remaining five (including the laboratory specialist assigned to the inter- country project SEARO 0094.2) are stationed in Djakarta. These seven staff members are covering as much of the Indonesian archipelago as possible. Schemes for the development of transmigration areas are given priority and assisted in some places by the World Food Programme. It is apparent that much technical work remains to be done in the other islands, particularly with regard to the identification of the mosquito fauna and the incrimina- tion of the vector species. In collaboration with WHO staff, plans of action have been prepared for Sumatra.

The programme in Irian Jaya (West Irian) continues. Sufficient funds, equipment and supplies are available, and the equipment and supplies have been ordered for the next two years.

The anti-malaria activities in the Maldives have been very satisfactory. Dwellings in more than half the number of atolls have been sprayed residually with DDT. A WHO sanitarian is working with the project. The sole factor responsible for the comparatively slow progress remains the lack of sea transport. With adequate facilities, it would be possible for the attack phase of the programme to be completed within two years, and, in view of the fact that A. t-esseZatus is extremely susceptible to DDT, total eradication could thus be achieved in a very short period of time.

Nepal has progressed considerably with its prograrmne: more than 80% of the country is now under consolidation after the annual independent assessment carried out in January/February 1973. Unfortunately, the withdrawal of US AID assistance is imminent. In view of the satisfactory state of the programme and the threat of P. faZcipam invasion from across the borders, as well as evidence (on a very small scale) of P. faZcipanrm resistance to chloroquine, the Regional Office has greatly increased its supply component to the programme, especially DDT.

In Sri Lanka, the malaria epidemic continued up to October 1972, with a plateau of 10 000 to 14 000 cases per month. However, a sharp rise up to 21 000 cases occurred during the months of December 1972 and January 1973. The situation of P. faZcipam malaria remains a threat, and the figures for the four years 1969-1972 have been 3 723, 1 608, 3 926 and 3 472 cases respectively. Concentrated work in the areas of Hingurakgoda, Rattota, Valaichenai and Badulla - areas which were previously the main contributors to P. fazczpanun malaria - have shown excellent results. However, the areas of Moneragala and Hambantota have shown increases; Atakalampanna, with fewer than ten cases a year in 1969 and 1970,accounted for nearly 900 cases in 1972. Two otner areas hitherto free of P.fa2ci- pmhave contributed to the increase. There has been an increase in the supply component of WHO assistance to the National Malaria Eradication Training Centre, and the WHO parasitologist has been provided with equipment to enable him to carry out the fluorescent antibody technique. The laboratory services were considerably assisted by the WHO laboratory specialist assigned to SEARO 0094.2 until his reassignment to Indonesia in February 1973. SEA/RC26 /2 Page 30

In Thailand, the malaria training centre at Prabudhabat has been considerably strengthened. Regular training courses are conducted for the national staff at all levels, and an inter-country Seminar on Malaria Epidemiology was held during February/March 1973 (for details, see SEARO 0114 in Part 111). Studies on A. baZabacensis have been continued, as has the work on the CDC and Monks wood light traps. The staffing position, both national and international, has suffered, but it is hoped that this situation will be rectified in the near future. More cases of malaria have been found in the heavily forested areas, and these tend to be of a pernicious nature, associated with severe jaundice as well as cerebral cases.

Because of the conditions mentioned at the beginning of this chapter and also the closure of the International Malaria Eradication Training Centre, Manila, greater emphasis is being placed by individual countries on training and research within the Region. WHO assistance to the programmes in Indone- sia, Sri Lanka and Thailand has helped to maintain high standards, particularly for technical staff. During the year, greater support has been given to the training of personnel in Burma, and it is proposed to provide training for professional staff at the existing centres in New Delhi and in Prabudhabat, Thailand.

The first Bangladesh-Burma-India Malaria Co-ordination Conference was held in Rangoon in January/February 1973.

2.2 Tuberculosis

Assessments of tuberculosis control programmes and their integration into the general health services were continued during the year.

An assessment of the national tuberculosis control programme in Mongolia was carried out during July-September 1972 by a joint Government/ WHO team and was followed by a national seminar, at which the findings were discussed. The Government is studying the recommendations made for improving the programme further along the lines indicated. Also, the regional tuberculosis training and c-~aluationteam (SEARO 0113) organized and conducted an evaluation of case-finding, treatmcut and BCG vaccination in various parts of the country.

In Burma, with assistance from a WHO consultant, a tuberculosis baseline survey was conducted between July 1972 and January 1973; the results are being evaluated.

The programme in Nepal was reviewed by a consultant during June- August 1972. The consultant noted that according to isolated sputum surveys, the prevalence rate of sputum serum positive tuberculosis was 1%in Kathmandu Valley and the Terai regions, and that the prevalence of infection in isolated hilly areas was much lower. He proposed the establishment of four regional tuberculosis control centres in the country in order to develop a country-wide control programme. s~A/RC26/2 Page 31

Assistance was provided to Indonesia in strengthening its activities, with the primary aim of improving the BCG vaccination coverage of the susceptible child population. The WHO consultant who visited the country during December 1972-March 1973 for this purpose reported satisfactory results.and has observed that if the trend continues, the total eligible child population of 55 million could be covered in the next two years.

In Mongolia, Sri Lanka and Thailand control activities proceeded as an integral part of the respective national health services. During October- December, a consultant on pneumology was provided to Mongolia to suggest measures for improving diagnostic work and for enhancing the competence of national staff in dealing with all chest diseases. The programme in India continued to expand, covering more districts. As of the middle of 1972, the number of district tuberculosis centres was 255, of which 189 were regularly and promptly reporting. The National Tuberculosis Institute, Bangalore, continued to prepare personnel to meet the needs of the programme.

The annual international course on the epidemiology of tuberculosis (Prague/Bangalore) was held as planned. The participants visited Sri Lanka as part of the programme.

2.3 Diseases Subject to the International Health Regulations and Epidemiological Surveillance

The table on page 32 shows the position regarding the diseases subject to the International Health Regulations, for the years 1970, 1971 and 1972,as reported to the World Health Organization. In general, there has been an increase in the number of cases of smallpox reported in Bangla- desh and India, whereas Indonesia reported only 34 cases during 1972. The smallpox case fatality in Bangladesh was 28.39% and in India 19.91%, a fact which is probably due to the majority of patients being unvaccinated young children. Nepal reported 399 cases, with a rather moderate case fatality, and Sri Lanka, after many years of being smallpox free,reported one case. The other countries of the Region, viz., Burma, the Maldives, Mongolia and Thailand, remained free of this disease.

Cholera shmed a relative decline in Bangladesh, Burma and Nepal. India reported an increase of about 50% in the number of cholera cases as compared with 1971. Indonesia reported 43 423 cases,an increase of 1.8 times over the figure for 1971. However,the case-fatality rate of reported cases showed a declining trend in India and Burma, i.e., from 32.27% in 1971 to 13.63% and from 10.55% in 1971 to 9.84% respectively. In Bangladesh (16.57% in 1971 and 18.98% in 1972) and Indonesia(l4.16% in 1971 and 15.80% in 1972) the case-fatality rate slightly increased. It is apparent that earlier efforts by governments to provide for early detection and treatment of cases contributed to a definite trend of reduction of the case-fatality rate below 25%,and that further improvement will be possible only by arranging for rehydration therapy to be available closer to the patients' homes through the general health services. For this purpose, health workers would need to be trained in rehydration techniques and rehydration fluids and antibiotics stored at strategic points (from which they could be rushed to DISEASES SUBJECT TO THE INTGRNATIONAl HEALTH REC[ILATIONS NOTIFIED BY COUNTRIES OF THE SOUTH-EAST ASIA REGION, 1970, 1971 AND 1972 (Information compiled from data made available to WHO Headquarters by Member Governments) - Smallpox Cholera Plague Yellow Fever Country Year Cases Deaths Cases Deaths Cases Deaths Cases Deaths

Bangladesh 1970 1 473 502 9 626 2 419 - - 1971 ...... 2 342 388 - - 1972 10 754 3 053 1 059 201 - -

Burma 1970 - - 808 74 49 3 z 1971 - - 398 42 189 16 m 1972 - - 61 6 56 3 2 *I India 1970 12 750 2 374 17 285* 3 784" - - " 1971 16 298 2 736 11 140" 3 595" - - c m 1972 27 407 5 457 21 329 2 908 - - r. am Indonesia 1970 10 081 I 266 6 525 1 379 - - T 1971 2 100 144 23 555 3 335 - - V) 1972 34 . . . 43 423 6 863 - - 0

Nepal 1970 78 11 293 .. . - - m 0 ' 5 7 - - m 1971 215 4 .. . n 1972 399 58 1 - - - ?. ?. m ,- Sri Lanka 1970 ------o 1971 ------1972 1 - - - - -

Thailand 1970 ------1971 ------1972 ------

"Figures exclude cases and deaths among refugees from East Pakistan - Nil . . . Data not available Figures in italics are final SEA/RC26/2 Page 33 the place of the outbreak). As attempts at controlling cholera by means of vaccination campaigns have had limited success, and in view of the enormous costs involved in improving environmental sanitation adequately in the countries of the Region, a reduction in the cholera fatality rate appears to be the main area where maximum results are likely to be obtained.

Of great importance to countries of the Region was the action recently taken by the Twenty-sixth World Health Assembly, which after having considered the Seventeenth Report of the Committee on International Surveil- lance of Communicable Diseases, decided to delete Article 63 of the international Health Regulations, which required the possession of a valid certificate of cholera vaccination for international travellers as a condition of entry to any country.

There was a further decrease in cases of plague reported in Burma (only 56 cases); it was not reported from any of the other countries of the Region. The plague epidemic foci in Indonesia, India and Nepal were dormant. With the experience of the past, when the reappearance of plague has often been observed, all the countries of the Region have continued to maintain a vigilance system as a part of their national surveillance organizations.

Although yellow fever has not been reported from South-East Asia, in view of favourable ecological conditions and abundant presence of the vector (Aedes aegyptil, surveillance is being carried out, particularly with respect to persons and aircraft arriving from infected areas.

In addition to the diseases subject to the International Health Regulations, the national epidemiological surveillance programmes in various countries of the Region cover other communicable diseases which are of major public health importance for the countries themselves. Dengue/ haemorrhagic fever is becoming a problem in Indonesia, Burma and Thailand, with an increase in the number of reported cases. Poliomyelitis surveillance programmes have been started in Indonesia, Sri Lanka, Burma, Thailand and India; surveillance of diphtheria, tetanus and pertussis in Mongolia and surveillance with respect to filariasis and salmonellosis in Burma are also underway.

Training activities aimed at increasing competence in epidemiological surveillance and the control of communicable diseases were maintained. Two regional seminars - one on immunization services and the other concerned with epidemiological surveillance - were held in the Regional Office during the year, and provided opportunities for the exchange of experience and views among national epidemiologists and for discussions on future action in the light of present knowledge. The Regional Epidemiological Surveillance Team (SEAR0 0193) assisted in the organization and conduct of seminars, helped to review the epidemiological situation and services in Bangladesh, organized a serological survey of poliomyelitis in Nepal and participated in the WHO Headquarters-sponsored study of cholera in Indonesia in connection with the expanded cholera control programme. SEA/RC26/2 Page 34

The WHO-sponsored training course in epidemiology (Prague/Delhi) has become a regular annual event, and during the year under review another course was completed, adding six more trained epidemiologists to the health services of the countries of the Region.

2.3.1 Smallpox

The outcome of eradication activities during the year was highly satisfactory in two countries, i.e., Indonesia and Nepal, but smallpox was a source of increasing concern in India and Bangladesh. In Indonesia, for the first year since the programme was begun in 1967, no cases were recorded Nepal, ten years after the start of the programme, has now been officially declared non-endemic, all outbreaks occurring since July 1972 being due directly or indirectly to importations. The considerable rise in the incidence of smallpox in the Region in 1972 (38 595 cases), as compared with 18 481 cases for 1971, is due to major epidemics which occurred in India (27 407 cases) and Bangladesh (10 754).

In Bangladesh, on the return of the refugees, massive outbreaks occurred in early 1972, localized mainly in the south-western districts of the country. Surveillance and vaccination programmes were rapidly established by national staff with the assistance of WHO, but owing to the magnitude of the outbreaks and other unfavourable factors (one being the increased movement of the population following a weak monsoon), the diseases spread to all the districts of the country with the exception of the Chittagong Hill Tracts. Surveillance measures were strengthened; a number of surveillance teams were established at all levels, and vaccination of the population was intensified, priority being given to Dacca and Khulna Municipalities and to other vulnerable areas. In view of the serious situation. about 20 000 health workers were assigned by the Government to assist with the smallpox activities. By June 1973, no cases had been recorded in two districts, and the incidence had declined in a number of others.

In India, major epidemics occurred in the highly endemic northern States. Out of the 87 districts of three States - Uttar Pradesh. Bihar and West Bengal - 83 districts reported cases during the first half of 1973, and as many as 324 cases in a single week were reported from Calcutta alone. A large number of importations from the northern zone occurred in most of the other States of India as well as in Nepal. Of considerable concern were the importations into smallpox-free States in the far eastern and southern regions of the country, in the eastern wing of Madhya Pradesh, and in Orissa, where massive importations from West Bengal resulted in eight districts being affected. Efforts were concentrated on preventing the spread of infection in the above areas and on controlling the epidemics in the most highly infected regions, especially in those bordering States and neighbouring countries which recorded a low incidence or were enjoying a smallpox-free status. By June 1973, some improvement in the situation had been registered, although the implementation of the emergency measures was, in a number of areas, handicapped by insufficient numbers of higher-level supervisory staff and surveillance teams and by problems encountered in the mobility of field workers. MALARIA In many countries of the Region. efforts to cilntrol malaria are being continued. Spraying. shown here in Bangladesh (1) and Thailand (Z), rsmains an important primary measare, In the Matdives a malaria woiker is shawn taking bfdod smears (31, which give an idea of the prevalence of infection in the community. SMALLPOX ERADICATION

The drive to eradicate smallpox has been intensified. A willing Indonesian girl (1). is being vaccinated; in Rajasthan State. India, a member of a smallpox surveillance team checks for vaccination scars (2); in Bangladesh, as part of the campaign 1. mn. ." ""vu with...... a- severe~ eoidemic, vaccination of children is being undertaken on a large scale (3) SEA/RC26/2 Page 35

As of June 1973, it has been 18 months since the last cases in Indo- nesia were notified (January 1972). An active search for cases in the 998 desas infected during the period from 1970 to 1972 was completed, and a further 327 non-infected desas, chosen on epidemiological grounds, were also visited. A new surveillance programe, to be extended throughout the country and involving local heads of desas, was initiated. Routine smallpox vaccination was continued in all the islands with the exception of Bali and Java, where a programe of simultaneous smallpox-BCG vaccination was carried out.

In Nepal, 143 cases were recorded from 1 July 1972 to 30 June 1973. As 14 of the 15 Indian districts bordering Nepal reported cases during the year, surveillance activities were strengthened, especially in the Terai. Surveillance teams were created; weekly reporting from all districts was initiated, and smallpox vaccinators and malaria workers were further involved in the reporting of suspect cases. Changes in the organization and schedule of the vaccination programme resulted in a better coverage of the population.

WHO consultants assisted the programme in many areas of the Region. The local production and testing of freeze-dried vaccine was supported by the Organization. Supplies and equipment were provided, including vaccine, which was either directly supplied by WHO or obtained through bilateral sources. In September-October 1972,WHO sponsored two inter-country seminars - one on the laboratory diagnosis of smallpox and the other on surveillance in smallpox eradication, both held in New Delhi.

2.3.2 Cholera

Cholera continued to be reported from Bangladesh, Burma, India and Indonesia. The case-fatality rate in the Region is still around 15%, ranging from about 5% to 25%, depending on the area. It is obvious that improvements in detection, rehydration and treatment of patients are the factors which determine the mortality and as such are the most important activities in cholera control.

A WHO Headquarters-organized controlled trial of cholera vaccine was carried out in Surabaya (Indonesia) during March-June 1973, to assess the practical value of a new preparation of the alum-precipitated vaccine. It is believed that this vaccine will give a higher degree and longer duration of protection than the vaccines so far available.

The surveillance and control of cholera in the Region were also discussed by the Regional Seminar on Epidemiological Surveillance mentioned above, for which a detailed review of areas reporting cholera in the Region was prepared. In connection with the WHO expanded cholera control programme, an inter-regional team reviewed the cholera problem in Indonesia in April and also held discussions in the Regional Office. The intensification of cholera control activities on a global scale is expected to be considered very soon.

Assistance continued to be provided in the field of rehydration therapy and in the preparation of infusion fluids. A consultant assisted the Government of Mongolia during September-December in formulating detailed SEA/RC26/2 Page 36 plans for the centralization of infusion fluids in Ulan Bator. In Nepal, the establishment of facilities for the production of rehydration fluids in the four zonal hospitals received assistance from a WHO consultant who visited the country in September. Another activity was the holding of an inter-country course on rehydration therapy centres in Rangoon in March, attended by senior paediatricians from Burma and Nepal. The consultant who assisted with this meeting also visited Indonesia to review the progress made in rehydration therapy since 1971, when he had undertaken a previous assignment.

The recent abolition of the article of the International Health Regulations regarding the requirement for valid cholera vaccination certificates has been mentioned in Section 2.3.

During the period under review cases of plague were reported only from Burma. The research project on the ecology of plague in Bojolali District in Indonesia continued its activities. Several isolations of bacilli suspected of being Yersinia pestis were made from the vectors (fleas) and organs of rodents captured in the study areas and were sent to the Haffkine Institute, Bombay, for further study. A WHO consultant (a specialist in rodent taxonomy) visited the project in March-April to assist the team in the identification of captured rodents. Earlier, for two weeks during November-December, a staff member from WHO Headquarters assisted in the preparation of the data collected so far for computer analysis.

In the first WHO-sponsored Regional Seminar on Methods of Epidemio- logical Surveillance, held in the Regional Office in December, there were 20 participants from all countries of the Region except the Maldives. Plague surveillance was reviewed and recommendations were formulated for the strengthening of the surveillance of reservoirs (rodents), vectors (fleas) and species, and for the promotion of studies on resistance to insecticides.

2.4 Bacterial Diseases

2.4.1 Leprosy

During the year under review, an epidemiological and operational assessment of the national leprosy control programme in Burma was carried out by a ioint Government/WHO team. The preliminary findings indicated that the programme had been successful and that leprosy control workers had been trained and deployed to cover new areas, so that by the end of 1972 the whole of Burma proper had been covered by the programme. The team also found that the treatment of leprosy cases had been satisfactory. Thousands of leprosy patients who had been registered for treatment were expected to be released as having been cured, after a careful scrutiny of the latest clinical and microbiological findings.

The conclusions of the assessment team will be used as the basis for future planning of leprosy control within the framework of the general health SEA/RC26/2 Page 37 services. It is expected that a national seminar on leprosy control will be held to discuss the conclusions and to draw up a plan for the future development of the programme.

Assistance was provided to Nepal in the form of a consultant, who, during October 1972-January 1973, assessed the national leprosy control programme and drew up recommendations for strengthening its various components, particularly the training of staff, case-finding and case-holding. The WHO consultant-leprologist who assisted the leprosy control programme in Sri Lanka during the first half of 1972 has suggested that the programme should concentrate its attention on the urban and semi-urban areas where prevalence is highest and difficulties are greatest, that top priority should be given to following up cases to improve regularity of treatment, and that integration of the leprosy programme should be implemented in progressive stages.

In other countries, i.e., India, Maldives and Thailand, the programme continued to be run by national staff. A national leprosy control programme was launched in Bangladesh, where a WHO consultant took up a nine-month assignment in March. In Indonesia, a control programme is being planned to start later in 1973, mainly for the training of staff and the demonstration of programme methodology.

2.4.2 Venereal Disease and Treponematoses

Late in 1972, two WHO consultants - a venereologist and a laboratory technician - were assigned to Thailand to assist, respectively, in the strengthening of clinical diagnostic and treatment work and in the improvement of laboratory techniques. In Burma, efforts were being made to improve the serology of syphilis and the laboratory diagnosis of other venereal diseases. Assistance was also provided to Bangladesh, where a WHO consultant reviewed the venereal-disease problem and made recommendations for a national control programme. The consultant recommended, among other things, development of facilities for on-the-spot diagnosis of syphilis and gonorrhoea and of hospital laboratory facilities for serological and cultural diagnosis. improvement in medical and paramedical staffing and provision for the training of staff both within the country and abroad, upgrading of all venereal- disease clinics, and special attention to "at risk" groups such as seafarers, armed forces personnel, expectant mothers and prostitutes.

A further consultant is being assigned to Indonesia later in 1973 to assist in a review of the yaws and venereal-disease problem in that country.

It has been observed that in all the countries of the Region increasing attention is being paid to venereal diseases and their spread among the younger population groups as well as to the increasing resistance to the treatment of gonorrhoea. SEA/RC26/2 Page 38

2.4.3 Diphtheria, Tetanus and Pertussis

No outbreak of any of these diseases was reported from the countries of the Region. There is an impression that diphtheria and pertussis do not represent major health problems in the tropics. However, the findings of surveys among a high percentage of children with antibodies against diphtheria and pertussis indicate that the circulation of the causative agents is very high. Because of the fact that there are other communicable diseases which are considered as being of major importance, diphtheria and pertussis seem to be getting lower priority.

The Government of Mongolia maintained its systematic immunization of children, including the surveillance of diphtheria cases and small outbreaks. In other countries continued efforts were made to increase the production of DPT vaccine (see Chapter 4) and to strengthen the basic health structure necessary for carrying out the national DPT immunization programmes.

2.5 Virus Diseases

2.5.1 Trachoma

As briefly reported last year, a WHO consultant reviewed the national trachoma control programme in Burma in June-July 1972 and also assisted in the further improvement of control methodology. In his report, he recommended that further control activities be geared to the existing situation and to the results already obtained, that the evaluation of the results should include a measure of the severity of the disease, in addition to prevalence rates, and that the integration should be proceeded with only after the severity and the endemicity of the disease had been sufficiently reduced and the basic health services strengthened. Field research should be undertaken in addition to control measures. The programme has now covered the entire trachoma endemic area in the country, and many of the patients have undergone one or two rounds of treatment. The results, particularly as regards the cure rate, are under investigation and will probably give a clear answer to the question OF what a mass programme can be expected to achieve under optimal conditions.

The trachoma control programmes in India and Thailand, which have long been integrated into the basic health services of those countries, are based generally on self-medication after diagnosis; the initial treatment and health education are given by competent and specially trained health workers.

2.5.2 Poliomyelitis

No outbreaks of poliomyelitis were reported. Burma, India. Indonesia, Sri Lanka, and Thailand are now included in a global polio surveillance programme initiated by WHO Headquarters last year. The surveillance is based on collection and analysis of data received from health administrations. SEA/RC26/2 Page 39

A WHO-sponsored Regional Seminar on Immunization Services was held in July in the Regional Office, and at this seminar polio immunization was discussed in detail. It is the general consensus that the disease is increasing in all the countries of the Region except for Mongolia, and that active surveillance and vigilance will have to be maintained in order to enable prompt action as necessary in case of outbreaks. Attention should also be paid to the production of vaccine and to the strengthening of the infrastructure of the health services so that they can give systematic immunization as and when introduced. So far, systematic immunization with a high coverage is being carried out only in Mongolia, but a similar less extensive programme in Sri Lanka is also going on.

The WHO virologist attached to the Regional Team on Epidemiological Surveillance and Training visited Nepal early in 1973 and arranged a serological survey for poliomyelitis among the child population in order to assess the immunity profile against this disease. The sera collected are being tested at the virological laboratory of the National Institute of Communicable Diseases, Delhi.

2.5.3 ~en~ue/HaemorrhagicFever

~engue/haemorrhagicfever continued to be reported from all provinces in Thailand, the number of cases reported in 1972 being 20 457. However, the case-fatality rate continues to be relatively low (2.6%).

In Burma, Rangoon reported 1 013 cases and 32 deaths, giving a case- fatality rate of 3.2%.

Indonesia reported an outbreak in Padang and Semarang for the first time, and WtiO assisted in studying the outbreak and in abating the adult mosquito vector population by the aerial spraying of insecticides.

An interesting feature in regard to denguelhaemorrhagic fever observed during the last two years is that the paired sera of a number of clinical cases were completely negative to dengue and chikungunya viruses. The Regional Office is making arrangements to hold a meeting of experts - clinicians, virologists and epidemiologists - to review all aspects of dengue/haemorrhagic fever later in 1973.

Towards the end of the period under review, a WHO consultant was recruited to visit Burma, Indonesia and Thailand in order to advise on surveillance and control.

2.5.4 Influenza and Other Respiratory Viruses

No large outbreaks of influenza were reported from any country of the Region.

A trial of measles vaccine was carried out in Mongolia during the latter half of 1972. The WHO consultant who assisted with the trial organized a short national seminar at which aspects of measles immunization were discussed. The Government has decided to carry out a mass immunization programme in order to immunize the susceptible child population. It is expected that the results of the testing of the sera collected from the trial group before and after the trial will be available to help to decide SEA/RC26/2 Page 40 on the age-group to be covered by the programme, as well as to show the seroconversion achieved by the L-16 measles vaccine strain used, which is also planned to be used in the mass immunization programme.

2.6 Parasitic Diseases

2.6.1 Filariasis

The filariasis control programme in Burma continued to concentrate on vector control by spraying the breeding places of Culex mosquitoes with Fenthion. The whole of Rangoon City has been covered by spraying operations as well as by environmental sanitation activities, both aimed at reducing the density of vectors in order to interrupt the transmission of the disease. The detection and treatment of filariasis cases are carried out by the general health services.

In Sri Lanka, the control programme was converted into one of vector control, also covering vectors transmitting other diseases. Again,filariasis control is the responsibility of the health services.

During September-November, a WHO consultant reviewed the filariasis problem in Indonesia and advised the Government on control methodology. The national filariasis control programme in India continued as planned. Two workers from Bangladesh were awarded WHO fellowships to attend the training course in filariasis control methodology which is conducted regularly by the Indian filariasis control programme.

2.7 Veterinary Public Health

Preparations were under way to hold a combined regional seminar on veterinary public health and inter-regional seminar on epidemiological surveillance. This seminar, which is scheduled to take place in Bangkok in October, will review zoonosis control, the training of staff and the organization of veterinary public health services in the Region and will include a programme of field visits for the participants.

2.7.1 Rabies

A WHO consultant visited Nepal during November-March to review the problem of rabies in that country, to assist the Government in planning a national programme for rabies control, and to advise on the production of sufficient quantities of anti-rabies vaccine. Among the consultant's recommendations was the establishment of a separate anti-rabies treatment centre in Kathmandu and of similar centres in each zonal hospital. He also suggested measures for the anti-rabies treatment of animals and for the control of stray dogs. A consultant was also provided to Thailand to review the production of rabies vaccine. Towards the end of the period under review, a further consultant visited Indonesia to advise on the strengthening of zoonosis control activities with particular emphasis on rabies as the main public health problem.

Progress in the manufacture of rabies vaccine is described in Chapter 4. SEA/RC26/2 Page 41

2.8 Immunology

A major activity in this sphere was the Workshop in Immunology which was held in Bangkok from 21 August to 1 September with fifteen participants, from India, Indonesia, Nepal, Sri Lanka and Thailand. The Workshop discussed the main aspects of cell-mediated and hurnoral immunity of some of the communicable diseases of major public health importance in this region (e.g., leprosy, cholera, viral hepatitis and poliomyelitis).

A WHO/ICMR Training-cum-Research Centre was established in New Delhi during the year. One of the first activities of this centre was to hold, in collaboration with WHO Headquarters, a bleeting of Investigators on Innnunological Problems in Leprosy Research, which took place from 30 November to 5 December.

WHO fellowships continued to be awarded to workers from the Region to attend the training courses in inununology being held in Singapore and Lausanne, Switzerland.

3. HEALTH LABORATORY SERVICES

It is heartening to note that the countries in South-East Asia are taking an increasing interest in developing co-operation with laboratories at international and regional levels; wherever possible, facilities available or arranged through WHO are being used with a view to building up national expertise. The following are examples of such co-operation between institutes: (1) Bio Farma, Bandung, Indonesia and the Statens Serum Instituut, Copenhagen, in the assay for BCG vaccine; (2) the Department of Medical Sciences, Thailand, and the Institute of Immunology, Zagreb, in biological standardization, and (3) the Burma Pharmaceutical Industry, Rangoon, and the Lister Institute, in England, in tetanus vaccine. Also, the central venereal-disease laboratories in India, Sri Lanka and Thailand continue to participate in the scheme sponsored by the CDC (Center for Disease Control, Atlanta, Ga., USA) for testing proficiency in syphilis serology; the National Health Laboratory in Burma had participated in this scheme in 1972. All four laboratories have achieved a high level of performance in MRL, and those in India, Sri Lanka and Thailand in FTAlABS tests as well. Moreover, all the countries in the Region have participated in the WHO Headquarters/CDC-sponsored collaborative study for the standardization of glucose tests. As experience with this study is acquired, it is planned to promote a scheme for the standardization of other chemical and laboratory procedures as well.

Regional co-operation is growing in strength, and,where possible, use is being made of expertise available within the Region to strengthen the national reference laboratories in the various countries. For instance, cholera, salmonella and streptococcus cultures are referred from Burma to India for verification and confirmation of the phage type; strains of Yersinia isolated in Indonesia have been tested and verified at the Haffkine Institute, SEA/RC26/2 Page 42

Bombay; antigens and control sera are supplied by the Virus Research Centre, Poona (India), to Burma and Indonesia to support their laboratory studies on dengue/haemorrhagic fever, and the facilities available in Thailand and India are being used for the training of physicians and technicians in vaccine production, anti-venin preparation and preparation of infusion fluids as well as in tutor training.

As smallpox is progressively being eradicated, post-eradication surveillance will require greater support from the laboratory. The two inter-country courses in the laboratory diagnosis of smallpox which were held in Bandung in 1970 and in Delhi in 1972 helped in introducing this concept and stimulated most countries to strengthen their respective laboratory services in smallpox. In some countries (such as Bangladesh, India, Indonesia, Sri Lanka and Thailand) regular services are provided by the national health laboratories. Regional and international co- operation is being maintained,through WHO, with a view to providing diagnostic services to those countries which have still to develop their own laboratory facilities, or for assisting in the confirmation of the results reported by the national laboratories.

Similar interest is being stimulated in the surveillance of other diseases. WHO has helped Burma, Indonesia and Sri Lanka to establish competence in the virological and serological surveillance of dengue/ haemorrhagic fever. Work continues in the national reference laboratories for cholera which WHO has designated in many countries in South-East Asia, and the National Health Laboratory, Rangoon, is one of those which have recently achieved consistency in the isolation, typing and phage typing of cholera. In Nepal, there is scope for extending the potential of the Central Health Laboratory for the examination of larger numbers of strains and the development of phage typing.

In efforts to harness the potentials of the national laboratories to provide reference services in respect of diseases of major public health importance, a WHO-sponsored course in virology with particular reference to epidemiological surveillance has been planned, to be held at the Virus Research Centre, Poona (India), in November 1973. In addition, fellowships have been provided to train national personnel in specialized aspects of microbiology and virology, and a WHO consultant is being assigned to report on the status of the salmonella reference laboratories in Burma, Bangladesh and Sri Lanka. Another consultant is to be provided to India to help establish a national reference centre for the streptococci.

With material assistance from UNICEF, WHO has pursued its efforts to strengthen rural health laboratories. During the year a number of such laboratories were upgraded: in India a further ten district and two regional laboratories, in Indonesia 33 Kabupaten laboratories, in Thailand six more provincial laboratories and in Burma 23 district hospital laboratories. In Indonesia, Mongolia, Sri Lanka and Thailand regular courses are being held for the refresher training of field laboratory staff. There is further scope for making the courses even more relevant to the work and for COMMUNITY WATER SUPPLY Safe water. which is basic to health. has long been considered of primary importance by WHO, and projects for the provision of community water supply are being accelerated in countries of the Region. Some of the problems in the Region are: the need to carry water for long distances. as shown in Indonesia (1). and the lack of clean water for drinking and other purposes, as in Nepal (2). Even though using standpipes such as those in India (3) and Bangladesh (4) may mean a long wait for water. they represent a great step forward as tar as public health is concerned. 4 LABORATORIES

Medical services need to be backed up by good health laboratories. Here, young men and women in Thailand (1) are receiving up-to-date training; a laboratory technician in Bangladesh is working on vaccine production (2). needed in greater quantities for the smallpox eradication programme. Mongolia is also modernizing and expanding its facilities for the manufacture of vaccines (3). SEA/RC26/2 Page 43 securing a larger coverage of the rural health workers as a team. Bangladesh, Burma, India and Nepal have plans for establishing similar training schemes.

Blood Transfusion

It is apparent from the reports of the WHO consultants who have reviewed the blood transfusion situation in India, Indonesia, Sri Lanka and Thailand that a wide gap exists between requirements and availability of blood supplies. Though they have not yet been accurately estimated, it is believed that against the recommended average of ten units of blood that are required per thousand population, the needs, which vary from one country to another, range between one quarter of a unit to five units per thousand population, as is the case in Sri Lanka.

Except in very few countries where the services are run as a national programme, blood collection and banking are essentially local activities undertaken by hospital staff, the Red Cross and voluntary and commercial establishments. The preponderance of professional donors, reliance on whom has increased with the commercialization of blood donations by private concerns, and the reduction in the numbers of voluntary donors have become major problems. There is an urgent need for governments to reorganize their blood transfusion services under a unified organization at the national or state level.

Also, it will be necessary to establish and observe minimum standards for quality and safety; provision should be made for adequate legislation to regulate the donation, collection, use, storage, issue and administration of blood.

4. VACCINE PRODUCTION

Freeze-Dried Smallpox Vaccine

The overall production of smallpox vaccine in South-East Asia has more than doubled, as compared with the 1970 figure of 69.3 million doses. Burma, lndonesia and Thailand have maintained their respective production rates. As for India, because of initial delays at the vaccine production centre in Belgaum, the starting of the expanded programme (10.6 million ampoules per year) fell short of its targetted schedule (January 1973) . It is, however, expected that, as production picks up momentum, the progress of the programme in Patwadangar, Hyderabad and Madras will offset earlier deficiencies. New equipment has been commissioned. Also the Dacca laboratory in Bangladesh has been fully rehabilitated. In general, the vaccine produced is of good quality and meets the WHO minimum requirements.

The trend in the next few years will be towards producing less smallpox vaccine,as the disease is being eradicated. Though small quantities will still need to be produced to meet the needs of the maintenance and surveillance programmes, it is expected that nevertheless substantial resources in men and material will be released and deployed for the improved production of other vaccines, both in quality and in quantity. SEA/RC26/2 Page 44

~iphtheria/Pertussis/Tetanus (DPT) Vaccine

Many vaccine-producing countries in South-East Asia have established the capacity to product DPT vaccine and combinations of D, P and T. However, in many places the production runs relatively low, below the capacity to produce the vaccine and the estimated capacity of the country to absorb it. This situation creates managerial problems, as the cost of the vaccine which is produced runs high and the skilled manpower is not fully utilized. Such problems could be averted if, on the basis of estimated requirements, firm orders were placed in advance with the producers.

In other places, such as India,where the demand for DPT is rapidly increasing, there is a need for a critical review of the methodology of manufacturing which is in use, as the existing equipment for the production of the vaccine is inadequate to meet the requirements of the programme. Interest is being taken by many countries, e.g., Burma, India and Indonesia, in developing their testing laboratories, referring their products for independent testing to a WHO Reference Laboratory and developing their own national reference preparations.

Rabies Vaccine

With technical assistance provided by WHO, the Central Veterinary Laboratory, Kathmandu, has started the experimental production of BPL inactivated 5% sheep-brain vaccine. It is expected that by early 1974 the first batches will be released for human use. This is part of a package plan which includes the establishment of post-exposure treatment centres in zonal hospitals, the control of rabies in rural and urban areas and rabies surveillance based on notifiration of cases and laboratory diagnosis.

In Burma, further progress has been made in the manufacture of the BPL inactivated freeze-dried rabies vaccine. The technique is now well established,and the batches produced, which have been tested in the Inter- national Reference Laboratory, have been found to meet the standards for potency.

In Thailand, the Department of Medical Sciences has taken further action towards the development of a pilot laboratory for ERA live tissue- culture rabies vaccine. Late in 1973, on the return of the national staff member from a WHO fellowship, a consultant will visit Bangkok with a view to formulating a detailed plan of action for the implementation of the project at the Department of Medical Sciences.

In a few countries phenol-treated monkey-based vaccine is being used. There are some objections to this vaccine,as the presence of adventitious viruses pathogenic and fatal to man is difficult to exclude and there are other vaccines that are safer. SEA/RC26/2 Page 45

5. HEALTH STATISTICS

The work connected with the development of an Asian Charter for Socio-Economic Development has brought the need for strengthening health statistics systems into sharp focus. Some basic statistical data were collected and presented to a meeting of the sub-committee set up by the Regional Committee which met in February in the Regional Office (see also Section 2.1 in Part 11).

During the year, emphasis was placed on the formulation of a strategy for the development of health information systems which could provide data necessary for planning and administering the health services and evaluating their effectiveness.

Assistance to countries continued through a number of country programmes and the inter-country statistical project "Collection and Utilization of Health Statistics, Records and Reports". The WHO statistician assigned to this project has studied priority areas as well as the means for providing effective statistical assistance to Bangladesh. With his departure, the project was reformulated and is now equipped to offer highly specialized advice on health statistical methodology. It also possesses expertise in the design of sample surveys, development of mathematical models for health care delivery systems, etc.

In Burma, assistance was given in the teaching of statistics to medical students at both undergraduate and post-graduate levels as well as in the preparation of appropriate teaching curricula.

A consultant in medical statistics assisted the Indian Council of Medical Research for six weeks during November-December in the planning and conduct of a Training Course on Statistical Methods in Medicine and Public Health.

In Indonesia, a WHO statistician continued to help with the statistical components of the project, "Strengthening of National Health Services". Another joined the project "Resources for Family Health" in September 1972 and has been helping with the census of health resources to be utilized for the development of the national family planning programme.

The results of a new, simplified hospital reporting system, designed by the inter-country statistical project mentioned above and introduced on a trial basis in Indonesia, were analysed by a consultant, who made recommendations for the introduction of the system on a country-wide basis in his report, which covered the period from July to November 1972.

In Mongolia, a consultant spent one month (during March-April) advising on the processing and analysis of the health and epidemiological data collected by the Ministry of Public Health. A specialist in the maintenance of data-processing equipment is being recruited. SEA/RC26/2 Page 46

A new recording and reporting system to be used in rural health posts has been introduced on a trial basis in some pilot areas in Nepal. The medical record officer assigned to the project "Strengthening of Health Services" reviewed the suitability of the system and made recommendations for simplifying the procedure so that it could be more widely used.

In Sri Lanka, a WHO statistician is providing assistance to the "Health Manpower Study" group and, together with another WHO statistician working with the inter-country Tuberculosis Training and Evaluation Team stationed in Sri Lanka, gave some help to the family health project.

A draft plan of action under the project "Vital and Health Statis- tics" operating in Thailand was prepared by a WHO statistician assigned to the project. Proposals for the implementation of a study in the field of vital statistics and lay reporting of causes of death were under consideration.

Some important group educational activities took place during the year under review. A meeting of the Working Group on the Ninth Revision of the International Classification of Diseases was held in New Delhi in December, at which 15 participants drawn from all countries of the Region discussed the regional proposals for the revision. One of the main suggestions was the introduction of a chapter on lay reporting techniques.

The Regional Office,in collaboration with Headquarters, organized an inter-country Workshop on Statistical Methods in National Family Planning Programmes, which was held in Bangkok in November, with participants from Bangladesh, India, Indonesia, Nepal, Sri Lanka and Thailand.

Two new elements are being added to the regional programme in vital and health statistics, i.e., electronic data-processing techniques and sample survey methodology, which will be the subjects of two further meetings being planned to take place in late 1973 and early 1974.

The Regional Office participated in some preparatory arrangements for the WHO Travelling Seminar for National Health Statisticians on Health Aspects of Population Dynamics and Measurement of Family Health, which is to visit Sri Lanka in this region some time in October-November 1973.

Regional Office and field staff assisted with the statistical aspects of meetings organized in individual countries as well as others sponsored by WHO, and, in some instances, contributed papers for discussion.

6. EDUCATION AND TRAINING

Implementation of the long-range plan for assistance in the establishment of a new health sciences centre at the Prince of Songkhla University in Thailand began in November, with the assignment of an architectladviser, sEA/~C26/2 Page 47 who has been working with the National Hospital Design Committee on the functional planning of the premises. The Government decided to take in the first groups of pre-medical and nursing students in the summer of 1973.

The Medical Education Unit of the Faculty of Medicine, University of Sri lanka, Peradeniya, received assistance in the development and implementation of institutional and departmental objectives. The two consultants who were assigned for this purpose also conducted a follow-up study of the medical teachers' training course held at Peradeniya in 1970. In the same Faculty, a further medical teachers' training course, the fourth of its kind in the Region, was held in January. New and more spacious accommodation has recently been allocated to the Medical Education Unit at Peradeniya, and two of its staff members are undergoing training abroad on WHO fellowships.

The work of the WHO team which visited Nepal in July 1972 also included assistance in planning the training of health personnel, and has been described in Section 1.1.

An "in-depth" evaluation of the regional health manpower development project (SEARO 0096), which was earlier known as "Medical Education", has been started in preparation for a UNDP mission which is scheduled to visit the Regional Office and some countries in South-East Asia in August- September, to review the activities of the medical teacher training centres (see also Section 1.1).

An inter-country Meeting on the Role of Operational Studies in Health Services, which was held in December in Bangkok and which brought together senior doctors and nurses from six countries of the Region, contributed towards instilling in the participants a deeper appreciation of the role and value of the application of scientific methods in achieving the aim of their health services. The method of approach adopted in the meeting was to introduce the participants to the elements of operational research studies through lectures and group activity sessions, which gave them opportunities to test the methodology of operational studies and to develop practical studies themselves for the solution of the actual health problems which they themselves brought up at the meeting.

In WHO'S assistance to training programmes, continued emphasis was placed on the team approach. Through the inter-country project SEARO 0139, "Short Courses for Nurses and Other Health Personnel", several courses were organized, some on different nursing specialties and others with the participation of both doctors and nurses. Through this project,countries were encouraged to organize and conduct their own educational programmes. India and Thailand have already started to carry out such activities.

Details of the preparation of different categories of health personnel such as nurses, sanitarians and auxiliary health workers have been given in Sections 1.1, 1.3 and 1.4. SEA/RC26/2 Page 48

The preparation of the reference manual for health centre staff in the Indonesian language mentioned in Section 1.1 and plans for subsidizing the translation of certain chapters from a well-known nursing textbook into Thai, at the request of the Government of Thailand, are illustrations of WHO'S preoccupation with helping to make useful textbooks more widely available in countries of the Region.

With the assignment of a consultant to the Regional Documentation Centre on Human Reproduction, Family Planning and Population Dynamics since December, a start was made with the collection of published and unpublished material on these subjects in the countries of the Region, and the first bibliography was compiled and distributed to Member States and institutions in and outside the Region (see also Section 6.5). In this connection, the booklet "An Aid to the Teaching of Human Reproduction, Family Planning and Population Dynamics", prepared by a consultant, was issued and widely distributed. It is planned to bring this booklet up to date every year, and the first revision is already in hand.

6.1 Medical Education

During the year, 34 consultants assisted in implementing programmes in medical education in various countries. This figure includes those assigned in connection with UNFPA-supported activities in medical schools.

Long-term assistance by WHO visiting professors was continued in Burma and Indonesia, where three medical educators were in position. A project manager for the large-scale LNJP project in Burma for the education and training of health manpower was assigned in November. A long-term medical educator has also been provided to Mongolia, and has been in position since January. Four medical educators completed their assignments during the period under report.

Some of the WHO-assisted activities specifically directed toward medical education were: Medical Teachers' Training Course, Bangkok; Seminar on Community Medicine for Medical Teachers, Rangoon; Seminar on the Place of Psychiatry in Medical Curriculum, Colombo; Medical Teachers' Training Course, Peradeniya (Sri Lanka); Seminar on Medical Pedagogy, Calcutta, and Seminar on Community Health Aspects of Medical Education, Bangkok (followed by a National Workshop on Community Health Aspects of Medical Education in Pattaya). (For details of these and other such activities see Part 111 and Annex 3.)

Of the other group educational activities, special mention should be made of the Course on Paediatric Patient Care, held in Hyderabad, and a National Workshop on Community and Family Health for Health Teams, at Medan (Indonesia), which aimed at bringing together various categories of health personnel and administrators with a view to facilitating a common understanding of problems. SEA/RC26/2 Page 49

6.2 Paediatric and Obstetric Education

While assistance in Indonesia and Sri Lanka is channelled, respectively mainly through the maternity-centred family planning approach of the post-partum programme and a broader-based family health programme, in India, in addition to these two types of programmes, there is a long- standing WHO input for fostering medical education in maternal and child health. This has taken the form of devising new undergraduate curricula in socially orientated paediatrics and social obstetrics. Assistance,in collaboration with UNICEF,is also given to paediatric and obstetric teaching centres, district hospitals with paediatric care units, and paediatric surgical departments.

During the year under review, a Workshop on Problems and Techniques of Community Studies in Child Health was held. This was also attended by senior paediatric teachers during the Indian part of the joint UNICEF/ WHO course (project SEAR0 0163). A revised paediatric undergraduate curriculum, evolved in previous years by a WHO-sponsored ad hoe group, was also tested out in one Indian medical college, assisted by a WHO consultant, and will be tested again later in 1973 in a second institution. These senior Indian paediatric educationists who have so far dealt with undergraduate curricula will direct their attention, at their next meeting in 1973 to teaching in the internship period in the field practice area, in line with the recommendations arising out of the technical discussions on the teaching of community health in medical colleges, held during the twenty-fifth session of the Regional Committee.

Preparations are well under way for the first of the refresher courses under project SEARO 0096, on "Care of the Newborn", to be held at tvo centres in the Region in September-October 1973.

A national seminar on social obstetrics is also planned for November 1973 to review progress in teaching departments assisted by WHO so far and to chart the future shape of this assistance.

Fellowships in social paediatrics, social obstetrics and paediatric surgery continue to be awarded. In Indonesia, (under project SEARO 0144) a follow-up visit was made early in 1973 by a short-term consultant in rehydration therapy (see also Section 2.3.2).

A Meeting on Education in Paediatrics was organized in Dacca in June,to provide an opportunity to senior teachers in child health in countries of the Region to review undergraduate paediatric education in medical colleges and discuss methods for its improvement. Special stress was laid on the organization of the teaching programme in aspects of child care and health appropriate to developing countries.

6.3 Teaching of Human Reproduction, Family Planning and Population Dynamics

Detailed guidelines for the implementation of a strengthened curriculum in the teaching of human reproduction, family planning and population SEA/RC26/2 Page 50

dynamics have been prepared and widely distributed. A two-week inter- country course was being organized in Dacca, Bangladesh, in July 1973 to discuss these guidelines and evolve effective measures for implementing them. Also, a long-term consultant was assigned to visit eight selected medical colleges in India. With the assistance of some short-term consultants, he will assess the present status of the teaching of these subjects and help the colleges to implement the strengthened curriculum. Relevant literature is being supplied as necessary. Also, in collaboration with the All-India Institute of Medical Sciences, New Delhi, a six-week course for teachers and medical students is being organized to be held in October. It is expected that, through these various activities, the teaching of human reproduction, family planning and population dynamics will be firmly established in the eight selected medical colleges and that they, in turn, will be able to train teachers from other medical schools.

In Indonesia, the WHO medical educator continued to assist the Consortium of Medical Sciences in planning and carrying out community health programmes, and a consultant assisted the medical school in Medan in introducing the teaching of human reproduction, family planning and population dynamics by organizing lectures and seminars and by the development of the field practice area.

Plans have been made to provide assistance in this subject to the two medical faculties in Sri Lanka,at Colombo and Peradeniya.

6.4 Fellowships

During the reporting period, 521 new fellowships were awarded. In addition, 93 were extended for a second year of study and 15 for a third or additional year necessary for the fellows concerned to complete specific programmes.

Of 149 fellowships in communicable-disease control and laboratory services, 44 (30%) were for malaria, 28 (19%) for laboratory services, 20 (13%) for tuberculosis control, 17 (11%)for epidemiology and 40 (27%) for airport health services, filariasis, plague, gastroenterology, haemorrhagic fever, venereal diseases, veterinary public health, vaccine production, smallpox eradication, leprosy, tropical public health, immunology and trachoma.

Of the total number of awards for the period under review, 65 (12%) were for training within the Region.

Out of the new awards, 161 fellowships were awarded to doctors, engineers and nurses for one-year post-graduate courses leading to a degree or diploma; in addition, 67 were given for attendance at international courses, 153 for other types of training or experience and 140 for study tours.

During the year, 95 fellows from outside South-East Asia visited the Region for periods varying from one week to two and a half months. Fellowships Awarded by the WHO South-East Asia Region, By Subject of Study and Country of Origin of the Fellow (1 July 1972 to 30 June 1973) - Subject Bangladesh Burma India Indonesia Maldives Mongolia Nepal Sri Lanka Thailand Total

1. Public health adminis- 1 - b 16 - 9 2 4 1 39 tration

2. Sanitation 4 - 28 6 2 - 8 6 - 54

3. Nursing 2 1 21 6 - 5 7 2 9 53

4. Maternal and child 3 3 13 7 - 13 - 4 4 47 health

5. Other health services 1 5 33 6 - 9 3 10 12 79

6. Communicable diseases 8 12 39 22 6 9 16 22 15 149 and laboratory services

7. Clinical medicine 2 2 20 5 - 3 4 8 9 53

8. Basic medical sciences - 2 8 6 - 11 2 6 12 47 and education

TOTAL 21 25 168 74 8 59 42 62 62 521 Annual Distribution of Fellowships.by Country and by Type of Fellowships, 1968 to 1972 (Calendar Year), for Study Within and Outside the South-East Asia Region

Bangladesh Burma India Indonesia Maldives Mongolia Nepal Sri Lanka Thailand Total -

i 3 4 4 Grand Year 3 3 3- 3- 3 3- i 3 m m - im m m am m in^ m 8m n~ - m m - m lm tm '" c c we c *c C UC c g LZ G Total g tg 0 is 0 QJO 0 moo QJ 0 uo 0 0 00 0 .A U4 . Lld g @g ,: ..i g % .a zG .$ M 2% M zz '$ "C '"M '% "G1 Hal=* ? 5r Crn QJ no "a% a !+ d u d Y a a k a Y w "," 2 U

1968 - - 6 30 1 58 7 26 5 - - 48 21 10 8 27 14 35 62 234 296

1969 - - 12 39 4 54 15 40 8 - - 58 20 11 14 35 16 58 89 295 384

1970 - - 7 41 8 133 14 67 10 2 - 42 19 25 16 51 14 88 88 449 537

1971 - - 8 43 9 143 18 59 6 - - 51 20 20 11 41 12 112 84 469 553

1972 2 9 3 35 1 162 25 47 12 - 4 44 13 29 11 60 7 92 78 478 556

I TOTAL 2 9 36 188 23 550 79 239 41 2 4 243 93 95 60 214 63 385 401 1 925 2 326 Graph 2-Fellowsh~ps Awarded by WHO in the last fwe years (1968-1972). South-East Asla Reg~on

BANGLADESH BURMA INDIA INDONESIA MALDIVES MONGOLIA NEPAL SRI LANKA THAILAND SEA/RC26/2 Page 53

These fellows came from the following countries or territories: Argentina, Austria, Bahrain, Chile, China, Colombia, Egypt, Ethiopia, Gilbert and Ellice Islands, Guam, Hong Kong, Iran, Iraq, Japan, Khmer Republic, Republic of Korea, Laos, Liberia, Malaysia, Nigeria, Philippines, Poland, Singapore, Sudan, Syria, Papua, New Guinea, Uganda, Viet-Nm and Yugo- slavia.

The table on page 51 shows the fellowships awarded by subject of study and country of origin of the fellow, from 1 July 1972 to 30 June 1973; Graph No.2 and the table on page 52 show the number of awards in each calendar year over a five-year period.

It may be seen from the following figures that there has been a steady increase in the number of awards issued annually during the last five years. These figures include extensions of fellowships:

Year 1968 1969 1970 1971 1972

Awarded 296 384 537 553 556

Tables 1 to 4 in Annex 6 give, in respect of each country of the Region, (1) the distribution of awards by source of funds and type of fellowship; (2) distribution by subject of study and country of origin of the fellow; (3) fellowship programmes arranged by the WHO South-East Asia Region in other regions and vice versa, and (4) utilization of former WHO fellms.

At the end of May 1973, 66 fellowships from 1972 were still awaiting finalization. An analysis of these shows the following causes for delay:

(1) Applications received too late for academic courses starting in 1972 . . 31

(2) Postponement of courses for which the applications in question had been invited (13 of these were for the Malaria Eradication Training Centre (METC) , Manila) . . 23 (3) Change in the programme of training . . 7 (4) Lack of language proficiency . . 5

6.5 The Regional Office Library

Since December 1972, bibliographical services have been offered to countries in the Region based on computer tapes of the medical literature SEA/RC26/2 Page 54

analysis and retrieval system (MEDLARS) supplied to WHO by the National Library of Medicine, Bethesda, Maryland, USA, and processed by the Inter- national Computing Centre, Geneva. The Regional Office Library is now receiving requests from governments for "Demand Search Bibliographies".

As a follow-up of the "Survey of medical college libraries in the countries of South-East Asia" carried out earlier, it is proposed that, to begin with, WHO might assist in establishing "student loan libraries", one each in the countries interested. Under this scheme, these libraries would each have ten sets of paperback editions of 50 textbooks published by the English Language Book Society and under the Indo-American Textbook Programme.

During the year, the Library acquired 2 146 books, pamphlets and WHO publications. It now receives 450 current periodicals. In all, 3 622 persons (3 164 WHO staff and 458 others) consulted publications in the Library; 2 392 publications were issued to Regional Office and field staff, and photocopies amounting to 6 107 pages were provided.

The Regional Office Librarian attended a Headquarters-sponsored inter-regional Training Course on Medical Documentation with Special Reference to Family Health, held in Geneva from 23 October to 3 November 1972.

A member of the Ministry of Health, Sri Lanka, received training in the Library in May-June.

Some 1 770 duplicate books and periodicals available in the library were sent to medical libraries in Bangladesh.

In September 1972, lists were prepared for the acquisition of medical literature, equipment and furniture for the Regional Documentation Centre on Human Reproduction, Family Planning and Population Dynamics, and at the time of writing, some of this material had arrived.

7. TECHNICAL INFORMATION AND REFERENCE SERVICES

Progress was made in clearing up the backlog of assignment and other reports and towards ensuring prompt issue of such reports.

Reports

During the period July 1972-June 1973, 196 reports were edited and issued. Of these, 16lwere assignment reports and the rest consisted of field visit reports of Regional Office staff and reports on seminars, meetings and workshops. Two reports - one on the Seminar on Functional Programming of Hospital Facilities (held in October-November 1971), and one on the Seminar for the Training of Medical Officers in Rural Areas, which took place in Najafgarh (Delhi) in October 1972 - were brought out under printed cover. Three reports on (1) the Seminar on Community Medicine for SEA/RC26/2 Page 55

Medical Teachers with Particular Reference to the Strengthening of the Teaching of Maternal and Child Health (held in October 1972), (2) the Work- shop on Field Training in Health Education (which took place in October- November 1972) (the "Guide" prepared by the Workshop was also issued as a separate printed document),and (3) the First SEARO Meeting on the Role of Operational Studies in Health Services and Education For These Services (held in December 1972), were brought out as printed documents.

Documents and Other Publications

The report and minutes of the twenty-fifth session of the Regional Committee, as well as the report of the technical discussions on "The teaching of community medicine in undergraduate medical education", held during the Regional Committee's last session, were, as in the past,compiled, edited and issued under printed cover. The "Handbook of Resolutions and Decisions of the Regional Committee", which is normally brought up to date each year by adding the resolutions adopted at the session held the previous year, was somewhat revised for issue as a printed document containing the Regional Committee's resolutions taken during the first twenty-five years. At the time of writing, work was also in hand to bring up to date the annexes to the publication "WHO: Twenty Years in South-East Asia", in connection with the twenty-fifth anniversary of WHO and of the South-East Asia Region.

Distribution

The Regional Office continued to make technical information available to governments as well as to health workers and institutions. In addition to the material mentioned above, various documents, reprints and articles received from Headquarters and other sources were given wide distribution. These included (a) a document entitled "Illustrated procedures of induced mating technique for Anopheles mosquitos" (MEl72.2); (b) a technical circular, "Pathogenesis and pathophysiology of childhood diarrhoea" (TCICDI3); (c) several issues of the Technical Digest issued by the Central Public Health Engineering Research Institute, Nagpur (India); (d) the "Bibliography on Human Reproduction, Family Planning and Population Dynamics - Articles in Journals Published in the South-East Asia Region, 1972, No.1"; (e) a reprint, "Status of Malaria Eradication During the First Semester of the Year 1972" (from the WHO Weekly EpidemioZogicaZ Record); (f) a publication, "Uses of Epidemiology in Planning Health Services" (proceedings of the Sixth International Scientific Meeting organized by the International Epidemiological Association); (g) a set of colour slides on trachoma (provided by the WHO International Reference Centre for Trachoma and Other Chlamydia1 Infections, San Francisco); (h) a list of technical reports produced in SEARO (1948-June 1972), and (i) smallpox surveillance reports and reprints on tuberculosis, malaria and other diseases.

Documentation and reference services continued to be provided during meetings organized by WHO; document lists were compiled and requests for documents dealt with. s~A/RC26/2 Page 56

-Sales Sales promotion work, undertaken with a view to achieving the widest possible dissemination of WHO publications, resulted in a 38.7% increase in the sale of publications during the year 1972 over 1971. The 1972 sales amounted to $26 910* (subscriptions to $12 989 and other sales to $13 921), as compared with $19 390 during 1971. They involved the preparation of 1 672 invoices and attending to 405 transactions over the counter. The volume of sales during the first six months of 1973 amounted to $10 600.

The fifth edition of a popular publication, "Notes for the Practis- ing Midwife", originally issued by the Regional Office in 1957, was brought out at the end of the period under review. WHO publications were displayed during thirteen meetings, most of them organized by the Regional Office in New Delhi, as well as on the occasion of the twenty-fifth session of the Regional Committee. Further lists of publications were compiled and discri- buted widely to public health workers and institutions in the Region (including medical colleges, district and municipal medical officers and research institutions). Groups of student nurses, health assistant trainees and other health workers who visited World Health House during the year were briefed on WHO publications and their availability at concessional rates.

*All figures relating to sales are based on the net amount shown in the invoices, in most of which a 50% discount (40% in respect of subscrip tions) and, in some cases, an additional 10% trade discount have been allowed. Therefore, the commercial value of the publications sold should be taken to be approximately double the figures given. SEA/RC26/2 Page 57

PART I1

ORGANIZATIONAL AND

ADMINISTRATIVE MATTERS sEA/~C26/2 Page 59

1. THE REGIONAL COMMITTEE

The twenty-fifth session of the Regional Committee for South-East Asia was held in Colombo, Sri Lanka, from 12 to 18 September 1972. It was inaugurated by the Prime Minister. Representatives from all countries in the Region and of a number of United Nations and inter-governmental and non-governmental organizations were present. Dr C.E. S . Weeratunge (Sri Lanka) was elected Chairman and Dr J.B. Shrivastav (India) Vice-Chairman.

The Regional Committee nominated Dr V.T.H. Gunaratne as Regional Director for a new term.

In the discussion of the Annual Report of the Regional Director, the Committee emphasized the need for the further strengthening of planning organizations and of administration and management at all levels of the health administration, the special need for improved manpower planning and appropriate training systems to prevent the exodus of urgently required health personnel from some countries of the Region, continued emphasis on family health in government health programmes and improved co-ordination of assistance for the furtherance of these programmes.

It was felt that health ministries needed to view with concern the real possibility of lower priorities being accorded to health because of the country programming approach, and that they should continue giving high priority to programmes for reducing mortality and morbidity rates from malnutrition, poor environmental conditions and infectious diseases among children. On the subject of environmental health, it was stressed that the main problem remained the provision of safe water suppliesto the population, especially in rural areas, and of waste disposal systems in the fast-developing urban areas. The constraints continued to be lack of resources. In considering the proposed health charter for Asia, the Committee stressed that the first step towards developing such a charter was the collection of data in a scientific manner, and it appointed a sub-committee to provide guidance and assistance to the Regional Director in this matter.

Because of the withdrawal of aid to malaria programes by assisting agencies and the importance of ensuring the availability of DM', concern was expressed regarding the future of anti-malaria campaigns; the efforts to persuade the major manufacturing countries to maintain production to meet global needs were welcomed.

The continuation of assistance with regard to the other communicable- disease programmes, such as the assessment of tuberculosis control by WHO teams, smallpox eradication, research to find a better vaccine for cholera, and efforts to help countries to become self-sufficient in the production of rehydration fluids,was considered essential.

The Annual Report was adopted, and a proposal that the Regional Office might provide more information on costs to facilitate the assessment of budget performance was referred to the Regional Director for further study. SEA/RC26/2 Page 60

The Committee adopted the report of the Sub-committee on Programme and Budget, consisting of representatives of all the governments, and approved the proposed programme and budget estimates for 1974 for transmission to the Director-General.

Technical discussions were held on the subject of "The teaching of community medicine in undergraduate medical education". For the technical discussions to be held during the twenty-sixth session, in 1973, the topic selected was "Application of modern management methods and techniques for the improved delivery of health services".

With regard to administrative matters, the subject of recruitment was discussed, and the Committee expressed its satisfaction with the progress which had been made in recruiting staff for the Regional Office and field programmes. A suggestion was made that expertise available within the Region should be used in the expeditious filling of posts,and the Director-General explained that the principle of equitable geographical distribution was a constitutional requirement and that it applied on a global basis throughout the Organization.

Among other matters discussed were the Executive Board's special study on medical literature services to Member States and possible increased WHO assistance in the supply of paperback editions of textbooks for the use of students and in translating textbooks into the national languages.

The Executive Board's resolution on the celebration of WHO'S twenty- fifth anniversary in 1973 was noted, and the Chairman of the Regional Committee was asked to be the speaker on behalf of the South-East Asia Region at the celebrations to be held during the Twenty-sixth World Health Assembly; moreover, it was decided that the twenty-fifth anniversary of WHO'S South-East Asia Regional Office, which coincided with that of the Organization, should also be celebrated in an appropriate manner at regional level.

The Committee confirmed the previous decision to hold its twenty- sixth session at the Regional Office and, accepting an invitation from the Indonesian Government, decided to hold its twenty-seventh (1974) session in Indonesia.

2. ADMINISTRATION

2.1 General

The Democratic People's Republic of Korea became the 138th Member of the World Health Organization on 19 May 1973 and, on its request, was assigned to the South-East Asia Region.

During the period under review the Regional Director paid official visits to India and Sri Lanka and, with one of the Assistant Directors- SEA/RC26/2 Page 61

General from Headquarters, Indonesia. He attended the Fifth Meeting of Directors or Representatives of Schools of Public Health, held in Brazzaville from 24 March to 1 April 1973. He also inaugurated at least nine of the group educational activities sponsored or assisted by WHO during the year. The more important among these included the inter- country Seminar on the Development of Imunization Services, the inter- regional Seminar on Planning, Organization and Administration of Medical Rehabilitation Services, the Seminar on the Teaching of Psychiatry in Medical Colleges, the Seminar on Surveillance in Smallpox Eradication, and the Discussion Group Meeting on Medical Care.

The Director of Health Services visited Bangladesh, Burma, Indo- nesia, Mongolia and Nepal for discussions with health officials. With the Chief of Administration and Finance, he also attended a Headquarters seminar on the new form of presentation of the Programe and Budget Esti- mates and UNDP operational procedures, held in Geneva in November.

The twenty-fifth anniversary of the World Health Organization was celebrated in all countries of the Region. Several issued commemorative stamps, and the Government of Thailand specially minted a one baht coin.

The Office of the WHO Representative in Bangladesh was developed and consolidated, in support of the implementation of the expanding health programmes in that country.

During the period under review, 49 WHO-sponsored meetings, seminars and courses were held in the Region, ten of them in the Regional Office. Among the most important meetings held in the Regional Office was that of the Sub-committee on Health in the Service of Asian Development (Asian Health Charter) appointed by the Regional Committee at its twenty-fifth session.

2.2 Organizational Structure

The structure of the Regional Office as on 30 June 1973 is shown in Annex 1.

2.3 Personnel

2.3.1 Staffing

The distribution of professional staff in the Region by nationality as on 30 June 1973 is shown in Annex 2. A column giving the world-wide distribution of WHO staff by nationality has also been included.

The following- table shows the number of posts in the ~rofessional category in the Region and the number actually filled as on 30 June 1973: .uoy:,ezyue8lo aq3 q2FM a3yluas jo s2ea.t 02 paja~dmo3sraqmam jjeqs a3rluas p.xaua8 alom xrs

'X~npuo %uyT~a~ea:,aTyqn qmmJTnsuo3 e pue laqmam jje:,~puoyssajold 1aq2.1n3 e pue SSaUTTy jo payp laqmam 3je:,s asyAlas plaua% auo pue puoyssajoxd an0 'uoy2yppr? UI 'a3yNaS JJaT - a3yNaS ~elaua8auo pUe ~suoyssa~oadXyS - slaqmm jje:,s uams '&[6~30 sq~uomxys 2s.x~~aq3 Zuylnp 'pue slaqmam jje:,s aayuas Teaaua8 aalq:, 's~aqmam jjegs puorssajoxd 02 '2~6~~u~I"(I

'~~61uy pa~u~odde aq o:, paa~adxaale s:,ue:,Tnsuor, 002 :,noqe 'iaq?a80:,m -padoldma aran s:,ue:,Tnsuo> L[ '&L~Taunr O& 02 EL~Tdzsnuer T "01J

-sqquom uaAaTa 02 sljaan on2 mo~38urSuez spoy~ad 103 sammel8old pTaT3 103 pado~dmaaaan slue2Tnsuo3 &Oz 'ZL~T8uylna

.auamluyadde aqa sajja pIno3 oora~zyue810 aq3 alojaq a~qslyeneunacmmaq 9 pme 'd.zeles ro asnaaaq pauyIJap I !auamuxano8 sjq bq paseapa aou pan 1 'saaepypua3 9 aqa 30 rr

.(,,szasThpv ~suo~)lau,,zapun asod I pus ,,a=rjro leuoyaau,, aq2 uy 83~0dL) s>uamax~nbazpasuaq~ xo (s~sodaonve18ozd play3 12) spunr VddNn/d(LNfl )o barl~qs~yens-uoujo aenwaq lo sauaunnano8 jo asanba~aq, 3s "a',

ssa~olduy auaolayna:, -a1 pue paawlas bpeaxls EL61 UT lu: .slspTpus., P~~WAlas~nq)~f61 wrqn 103 -~aasuy xo3 sasod sasod DlSOd PaqSTlq81B3 SEA/RC26/2 Page 63

2.3.2 Briefing

Efforts were continued to strengthen the technical briefing of newly recruited staff. Measures adopted included providing suitably detailed technical and project background information to selected candidates before they come to the Regional Office and, on their arrival, a more thorough briefing on all the technical and administrative aspects of their work.

Documents on living conditions in nine countries of the Region and a short briefing paper on the Democratic People's Republic of Korea were brought out. Also, short papers on local living conditions in 17 duty stations in five countries were prepared, to be sent to all selected candidates before they take up assignments in the respective countries.

During the year, 226 staff members and consultants were briefed and 230 debriefed in the Regional Office.

2.3.3 Staff Trainina

(a) Professional staff

One application for refresher training for field staff in the Region was approved for 1973-1974. During the year under review, one professional field staff member proceeded on previously approved study leave. Four professional staff members (two WRs, one Regional Office staff member and one field staff member) attended the Ninth Training Course for WHO Representatives, held in Alexandria in FebruaryJMarch 1973.

One of the Assistant Directors of Health Services, one of the Regional Advisers on Nursing and a field staff member (nurse educator) attended the Training Programme for Senior WHO Staff in Health Aspects of Human Reproduc- tion, Family Planning and Population Dynamics, organized by WHO and also held in Alexandria in October 1972.

Planning was begun for a detailed review of the training needs of Regional Office staff with the aim of designing and implementing appropriate short courses relevant to their work.

2.3.4 Employment Conditions

A "spot-check" of the salaries and allowances of the general service staff in New Delhi was conducted with the participation of staff representatives, and the salary scale was being revised. The salaries and allowances of this category of staff in Indonesia, Sri Lanka and Thailand were also revised.

A time-to-time cost-of-living survey for post adjustment was conducted in India in AprilIMay 1973.

Meetings continued to be held between the Administration and representatives of the Staff Society to discuss matters of mutual interest, particularly those concerning conditions of service of the general service staff. The heads of the various agencies of the United Nations system in New Delhi also continued their regular review of matters affecting staff posted in India. SEA/RC26/2 Page 64

2.4 Finance, Budget and Accounts

The total obligations incurred on field activities during the last five years, under the Regular budget, UNDP funds, UNFPA, FUNDWI and "Funds- in-trust", were as follows:

Source of Funds

Regular LNDP UNFPA FUNDWI Funds- Total (including in- Year malaria and trust smallpox eradication programmes) us $ us $ us $ us $ us $ us $ 1968 4 686 760 1 486 619 - - - 6 173 379 1969 5 010 196 606 765 - - - 5 616 961 1970 5 885 225 1 178 234 36 978 23 707 20 542 7 144 686 1971 6 900 963 1 354 666 430 115 121 785 27 138 8 834 667 1972 8 232 391 1 357 639 786 488 115 091 29 491 10 521 100

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

Special Account for - Year Smallpox Malaria Miscellan- Leprosy Yaws Total Eradication Eradication eous us $ us $ us $ us $ us $ us $ 1958 88 410 14 738 30 667 - 41 943 175 758 1959 38 489 - 30 023 3 686 3 750 75 948 1970 10 778 - 34 897 1 140 - 46 815 1971 25 447 - 5 000 - 135 293 165 740 1972 90 093 - 36 032 2 337 82 505 210 967

-Note: In the above tables, figures in respect of Afghanistan have been excluded from the totals; hence the figures for 1968 differ from the totals given in some earlier reports. .. eement 011 a large-scale project, Ed~cat.~..1;"" ...,-"A T...,.ining of Health Manpower in Burma", to be financed by the UNOP. with WHO as executing agency, being signed in Rangoon in March 1973 by U Chit Moung, Deputy Minister of Planning and Finance. Union of Burma (centre). Mr. H. S. Rana. UNDP Resident Representative (left), and Dr. C. Guttuso. WHO Representative (right).

HIGHLIGHTS

A group panel discussion organized by the Indian Public Health Association in New Delhi as part of the commemoration WHO'S 25th anniversary and observant of World Health Day. 1973: WHO sta also participated.

The annexe to the Regional Office building in New Oelhi, the construction of which was completed towards the end of 1972. EDIFtATlf3NAL ACTIVITIES SEA/RC26/2 Page 65

2.5 The Regional Office Building

Following the completion of the Annexe to World Health House, a major reallocation of office space took place. Some additional car sheds were erected.

3. PROCUREMENT OF SUPPLIES AND EQUIPMENT

During the period under review, the purchase of supplies and equipment costing US$ 1 666 749 was authorized, mainly for laboratory equipment and chemicals, hospital and surgical supplies, drugs, vaccines, biologicals, audio-visual and teaching equipment, vehicles and limited supplies of office equipment and stationery. In addition 10 625 medical books and periodicals costing US$ 107 116 were ordered.

Supplies provided by WHO to a number of research institutions receiving WHO research grants were cleared and sent to the institutions concerned.

Under the Revolving Fund for the procurement of teaching and laboratory equipment for medical and paramedical education and training, three new requests were received during the period.

Freeze-dried smallpox vaccine totalling 8 592 500 doses was donated by Member States to three countries in the Region.

Under "Supply Services for the States", anti-rabies vaccine was purchased in India for the Government of Nepal on a reimbursable basis.

Close follow-up has been maintained of the supplies and equipment requested and of shipments made from various sources, including UNROD allocations for Bangladesh, and also under the allocations made for the East Bengal refugees in India.

4. PROGRAMME SUPPORT AND CO-ORDINATION

The activities of the Programme Support and Co-ordination Unit in the Regional Office were further developed. A project management officer and an economist (the latter under project SEAR0 0148) took up duties in the third quarter of 1972.

Assistance was provided to a team from Headquarters in the transfer of the project systems analysis methodology to this region. A concise guide for project formulation was compiled in September 1972 and has been utilized in the preparation of detailed project documents for some new projects.

The compilation of country information for some of the countries of thc Region was completed. A staff member from the Information Retrieval Unit visited lndonesia to assist in the preparation of a country document. SEA/RC26/2 Page 66

The monitoring of plans of operation for existing projects was proposed and improved guidelines for preparation of plans of operation were worked out.

Implementation of a revised project information system was started in January 1973. Monthly PMIS reports were issued at the end of each month. Work on the review, redesigning and introduction of a project card for the information system as also on the revised PIRS modules for inter-country projects was completed.

An analysis of the management system of the regional structure was developed, and proposals for more effective management were formulated. A programme in health economics for the Region and a plan for assistance to governments in health service research were drawn up.

5. COLLABORATION WITH OTHER AGENCIES

Collaboration with other agencies has been continuing satisfactorily and has been maintained through meetings and informal contacts at both Regional Office and country levels. Full co-ordination was maintained with the United Nations and the other agencies of the United Nations system,with frequent consultations in regard to the work being carried out by the various agencies.

5.1 United Nations

The Regional Office Conference Hall was made available for a meeting of staff of the United Nations and other agencies which was addressed by the United Nations Secretary-General during a visit to New Delhi in February.

5.1.1 United Nations Development Programme (UNDP)

Regular consultations were held with the Resident Representatives of the UNDP by both WHO Representatives and Regional Office staff in the implementation of, and in formulating requests for, UNDP-assisted projects.

Following approval by the UNDP Governing Council of the country programmes of seven countries in the Region, discussions were under way to implement UNDP-assisted projects, both current and new, in some countries; also,project documents were finalized and some of them signed.

In September 1972, one of the Assistant Directors in the Regional Office and the WHO Representative to India represented WHO at a meeting of the heads of United Sations agencies with the UNDP Assistant Administrator and Director of the Bureau for Asia and the Far East, to discuss the country programme for India.

A brief was prepared on the health sector of the country statement for Indonesia in connection with the second phase of the country programme, covering the period 1974-1978 (to be submitted to the Governing Council at its session in January 1974),and was sent to the UNDP Resident Representative in Djakarta. SEA/RC26/2 Page 67

The first annual review of the country programme for Sri Lanka was carried out as of 31 December 1972, and, on the basis of the information collected during the review, it was proposed to update the programme document.

WHO was associated with the discussions which took place when a UNDP Special Mission visited Burma from 11 to 15 September.

The Regional Adviser on Community Health Services represented WHO in a UNDP mission which visited Bhutan from 19 March to 2 April.

5.1.2 United Nations Children's Fund (UNICEF)

Regular contact was maintained with the UNICEF Regional Offices at both Bangkok and New Delhi, and joint UNICEF/WHO consultations were held with the governments. At country level, close co-operation with UNICEF representatives continued.

The Tenth and Eleventh Regional Staff Meetings of the UNICEF East Asia and Pakistan Regional Office, held in Bangkok from 7 to 15 July 1972 and from 18 to 23 June 1973 respectively,were attended by the WHO Represen- tatives to Burma, Indonesia and Thailand.

A series of meetings between WHO and UNICEF staff was held in January and February 1973 concerning UNICEF's participation in India's Fifth Five-Year Plan, and joint consultations were arranged on the proposed integrated child care service in India. These were followed by a meeting between the WHO and UNICEF Regional Directors to discuss, among other matters, maternal and child health programmes in some of the countries of the Region with a view to promoting closer collaboration in the provision of assistance to governments in the further development of these services.

A senior staff member from UNICEF Headquarters,accompanied by the WHO Chief Medical Adviser to UNICEF in New Pork, visited Bangladesh from 22 November to 6 December 1972 to review UNICEF programmes in that country.

Before taking up an assignment in Colombo, the newly-appointed UNICEF Representative to Sri Lanka and the Maldives visited the Regional Office in May to review health matters relating to WHOJUNICEF activities in these two countries.

At UNICEF's request, the Regional Office organized an orientation course on familv planning for senior UNICEF staff on 30 and 31 March 1973. The subjects for the panel discussions ranged from family planning technology to the role of international agencies in family planning programmes and approaches for delivery of family planning services in country programmes.

5.1.3 United Nations Fund for Population Activities (UNFPA)

Close co-operation with UNFPA in strengthening efforts in the field of family health continued through WHO Headquarters, at Regional Office level and with the UNDP Resident Representatives in the field, including the UNFPA Co-ordinators working in some countries of the Region. SEA/RC26/2 Page 68

Assistance was provided to a UNFPA mission which visited Bangladesh in Jacluary-February to undertake a broad overview of possibilities for assistance in all sectors. The draft report of the mission has been received from UNFPA for comment.

Discussions were held with the Executive Director of UNFPA, who visited the Regional Office and Sri Lanka in February.

Close collaboration was maintained with the RR UNDP and all concerned in Indonesia with regard to WHOIUNFPA-financed projects. The WHO staff in Indonesia assisted also in the implementation of activities under the IDA/ WFPA grant.

A four-member WHO team which went to Nepal in July 1972 to assist in formulating a programme for the accelerated development of maternal and child health and family planning services (see Chapter 1.2) also helped in the preparation of a draft request to UNFPA.

In Sri Lanka, a project agreement was signed between UNFPA and the Government in February in respect of assistance to 11 projects,for five of which WHO will be the executing agency, for a total of US$ 4.7 million over a period of four years. The plans of action as required in term of the project agreement were prepared and submitted to UNPA.

In Thailand, plans of operation in respect of four projects were concluded,following negotiations with the UNDP Resident Representative, the UNFPA Co-ordinator and UNFPA representatives.

During a visit to New Delhi of the Chairman and a Member of the UNFPA Review Committee in July 1972, WHO participated in a meeting held in the Office of the RR UNDP. A similar meeting organized in Djakarta at the time of the visit of the Chairman of the UNFPA Review Committee to Indonesia was attended by the WHO Representative in that country.

In accordance with instructions for converting to a new format the budgets for UNFPA projects continuing beyond 1972, the required documents were prepared and submitted to UNFPA through Headquarters.

As of June 1973, the fact that the necessary funds had not yet been received for carrying out many of the UNFPA-financed projects proposed for implementation in 1973 in the Region was causing concern; however, this matter was receiving attention, and it was hoped that the funds would soon be released, to avoid delays in implementation.

5.1.4 World Food Programme (WFP)

Close co-operation was maintained with the World Food Programme.

The Regional Office scrutinized from the technical point of view WFP proposals on the following: the Sone High-Level Canal Project in Bihar, construction of canals in the Ukai Dam Project and food assistance for SEA/RC26/2 Page 69

labour working on the Rajasthan Canal Project, all in India; transmigration for agricultural development in Luwu, South Sulawesi, the hospital-feeding project and irrigation and land development in South-East Sumatra in Indonesia; construction of fish farms at Sansari, Hatchery and distribution centre at Rajbiraj, transport development in the Central and Northern Hill Area, development of milk procurement and marketing in Kathmandu and dairy development in Biratnagar, all in Nepal, and rehabilitation of village tanks in Sri Lanka.

The Executive Director of the World Food Programme visited India, Indonesia and Sri Lanka in December 1972.

5.1.5 Economic Comission For Asia and the Far East (ECAFE)

The WHO Liaison Officer to ECAFE attended various meetings organized by ECAFE and continued to maintain good working relations with the ECAFE Secretariat. He represented WHO at the 29th session of ECAFE, which was held from 11 to 23 April in Tokyo, and at the 60th session of the Mekong Committee, from 17 to 23 January in Saigon. Towards the end of the reporting period, he completed his assignment and efforts were being made to assign a successor.

The WHO staff at the Asian Institute for Economic Development and Planning, Bangkok, continued to assist the Institute in its activities.

An informal meeting was organized by the ECAFE Statistical Division to finalize the list of selected indicators of social development as revised by the ECAFE Secretariat in the light of comments made at the Conference on Social Development held in December 1972. WHO was represented at this meeting by the WHO Liaison Officer to ECAFE, the economist attached to an inter-country project stationed in the Regional Office and the WHO statistician working in Bangkok.

The WHO Representative to Thailand represented the Regional Office at the Tenth Regional Inter-agency Meeting on Social Development held in Bangkok on 28 and 29 June 1973.

5.1.6 International Atomic Energy Agency (IAEA)

WHO'S participation in the joint FAOIIAEA-sponsored symposium held in Bombay, collaboration in regard to dosimetry services and the postal disc inter-comparison service, and advice on the siting of nuclear reactors have been described in Section 1.10.

5.2 Specialized Agencies

5.2.1 Food and Agriculture Organization of the United Nations (FA01

As mentioned in Section 1.10 of Part I, WHO was represented at the FAOIIAEA International Symposium on Radiation Presemation of Food, held in Bombay from 13 to 17 November 1972. SEA/RC26/2 Page 70

5.2.2 International Labour Organisation (IU))

ltro senior officials of the International Centre for Advanced Technical and Vocational Training, located in Turin, visited India in August 1972 for consultations with the Government of India on possible assistance from the Centre in regard to advanced training. A meeting was arranged between the Director of Health Services and the visiting officials to exchange views on the Centre's activities.

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

The Tenth Conference of the Indian National Commission for Co- operation with UNESCO was held in New Delhi on 30 June and 1 July 1972, and the Regional Adviser on Medical Education attended the Conference as a WHO observer.

A joint UNESCOIWHO Consultation Meeting on Communication and Educa- tion in Family Planning took place in the Regional Office from 18 to 22 December. A total of 22 temporary advisers (coming from Bangladesh, India, Indonesia, Sri Lanka, Thailand, Egypt, Kenya, Korea, Malaysia, Ghana, Iran and the Philippines) participated in the Consultation, which was organized to identify the priority needs of family planning programmes in regard to education and communication and areas requiring WHOIUNESCO assistance.

5.2.4 International Bank for Reconstruction and Development (IBRD)

In connection with a request made by the Government, an IBRD mission visited India for six weeks from 16 July 1972 to review the policies, organization and management of the Uttar Pradesh Water Supply and Sewerage Board and its relationships with other authorities.

An IBRD official visited the Regional Office in February for an exchange of ideas on the inter-phases of operations and strategies.

The WHO Representative in Bangladesh was a member of an IBRD mission which visited Dacca in May-June 1973 to review the family planning programme in that country. The mission also received support from two staff members from the Regional Office. Subsequently, the WHO Representative visited Geneva and Washington for discussions on the mission's findings.

5.3 Non-governmental Organizations in Official Relations with WHO

At the twenty-fifth session of the Regional Committee in Colombo, representatives of seven non-governmental organizations in official relations with WHO were present, and, as usual, advantage was taken to hold informal discussions and exchange ideas with them. SEAlRC2612 Page 71

Regional Office staff also continued to maintain close contact with the national organizations affiliated to the world bodies in the countries of the Region. WHO staff attended meetings arranged by these organizations.

5.4 Inter-governmental and Bilateral Agencies

Close co-operation with US AID continued in the field of health in several countries. In Nepal, consultations were held in respect of a pilot project for the development of basic health services and a maternal and child healthlfamily health project. There was also collaboration in regard to health education activities in Indonesia.

WHO was in contact with the Norwegian Agency for International Development (NORAD) and the Danish International Development Aaencv (DANIDA). WHO was associated with discussions culminating in the agreement for assistance from DANIDA to medical colleges in Bangladesh amounting to about 3 million kroners.

An announcement was made in January 1973 that the Government of Japan would assist Indonesia with a new water supply scheme for eastern Djakarta. The Bogor water supply project, assisted by the Government of Australia, was officially opened on 9 March.

5.5 National and Other Agencies

Numerous meetings convened by governmental and voluntary agencies in the various countries were attended by the respective WHO Representatives or other WHO staff members.

WHO was represented, as in the past, at the annual meetings of expert groups/advisory cornittees of the Indian Cauncil of Medical Research held in November-December 1972.

Close contacts continued with the Danish "Save the Children" Organization, Emmaus Suisse, the Order of Halta and the Deutsches Aussatzigen Hilfswerk, in connection with leprasy control. An agreement between the Government of Indonesia and the Danish "Save the Children" Organization in connection with a leprosy project was finalized in February. In India, the Government took over the activities of the leprosy project assisted by the Danish Organization from mid-1972. Emaus Suisse decided to continue its assistance to the leprosy programme in Burma with an annual contribution of $10 000 until 1975; a similar amount was pledged for 1973 by the Deutsches Aussatzigen Hilfswerk, and the Order of Malta made available a sum of $5 000 for the first half of 1973.

6. PUBLIC INFORMATION

World Health Day

Attention was focussed on the theme chosen for World Health Day 1973, "Health begins at home", and a wide variety of activities was undertaken to mark the event on 7 April. The occasion was also utilized by governments to review the health situation in their countries and to seek active public support for their national programes. SEA/RC26/2 Page 72

The Regional Office brought out a 40-page illustrated booklet entitled "The March to Health, 1948-73", which attempts to give an overall view of progress made in the health field in the Region during the past 25 years and also includes some projections into the future. Copies of this booklet were distributed among Member Governments, medical institutions, medical associations and others. Stickers proclaiming the theme of World Health Day and the 25th Anniversary were produced and widely distributed.

All India Radio and the Delhi Television Centre collaborated in the production of special programmes. In two of these feature programmes - one over the radio and the other on television - the Regional Director participated. Another programme was prepared for the external services of All India Radio and featured a ten-minute talk by the Regional Director, highlighting the achievements of WHO in the Region and touching on probable health problems and predictions for progress in the years to come.

All WHO Representatives in the Region were supplied with sets of information and with exhibit and film material. Six thousand sets of World Health Day articles were reproduced and distributed, as were, in India, 500 sets translated into Hindi. About 500 black-and-white photographs were distributed for display and reproduction throughout the Region. Large numbers of "jumbo" photographic enlargements were sent to the various countries for exhibition purposes.

A feature article on India's fight against smallpox, chosen as an example of the co-operative endeavour of governments and WHO in the fight against disease, was prepared by the Regional Office and published as a five-page illustrated spread by a leading Indian magazine.

Newspapers and periodicals all over the Region extensively used the World Health Day material distributed by the Regional Office. In several countries the original English text was translated into national and regional languages and further adapted to local situations.

Contribution to Headquarters Activities

Several articles and photographs resulting from visits to field projects in the Region were published by Headquarters in World Heatth. Photographs supplied by the Regional Office were used to illustrate several other articles appearing in this magazine. The WHO Chronicle continued to use press features prepared by the Regional Office. Severd of the news releases emanating from the Regional Office were incorporated in the news round-up programme produced regularly by the Headquarters radio unit in Geneva.

Arrangements were made for briefing international journalists on assignment from Headquarters. During the visit of a public information officer from Headquarters,plans of activities to be undertaken in this region to observe 1974 as World Population Year were discussed. SEA/RC26/2 Page 73

Press and Radio

Cordial relations continued to be maintained with representatives of the national, regional and international press and radio services. As usual, many requests for background information on a variety of health topics were received and promptly complied with. Facilities were provided to journalists to write their own stories based on material supplied by WHO; several articles resulted.

Efforts were made to induce radio stations in the Region to make increased use of the taped material produced and distributed by Headquarters. Names of new stations were added to the mailing list for this material.

Arrangements were made for WHO Headquarters and Regional Office staff to be interviewed by representatives of national and international radio and press agencies stationed in Delhi.

Photographs

The demand for photographs on health topics and general conditions in countries of the Region continued to be substantial. In addition to requests from the press, photographs were requested by writers and publishers of textbooks within and outside the Region, as well as by social workers, scholars, health centres, teachers and medical institutions.

The Delhi Television Centre was provided with photographs for several of its programmes concerning health and hygiene. Photographs were also supplied to a number of participants in the Third Asian Trade Fair, held in New Delhi towards the end of 1972, for display.

Although the Regional Office has no regular loan service for films, maximum use was made of the WHO films on hand. These were supplied, upon request, to WHO Representatives and health authorities in several countries. Moreover, films were obtained from other sources for screening at meetings and seminars organized by WHO in New Delhi and elsewhere. Films on the World Health Day theme and the 25th Anniversary were in great demand, and many requests were complied with.

Hindi Edition of WorZd HeaZth

In the second year of publication of this quarterly four issues were brought out. Subsequently, the publication of t.his edition ceased.

Miscellaneous

The increasingly large number of meetings and seminars being organized by WHO provide an excellent opportunity to create interest among writers and journalists to undertake "in-depth" studies of related topics. SEA/RC26/2 Page 74

Interest is generated in subjects which are topical by the fact that these meetings bring together experts from various countries and regions and allow for comparative studies of widely differing health conditions.

The Regional Office has handled an average of about 500 requests a month for general information on WHO and its work in South-East kia. Numerous groups of nursing, medical and other students who have visited World Health House have been briefed on the activities of WHO. SEA/RC26/2 Page 75

ACTIVITIES UNDERTAKEN BY GOVERNMENTS

WITH THE HELP OF WHO SEAlRC2612 Page 77

PROJECT LISl

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

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

In the first column (under "project No., Source of Funds, Co-operating Agencies") "R" means the Regular budget; "UNDP" the United Nations Develop- ment Programme; "UNFPA" the United Nations Fund for Population Activities; "FUNDWI" the Fund of the United Nations for the Development of West Irian; "UNICEF" the United Nations Children's Fund, and "US AID" the United States Agency for International Development. Names of co-operating agencies,except for UNICEF, whether or not they have contributed funds, are given in paren- theses. In the second column, under the title of the project, the starting and, where relevant, finishing dates are shown within brackets.

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

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

It should also be noted that there are a number of projects not included in the list for which UNICEF is furnishing supplies and WHO technical advice only (with no special personnel being provided). SEAlRC2612 Page 79

1. BANGLADESH

PROJECT LIST

Proi ect No. Source of Funds

Agencies

Bangladesh 0001 Malaria Eradication R (Nov. 1972; - )

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

Assistance provided by WHO during the year. (a) Temporary assistance from two consultants provided under SEARO 0007; (b) supplies and equipment.

Probable duration of assistance. Some years.

Work done during the year. The malaria eradication programme started in 1961, when the entire population of the country was considered to be at malaria risk. The country was grouped into three regions and 31 malaria eradication zones were created in the 19 administrative districts, and a phased programme to achieve complete eradication of malaria by 1975 was formulated. The programme has now completed its eleventh year of operation. Spraying and surveillance were carried out in all the operational zones as planned every year (except in 1971). generally following the plan of operation.

Out of the total of 66.292 million people in Bangladesh, 25.368 million are in the pre-maintenance phase, 32.697 million in the consolidation phase and 8.227 million in the attack phase.

An independent assessment was carried out in February-March 1973 and is described under project SEARO 0007.

During 1972, 17 537 positive blood slides were recorded, a£ which 13 649(77.8%) were from areas in the attack phase, 3 663 (20.9%) from those in the consolidation phase, and 225 (1.3%) from pre-maintenance areas. The annual parasite incidence in consolidation and pre-maintenance areas was O.ll%o and 0.02Xo respectively.

A scheme of integrated healtt services was under trial in the Tangail pilot project.

Bangladesh 0002 Tuberculosis Control R (Nov. 1972; March 1973; - )

Aim of the project. To develop a national tuberculosis programe integrated into the basic health services, to formulate and implement a plan of operation, train key personnel, and prepare a suitable assessment methodology for the programme.

Assistance provided by WHO during the year. (a) A three-month fellowship for study in India and a four-month fellowship for studies in Czechoslovakia and Sri Lanka; (b) supplies and equipment.

Probable duration of assistance. A number of years. SEA/RC26/2 Page 80

Bangladesh 0003 Smallpox Eradication R (March 1972 - )

Aim of the project. To develop the smallpox eradication programme.

Assistance provided by WHO during the year. (a) Four medical officers, a consultant laboratory technician, a consultant operations officer, and assistance from a Head- quarters staff member: (b) a six-month fellowship for studies in the United Kinzdom,- Switzerland and India; (c) supplies and equipment.

Probable duration of assistance. Until 1975.

Work done during the year. After a successful smallpox eradication programme had given 18 months of freedom from the disease, outbreaks were reported once more in early 1972, following the return of smallpox-infected refugees. A total of 32 852 cases were reported from 1 July 1972 to 30 June 1973. With the assistance of bHO, the smallpox eradication programe was rapidly re-established, An effective vaccination drive was organized, and a number of surveillance teams were created at the divisional, district and sub-divisional levels. With the spread, in early 1973, of the disease to all the districts in the country with the exception of Chittagong Hill Tracts, the efforts were intensified. Additional staff was recruited, provision being made to ensure their mobility. Throughout the country work on active search for cases, reporting and containment of outbreaks, and vaccination of the un- protected was accelerated. The services of malaria workers and other health staff were utilized to assist in the reporting of cases and vaccination of the population, and special vaccination campaigns, using "ped-o-jets" to ensure a wide coverage, were launched in the most vulnerable municipalities. Priority measures were taken in the eastern wing of the country bordering Burma and in those areas adjoining the smallpox-free eastern States of India, into which some importations from Bangladesh had occurred.

WHO assisted the prograume by the provision of long-term medical officers and consultants. Supplies and equipment and financial subsidies were also provided. Support by GRlO was also given for the training of SEP staff, the development of a laboratory for smallpox diagnosis, and the local production of freeze-dried vaccine. Smallpox vaccine was provided, when necessary, directly by the Organization or through bilateral sources.

Plans were drawn up to provide further WHO support later in 1973 in the farm of five WHO consultants who will each assist the programme in a given area.

Bangladesh 0004 Leprosy Control R (April 1973 - )

Aim of the project. To formulate and implement a national leprosy control programme, integrated into the general health services.

Assistance provided by WHO durin~the year. A consultant leprologist.

Probable duration of assistance. A number of years.

Work done during the year. The leprosy control project is located at Mitford Hospital, Dacca, and the peripheral organization has four units, each consisting of a mobile unit, a clinic and a ward. The total number of cases registered under the care of the four units is 20 846, of which 4 699 (22.5%) are lepromatous. Males constitute 70% of the total patients.

A WHO consultant took up a nine-month assignment early in April to advise and assist in the organization and implementation of a leprosy control program, including the training of staff. The epidemiologist attached to the inter-country team on epidemiological surveillance and training visited the project early in 1973 for discussions on the activities. SEA/RC26/2 Page 81

Bangladesh 0006 Strengthening of Epidemiological Services R (Aug. 1972; Feb. 1973; - ) m DP

Aim of the project. To establish and implement a programe for the epidemiological control and surveillance of infectious diseases of public health importance.

Assistance provided by WHO during the year. (a) Two six-week fellowships for study in India and a twelve-month fellowship for study in the United Kingdom; (b) supplies and equipment.

Probable duration of assistance. Some years.

Bangladesh 0007 Cowunity Water Supply and Sanitation R (kc. 1972 - )

Aim of the project. To plan, organize and administer a national environmental health programe and, more specifically, to expand the national community water supply and other environmental health programmes.

Assistance provided by WHO during the year. (a) A sanitary engineer, two consultants and assistance from a sanitary engineer assigned to project SEAR0 0064; (b) four two-month fellowships for studies in India, Thailand, Singapore and the Philippines; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. The project commenced in December 1972, when a consultant was assigned to assist the Government in carrying out an assessment of public health laboratory facilities in the country and in investigating the possibility of setting up of a public health engineering research institute. In January-February, another consultant studied the post-graduate training programme in sanitary engineering at the Bangladesh University of Science and Technology with a view to suggesting any necessary strengthening of staff and laboratory facilities. Their recommendations were submitted to the Government.

A WHO sanitary engineer joined the project in March and has been assisting in the planning, design, execution and maintenance of water supply and sanitation schemes, particularly in rural areas. A two-month study tour was arranged for some senior national engineers to observe community water supply programmes in some Asian countries.

The programme receives material and equipment from UNICEF, mainly for tubwell handpumps.

Bangladesh 0009 Organization of Health Services and Planninq R (Jan. 1973 - )

Aim of the project. To establish and strengthen a sound organization for health planning in the Ministry of Health, to train personnel in health planning, to develop a health information system, including evaluation, to plan efficient integrated rural health services, including the development of a referral system, and plan health and manpower studies with the aim of improving the delivery of medical care with emphasis on rural areas.

Assistance provided by WHO durin~the year. (a) A public health administrator and a consultant statistician; (b) a three-mnth fellowship for study in Hungary and a three-week travel fellowship far studies in India. Thailand, Malaysia and Singapore.

Probable duration of assistance. A number of years. SEA/RC26/2 Page 82

Work done during the year. A WHO public health administrator was assigned to the project in January 1973.

The WHO statistician attached to the inter-country project on the collection and utilization of health statistics, records and reports (SEAR0 0220) and a regional office staff member visited Bangladesh during the first quarter of 1973 to review the vital and health statistics services and to formulate plans for future assistance in the field.

During March-June 1973, a WHO consultant was assigned to advise on the development of health information systems, i.e., on the planning and implementation of the administrative set-up for the collection, processing and utilization of health and vital statistics data at the national and lower levels. He also advised on the co- ordination of vital and health statistics and epidemiological activities with a view to achieving the best utilization of health statistical information and fulfilling the needs of health planning and the management of the health services.

Bangladesh 0011 Pharmaceutical Quality Control R (Aug. 1972 - Feb. 1973; - )

Aim of the project. To re-organize and develop medical stores and supply services.

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

Probable duration of assistance. Some years.

Work done during the year. A consultant in medical stares management was assigned for a period of six months from August 1972 to (1) assist in the ca-ordination of requests for supplies made to various multilateral and bilateral sources and, where appropriate, also to advise on priorities; (2) study the methods at present being employed by the Government in the purchase, storage and distribution of drugs, medical supplies and equipment; (3) receive and distribute medical and other project supplies from WHO and various United Nations organizations and other agencies, and (4) advise generally on matters relating to pharmaceutical and medical stores management .

In his report, which has been forwarded to the Government, the consultant has outlined steps for thc organization of pharmaceutical and medical supply services. He has proposed the establishment of a directorate of health services to administer, control and organize both pharmaceutical services and medical supply services. His other recommendations include the establishment of departments on legislation, registration, inspection, hospital planning administration and quality control in regard to pharmaceutical services, reorganization of the central medical stores and the establishment of divisional and district medical stares, immediate organization of a training course for technicians concerned with the repair and maintenance of medical equipment, appointment of a commission to study ways and means of bringing about improvments in the country's pharmaceutical industry, and the setting up of a panel of experts to assist the Government, on request, in studying the existing system of pharmaceutical education and surveying the related medical sciences.

Bangladesh 0012 Family Health KIUNFPA (Jan. 1973; April 1973 - )

Aim of the project. To develop family health services as an integral part of the general health services.

Assistance provided by WHO during the year. (a) A consultant; (b) three one-month fellowships far study in India. SEA/RC26/2 Page 83

Probable duration of assistance. A number of years.

Work done during the year. As an interim measure, a WHO consultant was assigned in April 1973 to review all aspects of the existing maternal and child health programe and to assist the Government in the preparation of plan for its further development, especially with WHOIUNICEF and possible UNFPA assistance.

Bangladesh 0013 Nursing Advisory Services and Training R (Aug. 1972 - )

Aim of the project. To assess the nursing-midwifery component of health services, particularly in the rural areas, and develop further nursing services and education.

Assistance provided by WHO during the year. (a) A nurse adviser and a public health nurse educator; (b) two twelve-month fellowships for study in the United Kingdom; (c) supplies and equipment.

Probable duration of assistance. Some years.

Work done during the year. Plans for the project were developed during the visit of a WHO team to Bangladesh in early July 1972, and the activities started with the arrival of a WHO nurse adviser at Dacca in September. A WHO public health nurse educator was assigned to the project in December, to assist with the further development of post-basic nursing education programmes. She is based at the College of Nursing, Dacca.

Discussions were held concerning the current nursing personnel system and the development of one which would help ensure more adequate provision of the nursing- midwifery services required in Bangladesh.

The WHO nurse adviser, accompanied by one or more national nurses,visited various nursing schools and areas used for clinical practice in order to: (1) become fami- liar with the organization and implementation of nursing services and education, (2) appreciate regional disparities in the availability of resources and facilities, (3) make an assessment of resources for the training of nursing personnel, (4) assist in developing a plan for strengthening and developing nursing education and services based on the assessment, and (5) co-ordinate UNICEF assistance to training facilities for nursing personnel. A survey of 12 nurse training centres was made.

Of the 19 government nursing schools, 13 were started in 1970 under a "crash programme". The target for enrolment of basic students for the first year was increased in October from 700 to 1 200.

The College of Nursing was reactivated and an educational programme to prepare nurse teachersladministrators for the basic schools of nursing was implemented. The central aim of the programme is to accelerate the preparation of nurse teachers, and it is so designed that the graduates will meet future as well as current government requirements in the basic schools of nursing. The WHO project staff have been active faculty members of the College.

A working committee on nursing education was established.

Seven students were enrolled in the first term from February to llay 1973. Fifteen candidates were selected provisionally for the second group to start an 14 April but, on account of administrative problems, they had not yet been released from service and admitted to the College.

Bangladesh 0015 Venereal Diseases and Treponematoses Control R (Oct. - Nov. 1972; - )

Aim of the project. To re-organize the programme. SEAIRC2612 Page 84

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

Work done during the year. A WHO consultant was assigned to the project during October-November 1972 to review the problem of venereal disease and its control in the country. In his report, which has been sent to the Government, the consultant has recommended development o£ facilities for on-the-spot diagnosis of syphilis and gonorrhoea and of hospital laboratory facilities for serological and cultural diagnosis. Other measures suggested by him include the upgrading of all venereal- disease clinics and special attention to "at risk" groups such as seafarers and personnel of the armed forces.

Bangladesh 0016 Blindness Survey R (Nov. - Dec. 1972; Feb. - March 1973; -

Aim of the project. To undertake a survey of blindness and to formulate a comprehensive plan of action for the prevention of xerophthalmia.

Assistance provided by WHO during the year. Two consultants.

Work done during the year. A WHO consultant visited Bangladesh twice during the period under review - in November-December 1972 and February-March 1973. He assisted the Government in designing and planning a blindness survey with special reference to the incidence of xerophthalmia. He also prepared a plan of action and assisted with the in-service training of national staff and the initial implementation of the plan, under which capsules of high potency vitamin A supplied by UNICEF will be distributed to all pre-school children in the country at six-monthly intervals through the national malaria eradication programme. The effect will be monitored in selected areas. Distribution of the capsules has started in 9 out of the 31 zones of the malaria eradication programme.

Bangladesh 0017 Production of Rehydration Fluid R (July 1972; Jan. 1973 - )

Aim of the project. To produce rehydration fluid at the Cholera Research Labora- tory, Dacca, and to train national staff.

Assistance ~rovidedby WHO during the year. Two consultants (one provided by Headquarters).

Probable duration of assiw. Until 1977.

Work done during the year. The major equipment and supplier. far the installation of the plant for the production of rehydratian fluid, procured by UNICEF, were received in March. A WHO engineer has been in position since January 1973 and has supervised the masonry and engineering work an the premises of the plant and the installation of the machinery. Another consultant technician was expected to join the project later in 1973 to assemble and start the trial run of the automatic welding machine. The Government has sanctioned the posts for staff and recruitment action is in hand. Meanwhile, many senior posts were filled on a temporary basis.

Two staff from the plant, a technical supervisor and a technical officer, were expected to proceed on WHO fellowships to VIFOR Laboratories, Switzerland. Difficul- ties have been experienced in the implementation of the project mainly because of delay in the recruitment of staff and arrival of equipment, as well as lack of other facilities such as adequate water supplies. Under the circumstances, it became necessary to extend the term of the WHO engineer by four months. SEAlRC2612 Page 85

A draft plan of operation covering Government/UNICEF/WHO commitments through 1975, to assist in the initial stages of the operation of the plant, has been sent to the Government.

Bangladesh 0018 Development of Health Services and R Education in Public Health (Oct. 1972 - )

Aim of the project. To establish and strengthen integrated health programmes for rural areas, and plan and implement training programmes for professional and auxiliary health workers.

Assistance provided by WHO during the year. (a) A medical officer, an auxiliary health training officer, a nurse educator, and a consultant (hospital architect); (b) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. With assistance from WliO, a National Training Seminar far Health and Family Planning Personnel and a one-month re-training workshop for lady health visitors and lady family planning visitors werc organized late in 1972 Assistance was also given in the training of 300 new doctors to be assigned to the thana health ccntrc complex for the implementation of integrated health scrvices.

Towards the end of the period under review, a consultans (hospital architect) was assigned to advise on the plans of thana health complexes, to suggest imprave- ments with a view to achieving maximum functional efficiency and scope for future expansion, and to suggest measures for the maximum utilization of locally available building materials.

Arrangements wcre made for he visit of six health administrators and planners from Bangladesh to thc USSR and India to obscrvc the organization of general health services.

Bangladesh 0019 Public Health Education R (Nov. 1972 - Feb. 1973; - )

Aim of the projcct. To strengthen the Department of Social and Preventive Mcdirine in the Medical Collrgc, Dacca, and institute a DPH course at thc Institute of Public Health.

Assistance provided by WHO during the year. (a) A consultant (professor of public health administration):~. (b)~. a three-month fellowshin for studv in the United Kingdom; (c) supplies and equipment.

Work done durine, the year. A .fit0 consultant was assigned to the project from November 1972 to February 1973 to carry out a survey of the departments of preventive and social medicine in the eight medical colleges and also the teaching of public health in the post-graduate institute, Dacca. In his report, the consultant has suggested revision of the curriculum for undergraduate medical education, increase in the number of students admitted into medical colleges, and encouragement of research activities in all departments. He has also recommended upgrading of the teaching of various subjects such as microbiology and preventive and social medicine, and intensification of field training in the community aspects of medicine. His recommendations on post-graduate education include the introduction of a one-year diploma course in preventive and tropical medicine. His report has been sent to the Government, and the lists of equipment and supplies recommended by him are being processed. SEA/RC26/2 Page 86

Bangladesh 0200 Fellowships R

Preventive and social medicine. A twelve-month fellovship for study in the United States of America.

Master of public health (epidemiology). A twelve-month fellowship for study in the United States of America. SEA/RC26/2 Page 87

2. BURMA

PROJECT LIST

Project No. Source of Funds Co-operating Agencies Title

Burma 0006.2 Maternal and Child Health R (June - Aug. 1969; Aug. 1970: Oct. - Dec. 1970; Oct. 1971; Jan. 1972; March 1972; hug. 1972; Oct. 1972; Feb. 1973; - )

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

Assistance provided by WHO during the year. Two nine-month fellowships - one for study in the United Kingdom and one for studies in the United Kingdom, Uganda and India - and a twa-month fellowship for studies in India, Yugoslavia, France, United Kingdom and Thailand.

Burma 0017 Leprosy Control R (April 1960 - ) UNICEF

Aim of the project. To intensify the lcprasy control progrmme, to extend it to cover all the endemic areas, and to train personnel.

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

Probable duration of assistance. A number of years.

Work done during the year. The programe activities, consisting of case-finding, case holding, treatment and health education, continued as planned.

A joint team consisting of WHO consultants and national staff carried out an assessment of the leprosy control programe during Aovember 1972-February 1973. The findings of the assessment, which were being analysed, were expected to be used as the basis for the future planning of the programme. It was the preliminary impression of the team that the programme had successfully achieved its objectives, since a large number of cases had been detected, registered and treated. The case- detection rate has been somewhat low during the last few years.

Burma 0022 Vital and Health Statistics R (Dec. 1955 - June 1961; Jan. 1962 - Dec. 1967; April - June 1968; Aug. 1972; - )

Aim of the project. To develop further a system of reporting and recording health statistical data, improve their processing and train staff.

Assistance provided by WHO during the year. A twelve-month fellowship for study in the United Kingdom. SEA/RC26/2 Page 88

Burma 0028 Institute of Medicine I and School of Preventive UNDP and Tropical Medicine, Rangoon (Feb. 1955 - Feb. 1959; Feb. 1961; Sept. 1963; Aug. 1966 - Jan. 1967; Dec. 1967; July 1968 - )

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

Assistance provided by WHO during the year. (a) A professor oE epidemiology, a tutor technician and two consultants; (b) a twelve-month fellowship for study in India; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1973.

Work done during the year. A technician tutor in anatomy and a visiting professor in paediatrics were assigned to the project during the year. The visiting professor in paediatrics completed his assignment early in 1973 and his report was sent to the Government. The diploma course in child health which was being assisted by him was continuing satisfactorily. The tutor technician, who continued to be in position, was teaching an increasing number of students.

The professor of epidemiology who has been with the project for several years, completed his assignment in November and was reassigned as project manager for the project, "Education and Training of Health Manpower" (Burma 0100).

This project will be terminated at the end of 1973 and all activities for the development of health manpower will be carried out under Burma 0100, the recently approved UNDP project.

Burma 0031 Malaria Eradication R (May 1954 - )

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

Assistance provided by WK0 during the Year. (a) A three-week fellowship for study in Japan; (b) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. The malaria control programme in 1972 protected a population of 5.158 million by Dm spraying, 8.205 million by active case-detection, treatment and focal spraying, and 3.164 million by passive case-detection, treatment and remedial measures by the general health services. A population of 6.859 million is covered by anti-malarial drug administration only.

In 1972, 6 478 positive blood slides were recorded, of which 4 704 (3 876 in 1971) were in the areas under DDT spraying, 1 319 (1 652) in areas under active case-detection, and 455 (174) in areas under passive case-detection, showing an increase over 1971.

The first Bangladesh-Burma-India Malaria Eradication Co-ordination Conference was held in Rangoon from 31 January to 3 February 1973.

Burma 0044.2 Strengthening of Health Services (Epidemiology1 LJNDP (Feb. - May 1968; Jan. 1969 - )

Aim of the project. To strengthen the Epidemiological Unit in the Directorate of Health Services; to study the prevailing pattern of comunicable diseases and to provide information for sound public health planning and control measures; also to develop public health laboratory services in support of the Epidemiological Unit. SEA/RC26/2 Page 89

Assistance provided by WHO during the year. (a) A microbiologist; (b) a twelve- month fellarship far studies in Czechoslovakia, India, Indonesia and Thailand; (c) supplies and equipment.

Work done during the year. The activities continued according to plan.

A WHO virologist attached to the inter-country epidemiological surveillance and training project (SEAR0 0193) reviewed the existing conditions for the establishment of a laboratory for enteroviruses, in accordance with advance planning for starting an effective programme for surveillance of poliomyelitis and immunization against this disease. He recommended a phased development of this facility.

A consultant was under recruitment to assist the Government in studying the problem of leishmaniasis and advise on the establishment of a surveillance programme.

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

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

Assistance provided by WHO during the year. (a) Two nurse consultants; (b) a twelve- month fellowship for study in New Zealand; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. An eight-week course an "Orthopaedic Nursing Care" was conducted for twenty regular and five guest participants at Mandalay General Hospital from 11 September to 4 November 1972. A WHO nurse consultant assisted with the conduct of the course. In Rangoon, an eight-week course on "Nursing Care of Surgical Patients", also assisted by a WHO consultant, was organized from 30 April to 30 June for 24 participants. The two WHO nursing consultants were assisted by national nurses and doctors. WHO provided textbooks as well as some supplies and equipment far the courses. A consultant was under recruitment ta conduct a course an neonatal nursing care later in 1973.

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

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

Assistance provided by WHO during the year. (a) A consultant; (b) a twelve-month fellarship for studies in the United Kingdom and India; (c) supplies and equipment.

Work done during the year. A tuberculosis baseline survey was carried out in Burma in the latter half of 1972, and the results were being evaluated. The WHO consultant assigned from July 1972 to January 1973 to assist the national authorities in the conduct of the survey prepared a report containing his findings; the report has been sent to the Government for consideration.

It is expected that the findings of the survey and the results of the assessment of the tuberculosis control programme will serve as the basis for the planning of tuberculosis activities within the general health services.

Burma 0066 Health Education R (Nov. 1966:. Mav. 1968:. Aua.- 1971: Nov. 1971 - Jan. 1972; June - Aug. 1972; - )

Aim of the project. To develop health education services and to provide training in health education to teachers and those holding key posts in the school organization and in the general health services. SEA/RC26/2 Page 90

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

Probable duration of assistance. Until the end of 1976.

Work done during the year. A consultant was assigned to Burma from June to August 1972 to assist in reviewing the action taken to implement the recommendations made by a previous consultant. In his report, which has been sent to the Government, the consultant has, among other things, recommended provision of administrative assistance to the Chief Health Education Officer to enable him to devote greater attention to his technical responsibilities, and the development of research on a small scale to ascertain the effectiveness of the present health education activities. He also assisted in planning, conducting and evaluating a training course for health education staff which was held in Rangoon from 17 July to 11 August with 25 participants.

Action was taken to recruit another consultant to assist in the further development of health education services through the continuing education of health educators and the training of teacher educators. He is expected to join the project in the last quarter of 1973.

Burma 0069 Trachoma Control R (March 1966; Sept. 1966; May 1967; Nov. 1967; UNICEF Feb. 1970; Aug. 1970; July 1971; June 1972; - )

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

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

Probable duration of assistance. Some years.

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

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

Assistance provided by WHO during the year. (a) A virology technologist and a consultant; (b) three twelve-month fellowships for study in the United Kingdom and the Regional Office; (c) supplies and equipment.

Probable duration of assistance. Until 1977.

Work done during the year. Following a review of the areas of assistance, it was decided that, as a priority in 1972/73, the WHO scientist should assist in upgrading technicians' training in bacteriology. A national counterpart to the scientist was appointed in March 1973. Much effort was put in planning, organizing, making arrangements and assisting in the conduct of an upgraded training course for Grade I technicians. The course, which started in July 1972, had on its rolls 30 students and was completed in 34 weeks. Notes in bacteriology were provided. With new technological developments taking place in the bacteriology laboratory, the National Health Laboratory (NHL) is now in a position to provide qualified opinion on rheumatic fever (streptococcus grouping); diphtheria (typing and toxigenicity); pyrexia of unknown origin (leptospirosis). Ad hoe consultation is provided on request and the international expertise in the NHL is often consulted. The different laboratory activities - those under way and those that are being developed - operate under strain, and this factor puts serious limitations on the volume of work that can be delivered, the quality of the work, and the extent to which the existing capabilities can be stretched. SEA/RC26/2 Page 91

Among the main problems art the shortage of medical or scientific staff, the absence of an animal house to support the investigations of the different laboratories, the condition of the premises making remodelling extremely expensive, and the absence of a planned programe for the importation of reagents, essential laedia and glassware.

Substantial material assisrance is being provided by WHO and UNICEF to set the project on course. However, now that the scientific and technical potentials have been established at the NHL, a planned programe should be drawn up to support the development of the services already introduced with WHO assistance. A draft plan of operation covering the assisrance to be provided by the Government and WHO to the health laboratory services in Burma is awaiting the Government's signature.

A WHO consultant visited Burma late in 1972 to advise the Department of Medical Research on the establishment of a breeding centre for small laboratory animals. The report containing his recommendations has been forwarded to the Govemmnt.

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

Aim of the project. To assist the Biological Division of the Burma Pharmaceutical Industry, Rangoon, in mademizing methods of production and assaying of bacterial and viral vaccines and anti-sera preparations,as well as in developing new vaccines.

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

Probable duration of assistance. Until the end of 1977.

Work done during the year. In November-December 1972, a WHO consultant (vaccine specialist) reviewed the development of DPT vaccine at the Burma Pharmaceutical Industry (BPI). In the absence of firm orders for lifting DPT vaccine, the potentials of the plant remain idle. According to the consultant and considering an overall recovery rate of 50%, the plant at BPI has an installed capacity estimated as follows: diphtheria vaccine 3 million doses (30 Lf each); tetanus vaccine 6 million doses (6 lf each) and pertussis vaccine 3 million doses - against an annual demand of half a million doses of DTP vaccine which are procured free by UNICEF. The BPI is ready, if commissioned, to meet the immediate and future requirements of the Government's immunization programmes. The consultant's report was sent to the Government.

The upgrading of the tetanus vaccine laboratory, as recornended by another consultant, was completed. The same consultant is visiting Burma again to advise on the purification of anti-sera: tetanus, diphtheria, venom.

The supplies and equipment procured by WHO for the veterinary department will substantially improve the accomodation of the laboratory animals within the veterinary department at the BPI. Two consignments of guineapig and mice were delivered with a view to stepping up.immediately.the capacity of the veterinary department to breed small laboratory animals.

Burma 0078 Plague Control R (Dec. 1966; June 1970; Sept. 1970; Nov. 1970; Dec. 1971 - March 1972; Feb. 1973; - )

Aim of the project. To identify the factors responsible for the persistence of foci of plague and to train personnel in the epidemiology and control of the disease. SEA/RC26/2 Page 92

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

Probable duration of assistance. Until the end of 1974.

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

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

Assistance provided by WHO during the year. (a) A consultant; (b) two tvelve-month fellowships for study in the United Kingdom, a one-month fellowship for study in the United States of America, and a twelve-month fellowship for study in the United Kingdom and WHO Headquarters; (c) supplies and equipment.

Work done during the year. A consultant was assigned to the project in early February 1973 for a period of two months to advise the Rector of Institute of Medicine I1 and the Directorate of Post-graduate Medical Studies an the teaching of medical statistics and to develop and implement a teaching programme leading to a better understanding of statistical problems in public health and research. A summary of his recommendations has been forwarded to the Government.

Burma 0087 Filariasis Control R (Dec. 1969 - Jan. 1970; July 1970 - Dec. 1972; - )

Aim of the project. To apply filariasis control methods.

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

Probable duration of assistance. Until the end of 1977.

Work done during the year. The WHO epidemiologist who had been with the project since July 1970 completed his assignment in December 1972. In his report, which has been sent to the Government, he has indicated that effective control of the vectors has been achieved in all areas of the city of Rangoon which have been covered by larvicidal operations.

The project activities have been developing satisfactorily. Larvicidal spraying has been extended to all areas of Rangoon City and a reduction of about 95 - 98% in the density of mosquitoes has been achieved. In parallel with spraying operations, steps have been taken to improve environmental sanitation in order to reduce the number of breeding places of Culex mosquitoes.

Burma 0088 Rehabilitation of the Handicapped R (Oct. - Nov. 1969; July 1970; July 1971; Oct. - Nov. 1971; May 1972; Sept. 1972 - )

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

Assistance provided by WHO during the year. (a) A scientist - prosthetic tutor and three consultants; (b) a twelve-month fellowship for study in the United Kingdom; (c) supplies and equipment. SEA/RC26/2 Page 93

Probable duration of assistance. A number of years.

Work done during the year. A consultant (prosthetist) was assigned to the project on 1 November 1972 to assist in (i) upgrading the prosthetic and orthotic services at the Hospital for the Disabled, Rangoon, (ii) establishing prosthetic and orthotic services at Mandalay and planning such services at other centres in the country, (iii) organizing orthopaedic and prosthetic workshops in rehabilitation centres or departments, and (iv) initiating staff training schemes.

A consultant (occupational therapy tutor) was also provided to the project for about two months early in 1973 to assist in planning, organizing and implementing occupational therapy programmes in hospitals or centres for the rehabilitation of physically or mentally ill patients. The consultant also helped with the activities related to pre-vocational evaluation and teaching of disabled persons in their daily routine activities such as personal care and home making, utilizing creative and manual arts, and recreational, educational and social activities. The recommendations of this consultant were forwarded to the Government.

In January, a team of two consultants - a medical officer in the field of medical rehabilitation and a physiotherapy tutor - together with the consultant (prosthetist) mentioned above, assisted in the conduct of two courses for medical rehabilitation personnel on the integration of the various components of medical rehabilitation. The courses were held at Rangoon and Mandalay.

Burma 0089 Institute of Technology, Rangoon R (May 1969 - ) UNDP

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

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

Work done durine. the year. The WHO consultant who had taken up a six-month assignment in April 1972 completed it in October; the report containing his main recommendations and findings was sent to the Government.

In October, the Regional Adviser on Environmental Health visited the project and reviewed the activities with the WHO consultant.

A WHO professor of sanitary engineering took up his assignment at the Institute of Technology, Rangoon, in May 1973 to provide assistance in the further development and expansion of the teaching programme in sanitary engineering.

Burma 0091 Radiation Health R (June 1970; Jan. 1971; Dec. 1971; June - Sept. 1972; May 1973; - )

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

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

Probable duration of assistance. Until the end of 1978. SEA/RC26/2 Page 94

Work done during the year. A consultant assigned from mid-June to mid-September 1972 assisted in setting up a film badge monitoring service and in conducting in- service training for personnel connected with radiation protection services. Some 250 film badges were supplied to hospitals in Rangoon for establishing personnel monitoring film badge services, and action was taken to procure further supplies and equipment for the project.

Burma 0093 Nutrition Services R (May 1972; Oct. 1972; - )

Aim of the proiect. To strengthen the nutrition work of the health services by assisting the nutrition project of the Health Department in its prograuune of pilot studies and training.

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

Probable duration of assistance. A number of years.

Work done during the year. During October 1972, a WHO consultant and the Regional Adviser on Nutrition assisted in the organization of a one-week orientation course on the role of health services in the prevention and treatment of nutritional diseases for personnel responsible for public health activities in Burma. About 30 medical officers participated in the course and 20 persons from other medical and health agencies attended as observers.

The kRlO consultant also assisted in planning the work of the nutrition project of the Directorate General of Health Services (started in 1952) and made suggestions for its further development. It was considered desirable that the project carry out epidemiological studies of major nutritional problems in the country, primarily in areas where there was a possibility of developing nutrition activities as part of the existing health services. He felt that there was a need for the development of simple measures for the treatment and prevention of malnutrition, as well as the provision of in-service training for health personnel. The report of the consultant has been sent to the Government.

Bunna 0094 Strengthening of tlealth Services R (Mav - Aur, 1969: Jan, - Karch 1970: UNICEF NO;. 1970; May i972; oct. 1972; - j

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

Assistance provided by WHO during the year. (a) Three temporarv advisers and assistance from staff assigned to an inter-country project; (b) cost of attendance of participants; (c) supplies and equipment.

Probable duration of assistance. A number of years.

&done during the year. Assistance was given in the conduct of second four-week course in development and health planning, which was attended by 23 participants consisting of Assistant Directors and Health Officers of Divisions. In addition to the staff of the inter-country project SEAR0 0102, two temporary advisers were appointed to assist in conducting the course, which was held early in 1973.

Arrangements were made for a national staff member to attend, as a WHO temporary adviser, the International Congress on Nephrology which tcok place in Mexico in October 1972. SEA/RC26/2 Page 95

Burma 0095 Burma Medical Research Institute R (Jan. 1972; Nov. 1972 - Feb. 1973; - )

Aim of the project. To strengthen the units of the Medical Research Institute.

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

Probable duration of assistance. A number of years.

Work done during the year. Two WHO consultants were provided during the period under review.

hrring November 1972-January 1973, a consultant on growth and development visited Burma and drew up a plan for an anthropometric study of the various ethnic, geographical and socio-economic age groups of the population and also a similar plan for a study of individual food intakes in a more restricted sample of the population, to begin in October 1973. Equipment and supplies, to be provided by WHO, were under procurement.

A further consultant, assigned from December 1972 to February 1973, assisted in the planning of a study of physical fitness and physical working capacity and drew up a plan for this study, which is to be co-ordinated with the growth and development study mentioned above. Equipment for this study was also being provided by WHO.

The assignment reports of the two consultants were forwarded to the Government.

Burma 0097 Maintenance and Repair Workshop for R Health Equi~ment UNICEF (Sept. 1971 - )

Aim of the project. To establish workshops and train staff in the maintenance and repair of equipment used in health institutions.

Assistance provided by WHO during the year. (a) An electro-medical engineer; (b) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. The IJHO electro-medical engineer continued to provide assistance in the repair of health equipment and the training of technicians.

The fourth course for the training of technicians in the repair and maintenance of hospital equipment started in November 1972 with 8 students selected from the various hospitals in the country.

The new electronic workshop at Rangoon General Hospital was completed and put into operation. Extensions to the mechanical and electrical workshops were also completed.

Lists of equipment, tools and materials for setting up workshops in the provincial hospitals were drawn up and submitted to UNICEF for consideration and possible inclusion in the 1973-74 budget.

Burma 0098 Virus Diseases R (May 1972; - )

Aim of the proiect. To carry out epidemiological studies and control viral diseases, and also to train staff. SEA/RC26/2 Page 96

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

Burma 0099 Mental Health Training and Services R (March 1973; - )

Aim of the proiect. To organize mental health services and train staff.

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

Probable duration of assistance. Some years.

Burma 0100 Education and Training of Health Manpower UNDP (Nov. 1972 - )

Aim of the project. To strengthen undergraduate and post-graduate education in the three existing medical institutes in Burma, the education and training of nurses, midwives and lady health visitors, the education and training of various categories of auxiliav health personnel, and expand and strengthen the Hlegu Rural Health Demonstration Area as the common training field for all members of the health team.

Assistance provided by WHO during the year. A professor of epidemiology.

Work done during the year. The project document was signed by the UNDP, the Govern- ment of the Union of Burma and WO.

The WHO project manager (professor of epidemiology) assumed duties in November 1972 and action is in hand to recruit further staff.

Burma 0101 Clinical Pathology, Institute of UN DP Medicine, Mandalay (Dec. 1971; - )

Aim of the project. To raise the standards and widen the scope of laboratory services offered by the Department of Clinical Pathology at the Institute of Medicine, Mandalay .

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

Burma 0200 Fellowships R

Child psychiatry. A twelve-month fellowship for study in the United Kingdom.

Narcotic addiction control. A five-month fellowship for studies in Sweden, United Kingdom, United States of America, Canada, Hong Kong, Singapore and WHO Headquarters. SEA/RC26/2 Page 97

3. INDIA

PROJECT LIST

Project No. Source of Funds Ca-operating Agencies -Title

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

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

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

India 0081 Leprosy Control (National Programme) R (Jan. 1961 - ) UNICEF

Aim of the project. To develop a programme for leprosy control, to provide technical direction for a control project, and to train staff.

Assistance provided by WHO during the year. A six-month fellowship for studies in Burma, Ethiopia, Hong Kong, Malaysia, Philippines, Singapore, Sri Lanka, Thailand and Uganda, and a five-month fellowship for studies in Burma, Hong Kong, Indonesia, Philippines, Sri Lanka, Thailand and the United States of America.

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

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

Assistance provided by WHO during the year. (a) A four month fellowship for studies in Burma, Czechoslovakia, Kenya and Sri Lanka (extension); (b) supplies and equipment. SEA/RC26/2 Page 98

India 0108 Health Education: Assistance to States* WDP (Oct. 1971 - Jan. 1972; July 1972; Aug. - Nov. 1972; Jan. 1973; March 1973; - )

Aim of the project. To establish and develop State health education bureaux; to integrate - co-ordinate health education activities of the general health services with those of the family planning programme at different levels of the health administration.

Assistance provided by WHO during the year. (a) A consultant; (b) two fellowships - one for three months and one for twelve months - for study in the United States of America, and a three-month fellowship for studies in Thailand, the United States of America, Republic of Korea and the Philippines; (c) supplies and equipment.

Probable duration of assistance. Some years.

Work done during the year. In accordance with the request of the Government of India, a WHO consultant was assiqed to the State of Maharashtra for three months instead of a year as originally planned. He started his assignment in August and completed it at the end of November 1972. At the State Government's request the services of the consultant were extended for a Further period under project India 0274. The Government of India's clearance for the provision of a long-term health education specialist to the State of Haryana and short-term consultants to other States is awaited.

The reports of the WHO consultants assigned to Tamil Nadu and Maharashtra were being forwarded to the Government.

India 0110 Nursing Advisers to States UN DP (Dec. 1967 - Dec. 1968; Dec. 1969; Aug. - Sept. 1970; Jan. 1971; July 1971; July 1972; Oct. 1972; Dec.1972)

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

Assistance provided bv WHO during the vear. Five fellowships - four for four months and one for three months - for studies in Canada, Sweden and the United Kingdom, and a six-month fellowship for studies in the United Kingdom and the United States of America.

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

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

Assistance provided by WHO during the year. (a) A consultant; (b) seven fellowships - three for twelve months, three for three months and one for three and a half months - for study in the United Kingdom, two fellowships - one for twelve months and one for four months - for studies in the United Kingdom, Canada and the United States of America, three fellowships - two for twelve months and one for ten months - for studies in the United Kingdom and the United States of America, three fellowships - two for twelve months and one for three months - for study in

*Under this project, which Started in March 1958, assistance has been given to the States of Maharashtra, Uttar Pradesh, Bihar, Orissa and Gujarat. SEAlRC2612 Page 99

the United States of America, a faur-month fellowship for studies in the United Kingdom, United States of America, Canada and Switzerland, a six-month fellowship for studies in the United Kingdom, Norway and Sweden (extension), a three-month fellowship for studies in the USSR, United Kingdom, Canada and the United States of America, a three-month fellowship for studies in Czechoslovakia, United States of America, United Kingdom and France, and a three-month fellowship for study in Japan; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1975.

Work done during the year. A WHO consultant advised the Dean and the Head of the Department of Medicine, All-India Institute of Medical Sciences, New Delhi,on the development of teaching, service and research in the field of endocrinology and introduction of modern techniques. He also visited various other institutes in India. During the assignment, which lasted from December 1972 to February 1973, the consultant delivered a number of lectures at the places visited and also participated in a symposium on the "Etiogenesis of Diabetes Mellitus", sponsored by the Indian Council of Medical Research and held in New Delhi from 19 to 23 December. His report, which mainly deals with the development of research programmes, has been sent to the Government.

WHO participated in the celebration of the golden jubilee of the DPH course at the All-India Institute of Hygiene and Public Health, Calcutta.

Early in 1973, a Headquarters consultant visited the All-India Institute of Medical Sciences, New Delhi, and advised the Educational Technology Unit of the Institute.

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

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

Assistance provided by WHO during the year. (a) Two consultants and two temporary advisers; (b) three three-month fellowships - one for studies in the United Kingdom, United States of America and Japan, one for study in the United States of America, and one for study in Australia - a ten-week fellowship for studies in the United Kingdom, United States of America and Canada, and a nine-month fellowship for studies in the United Kingdom, Uganda, and India (WHOIUNICEF Course for Senior Teachers of Child Health); (c) supplies and equipment.

Probable duration of assistance. Until the end of 1977.

Work done durin~the Year. In pursuance of the policy of holding periodic meetings of senior educators on paediatric education, a workshop was held in October 1972 on problems and techniques of community studies in child health and their relationship to post-graduate education. A WHO consultant and two temporary advisers assisted at this meeting, the report on which was distributed.

Preparations are under way to conduct a further meeting in August 1973 to consider teaching and training in the post-graduate period at diploma and doctoral levels, and also the teaching methodology and cuxricular content of the internship periods. The outcome of the pre-test at Ahmedabad (November 1972 - March 1973) of the model undergraduate curriculum developed during 1970 and 1971 under this project will also be considered at this meeting. A WHO consultant assisted the medical faculty in Ahmedabad for four months in pre-testing the model curriculum. A further pre-test of the new undergraduate curriculum is being undertaken later this year at Calicut Medical College in Kerala. SEA/RC26/2 Page 100

The master plan of Operation For the project was under negotiation with the Government and UNICEF.

India 0121 Indian Council of Medical Research (Statistics) (Aug. 1962 - Feb. 1963; Dec. 1963 - June 1965; Aue.- 1966 - Julv 1967:. Sevt.1967. - Mav 1968: Oct. 1968 - Jan. 1969; Aug. - Dec.1969; Nov. - Dec. 1970; July 1971; Sept. 1971; Nov. - Dec. 1971; Nov. 1972 - Jan. 1973; - )

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

Assistance provided by WHO during the year. (a) A consultant; (b) a twelve-month fellowship for study in the United States of America; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1975.

Work done during the year. A Training Course on Statistical Methods in Medicine and Public Health was held at the Indian Council of Medical Research, New Delhi, from 4 to 23 December 1972 and was attended by 20 biostatisticians attached to medical colleges and research institutions in various parts of India. The aim of the Course was to train the biostatisticians so as to enable them to apply their statistical knowledge in medicine and public health. A WHO consultant was assigned From November 1972 to January 1973 to assist the Council in the preparation,conduct and evaluation of the Course. Two temporary advisers to the Regional Director (From India) also assisted the Course as faculty members for a period of ten days each. The observations of the consultant were forwarded to the Government.

Zt is proposed to provide the same consultant for a period of three months starting from September/October 1973 to assist the Indian Council of Medical Research on mathematical models in comunicable diseases.

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

India 0136.1 Post-basic Nursing Education. Uttar Pradesh R (Jan. - Nov. 1962; March 1972 - )

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

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

Probable duration of assistance. Until the end of 1977.

Work done during the year. The Principal of the College was appointed in July 1972 and a post of lecturer and two posts of clinical instructor (medical-surgical nursing and public health nursing) were created.

Vhe project started in January 1962 and is expected to continue until the end of 1977. During the year, a candidate from the College of Nursing, New Delhi,was awarded a twelve-month fellowship for study in the United States of America. SEA/RC26/2 Page 101

A WHO senior nurse educator, on transfer from the College of Nursing,Chandigarh, joined the College in September.

The College opened with the enrolment of 12 students (all deputed by the State of Uttar Pradesh) and the classes started in September 1972. Curriculum patterns, syllabus and course outlines were prepared. Plans were drawn up for the development and expansion of the College.

The College of Nursing was created as the 19th department of the Medical College.

One hundred and twenty-four books were purchased out of the college funds. Orders were placed for the purchase of office and hostel supplies and equipment for which the Government had sanctioned funds. Books, equipment (such as overhead projector), slides and filmstrip projector were received from WHO.

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

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

Assistance provided by WHO during the year. (a) Two nurse educators; (b) a twelve- month fellowship for study in the United States of America; (c) supplies and equipment

Probable duration of assistance. Until the end of 1977.

Work done during the year. All students passed their annual examinations in 1972. Most of the graduates were appointed as tutors in various educatianal programmes and unr returned to the College as n senior cl~nicnlinstructor. Two fellows completed their studies at the College and returned to Nepal. The present enrolment is 22, including 12 students deputed by the Gujarat Government.

A beginning was made with the construction of a new building for the College.

Faculty members were interviewed by the Union Public Service Commission for three lecturers' posts. One clinical instructor left on 1 August for study abroad an a WHO fellwship.

The faculty worked on curriculum revision and other problems and decided not to make any major curriculum changes except for having the total course in biology- physiology taught by the Physiology Department of the B.J. Medical College (instead of sharing it with the staff of the St. Xavier's Medical College, as hithertofore). The credit system was discussed and credits were assigned to each course.

The appraisal forms designed in 1971 to determine students' attitudes at the time of admission and to assess changes during and after graduation were disconti- nued till such time as a suitable form was prepared. The questionnaire for graduates, which formed a part of the evaluation or appraisal procedure, was revised. It was also decided to drop the plan to visit each graduate, which was a part of the above proposals. College objectives for the students were written.

In view of the increasing number of qualified applicants seeking admission to the College, the Government was approached to increase the number of seats far each class from 15 to 20 and to sanction the posts of library assistant and junior clerk,

Two members of the Indian Nursing Council inspected the College an 9 March 1973 for the purpose of granting national accreditation. SEA/RC26/2 Page 102

The College received new books from WHO and UNICEF and also those purchased out of its own budget.

The WHO nurse educator in public health nursing left in October 1972 and the WHO nurse educator in comprehensive nursing in March 1973, on completion of their assignments. A WHO nurse educator on transfer from the College of Nursing. Madras, was assigned to this college in June 1973.

India 0136.3 Post-basic Nursing Education, Punjab R (March 196L - August 1972)

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

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

Work done. Since the inception of WHO assistance in 1964, work has progressed rapidly towards the development of a post-basic degree programme for nurses. The Board of Nursing Studies was established in the Faculty of Medicine of the Uni- versity of Punjab in 1964, when the syllabus and regulations for the two-year post- basic degree programme, offering specialization in teaching and administration, were prepared. The first class of students was enrolled in July 1964, since when the educational programmes have continued to develop along sound lines. Emphasis was placed on the need for the nurse teacher and administrator to be a good nurse practitioner before she could become a specialist in any of the fields of nursing. Special care was taken to integrate basic physical sciences throughout all related courses and to offer the student a sound background in modern concepts and practices of prevention of disease and preservation of health. In 1966, the College of Nurs- ing, located in Chandigarh, became a well-established educational institution.

Kegular degree programmes have continued. Detailed course outlines for subjects offered in the programme were developed. Curriculum committee meetings were organized and planning for the clinical experience for students was expanded and the rural public health field and paediatric wards given special attention. In 1967, a degree programme designed to prepare nurses as specialists in maternal and child health nursing was started.

In 1968, the Government of Punjab State recognized the B.Sc. Nursing (Post- certificate) degree retrospectively from December 1964. Such recognition was essential for its further recognition by the Indian Nursing Council.

A major activity of the project was directed toward curriculum evaluation and revision. The philosophy of the College was revised to provide for inclusion of the basic, post-basic and master's degree programmes with behavioural objectives developed for all three programmes. A curriculum pattern for both the basic and post-basic degree progrannnes was developed. WHO assistance to the college included fellowships to the faculty for advanced studies in nursing education and administration, and provision of books and supplies and equipment to strengthen the physical facilities. During the period 1964-1972, five WHO nurse educators and three short-term consultants assisted with the activities of the project.

Short-term paediatric nursing refresher courses were offered under the aegis of the College of Nursing, with the assistance of a WHO Nurse.

The College provides advisory services in nursing education to institutions throughout the State and serves as a centre for fellowship study and field practice for nurses from other colleges in India and abroad. s~A/RC26/2 Page 103

India 0136.5 Post-basic Nursing Education, Tamil Nadu R (June lY64 -

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

Assistance provided by WHO during the year. (a) A nurse educator; (b) a twelve- monrh fellowship for study in the United States of America (extension); (c) supplies and equipment.

Probable duration of assistance. Until the end of 1977.

Work done during the year. All the first and second-year students who appeared in the December 1972 university examinations passed, and 80% of the class of 1972 passed Pre-registration examination.

Policies far the College of Nursing pertaining to staff, students, etc., were framed by the faculty and submitted to higher authorities for revision.

A draft of the master curriculum schedule for 1973 was completed. A revision was made of the second-year medical-surgical nursing programme. Curriculum revi- sions affected equalization of student load each term and combined programme offerings in public health and medical-surgical nursing eliminated unnecessary duplication of student experiences. Make-up classes for irregular students continued to be held. Over 50% of the medical-surgical content for the second-year was taught by outside lecturers. The nursing faculty taught all medical-surgical can- tent for the first year.

A student in the pre-registration course received the President's National Award for outstanding nursing service in rural areas in Tamil Nadu.

Plans and estimates for the college building were approved by the State Public IJorks Department.

India 0136.8 Post-basic Nursing Education, Maharashtra (Nov. 1970 - )

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

Probable duration of assistance. Until the end of 1977

Work done during the year. The permanent quarters for the College (an old maternity hospital) are not ready for occupation,although work on renovating it has been going on for the past year. The Board of Nursing Studies met during the year to review selected aspects of the proposed new syllabus. The third group of students completed the post-basic B.Sc. (Nursing) programme. The Indian Nursing Council's recognition of the programme is still pending.

In the first year of the interim phase (prior to the new syllabus in June 1974), the nursing faculty and the external lecturers completed an academic year of teaching their respective subjects within a scheduled term, instead of throughout the year, until the lecture hours were completed. The topics allotted to various indi- viduals were modified and made a more integral part of the total subject for added coherence, continuity and logical sequence. SEA/RC26/2 Page 104

Regular curriculum meetings were held throughout the year. The faculty as a group made strenuous efforts in taking the initial steps towards student-centered teaching. The stability of faculty has been a major asset. There has been a gradual rise in the level of faculty commitment, interest and initiative in curriculum development.

India 0153 Malaria Eradication R (Aug. 1958 - )

Aim of the project. To eradicate malaria.

Assistance provided by WHO during the year. (a) An epidemiologist and a consultant; (b) six three-and-a-half-month fellowships for studies in the Philippines and Thailand, and eleven fellowships - four for three and a half months, four for two months, two for three weeks and one for two weeks - for study in the Philippines; (c) supplies and equipment; (d) subsidy.

Probable duration of assistance. Some years.

Work done during the year. The Government of India continued to give priority to the programme. In 1972-73, a population of 132 million (24%) was living in the attack phase, 91 million (16%) in consolidation and 331 million (60%) in maintenance. The situation in areas in the maintenance phase under the responsibility of the general health services deteriorated further, particularly in the States of Punjah, Haryana, Maharashtra and Uttar Pradesh. Problems in areas in the attack phase continued to be confined to the States of Gujarat, Madbya Pradesh, Maharashtra and Rajasthan, where 80.2% of the total cases for the whole of India were found. The annual assessment of the programme was carried out in December with the asistance of a WHO consultant.

Figures for the year 1972 have not been received from all the States. So far, 1 105 471 cases have been recorded as compared with 1 323 118 in 1971 and 694 647 in 1970. It is almost certain chat the total for 1972 will exceed that for the previous year.

The centrally-sponsored urban malaria unit is now active. The ultra-lm-volume application of malathion for the control of urban malaria in the Jodhpur pilot project is under trial, and the results are promising.

India 0174 Production of Freeze-dried Smallpox Vaccine R (Sept. - Oct. 1964; June 1965 - March 1966; UNICEF Feb. 1967 - Jan. 1970; Aug. - Sept. 1972; - )

Aim of the project. To become self-sufficient in the production of freeze-dried smallpox vaccine of standard quality.

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

Probable duration of assistance. Until 1974.

Work done during the year. The planned target for 1973 could not be met mainly because of delays at Belgaum: the Repp 42 plant could not be commissioned and the three shelf-driers were not re-deployed at Hyderabad and Madras. In August-September 1972 a consultant (an engineer from the manufacturers) visited India to assist in installing the Repp 42 machine at Patwadangar and Belgaum and in training local personnel. His report on this assignment has been sent to the Government. SEA/RC26/2 Page 105

With regard to quality, the freeze-dried vaccine produced in India is maintain- ing a very high level of potency and stability, as evidenced by the reports received from the WHO International Reference Laboratory.

The production programme is to be reviewed technically. For this purpose, a consultant (an expert in large-scale vaccine production) was being recruited to advise on problems related to management, large-scale production, seed lot, etc. Another WHO consultant (an engineer from the manufacturers) is scheduled to visit all the four vaccine laboratories later in 1973 in order to survey all shelf-driers, undertake repairs for their re-commissioning with equipment received from UNICEF, and train the local engineers in preventive maintenance.

India 0176 Central Public Health Engineering Research R Institute. Nagpur (Feb. 1961 - )

Aim of the project. To develop the Institute as a major research and training centre for environmental sanitation problems; to co-ordinate research programmes.

Assistance provided by WHO during the year. (a) Two consultants; (b) two three- month fellowships - one for studies in the United Kingdom,Netherlands and the Federal Republic of Germany and one for study in the United States of America; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. Two consultants were assigned to the Institute during the year, one to assist in micro-meteorological work and in conducting a training course on air pollution control, and the other to study the design and construction of marine autfalls aspects of a project in Gujarat State and to provide technical advice and guidancc in this respect.

The consultant who studied problems of marine outfalls in Gujarat State was in India during January-February 1973. In his report, which has been sent to the Government, he has recommended, among other things, carrying out of a one-year survey of the marine recipients to enable a decision on the disposal of waste water at Baroda, and, as an alternative, a study of the feasibility of treating the waste water to irrigation standards. He has also suggested setting up of an organization to co-ordinate and conduct planning and surveys in coastal pollution control and to train staff in this regard.

The other consultant, who was assigned during February-March, assisred in the conduct of a training course on air pollution control, held in Bombay from 12 to 17 March. In addition, he contributed to the preparation of a manual on air pollution which was published by the Institute. His report also has been sent to the Government.

It is planned to provide consultants in the fields of indistrial waste disposal and sewage treatment.

India 0181 Applied Nutrition Programme R (Oct. 1964 - ) UNICEF (FAO)

Aim of the project. To expand and improve the health component of the Applied Nutrition Programme assisted by FAO, UNICEF and WHO.

Assistance provided by WHO during the year. (a) A public health officer; (b) a four-month fellowship for studies in Colombia, Guatemala, Haiti and Nigeria. SEA/RC26/2 Page 106

Probable duration of assistance. Until the end of 1975.

Work done during the vear. The WHO public health officer continued to assist the programme.

A government working group on the evaluation of the programme recommended co- ordination of the programme with the multi-departmental integrated child care service which is under discussion for implementation during the next five-year plan. Upgrading of the posts of State nutrition officers is among the recommendations of the group.

Pilot schemes for the treatment of protein-calorie malnutrition with a case- inate formulation were started in several paediatric hospital wards and in one health centre through a nutrition clinic.

A manual for the integration of a programme for the treatment and prevention of malnutrition into the work of the health services was being prepared by the Directorate General of Health Services.

India 0182 Strengthening of Health Services (Epidemiolo~y) UN DP (March 1963 - )

Aim of the protect. To establish or improve health intelligence units in State health directorates; to train staff in epidemiology, health statistics, microbiology and communicable-disease control, and to develop the National Institute of Camunicable Diseases (NICD) , Delhi.

Assistance provided by WHO during the year. (a) A virologist; (b) a six-month fellowshir, for studies in Czechoslovakia and India. a nine-month fellarshi~for studies in Czechoslovakia, India, Burma, Thailand and Sri Lanka, a six-and-a-half- month fellowship for studies in Czechoslovakia, India and Burma, and a twelve-month fellowship for study in the United States of America; (c) supplies and equipment.

Probable duration of assistance. Until 1974.

Work done during the vear. During July-December 1972 the study on poliomyelitis - pre-immunization status and seroconversion in infants after administration of oral polio vaccine - was completed in the Enterovirus Laboratory of the National Insti- tute of Communicable Diseases (NICD). It was noted that the seroconversion rate was lower in the group of vaccinees who excreted enteroviruses before the administration.

Investigation of materials from Srinagar, Kashmir, was continued. It was found that poliovirus type 1 was predominant and sera from the patients contained mostly neutralizing antibodies against this type.

The investigation of sera and rectal swabs collected from the poliomyelitis survey in Kathmandu Valley, Nepal, is being carried out in the Enterovirus Labora- tory, and the first batch of 27 sera and 49 rectal swabs have been tested.

The WHO virologist completed his assignment at the NICD in December 1972.

India 0185.213 strengthen in^ of Health Services, R Puniab and Haryana UNICEF (Jan. 1967 - )

Aim of the project. To strengthen national health services at State, district and local levels, with wphasis on training programmes for health staff, particularly medical officers and assistant nurse/midwives, supervision of auxiliarfes by professional staff, and operational studies. SF,A/RC26/2 Page 107

Assistance provided by WHO during the year. (a) A public health officer, a public health nurse and three temporary advisers; (b) two three-week fellowships for study in Thailand:(c) cost of attendance of participants in the seminar (see below); (d) supplies and equipment.

Probable duration of assistance. Until the end of 1973.

Work done during the year. The WHO project staff stationed at Chandigarh advised the Directorates of Health of Haryana and Punjab States on the development of basic health services and assisted in organizing a number of in-service training courses for auxiliary nurse-midwives, lady health visitors and nurses. Assistance was also given in the preparation of a workshop for hospital nursing superintendents, matrons and senior ward sisters with a view to establishing a pattern for providing effective nursing care over a twenty-four hour period, in the preparation of a handbook to be used by lady health visitors and auxiliary nurse-midwives in rural areas, and in the conduct of a workshop on teaching human reproduction, population dynamics and family welfare planning far teachers in medical colleges.

In October 1972, a national seminar on the training of medical officers in rural areas was held at the Rural Health Training Centre, Najafgarh (Delhi), for 18 participants from different States of India. The objectives of the Seminar, which was assisted by a WiO nurse and three WHO temporary advisers, were to exchange ideas and experiences on problems in the rural health establishment with community health personnel, to develop orientation training programmes for the medical officers in the rural health services, and to finalize the curriculum for a short training programme for trainers in the basic health services.

India 0187 Training of Radiographers R (March 1967 - )

Aim of the proicct. To establish a degree-level training programme for radiographers at the Institute of Post-graduate Medical Education and Research, Chandigarh.

Assistance provided by WHO during the year. (a) A radiography tutor; (b) a twelve- month fellowship for study in the United Kingdom; (c) supplies and equipment.

Work done during the year. The B.Sc. course in radiography was further improved with the introduction of a system of periodic assessment through recording of the practical work done hy the candidates. A record book was designed for this purpose. The teaching of radiography was also improved through greater participation in training by the staff from other academic units in the Institute. Students for the M.Sc. course were in the second year, having successfully completed the first year examination.

The WHO radiography tutor completed his assignment at the end of April 1973 and submitted a report which has been sent to the Government. His recommendations include provision of new premises for the School of Radiography, establishment of a course for radiography tutors from other institutes in India having a status similar to that of the Post-graduate Institute, Chandigarh, encouragement to senior tutor technicians involved in the course to participate in various international conferences and seminars, and provision of facilities to enable radiologists to visit well administered and well organized schools of radiography in other countries.

India 0188 Strengthening of Laboratory Services R (Feb. 1965 - )

Aim of the project. To strengthen health laboratory services in India.

Assistance provided by WHO during the year. (a) A laboratory technician; (b) a three-month fellowship for study in Hungary; (c) supplies and equipment. SEA/RC26/2 Page 108

Probable duration of assistance. Some years.

Work done durinp. the year. The WHO technical officer continued his assistance to thc training of technicians in Chandigarh. The involvement of the project in field activities planned for early 1973 had to be postponed to 1974 as the Government of Maharashtra could not receive the team in 1973.

The number of full-time tutors was raised to five- one tutor for each laboratory subject. All five posts have been filled. The tutors, M.Sc. graduates, have all followed a course in the United Kingdom in training methodology and teaching pedagogy for technicians, followed by training in a special subject under the WHO fellowship programme. The two-year B.Sc. and three-year post-graduate M.Sc. courses progressed satisfactorily. Altogether, there are 38 students attending the degree course and 18 the post-graduate course.

As a pre-requisite, third-year trainees will have to produce a thesis on a laboratory topic; dissertation on the subject of the thesis will form part of the final examination for the M.Sc. degree. The first group of five students should complete their M.Sc. course in September 1973; judging from the satisfactory results of an internal assessment which was conducted early in 1973, it is expected that all five trainees will pass successfully.

So far 45 B.Sc. degree holders have qualified from the Chandigarh Institute. By the end of the 1972173 academic year, the seventh year of operation of the project, the number will rise to 60 graduates.

As the demand for admitting more students is increasing, the training facilities were nsscssed with a view to stepping up the annual admission, which is at present fixcd at 20. It was not found possible to add additional seats as it was nppr?hendcd that such an incrensc would disrupt the functioning of thasc departmenls cnnccrned with npprenticcship training.

--India 0190 Training in Health Education R (Sept. 1968; June 1969; April 1970; July 1970; Nov.1970: April - Mav 1971: Aue.1971: Nov. -

Aim of the project. To establish and develop three post-graduate health education training centres with rural and urban field practice areas.

Assistance provided by WHO during the year. (a) A consultant (b) a twelve-month fellovshjp for study in the United States of America; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during, the year. A WHO consultant was provided to the project for a period of three months from January 1973. He undertook a critical examination of the curriculum and training programme of Paper 111 (Behavioural Sciences Founda- tion for Health Education) and Paper IV (Health Education, Communication and Community Organization) of the post-graduate course in health education, and suggested measures for improvement. The concurrent field training and the supir-- vised field training provided to the students were reviewed for possible improvements. He also made useful observations on Papers I and I1 besides making importar,, recommendations about faculty development, student needs and facilities required. The report of the consultant has been forwarded to the Government.

India 0192 Radiation Medicine Centre, Bombay R (Jan. - Feb. 1963; March 1967 - )

Aim of the project. To strengthen the Radiation Medicine Centre, Bombay. SEA/RC26/2 Page 109

Assistance provided by WHO during the year. (a) A consultant; (b) a twelve-month fellowship for study in the United States of America; (c) supplies and equipment.

Probable duration of assistance. Until 1977.

Work done during tho year. A consultant was assigned to the Centre during January- February 1973 to assist with the clinical, experimental and training programmes in nuclear medicine and also in planning refresher and post-graduate courses in this specialty. He advised on the Centre's nuclear medicine programre in collaboration with the Bhabha Atomic Research Centre, the Tata Memorial Centre and other medical schools in Bombay. He participated in a goitre survey anvongst school children in some city schools, which revealed that 39.02 of the children in a municipal schdol had goitre. In his report,which has been forwarded to the Governnent.the cons~ltant has suggested a study on the correlation of goitrc prevalence with the ag*, bright and weight of the children.

India 0194 Medical Rehabilitation R (Nov. 1963 - Feb. 1964; April - June 1967; UNICEF Fcb. - June 1969; Oct. 1969; June 1970 - )

Aim of the proicct. To expand medical rchabilitation services and to establish training schools in the various disciplines.

Assistance provided bv WHO durins the year. (a) A prosthetic tutor and a consultant; (b) two six-month fellowships - one for study in the United States of America and one for studies in the United States of America, Canada and the United Kingdom.

Probable duration of assistance. A number of years.

14ork dune during thc ycar. The IJHO prosthetic tutor who had been assisting the Rehabilitation 1lcp.rrtmcnts of thc All-lndin Institute of Medical Sciences and Safdarjang Hospital, Ncw Dclhi, left the project in the last week of September 1972 on completion of his assignment. Earlier, he visited the Department of Orthopaedics, S.M.S. Medical Collcge, Jaipur, to advise on the extension of the prosthetic artho- tic workshop in that department.

The WHO tutor also assisted in the conduct of the inter-regional Seminar on Planning, Organization and Administration of Medical Rehabilitation Services, held in New Delhi from 4 Lo 15 Scptembcr 1972 (see Inter-regional 0714).

A consultant (physiotherapy tutor) was also assigned during January to assist in upgrading the srrvirrs in the Physiotherapy Schools at Lucknow, 'l'rivandrum and Madras. She was ablc to visit only the Departmellt of Orthapaedic Surgery at K.G. Medical College, Lucknow, before her departure from India on account of personal reasons. The findings resulting from this visit have been sent to the Government.

India 0197 Occupational Health R (April - Sept. 1964; Aug. 1970; Nov. 1970 - Jan. 1971; July 1972; - )

Aim of the proiect. To conduct courses in occupational health related to spccific hazards found in industries, and to undertake studies on specific hazards.

Assistance provided by WHO durinz the vear. (a) A six-month fellowship for studies in Finland and the United Kingdom; (b) supplies and equipment.

Probable duration of assistance. Some years. SEAIRC2612 Page 110

India 0199 School for Traininz of Technicians UNDP (Dec. 1967 - )

Aim of the project. To train technicians in the installation, maintenance and repair of electrical and mechanical equipment available in health institutions.

Assistance provided by WHO during the year. (a) An electro-medical engineer; (b) a five-and-three-quarter-month fellowship for studies in the Netherlands, United Kingdom and the United States of America; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1977.

Work done during the year. The new WHO electro-medical engineer took up his assignment with the project in the last week of July 1972 and started assisting the six- month course for the training of technicians in the installation, maintenance and repair of electrical and mechanical equipment available in health institutions. The ninth course, which started in July 1972, had seven students and the tenth, which started on 12 January 1973, eleven trainees. Extension of the duration of the course to 12 months was under consideration. The project received supplies and equipment provided by WHO.

Fellowships

Water supply. Six three-month fellowships for studies in Thailand, Malaysia, Singapore and the Philippines.

India 0208 Improvement of Dental Education UNDP (July - Dec. 1966; Sept. 1967 - )

Aim of thc project. To improve and strengthen dental education.

Assistance provided bv WHO during the year. (a) Two twelve-month fellowships - one for study in the United Kingdom and one for study in the United States of America, and a six-month fellowship for studies in Denmark, United Kingdom and the United States of America; (b) supplies and equipment.

India 0210 Public Health Engineering Education UNDP (Oct. - Dec. 1967: March - A~ril1968:

Aim of the project. To assist with the education and training of sanitary engineers and the development of advanced courses in design for community water supply programmes.

Assistance provided bv WHO during the year. (a) Two four-month fellowships for study in the United Kingdom; (b) supplies and equipment.

Probable duration of assistance. Until 1974.

India 0212 Nursing Administration* R

*The project started in January 1968 and is expected to continue until the end of 1973. During the year six fellowships were awarded - a twelve-month fellowship for a candidate from Nagaland for studies in the United Kingdom, Finland and the United States of America, and five six-month fellowships, two for candidates from West Bengal and Maharashtra for studies in the United Kingdom, Sweden, Canada and the United States of America, and three for candidates from Maharashtra (I) and Delhi (2) for studies in the United Kingdom and the United States of America. SEA/RC26/2 Page 111

India 0212.1 Nursing Administration, Chandigarh R (Jan. 1968 - )

Aim of the project. To develop nursing administration in teaching hospitals and to promote in-service training and co-ordination of nursing services.

Assistance provided by WHO during the year. (a) A nurse administrator; (b) a four- month fellmship for studies in the United States of America and some countries of Europe; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1973.

Work done during the year. Orientation courses for newly appointed staff nurses were continued. One-day workshops for ward and departmental sisters and senior staff nurses in preparation for the introduction of ward clerks (who will assist the nurses in clerical duties) were well attended with active participation. Appointment of eight ward clerks was authorized for an initial trial period. An important factor was that there was evidence of progressive thinking in relieving nurses of non-nursing duties.

Fifty additional staff nurses were recruited for the Nehru Hospital.

A Nursing Co-ordination Committee, consisting of representatives of the College of Nursing and of the Nehru Hospital, which was constituted to prepare for the introduction of the basic B.Sc. nursing programme scheduled to commence in August 1973, continued to meet regularly under the chairmanship of the Dean of the Post- graduate Institute and discussed many important matters concerning the relationship between the nursing education and service programmes. These included changing the titlc "College of Nursing" to "Department of Nursing Education", an organizational chart showing relationship and channels of communication between educational and service staff, and desirable qualifications for posts of clinical supervisors. The Committee also started preparing acceptable patterns of staffing for the Nehru Hospital and the School of Nursing, and educational programmes for all the senior nursing staff in the Nehru Hospital.

Three ward sisters' courses were completed. The ward sisters attending the second ward sisters' course collected the data for the 'Study of the Activities of Nurses in the Out-patient Department' and completed reports and recommendations. The recommendations made by them after studying the problems of the collection and delivery of laboratory specimens were implemented. A system of requisition and delivery of stores was devised and put into effect, resulting in the saving of nursing time. The linen service was reviewed and a laundry manual prepared by the Department of Hospital Engineering.

A programme for in-service education for the staff in the Nehru Hospital in 1973 was drawn up and implemented. The tutor in charge of the in-service education programme was assisted by the Clinical Instructor in the College of Nursing, who has had special preparation in the field of nursing in-service education through a WHO fellowship.

Data on 'Nursing Time Available for Patient Care' were collected.

India 0212.2 Nursing Administration, Guiarat R (July 1968 - )

Aim of the project. To develop nursing administration in teaching hospitals and to promote in-service training and co-ordination of nursing services.

Assistance provided by WHO during the year. (a) A nurse administrator; (b) supplies and equipment. SEAIRC2612 Page 112

Probable duration of assistance. Until the end of 1973.

Work done during the year. Progress continued in administration, i.e. policy development, improved discipline, development in rostering and improvements in the nursing environment.

Forty-four additional posts of staff nurses were sanctioned arid filled, as was the vacant ~ositionof hostel warden.

A submissioa was made for staff and other requirements of the school of nursing. Out of the 362 applicants, 101 were selected for admission to the school in 1972. The calibre of the applicants for the 1972 admission was noticeably higher than for 1971. The applicants selected included 28 with university education, some of whom are graduates.

Two orientation courses for the nursing staff of Civil Hospital, Ahmedabad, were conducted. Three sisters and one staff nurse were deputed for training in intensive nursing care in Bombay. One staff nurse who was deputed to the All-India Institute of Hental Health, Bangalore, completed her psychiatric nursing course and resumed duty in January 1973.

There was a marked decrease in post-surgical infections, and this was credited to more reliable sterilization due to better maintenance and testing of autoclaves. Surgical wards, which previously had been much overcrowded, no longer had patients accommodated on the floor because of the reduced length of patient stay in hospital.

The assistant matrons completed an excellent survey/report of Class IV employees throughout the hospital which was used in identifying problems and in the determination of staffing requirements. A survey of all existing hospital equipment and the conditions necessary for safe nursing care was completed. The work on collecting and recording data for personal records progressed. The staff evaluation form introduced in 1972 provided an effective administrative tool. The Direc- torate of Medical and Health Services expressed interest in introducing this evaluation method throughout the State.

The WHO nurse paid a visit to S.S.G. Hospital, Baroda. At Baroda, additional staff nurses were sanctioned; the matron and assistant matrons continued to be overburdened with clerical work.

India 0214 Virolonical Techniques R (Sept. 1968; Nov. 1969; AUK. 1971; Oct. - Nov. 1972; - )

Aim of the project. To develop the laboratory capacity for the diagnosis and surveillance of virus diseases, and to establish competence in the production and testing of live poliomyelitis vaccine.

Assistance provided bv WHO during the year. (a) A consultant; (b) a six-month fellowship for studies in France and the United Kingdom; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1977.

Work done during the year. On the recommendation of the consultant neuropathologist who visited the project in late 1972, the neurovirulence testing (NW) unit at the National Institute of Communicable Diseases, Delhi, was further strengthened: one senior post of virologist and several technical posts have been sanctioned; WHO has provided supplies and equipment to strengthen the pathology and virology laboratories. Wring the year under review, the NVT unit established national standards for neurovirulence in rhesus monkeys for all three types of polio virus based on United Kingdom standards; also, it has tested the neurovirulence of two bulk suspensions of types 1 and 3 received from Coonoor; trivalent vaccine from imported stocks is being retrieved SEA/RC26/2 Page 113

from the field to have its potency tested; while the study is continuing, initial observations indicate a substantial drop in potency, probably due to defective storage.

The polio vaccine being produced at Coonoor has been released for use by the public. It was used in Delhi and Bombay and several other places in India.

It is planned to provide two WHO consultants later in 1973 - one to visit the Haffkine Institute, Bombay, in order to assess its readiness for the production of Sabin polio vaccine, and the other to review the national virology course in Poona and to advise on the strengthening of the rickettsia1 laboratory at the Virus Research Centre, Poana.

India 0218 National Institute of Health Administration R and Education (NIHAE) UNICEF (Sept. 1965 - May 1967: March 1968: Dec. 1968 -

Aim of the project. To conduct studies in district health administration at Rohtak (Haryana) as a prelude to the promotion and planning of comprehensive health care services at the district level; to formulate research and teaching programmes pertaining Lo health administration, and to undertake teaching programmes, studies and research in the Cicld of hospital administration.

Assistance provided by WHO during the year. (a) A hospital actministrator and a public health officer; (b) two fellowships - one for six months and one for four months - for studies in the United States of America and the United Kingdom, a faur-month fellowship for studies in Thailand, Republic of Korea, United States of America, United Kingdom, USSR and Turkey, a three-month fellowship for studies in the United Kingdom, United States of America and WHO Headquarters, and a tcn- month fcllovship for study in the United States of America; (c) supplies and cquipmcrlt.

Probable duration of assistance. Until the end of 1975.

Work done during the year. Financial assistance for the conduct of the second phase of the research project in district health administration to cover the cast of emoluments, allowances and expenses of eight Cield investigators was given to the National Institute oi Health Administration and Education. New Delhi.

Undcr the second phase oi the project, job descriptions for the various categories of staff of primary health centres and guidelines for the programmes werr finalized. Based on a diagnostic study of Phase I in Rohtak District, certain operational changes, which are likely to improve the effectiveness and efficiency of health programmes with the resources already available, are being made in the second phase of the study in the area of one primary health centre in the District. Assistance was also given by the long-term staff members assigned to the Institute in its courses, including the Seminar on Nursing Services and the 12th Seminar on Hospital Administration.

India 0221 Seminars and Workshops on Medical Education R (Dec. 1965 - May 1966; Jan. 1967 - )

Aim of the project. To strengthen further medical teaching.

Assistance provided by WHO during the year. (a) Two consultants and three temporary advisers; (b) cost of attendance of oartici~ants:(c) secretarial assistance.

Probable duration of assistance. A number of years. SEAlRC2612 Page 114

Work done during the year. In collaboration with the Indian Academy of Medical Sciences,a Seminar on Medical Pedagogy was held at Calcutta in April 1973. There were 28 participants from ten medical colleges in India. Two short-term consultants and three temporary advisers provided by WHO assisted in conducting the seminar.

Newer concepts in curriculum building, educational technology and evaluation procedures were discussed, and the participants were exposed to practical exercises in the implementation of these concepts.

This was the ninth activity under this project, and a follow-up has been proposed.

India 0222 Drug Laboratory Techniques and Biological Standardization (June 1967; Oct. - Dec. 1967; AUK. 1968; July - Aug. 1969; Nov. 1969 - Jan. 1976; Sept. 197b - Feb. 1971; Dec. 1971; Oct. - Dec. 1972; Feb. 1973; - )

Aim of the project. To develop services concerned with quality control of pharmaceutical and biological preparations, and to train staff.

Assistance provided by WHO during the year. Six three-month fellowships - two for studies in the United Kingdom, Denmark and Finland, two for studies in the United Kingdom, Federal Republic of Germany, Switzerland and Italy, one for studies in the United Kingdom, Denmark and Switzerland, and one for studies in Sweden and the United Kingdom - and a six-month fellowship for studies in Switzerland, Federal Republic of Germany, Denmark, United Kingdom, United States of America and the USSR.

Probable duration of assistance. Until 1975.

India 0225 Freeze-dried BCG Vaccine Production R (May - June 1968; June - Sept. 1970; - ) UNICEF

Aim of the project. To produce freeze-dried BCG vaccine of standard quality.

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

Probable duration of assistance. Until 1975.

India 0226 Prevention and Control of Water Pollution R (Oct. - Nov. 1969; April 1971: Oct. - Dec. 1971: ~uly1972; Dec. i97i - Feb. i973; - )

Aim of the project. To provide technical advice on organizational and other matters related to the abatement and control of water pollution.

Assistance provided by WHO during the year. (a) A sanitary engineering consultant; (b) four six-month fellowships for studies in the United Kingdom, Federal Republic of Germany and the Netherlands, and a three-month fellowship for studies in the Federal Republic of Germany and the United Kingdom; (c) supplies and equip- men t .

Probable duration of assistance. A number of years. SEA/RC26/2 Page 115

Work done during the year. A consultant was provided during the last quarter of 1972 to advise the Government on matters of water pollution control and specially on the use of analytical control techniques in this field. In this connection he visited several places in the country to study the situation, and his assignment report, covering his findings and recommendations, was submitted to the Government. Among other things, he has recommended that greater efforts should be directed to the solution of the country's basic environmental problems and that a national water quality monitoring programme should be begun. He has also suggested that the growth of analytical facilities should be stimulated,that water quality standards applicable to Indian conditions should be established, and that a training course in advanced analytical techniques for water quality analysis should be offered.

Assistance was also given by means of advice and literature in regard to the preparation of draft water pollution control regulations. Action was initiated for the assignment or two further consultants in analytical control techniques and toxicity bioassay and also for the provision of additional supplies and equipment.

India 0232 Course in Hospital Physics R (Oct. 1967 - )

Aim of the protect. To assist in training hospital physicists.

Assistance provided by WHO during the Year. (a) A consultant; (b) a six-month fellowship for studies in the United Kingdom and the United States of America.

Probable duration of assistance. Until the end of 1974.

Work done durinr the year. A consultant was assigned to the project during January- February 1973. He delivered a series of lectures on the latest advances in nuclear physics to supplement the course syllabus for the training of medical physicists and advised and assisted in academic and research developments. A collaborative research project was completed and two papers were prepared for publication. The potentialities of the Directorate of Radiation Protection were evaluated and the Directorate was round to be under efficient direction and supervision. The report containing the consultant's findings has been sent to the Government.

India 0233 Smallpox Eradication R (Oct. 1967 - )

Aim of the project. To develop the smallpox eradication programme.

Assistance provided by WHO during the year. (a) Four medical officers and three consultants and temporary assistance from four Headquarters staff members; (b) a six-week fellowship for studies in Ethiopia. Afghanistan and WHO Headquarters and a three-month fellbwship for studies in ;he.Uni;ed Kingdom, etherl lands, Czechos- lovakia and Yugoslavia; (c) supplies and equipment.

Probable duration of assistance. Until 1976.

Work done durinr the year. A total of 57 361 cases were reported in India during the period 1 July 1972 to 30 June 1973 as compared to 22 069 cases for the same period last year, representing a 160% increase. This increase was mostly attributable to the major epidemics that occurred in the northern belt of the country, especially in the States of Uttar Pradesh and West Bengal. Uttar Pradesh alone accounted for 40% of the total number of cases reported in the country(47 832 Cases), 52 districts out of 54 districts reporting cases in 1973. In West Bengal, of considerable concern was the outbreak of an epidemic in Calcutta and the adjoining districts - the severest in the last ten years in this very densely populated area. SEA/RC26/2 Page 116

With assistance from WHO, emergency measures were taken in a number of highly infected areas, and every effort was made to prevent the spread of infection, occurring mainly from the States of Uttar Pradesh, Bihar, West Bengal and Madhya Pradesh, to other regions of the country. However, a large number of importations re-established foci in areas of the country previously considered smallpox free or with a low level of incidence, and importations were also recorded in Nepal as well as in the United Kingdom (one case). Of special concern were the outbreaks which occurred in four States of the eastern wing of the country, in four districts in eastern Madhya Pradesh and in Orissa, which had recorded a very low incidence in the last two years, and where eight districts were infected, resulting in 982 cases being reported from that State.

In Jammu and Kashmir, Rajasthan and Andhra Pradesh, where interruption of smallpox transmission was expected by mid-1973, transmission was still continuing in certain districts beyond this deadline. However, in Haryana State, which in 1972 recorded the highest smallpox morbidity in India, the incidence sharply declined during the first six months of 1973.

It is expected that the assignment during the second half of 1973 of additional State-level staff and WHO personnel to assist in the surveillance, organizational and supervisory elements of the programme, should lead to much improvement in the situation by the end of the year.

India 0234 Training of Medical Educators UNDP (May 1968; July 1968; Sept. 1968; Nov. 1971; Dec. 1971; Sept. 1972; Jan. 1973; May 1973; - )

Aim of the project. To provide further training to national medical educators.

Assistance provided by WHO during the year. Two fellowships - one for three months and one for six months - for studies in the United Kingdom, Canada and the United States of America, a three-month fellowship for study in the United Kingdom, and a six-month fellowship for studies in Australia, Singapore and Malaysia.

India 0238 Cancer Control Pilot Project, Tamil Nadu R (July 1968 - )

Aim of the project. To start and develop n pilot project for the early diagnosis and control uf oropharyngeal and cervical cancer and to establish a training centre in Kancheepuram (Tamil Nadu).

Assistance provided by WHO during the year. (a) A medical officer (epidemiologist) and three consultants (one provided by WHO Headquarters);(b) two six-month fellowships for study in Australia; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. The first phase of the cancer control project in Tamil Nadu was completed with the departure of the lJHO medical officer early in January 1973 after a two-year assignment. His report has been forwarded to the Government.

The Arignar Anna Memorial Cancer Institute was completed, and the cervical and oropharyngeal cancer detection clinics, a minor operation theatre, the histological and cytological laboratories, registration, recording and follow-up systems, the health education unit with photo-art section and audio-visual aids, and the library and conference room were all functioning. Regular home visits, health education through group meetings in the cowunity and facilities for screening women in municipal maternity homes and dispensaries, were organized. Cases detected with cancer were being referred to hospitals in Madras for treatment. Steps have been SEA/RC26/2 Page 117

taken to provide cancer treatment facilities in the District Headquarters Hospital at Kancheepuram. A plan for a 100-bed cancer hospital in Kancheepuram was finalized and a master plan for a comprehensive cancer control programme in Tamil Nadu was prepared, incorporating the model evolved for cancer detection based on a sociological study of the urban and rural population in Kancheepuram.

A cytopathologist, four laboratory technicians and a statistician received training abroad, and the principal medical officer was expected to proceed abroad for training in cancer control. Consultancy services were provided in cancer control, cytology, health education and statistics. The reports of the three consultants (including one assigned by WtlO Headquarters) provided in these specialties were forwarded to the Government. A training programme in cytology for technicians in the State was expected to st-art functioning soon in the Institute.

India 0244 Training in Veterinary Public Health R (Aug. 1969; March 1970; May - July 1971; Oct. 1972; March 1973; - )

Aim of the project. To develop further a post-graduate (Master's degree) course in veterinary public hcalth at the All-India Institute of Hygiene and Public Health, Calcutta, and the Indian Veterinary Rescarch Institute, Izatnagar.

Assistance provided by W110 during the year. (a) A twelvc-month fellowship far studies in the United Kingdom, Denmark, Czeclloslov,lkia and Poland, and two three- month fellowships - one for studies in the United Kingdom and the United States of America and one for study in the United States of America; (b) supplies and equipment.

Probable duration of assistance. A numbcr of years.

India 0250 Ii~tc~rationof M~Lernuland Child HM R Services into the General Health Services (Sept. 1967; Nov. - Dec. 1967; June - July 1968; June 1970; No". 1970 - Feh. 1971; May 1971; July - Aug. 1971; July 1972; - )

Aim of the project. To integrate maternal and child health services, including family planning, into the general health services in selected States.

Assistance provided by WHO during the year. A twelve-month fellowship far studics in the United States of America and Jamaica.

India 0255 Strengthening of Health Statistics Services R (July - Oct. 1970; July 1972; - )

Aim of the proiect. To develop and strengthen health intelligence units in State health departments and to train national statistical staff.

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

Probable duration of assistance. A number of years.

India 0257 Physical Therapy School, Baroda R (May 1968; March 1969 - April 1972; July 1972 - )

Aim of the proiect. To train physiotherapists to degree standard (Bachelor of Physiotherapy) at the Physiotherapy School in S.S.G. Hospital, Baroda, over a three-year period. Assistance ~rovidedby WHO during the year. (a) A physiotherapy tutor and a consultant physiotherapy tutor; (b) supplies and equipment.

Work done during the year. The new WHO physiotherapy tutor took up her assignment in July 1972 and started assisting the training programmes of the Physical Therapy School, Baroda.

The second group of physiotherapists graduated from the School in June 1973.

As the Electrotherapy Section was not functioning for some time owing to constant break-downs of short-wave diatherapy machines, the students did not receive adequate instructions in the use of these machines.

A new scheme for the allocation and treatment of patients was started, which resulted in the patients receiving a more effective and progressive treatment and enabled the students to obsenre and take part in the complete treatment of a disability.

The entire syllabus of the School was discussed and revised, where necessary, by the Board of Studies of the School, and was submitted to the M.S. University Senate. The Indian Association of Physiotherapy gave provisional recognition to the School subject to the approval of the revised syllabus by thc M.S. University of Baroda. Supplies and equipment provided by WHO were received.

India 0259 National Institute of Communicable Diseases R (Feb. 1972; Sept. - Dec. 1972; - )

Aim of the project. To assist the National Institute of Communicable Diseases in strengthening its faculty in order to improve further field training of epidernio- logists.

Assistance provided by WHO during the year. (a) Two consultants; (b) grant

Probable duration of assistance. Some years.

Work done during the year. The Director of the National Institute of Communicable Diseases was assigned as a WHO short-term consultant to scrutinize the programme of the international (Prague-Delhi) course togethcr with the Director of the course. He has suggested an assessment methodology and exchange of experience between the WHO-sponsored PragueIDelhi and Moscow/Alexandria courses. From the beginning of December to February 1973, ten participants in the International Course in the Epidemialogy and Control of Communicable Diseases attended the Indian Chapter of the course. They visited several research and field centres in India concerned with the control of viral infectious diseases. A WHO consultant visited India in December to assist with this part of the course.

The Director of the National Institute of Communicable Diseases was invited by WHO Headquarters to participate in informal discussions between the Directors of the WHO courses in epidemiology.

India 0267 Nutrition Training R (Dec. 1970; May 1971; - )

Aim of the project. To expand and improve the health component of the Applied Nutrition Prograrmne assisted by FAO, UNICEF and WHO.

Assistance provided by WHO durinz the year. Supplies and equipment.

Probable duration of assistance. A number of years. SEA/RC26/2 Page 119

Work done during the year. The plan of operation for the project.valid till the end of 1974,was signed by the Government, UNICEF and WHO.

The fifth degree course and the tenth certificate course in nutrition were completed at the National Institute of Nutrition, Hyderabad. Eight candidates from India on UNICEF stipends and one from Thailand on a WHO fellcwship attended the degree course. In the certificate course one candidate from Bangladesh and four from Thailand participated on WHO fellwships and 11 from India on UNICEF stipends. WHO provided two guest lecturers from among internationally known nutrition specialists for two weeks each. Supplies and equipment were provided to the Institute and training,on WHO fellowships,arranged far some of tne teaching and research staff.

The sixth d~grcccourse in nutrition started at the Institute in Junc 1973 with two candidates on In10 fellowships (one from Bangladesh and one from Indonesia) in addition to Indian participants on UNICEF stipends.

India 0268 Village Water Supply R (May 1971 - ) UNICEF

Aim of the project. To plan and co-ordinate the development of community water supplies in rural areas, including the well-drilling programme in areas where hard rocks present special problems and in those whcre water is scarce; to train professional and drilling staff.

Assistance provided by WlJc during theyear. (a) A sanitary rngineer; (b) a six- month fellowship for study in Australia; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1975.

Work done durin~the year. Thc village water supply programme under implemcntation in various States continued as planned with full support from the Central and Statc governments and increasing material aid from UNICEF, including the supply of additional drilling rigs. The WHO sanitary engineer regularly visited the Statcs under his responsibility to review the progress and to provide technical advice and guidance in the planning, design and execution of water supply schemes. Plans were in progress to extend the programme to other States.

The Government, in collaboration with UNICEF and WHO, sponsored in November 1972 a four-day mceting of State chief public health engineers to discuss the problems of operation and maintenance of village water supply systems and to find ways and means of solving them. At the initiative of the State Government of Mysore a programme of development of deepwell handpumps was started with financial assistance from UNICEF.

A second l\nIO sanitary engineer for the project was selected and his placcment is being arrangcd. It is also to provide consultant services to assist the Government in the training of national personnel engaged in the program in the techniques of well drilling in hard rock and boulder formation, etc., and in the operation and maintenance of geophysical instruments.

India 0269 Nursin~in Clinical Specialties* R

India 0269.1 Nursing in Clinical Specialties. New Dclhi R (Jan. - Nav. 1972; - )

Aim of the project. To improve clinical practice in selected specialties.

*The project started in January 1972 and is expected to continue for a number of years. During the year, a six-month fellowship was awarded for study in the United Kingdom. sEA/~C26/2 Page 120

Assistance provided by WHO during the year. (a) A nurse educator in orthopaedic nursing; (b) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. Two four-week courses for sisters and staff nurses of local hospitals in Delhi and for a clinical instructor from the College of Nursing were conducted by the WHO consultant to prepare them for responsibilities in supervision.

At the request of the Government of India,the consultant visited army hospitals at Lucknow, Calcutta and Poana and discussed orthopaedic patient care. She also prepared the content of a 12-week course for nurse participants from all over India on "Nursing Management of Orthopaedic Patients", which represented the culmination of her activities at the Central Institute of Orthopaedics, Safdarjang Hospital, New Delhi. The content covered the whole field of orthopaedic nursing practice (including rehabi1itation)and linked it to allied specialties such as neurology and neuro-surgery. Emphasis was placed an the concept of comprehensive patient care and on the emotional, psychological and socio-economic aspects of disease and injury. Management skills and team work were stressed throughout the course,particularly with regard ta the working relationship between doctor and nurse. At the end of the course the nurses displayed excellent knowledge of the needs of orthopaedic patients. A syllabus for the course and guidelines for use in preparing similar courses were prepared. It is hoped that eventually the Indian Nursing Council will recognize this programme for certification.

The consultant read a short paper at the WHO-sponsored inter-regional Seminar on Planning, Organization and Administration of Medical Rehabilitation Services, held at the All-India Institute of Medical Sciences, New Delhi. She also presented awards and gave a short address at the conclusion of the Ward Sisters' Course at the College of Nursing, New Delhi. She completed her assignment in early December 1972.

India 0269.2 Nursing in Clinical Specialties, Rajasthan R (Feb. 1972 - )

Aim of the project. To improve clinical practice in selected specialties.

Assistance provided by WHO during the year. (a) A maternal and child health nurse educator; (b) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. The WHO maternal and child health nurse educator completed her assignment at S.P. Medical College Hospital, Bikaner, in September 1972. During the period of her assignment, a staff education programme was started and continued on a limited basis. A Procedure Committee started and continued work on writing a nursing procedure book for use in the hospital and in the school of nursing. A booklet for the premature nursery was prepared. A teaching programme for the diabetic child was instituted by demonstrating with a child the goal of teaching about the disease, how to examine the urine and how to administer self-injection. A survey on two different occasions was taken of all children up to three years of age on the paediatric ward and it showed that half the children in this age group were having some state of malnutrition. Classes were regularly held for the nurses attending the premature nursery, resulting in improved understanding of the special needs of the premature infant and also in techniques of feeding. SEAIRC2612 Page 121

The WHO maternal and child health nurse educator undertook an assignment at JLN Hospital, Ajmer, from October 1972 to April 1973. Steps were taken to improve the physical facilities and to make available equipment essential for carrying out safe nursing care. In-service education programmes for staff from the JLN and Maternity Hospitals were started. Some basic equipment such as syringes, needles, oxygen catheters and medicine glasses, were obtained and put into use. Some routine procedures were revised with the staff with a view to performing them in a safe manner. Several forms were mimeographed in order to facilitate accurate and quick record-keeping. Demonstrations were given to both staff and students as to the techniques of tube feeding babies and children.

The WHO nurse educator began an assignment at Medical College, Udaipur, from May 1973. She assrssed thc situation in the Hospital in order to determine the needs and priorities for assistance.

India 0269.3 Nursing in Clinical Specialties, New Delhi R (Jan. 1972 - )

Aim of the project. To inlprove clinical practice in sclccted specialties.

Assistance provided by WHO during the ycar. (a) A pacdiatric nurse cducator; (b) supplies and equipment.

Probable duration of assistance. A number of years.

Work done durin~the year. A draft of the policy and procedure manual for the paediatric surgical ward and that of a handbook of paediatric surgical nursing were completed.

The Control of tnfcction Comitcee designed a simple form to be uscd to collect data related to infections among the patients on tht, pacdiatric surgical ward. Some practices were introduced to lessen the hazard of hospital-acquired iniection. The establishment of the Treatment Room was one step toward eliminating some factors which contribute to transmission of infection.

India 0269.4 Nursing in Clinical Specialties. Mysarc R (Jan. 1973 - )

Aim of the project. To improve clinical practice in selected specialties

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

Probable duration of assistance. A number of years.

Work done durin~the ycar. A WllO nurse educator Look up duLies at the All-India Institute oi Mental Ilealth, Bangalore, on 23 January. Identification of needs and determination of areas of assistance in the fields of psychiatric nursing educ;a- tion and services were made. There is an acute shortage of nursing personnel in all categories and poor supervision of nurses, resulting in poor teaching and learning experiences for students utilizing the facilities. It was decided to establish a model unit consisting of three wards to be utilized primarily for teaching purposes. Intensive planning was done for the development of the model units and consultations were held with the hospital authorities in this regard. Job descriptions for nursing staff and syllabi far the in-service programmes were prepared.

Efforts were made to evolve uniform methods for clinical evaluation of students. Emphasis was placed on improving methods of teaching and on attaining consistency in teaching and evaluation of students. Planned faculty meetings were instituted with acceptable procedures. SEA/RC26/2 Page 122

India 0269.5 Nursing in Clinical Specialties, Maharashtra R (Jan. - March 1973; - )

Aim of the project. To improve clinical practice in selected specialties.

Assistance provided bv WHO during the year. (a) A maternal and child health nurse educator; (b) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. The WHO nurse assigned to the All-India Institute of Medical Sciences, New Delhi, completed a short assignment (22 January to 31 March) at K.E.M. Hospital, Bombay. She undertook an assessment and review of the needs for a staff education programme at the Hospital; plans were completed for this programme as also for the paediatric nursing component of basic nursing education.

India 0270 Control of Air Pollution* R (Feb. - March 1971; March 1973; - )

Aim of the project. To study the problems of air pollution connected with industrial dcvclapmcnt and to promote a control programme.

Assistance provided by WHO durin~the year. (a) Four six-month fellowships for studies in the Federal Republic of Germany, Netherlands, Sweden, United Kingdom and the Unitcd States of America; (b) supplies and equipment.

Probable duration of assistance. A number of years.

India 0272 Solid Wastes Disposal R (Feb. - March 1973; - )

Aim of the project. To study the problems of solid wastes in urban communities and plan the management of solid wastes.

Assistance provided by WHO during the year. Four six-month fellowships - one for study in the United Kingdom and three for studies in the United Kingdom, Switzerland. Thailand, Hong Kong and Japan.

Probable duration of assistance. Until 1975.

India 0274 ileslth Education in Schools, Including UNFPA Family Life Education (July - Aug. 1971; Nov. 1972 - )

Aim of the protect. To integrate family life education in school, college and teacher-training curricula, establish and develop a health education programme in the educational system,prepare teachers in health education, and develop teaching aids required for primary, secondary, collegiate and teacher-training institutions.

Assistance provided by WHO during the year. (a) A consultant; (b) a three-month fellowship for studies in the United States of America, Japan, Republic of Korea, Malaysia and Singapore; (c) supplies and equipment.

Probable duration of assistance. Five years.

Work done during the year. The services of the WHO health education consultant provided to Maharashtra in August 1972 under project India 0108 were continued for a period of another eight months under this project to promote the health education

*Previous title: Air Pollution SEAlRC2612 Page 123

aspects of the family health programme and to assist the State Government in the integration and/or co-ordination of health education activities of the family planning programme with those of the maternal and child health and related general health services at different levels of the health administration.

The consultant assisted in establishing the State School Health Committee, which includes senior officers of the Health and Education Departments. The first meeting of the Committee was being planned to discuss its scope and objectives as well as methods and procedures for the development of health and population education in the educational system of the State. He also assisted in a quick assessment of the mass vasectomy campaign with regard to its motivational aspects and involvement of official and non-official leaders.

Basic educational aids developed in the context of family health were pre- tested and technically cleared and were being reproduced by the Family Planning Bureau in adequate numbers to meet the needs of family planning education.

Six State-level follow-up workshops on health and population education in the school system were held. The revised proposals for thc project were formulated by the Government on the basis of the recommendations made in these workshops.

India 0275 Strengthening of the Teaching of Human Reproduction. UNFPA Family Planning and Population Dynamics in Medical Colleges (May - Sept. 1971; Dec. 1971; April 1973 - )

Aim of the project. To strengthen the service, teaching and research functions of thc departments involved in thc teaching of human reproduction, family planning and population dynamics in mrdical colleges.

Assistance provided by WHO during the year. (a) A medical officer; (b) two three- month fellowships for study in the United Statcs of America, a twelve-month frllowship for studies in the United States of America and the United Kingdom, a twelve- month fellowship for studies in the United States of America, Canada and the United Kingdom, a nine-month fellowship for studies in Norway, Sweden, United Kingdom and the United States of America, an eight-month fellowship for studies in Sweden, United Kingdom, Canada, United States 01 America, Hang Kong and WHO Head- quarters, a four-month fellowship far studies in the USSR, Federal Republic of Germany, Yugoslavia, United Kingdom, Nigeria, llni tcd StaLes af America, Canada, Hong Kong, Thailand and WHO Headquarters, a threc-month fellowship for studies in the USSR, Federal Republic of Germany, Sweden, United Kingdom and the United States of America, and a ten-week fellowship for studies in the Philippines, Republic of Korea, Malaysia and Thailand; (c) supplies and equipment.

Probable duration of assistance. Same years.

Work done during the year. A WHO medical officer was assigned to this project in April 1973. After discussions with the national authoritirs, it was agreed that hc should visit the fallowing medical callcges during 1973: (1) G.R. Medical College, Gwalior, (2) Osmania Medical College, Hyderabad, (3) Medical College, Madurai, and (4) Medical College, Nagpur.

The following four medical colleges will be visited by him during 1973: (1) Medical College, Cuttack, (2) Medical College, Calcutta, (3) College of Medical Sciences, Banaras Hindu University, Varanasi, and (4) Medical College, Baroda.

It was also agreed that in addition to the medical officer, three consultants for six months each, in the fields of medical education, paediatrics and social and preventive medicine respectively, should visit these medical colleges for a period af 4-5 weeks for implementing the programme.

The eight medical colleges are being supplied with books and teaching equipment. SEA/RC26/2 Page 124

India 0276 Strengthening of Family Planning As~ects UNFPA of Nursing Administration (March 1972 - Feb. 1973; April 1973; - )

Aim of the prolect. To strengthen the nursing and midwifery components of health care in the maternity cycle.

Assistance provided bv WHO during the year. (a) A nurse-midwife educator consultant; (b) a six-month fellowship for studies in the United States of America and the United Kingdom; (c) supplies and equipment.

Work done during the year. A WHO consultant (nurse-midwife educator) was assigned to the Government Erskine Ilospital, Madurai, between March 1972 and February 1973. During this period, she made an analysis of nursing staff of the hospital, which showed that thc present staff was 48% below the requirements of the Tamil Nadu Nurscs and Midwives Council. Shortage of nursing personnel and inadequate use of cxisting personnel presented a great problem. Her report has been sent to the Govcrnmcn t .

Studies of staff utilization wcre started. A job analysis of two wards showed thaL tl,~mast time-consuming task of the nurses was "accompanying doctors on rounds" (15.2%). Clerical work took up 10.2% and basic nursing care by staff nurses 0% and by student nurses 10.2%. Subsequently, some non-nursing duties were delegated to other catcgorirs of personnel.

A four-week course on family planning was conducted for the graduate nurses from the local hospitals and plans were made for the follow-up of thc participants in the course.

Assistanrc was given with plans and suggestions Tor the establishment of a ccntr;tl sterile supply department. Thc WHO nurse assisted with a pragr;lmmc of c1inic;ll teaching of final year medical students, dealing with the nursing aspects of obsLrLrica1 patient care.

India 0277 Strengthening of the l'eachin~o_f Human Reproduction, UNFPA ~opulationDynamics and Family Planning in Nursing and Midwifery Education (March 1972 - Jan. 1973; March 1973 - )

Ainl of the project. To improve the maternal and child health and family planning rumponrntti of auxiliary nurse-midwifc training and to strengthen thc domiciliary mirlwifery and public health nursing experience of nursing students in hospital schools of nursing; to strengthen the teaching of human reproduction, family planning .and population dynamics at teaching institutions for nursing personnel.

Assistance provided by WHO during the year. (a) A nursc educator consultant; (h) supplies and equipmrnt.

i'rol,nble duration of assistance. A number of years.

Uork done durin~fhc yudr. As a follow-up of the first orientation course, the WHO consultant visited all the auxiliary nurse-midwife schools in Bihar from which trainees had been deputed to the course. It was found that most of the principles taught in the course were actually being put into practice by the trainees. The visits revealed that the schools suffered from lack of equipment and transporta- tion as well as poor hostel acco-dation.

The second and third three-month orientation courses for auxiliary nurse-midwife tutors were successfully completed with 21 and 20 participants respectively. SEA/RC26/2 Page 125

The WHO consultant completed her 11-month assignment in January and began a six-month re-assignment in March 1973.

Plans were made for conducting three workshops in the States of Madhya Pradesh, Orissa and Rajasthan in the latter part of 1973 - each of these three-week workshops will have 14 participants (tutorslsister tutors, public health nurses engaged in teaching auxiliary nurse-midwives, matronslassistant matrons of hospitals used for auxiliary nurse-midwife training, and district nursing supervisors involved in the supervision of centres used for the field teaching programme).

India 0278 Integration of Maternal and Child Health UNFF'A Services, Including Family Planning Services, into the General Health Services (May 1971 - )

Aim of the project. To plan, organize, operate and evaluate the family health programmes as an integral part of the general health services.

Assistance provided by WHO during the year. (a) A consultant, a temporary adviser and temporary assistance from a public health nurse assigned to another project; (b) three three-month fellowships - two for study in the United States of America and one for studies in the United Kingdom, United States of America and WHO Head- quarters; (c) cost of attendance of participants.

Probable duration of assistance. Until 1975.

Work done during the year. A Workshop on Methodology of In-service Training in the Integration of Maternal and Child Health Services, including Family Planning Services, into General Health Services, was organized in New Delhi from 26 to 30 December. The 23 participants from various parts of India were those concerned with the administration, training and service aspects of the maternal and child health and family planning programme.

The workshop was assisted by a WHO consultant and a temporary adviser. Assist- ance was also provided by a WHO nurse educator assigned to another country.

The report containing the conclusions of the workshop was being processed; a ?&cis of its contents, sent to the Government as an aide memoire, has given rise to a series of discussions on the next stage in the development of this project.

India 0279 Medical Toxicology Unit R (Oct. - Dec. 1972; - )

Aim of the project. Ta undertake studies on the effect of air pollutants and organochlorine pesticides in man.

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

Work done during the year. A WHO consultant was assigned to the Industrial Toxi- cology Research Centre, Lucknow, from October to December 1972 to assist the Centre in a review of its laboratory procedures and in the establishment and organization of an epidemiological unit. In his report, which has been forwarded to the Govern- ment, the consultant has made specific recommendations for the training of staff in pesticide residue analysis and in regard to cholinesterase assays. SEA/RC26/2 Page 127

4. INWNESIA

PROJECT LIST

Project No. Source of Funds Co-operat ing Agencies Title

Indonesia 0032 Malaria Eradication R (May 1955 - )

Aim of the project. To reduce malaria endemicity to the lowest possible level with the ultimate goal of malaria eradication.

Assistance provided by WHO during the vear. (a) Three malariologists, two enta- mologists, a sanitary engineer and a translator-typist; (b) three three-and-a-half- month fellowships - two for study in the Philippines and one for studies in the Philippines and India - two one-month fellowships for study in the Phillipines, and a three-week fellowship for study in Japan; (c) supplies and equipment; (d) subsidy.

Probable duration of assistance. A number of years.

Work done during the vear. The malaria control programme covered a population of 76.991 million in Java and Bali under extensive mosquito control measures, and a population of 42.538 million in the other islands under spraying operations carried out in selected areas of priority from the socio-economic paint of view.

Case detection in Java and Bali during 1972 revealed 128 830 positive cases compared with 72 829 in 1971. There has been an increase of cases in all the provinces except West Java and Jakarta Raya. Case detection improved in the other islands; 113 250 cases were detected in 1972 compared with 36 682 in 1971. Much of the increase can be attributed to more extensive case detection.

A special study was carried out in Bantu1 Regency, Java, to assess the impact of spraying in an area where the vector is highly resistant to DDT. Studies continued in Magetan and the results have revealed the irritant effect of DDT, thus reducing the man-vector contact, even in areas where A. aconitus is resistant to DDT. In Central Java, tests are under way to delimit the areas of vector resistance to DDT.

Indonesia 0050 Tuberculosis Control R (July 1961 - ) UNICEF

Aim of the project. To integrate BCG vaccination without prior tuberculosis testing into the work of the maternal and child health clinics and regency polyclinics; to train staff engaged in case-finding by microscopic sputum examination, and to provide ambulatory treatment.

Assistance provided by WHO during the year. (a) A consultant; (b) a four-month fellowship for studies in Czechoslovakia and Sri Lanka, a two-week fellowship for studies in the Republic of Korea and India, and three three-month fellowships - two for study in India and one for study in Denmark.

Probable duration of assistance. Until 1975. SEAlRC2612 Page 128

Work done during the year. During December 1972-April 1973, a WHO consultant assisted the Government in an assessment of the programme activities and reported remarkable improvement in the BCG vaccination coverage of the eligible child population. It is expected that in the next two years all the eligible children will be covered, and that the routine vaccination of the newborn will continue. This progress has been made possible because of the gradual utilization of vaccinators engaged in the smallpox eradication programme. With the eradication of smallpox, it is expected that the vaccinators engaged in the smallpox programme will assist systematically in other vaccinations, priority being given to BCG.

Indonesia 0060 Laboratory Services R (June 1967; June - Aug. 1968; June 1969; UNICEF June 1970 - )

Aim of the project. To strengthen health laboratory services.

Assistance provided by WHO during the year. (a) A microbiologist, a virologist and a laboratory technician; (b) a three-mmth fellowship for study in Hungary and a twelve-month fellowship for studies in Thailand and India; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1977.

Work done during the year. The 1WO virologist's national counterpart returned to the project on completion of his post-graduate studies in virology under a WHO fellowship.

During the year under review the project staff were involved in and completed a number of planned activities: the chapter on laboratory of the health centre manual was completed and the applicability of its instructions was being tested in the field; technical advice and guidance was provided to the staff of the newly established units of the Central Public Health Laboratory (CPHL), Djakarta.

There exists an awareness regarding the role of the CPHL in the surveillance of communicable diseases, and the demand by the epidemiological surveillance unit of the Directorate General of Comunicable-Disease Control for the involvement of the laboratory in surveillance activities is bound to increase rapidly with the CPHL's enhanced competence in handling complex diagnostic problems from the field. In this connection, the capability of the plague laboratory at Jogjakarta and the plague field laboratory at Bojolali has been stepped up as serological methods were introduced to secure rat sera and measures taken to improve the culture isolation of Yersinia from rodents and ectoparasites. Serological and virological studies have been conducted on blood samples and mosquitoes caught from Semarang, Solo and adjacent towns in Central Sumatra and from Padang in West Sumatra, in order to substantiate epidemiological observations on a dengue fever outbreak; material from smallpox suspects received from the field for testing is simultaneously tested in Bandung and sent to the WHO Reference Laboratory for verification and confirmation.

With regard to training, which is an important aspect of the project's activities, the team undertakes on-the-spot training of the staff in charge of the laboratories that it visits in the provinces. The team also participated in the organization and conduct of UNICEF-supported group educational activities such as the upgrading course for directors of provincial laboratories held in October 1972 and for senior analysts in January 1973, and the SEAMEO course on ectoparasite biology held in Bogor in May/June 1973. Discussions were being held with directors of schools of laboratory technology to ascertain the need Eor a training institute to provide more advanced specialized training to analysts than is at present available. Substantial assistance is provided by UNICEF to help the Government in upgrading provincial laboratories. Discussions with the Government and WICEF are held regularly for the continuation of UNICEF assistance in the next five-year plan SEA/RC26/2 Page 129

and for fuller utilization of the assistance already provided. In this connection, consideration is being given by two provinces to hold,in 1973, upgrading courses for nurses and technicians posted in kabupaten (regency) laboratories. If successful, the courses, which are based in the provincial laboratories, may he extended to other provinces.

The WHO microbiologist completed his assigment in January 1973; his report has been sent to the Government.

Indonesia 0061 Training in Sanitary Engineering R (Feb. - March 1968; Sept. 1968; May 1969; Aug. - Sept. 1969; July 1970 - )

Aim of the project. To train sanitary engineers at the Institute of Technalogy, Bandung.

Assistance provided by WHO during the year. (a) A professor of sanitary engineering; (b) a six-month fellowship for study in Australia; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. The WHO professor of sanitary engineering took up his assignment at the Institute of Technology, Bandung, in September 1972. The National Planning and Development Board designated the Institute as a "Centre of Excellence" for higher education in the field of engineering and decided to reduce its academic programme from five to four years with a six-month matriculation period.

Assistance was given in revising the curriculum of sanitary engineering in order to bring it in line with the above development. An assessment of the teaching and research laboratory equipment was made and a list of additional items essentially required was prepared. The library facilities were surveyed and an inventory of the material needed to upgrade the service was drawn up. A study on environmental health manpower was initiated, and a proposal for possible extension of WHO assistance in the development of a graduate progranme was under consideration of the Government.

At the request of the Government, assistance was given to the School of Public Health of the University of Indonesia in drawing up a course in environmental health for inclusion in the curriculum of the Master's degree in public health. The WHO professor of sanitary engineering visited other institutions in the country with a view to exploring the possibility of introducing training in sanitary engineering.

Indonesia 0062 Medical Education R (May 1964 -)

Aim of the project. To develop the teaching progranmes of the medical faculties in keeping with national needs and the progress of the educational sciences.

Assistance provided by WHO during the year. (a) Two professors - one in pharmacology and one in public health administration - and two consultants; (h) six twelve-month fellowships - four for studv in Thailand. one for study in the Federal Reuublic of Germany and one for study in the Netherlands - a four-month fellowship for studies in the United States of America, Canada, United Kingdom, Netherlands, Federal Republic of Germany, Turkey and India, and a two-month fellowship for study in France; (c) supplies and equipment.

Probable duration of assistance. A number of years. SEA/RC26/2 Page 130

Work done during the year. The WHO professor of pharmacology in Medan (Medan Medical School) and the WHO professor of public health administration at the University of Airlangga Medical School, Surabaya, completed their assignments in December 1972 and March 1973 respectively.

A consultant in the field of clinical biochemistry was assigned to Gadja Mada University Medical School in September-November 1972 to study the teaching of this subject. The report containing his findings has been sent to the Government.

A long-term medical educator in pharmacology was recruited and one in microbiology was under selection for the University of North Sumatra Medical School; in addition, a public health administrator for the School of Public Health, Uni- versity of Indonesia, Djakarta, was under recruitment.

Towards the end of the period under review, a consultant in physiology took up a two-month assignment at the Medical School at Denpasar, Bali, to assist with the development of curriculum, teaching and research in biology. He was also expected to help in introducing modern methods of teaching and evaluation of student performance as well as in developing interest in ergonomics and other aspects of the physiology of work.

Indonesia 0069 train in^ of X-ray and Electro-medical RIUNDP Technicians (March 1966 - )

Aim of the project. To train radiographers; to train electro-medical technicians in the installation, use, maintenance and repair of electro-medical equipment.

Assistance provided by WHO during the year. (a) A radiography tutor and an electro- medical engineer; (b) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. Nork on construction of the workshop for the training of X-ray and electro-medical technicians and on air-conditioning and equipping the laboratories was taken up. New students were enrolled for training and those who graduated underwent in-service training. The senior students were sent on field trips to gain experience in inspection, repair and maintenance of electro-medical equipment in Bandung, Semarang and Surabaya.

The training of radiographers progressed satisfactorily. A refresher course of two weeks' duration in radiology was conducted for 41 radiographers already in service. Plans were finalized for a second academy in Surabaya for the training of radiographers.

Indonesia 0071 National Cmunity Water Supply and Sanitation R (March 1969: June 1969 - ) UNICEF

Aim of the protect. To plan community water supply, sewerage and storm-water drainage systems, water pollution control and general sanitation work, and to train staff.

Assistance provided by WHO during the vear. (a) A sanitary engineer; (b) five two- month fellowships - four for studies in Thailand, the Philippines and Malaysia and one for studies in Thailand, the Philippines and Singapore; (c) supplies and equipment.

Probable duration of assistance. A number of years. SEA/RC26/2 Page 131

Work done during the year. The activities of the project progressed satisfactorily with the regular inflow of UNICEF material and equipment. Construction of 58 piped water supply schemes so far undertaken was in different stages of completion. Sixty- eight water supply systems were selected for construction during the year 1973-74 and a detailed list of UNICEF equipnent and material required for them was prepared.

A preliminary work plan was drawn up showing step by step the activities proposed for the period up to 1980 as well as indicating requirements for technical assistance. Work an collecting material and preparing technical guides for the use of health controllers and sanitarians working in the rural water supply programe continued. In response to a request, the teaching staff of the Institute of Technology, Bandung, agreed to assist in the preparation of detailed drawings of the rural water supply schemes. They also helped in the review of water supply schemes and provided detailed guidance.

A one-week national seminar on the training and education of sanitation personnel was arranged in Djakarta for eight sanitarians and health controllers. Two health controllers from the project were trained in the use of levelling instruments. The curricula £or in-service training courses for these two categories of personnel were developed.

The WHO sanitary engineer participated in the project systems analysis exercise on rural water supply in West Java conducted by a WHO team at the request of the Government. He also helped in the preparation of a project document for UNDP assistance in feasibility studies on rural water supply in East Java.

It is planned to assign a second engineer to assist the Ministry of Public Works and Electric Paver in the planning and development of an urban water supply programne.

Indonesia 0072 Establishment of Health Centres, mMDW1 Province of Irian Jaya (Jan. - April 1970; May 1972 - )

Aim of the project. To develop integrated services in Irian Jaya on a pattern consistent with the facilities and resources available, to co-ordinate projects in Irian Jaya in the health sector, and to advise on the health aspects of other projects.

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

Work done during the year. Assistance was given in the preparation of a draft Proposal for the development of health services in the Province during the second five-year health plan, in the preparation of basic minimum curricula for various categories of staff in the health centres and in the conduct of three upgrading courses in public health nursing. An upgrading course in health planning for regency and health centre medical officers was also organized to enable them and their staff to prepare health plans for one and Five-year periods. A draft summary description and proposals concerning further technical and pre-investment requirements in Irian Jaya were drawn up.

Indonesia 0074 Nursing and Midwifery Education R (June 1967; Aug. 1967; Jan. - Dec. 1969; April 1970 - )

Aim of the project. To strengthen and further develop nursing and midwifery education.

Assistance provided by WHO during the year. (a) A nurse educator; (b) three eleven- month fellowships for study in New Zealand; (c) supplies and equipment. SEA/RC26/2 Page 132

Probable duration of assistance. Until 1976.

Work done during the year. Various educational programmes were conducted or assisted during the year. At Cilandak, forty-three participants from twelve areas of the country were enrolled in a twelve-month programe to prepare them as teachers in auxiliary nurse-midwifery and nursing schools. The curriculum lays particular emphasis on student learning experiences, especially in the community end with fami- lies. This programme has been assisted by UNICEF and UNFPA.

Among the other programmes were: (1) a three-week course in ward administration for eighteen nurses and six midwives; (2) a two-week course on "Educational Technology" for twenty-five health staff in key positions in education at the central or provincial level; (3) a course on "Teaching Methodology" for twenty-five nurses; (4) a one-month course on "Teaching Public Health Nursing" for twenty-three nurses and midwives, and (5) a course on "Training Aspects of Human Reproduction" (conducted under project Indonesia 0112) for doctors, nurses and midwives. The possibility of holding a seminar on "Building health through comnunity participation and paramedical training" was discussed.

A draft plan of action for auxiliary nurse-midwifery training, which will be assisted by IBRD, was prepared. The WHO nurse educator visited Udjung Pandang, South Sulavesi, to plan for the teacher training programme; she also explored possibilities of forming teams of nurse teacher trainees and social workers and of having some joint theory sessions. She attended the training programme for senior WHO staff on health aspects of family planning and population dynamics, held in Alexandria in October 1972. A draft plan of operation for the project was prepared.

Indonesia 0076 Malaria Control, Irian Jaya FUN DW I (Jan. 1970 - )

Aim of the project. To control malaria in Irian Jaya.

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

Indonesia 0078 Health Education Ln DP (Aug. - Sept. 1968; July - Sept. 1969; July - Sept. 1970; - )

Aim of the project. To strengthen health education services.

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

Indonesia 0079 Dental Health R (Jan. - April 1968; July 1969; Aug. 1970 - Feb. 1971; UNDP Aug. 1971 - Jan. 1972; Nov. 1972 - April 1973; - )

Aim of the project. To develop further teaching and training programs for professional and auxiliary dental personnel, to expand dental health services within the framework of comprehensive health services, and to explore the feasibility of establishing water fluoridation schemes.

Assistance provided by WHO during the year. (a) Three consultants; (b) a twelve- month fellowship for study in Australia; (c) supplies and equipment.

Work done during the year. During Noverher 1972-February 1973 a consultant on dental jurisprudence was assigned to the project. In his report, which has been sent to the Government,he has proposed a basic dental law relating to the delivery of dental care. The proposed law would include the relevant existing laws,definition of dentistry and of dentists, procedures for disciplinary enquiries, and measures for more effective implementation of existing laws. It would also cover measures to improve dental education. SEAlRC2612 Page 133

The second consultant assigned to the project, who was in position during January-March 1973, assisted the dental schools and dental auxiliary training institutions in defining and formulating teaching objectives for the development of a community-oriented curriculum in dentistry. In his report, he has outlined recommendations for the gradual establishment of a service centre for the dental education system, the establishment of dental institutes consisting of inter- related departments or disciplines, and the supply of selected educational literature to the schools. His report has also been sent to the Government.

In May, a further consultant took up a six-month assignment to assist,among other things, in the development of a community-oriented curriculum in periodontology and in planning a dental survey.

Indonesia 0081 Smallpox Eradication R (Dec. 1967 - )

Aim of the project. To eradicate smallpox.

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

Probable duration of assistance. Until 1975

Work done during the year. No smallpox cases were reported from Indonesia during the period 1 July 1972 - 30 June 1973, the last cases being notified from West Java in January 1972. The 998 desas infected in the country during 1970-71-72 were visited, an active search for cases being also carried out in a further 327 non- infected desas chosen on epidemiological grounds. Specimens, collected from suspect cases of smallpox throughout the country, were examined in Bio Farma Laboratory, Bandung, and the Central Public Health Laboratory, Djakarta, and in WHO reference laboratories. The Organization continued to provide assistance to the two national laboratories as well as to the local production of vaccine, and a NHO consultant visited the Bio Farma smallpox vaccine production unit in December 1972.

Following the main decisions taken during the WHO-assisted national smallpox seminar held in Bandung in September 1972, smallpox surveillance activities, which will finally cover all the provinces, were initiated. A new surveillance programme, whereby local heads of desas are requested to send in a signed statement of "no smallpox in my area" following a month's search, enquiry, and check of suspect cases (by national staff), was begun. During the explanatory meetings held at different levels and organized by national, provincial and WHO staff, recognition cards and other material were distributed in those areas where the programme had started, as well as WHO "awareness" posters overprinted in 13 dialects, announcing awards not only to the person reporting a confirmed smallpox case but also to the health worker who has first investigated the case.

Routine smallpox vaccination was continued throughout the country with the exception of Bali and Java islands. Primary vaccination was administered to children in the age group 0-6 years and revaccination in the age group 12-13 years. In Bali and Java islands a programme for the simultaneous vaccination of smallpox and BCG vaccines was carried out. A trial of BCG vaccination with the bifurcated needle was initiated in Surabaya.

A vaccination field trial using smallpox vaccine produced in tissue culture was carried out in Lombok Island during May-June 1973.

Indonesia 0083 Vaccine and Sera Production UNDP (Dec. 1968: Jan. 1969: March 1970: Oct. - UNICEF Dec. 1970; Nov. 1971; Feb. 1973; - ) Aim of the Project. To improve methods of producing bacterial and viral vaccines, anti-toxins and toxoids; also to d~velopcapability for the quality control of vaccines and sera. SEA/RC26/2 Page 134

Assistance provided by WHO during the year. (a) A three-month fellowship for studies in the Netherlands, Yugoslavia and Denmark; (b) supplies and equipment.

Indonesia 0084 -, FUNDWI Province of Irian Jaya (Jan. - March 1970; April 1971 - April 1973)

Aim of the project. To strengthen and develop nursinglmidwifery service and education in Irian Jaya.

Assistance provided by WHO during the year. (a) A nurse educator/administrator; (b) two eleven-month fellowships for Study in New Zealand; (c) supplies and equipment.

Work done. The activities began early in 1970, when a WHO nurse consultant was assigned to collect first-hand information relating to nursing practice and educational programmes. He made recommendations for the strengthening and development of the nursing services and education programmes in the Province.

In April 1971, a WHO nurse educatorladministrator was assigned to the project and made long-range planning for the direct assistance to be provided to teaching centres and service institutions.

Translation of all syllabi being used in nursing and midwifery education in Irian Jaya was completed, and the syllabi were revised subsequently.

The WHO nurse educator/administrator assisted with the planning and conduct of a number of in-service and short course training programmes, including public health orientation courses for newly graduated midwives.

A nursing manpower survey was completed. As the data collected were limited, it was not possible to make accurate projections for future expansion of nursing services in the Province of Irian Jaya. In comparison with the 1971 survey, a rmrked increase was noted in all categories of nursing/midwifery personnel, particularly in the numbers of auxiliary staff. This increase may be due to new graduates as well as inclusion of staff not previously counted. The ratio of professional to auxiliary staff is still too low to provide quality nursing care. There is also an uneven distribution between coastal and highland areas and major centres and peripheral regions. The overall situation regarding midwifery personnel is very un- satisfactory. Only three nurses undertook midwifery training at the Jajapura School of Midwifery. Few women apply for training and there is a high attrition rate, primarily because of marriage.

The syllabus for the training of auxiliary nurse-midwives was re-written and translated into Bahasa Indonesia. A master plan for the nursing component of the four-year nurse-midwifery programme was prepared.

One nurse returned to the Province after completing a twelve-month fellowship at the WHO-sponsored Training Centre for Nurses, Wellington, New Zealand, and another joined the Centre in 1973.

The WHO nurse educatorladministrator left the project in March 1973 on completion of his assignment; his report has been sent to the Government.

Indonesia 0086 Strengthening of National Health Services R (Feb. - March 1969; May 1969 - ) UNICEF Aim of the project. To programme, co-ordinate and integrate health services; ta standardize and intensify training activities for health staff, and to promote SEA/RC26/2 Page 135

reviews of ~ublichealth practice and organization intended to lead to the optimum delivery of health care.

Assistance provided by WHO during the year. (a) A public health administrator, a medical officer, a nurse administrator, a statistician, a health educator, a systems analyst, a nurse educator, a sanitarian, a secretarial assistant and four consultants; (b) two twelve-month fellowships - one for study in the United Kingdom and one for study in the United States of America; (c) supplies and equipment.

Probable duration of assistance. Some years.

Work done during the year. The composition of the team under the project underwent a change during the year, in that it was decided to replace the public health nurse administrator and health educator by a systems analyst and a management expert. The systems analyst joined the project in May 1973 and the management expert was expected later in 1973.

Assistance was provided in the preparation of the second five-year health plan. Help was also given in the preparation of a manual for health centre staff; in planning a course for provincial medical officers in charge of health planning; in planning a study to evaluate teacher training in school health, and in collecting basic data on school health programmes. Assistance was given in the conduct of: (1) a one-week workshop on community and family health team, (2) a course for the upgrading of health centre medical officers (held at the Cilandak National Training Centre), (3) an upgrading course for nurse-midwife teachers; (4) a course in health atatistics for provincial health officials, and (5) workshops on the project systems analysis methodology. A team of senior staff members from WHO Headquarters and the Regional Office visited Indonesia early in 1973 to review the programme for the strengthening of health services and research and development facility.

Two consultants were assigned to the project during the year - one to write the study protocol of research projects in public health practice, and the other for the planning, conduct and evaluation of a workshop on health management. A senior public health administrator (consultant) and a management expert from the Regional Office advised on the re-organization and strengthening of the health service structure and the development of the Bureau of Health Planning. Assistance was also provided to the cholera vaccine trial, the household morbidity survey and the health service utilization survey.

Indonesia 0087 Rehabilitation of Hospitals and Polyclinics, FUNDWI Province of Irian Jaya (Dec. 1970; July 1971; - )

Aim of the project. To survey existing facilities in hospitals and polyclinics; to train national staff in hospital administration and in selected fields of community health services; to provide supplies and equipment for the upgrading of hospitals and polyclinics.

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

Indonesia 0089 Public Health Laboratory, Province FUNDWI of Irian Jaya (April - May 1971; Oct. 1971; Sept. 1972; -

Aim of the project. To organize the Public Health Laboratory at Jajapura and to train laboratory personnel.

Assistance provided by WHO during the year. A twelve-month fellowship for study in Australia (extension). SEA/RC26/2 Page 136

Indonesia 0091 Strengthening of Epidemiological Services R (June 1969 - )

Aim of the praiect. To develop epidemiological units at bath central and inter- mediate levels and to train staff.

Assistance provided by WHO during the year. (a) Two consultants; (b) four twelve- month fellowships - three for study in the United States of America and one for studies in Australia, East Guinea and Thailand; (c) supplies and equipment.

Probable duration of assistance. Some years.

Work done during the year. A WHO consultant assisted the Government in reviewing the filariasis problem in the country and drew up proposals for organizing a filariasis control programme as a part of the general health services. His report has been sent to the Government.

A further consultant, assigned in April-May 1973, advised on the clinical aspects of dengue/haemorrhagic fever. Her recommendations have been sent to the Government.

Efforts were made to recruit an epidemiologist; he was expected to Join the project later in 1973. It was also planned to provide a consultant to assist in an evaluation of the problem of schistosomiasis.

Indonesia 0097 Post-graduate Education in Public Health (Jan. - Feb. 1972; July - Aug. 1972; March 1973; - )

Aim of the protect. To develop further the teaching and training programmes conducted by the School of Public Health, University of Indonesia.

Assistance provided by WHO during the year. (a) A consultant; (b) ten ten-month fellowships for study in Indonesia (MPH course in public health); (c) supplies and equipment.

Probable duration of assistance. Until 1977.

Work done during the year. During July-August 1972, a WHO consultant in public health visited Indonesia and took part in studies, and also held discussions with the Government, the Consortium of Medical Sciences and other interested agencies, with regard to the development of the School of Public Health, University of Indonesia, Djakarta. His report on this assignment has been sent to the Government.

Steps are being taken to recruit a team of three short-term consultants to assist in developing the School.

Indonesia 0098 National Institute oE Medical Research R (June 1972; Aug. 1972; Nov. 1972; Jan. 1973; - )

Aim of the project. To assist in the design, organization and analysis of bio- medical studies.

Assistance provided by WHO durin~the year. (a) Two fellowships - one for three months and one for twelve months - for study in the United States of America, a

three-month fellowship for studies in the United Kingdom. Kenya,. ~ Malawi and Tanzania, and a six-month fellowship for studies in Thailand. Burma, India and Sri Lanka; (b) supplies and equipment.

Probable duration of assistance. Until 1975. SEA/RC26/2 Page 137

Indonesia 0099 Plague Epidemiology R (Nov. 1969 - Feb. 1970; March 1971; Jan. 1972 - )

Aim of the project. To study factors responsible for the persistence of plague.

Assistance provided by WHO during the year. (a) A scientist (animal ecologist) and a consultant, and temporary assistance from a staff member from Headquarters; (b) supplies and equipment.

Probable duration of assistance. Until 1974.

Work done during the year. The project activities developed according to plan. Several isolations from rodents and fleas, suspected to be Y. pestis, have been sent to the Haffkine Institute, Bombay, for further studies.

A WHO consultant assisted the project in the identification of species of rodents captured in the project area. In his report on the assignment, which was carried out during March-April 1973, the consultant has made detailed recommendations concerning the experimental studies (phase 3) to be undertaken in 1974. His report has been sent to the Government.

Towards the end of 1972 a staff member from WHO Headquarters assisted the project in the preparation, for computer processing, of data collected during the development of the programme. It is planned to have, at the end of 1973, a general review of the results obtained in order to decide on the continuation of the project and any change in its objectives.

Indonesia 0100 Veterinary Public Health R (Nov. 1971 - Jan. 1972; June 1973 - )

Aim of the project. To study major zoonoses and to train veterinary public health officers.

Assistance provided by WHO during the year. A consultant.

Probable duration of assistance. A number of years.

Work done during the year. In June 1973, a consultant took up a three-month assignment to assist in strengthening the national veterinary public health programme, and in particular to advise on the planning, organization and evaluation of zoonoses control activities. He was also expected to study the hygienic and health aspects of the production, distribution and consumptlon of foods of animal origin.

Indonesia 0105 Development of the National Institute of UNDP Occupational Health, Djakarta .and Regional Centres (April. - May 1970: Sept. 1970 - Jan. 1971; March 1973; - )

Aim of the project. To develop further the National Institute of Occupational Health, Djakarta,and the regional centres.

Assistance provided by WHO during the year. Temporary assistance from a staff member from Headquarters.

Work done during the year. The draft request for submission to the UNDP for assistance in the development of the National Institute of Occupational Health, Djakarta, and the regional centres was revised as a result of discussions with the concerned authorities in Indonesia. Copies of the draft were sent to the concerned ministries SEA/RC26/2 Page 138

and the United Nations agencies. The revised draft request was later amended and forwarded to UNDP Headquarters for consideration and approval.

The Chief of the Occupational Health Unit from WHO Headquarters visited the project during March 1973 for discussions with the national authorities concerning the above draft request. As desired by the Government, the draft request was re- written.

Indonesia 0107 Establishment of Cytology Services and Traininp UNFPA (Sept. - Nov. 1970: Dec. 1971; May 1972; Aug. 1972;

Aim of the project. To establish laboratory services for cytology as part of the national family planning programme.

Assistance provided by WHO during the year. (a) Two consultants; (b) three twelve- month fellowships for study in Australia; (c) cost of attendance of participants in the seminar (see below); (d) supplies and equipment.

Probable duration of assistance. Until 1975.

Work done during the year. Two consultants, one in cytopathology and another in cytotechnology, assisted in the conduct of a national workshop held in Djakarta on 12 and 13 February to consider the question of co-ordination in the establishment of cytological services and the training of cytotechnicians in Indonesia. The workshop recommended training abroad of cytopathologists and senior cytotechnicians., cytotechnicians in Djakarta and establishment of facilities for cytological services in eleven university hospitals.

The consultant in cytotechnology prepared time schedules for the training of cytopathologists and cytotechnicians. He also visited and surveyed the laboratories in Djakarta and Bandung and prepared a comprehensive list of supplies and equipment required for the project. His report and that of the consultant in cytapatholagy were sent to the Government.

The first course for training of cytotechnicians was conducted in Djakarta in May 1973. Supplies and equipment were made available to the training centre and also for some of the hospitals to establish cytological services.

Indonesia 0112 Course on the Health Aspects of Human UNFPA Reproduction (Jan. 1971 - )

Aim of the project. To strengthen family health services as an integral part of the general health services; to prepare staff for teaching and organizational responsibilities.

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

Indonesia 0113 Family Health Services UNFPA (Aug. - Oct. 1970; May 1971; Dec. 1971; April 1972 - )

Aim of the project. To plan, organize and manage maternal and child health and family planning activities as a regular function of the health services; to undertake operational studies of patterns of integrated services.

Assistance provided by WHO during the year. (a) A medical officer; (b) a twelve- month fellowship for study in India and a six-week fellowship for studies in Australia and New Zealand; (c) supplies and equipment. SEA/RC26/2 Page 139

Work done during the year. While inventories of the 26 hospitals included in this year's phase of the national post-partum programme are complete, the search for an agreed plan of action continues.

The WHO medical officer assisted in conducting the national training course on the "Planning and Evaluation of Family Planning Programmes with Special Reference to the Integration of Family Planning and Community Health Services" (Indonesia 0112), held in Novemher/December 1972. Assistance was also given to the Ministry of Health in preparing field manuals in maternal and child health care,in formulating the next five-year health plan and to a training course for nurse-midwives and tutors.

Indonesia 0114 Strengthening of the Teaching of Human Reproduction, UNFPA Family Planning and Population Dynamics in Medical Schools (Jan. 1971 - )

Aim of the project. To strengthen the teaching of human reproduction, family planning and population dynamics in medical schools by the development of educational objectives from knowledge of service needs and resources and through inter-departmental co-ordination and development of field training areas.

Assistance provided by WHO during the year. (a) Two medical educators and two consultants; (b) three six-month fellowships for study in India, a twelve-month fellowship for study in the United States of America. a twelve-month fellowshio for study in Thailand, and a twelve-month fellowship for study in New Zealand; (c) cost of attendance of participants; (d) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. A National workshop on Community and Family Health for Health Teams was held at Medan from 20 to 29 November 1972 for 41 participants from different medical schools in the country. WHO provided two short-term consultants and two temporary advisers.

A visiting professor in community and family health for the University of North Sumatra Medical School, Medan, was selected and was expected to be in position later in 1973.

The WHO medical educator in obstetrics and gynaecology left in March 1973 on completion of his assignment; his report has been sent to the Government.

Indonesia 0115 Assistance to Libraries for Health Personnel UN FP A (June - Sept. 1971; Nov. 1972; - )

Aim of the project. To establish lending and reference libraries for health personnel on subjects related to family health.

Assistance provided by WHO during the year. (a) An eleven-month fellmship for study in New Zealand; (b) supplies and equipment.

Indonesia 0116 Radiation Health R (June 1972; - )

Aim of the project. To develop a film badge monitoring service.

Assistance provided by WHO during the year. Supplies and equipment. SEA/RC26/2 Page 140

Indonesia 0119 Resources for Familv Health UNFPA (July - Sept. 1971; Sept. 1972 - )

Aim of the project. To take a census of health manpower, to make an inventory of health and training facilities, and to develop and bring up to date a records system.

Assistance provided by WHO durin~the year. (a) A statistician; (b) supplies and equipment.

Work done durin~the year. A plan of operation for the project was finalized. A statistician joined the project in early September 1972 to advise and assist the Government with a census of health manpower and an inventory of health and training facilities in preparation for the establishment of a permanent health resource information system based on recording and routine reporting required for national health planning.

An eight-member committee was formed by the Government under a ministerial decree to assist in the planning and development of the health manpower and resources studies to be carried out under the project. Final approval of a study design was obtained in October 1972.

The statistician assisted in the design of forms containing some modifications to the ones proposed previously by a WHO consultant and helped in the preparation of a study protocol, working manual and code instructions for the field operations. A pilot study was conducted in one municipality and a few regencies. The results of the pilot study were compared with those of the previous exercise conducted in the same area in 1971 and necessary alterations were made in the forms and in the collection procedures.

Field surveys oE health manpower covered West Java, Central Java, Jogjakarta and East Java.

A two-month training course for statistical personnel from Djakarta and some provincial statistical officers connected with the project was conducted by the Ministry of Health.

Action was taken to supply data processing and other equipment required for the project.

Indonesia 0120 Health Education (Behavioural Studies) UNFPA (July - Sept. 1971; June - Sept. 1972)

Aim of the project. To promote family health through behavioural changes.

Assistance provided by WHO durin~the year. (a) Two consultants; (b) a twelve- month fellowship for study in the United States of America.

Work done. A team of two consultants (the same which was provided in 1971) joined the project in June 1972 to assist the Government in reviewing the progress made in the implementation of their earlier recommendations and also to help in the assessment of work undertaken with regard to four studies started in 1971 and six more initiated in the first quarter of 1972.

The team completed its assignment in the middle of September 1972. Its main recommendations included the provision of a long-term WHO health education specialist to the National Health Research Institute (LRKN) and the need for research funds to be part of the Health Ministry's health education budget for REPELITA 11, and were also concerned with programme implementation and the evaluation of educational approaches. SEA/RC26/2 Page 141

The report of the consultants, which was forwarded to the Government, was under consideration by the authorities.

Funds for starting the study at Gadjah Mada University were released.

Since the beginning of 1973, the activities of this project have been merged with those of Indonesia 0121, "Development of Health Education in Family Health".

Indonesia 0121 Development of Health Education in UNFPA Family Health (Aug. - Nov. 1971; Jan. 1973 - )

Aim of the project. To develop health education in family health, including services, manpower development, training, studies, media and methods and other components such as school health and family life education.

Assistance provided by WHO during the year. A health education specialist.

Probable duration of assistance. Until 1977.

Work done during the year. Since 1 January 1973, all the three UNFPA-assisted family health education projects in the country, i.e., Indonesia 0120, Indonesia 0121 and Indonesia 0122, have been merged into one project. "Development of Health Education in Family Health".

The Government has taken action to implement the recommendations made by the WHO consultant provided in 1971.

The health education specialist assisted in planning, conducting and evaluating the work-experience for the student licalth education specialists after they had completed the basic orientation course. The work-experience was provided in four rural and four urban health centres in West Java and the students successfully completed the fourth and final phase. As part of their training, they organized eight workshops for the health centre and community leaders. In accordance with plans, 18 candidates were selected for the second basic orientation course,which started in March 1973. The field data collected by the students and the experience gained in health education work in the field experience area have been of great value in planning this second course. The Government has requested assistance under the project for the development of manpower in special areas of audio-visual media.

The health education specialist also assisted in organizing and conducting a two-week workshop far health education staff of provincial health dzpartments, held during the first quarter af 1973. Assistance was provided in pre-testing the draft chapter on health education far the manual for health centres currently being developed by the Ministry of Health.

Indonesia 0122 Health Education in Family Planning UNFPA Teaching Programme (Aug. - Dec. 1972)

Aim of the project. Ta strengthen the health education component in teaching family health.

Assistance provided by WHO during the year. (a) Temporary assistance from the health education specialist attached to the Regional Team an Family Health (SEAR0 0192); (b) supplies and equipment.

Work done during the year. See Indonesia 0121. SEA/RC26/2 Page 142

Indonesia 0126 National Institute of Public Health, R Surabaya (Nov. 1972; - )

Aim of the project. To assist the National Institute of Public Health, Surabaya, in its administration and its operational research into public health practices and family health.

Assistance provided by WHO during the year. Supplies and equipment

Indonesia 0200 Fellowshie R

Nutrition. A ten-month fellowship for studies in India, Burma, Thailand, Malaysia and Singapore. SEAlRC2612 Page 143

5. MALDIVES

PROJECT LIST

Title

Maldives 0005 Public Health Administration R (Oct. 1959 - )

Aim of the project. To develop comprehensive health services, to train personnel, and to strengthen the medical care services.

Assistance provided by WHO during the year. (a) A medical officer, a sanitarian and a laboratory technician; (h) two three-month fellowships (one an extension) for study in Sri Lanka; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. A WHO medical officer took up duties in February 1973. Assistance was given to the Government in the strengthening of health services, in the control of communicable diseases and in the preparation of plans for a two-year course for male and female auxiliary health workers. Activities such as BCG vaccination of children and filariasis mass blood film surveys were continued, as was work on the detection and treatment of cases of leprosy.

One of the Regional Advisers on Communicable Diseases visited the Maldives in January-February 1973 together with the WHO Representative in Colombo in order to get acquainted with the activities of the health services in the field of comunicable diseases and to ascertain the epidemiological situation in the country.

Maldives 0007 Water Supply and Sanitation R (April 1971 - )

Aim of the project. To develop water supply and sewage disposal systems for Male and an environmental sanitation programme; to train staff.

Assistance provided by WHO during the year. (a) Two twelve-month fellowships for study in India; (h) supplies and equipment.

Probable duration of assistance. Until the end of 1976.

Maldives 0009 Training of Auxiliary Health Personnel UNDP (Nov. 1971; Sept. 1972 - )

Aim of the project. To establish a school for the training of auxiliary health personnel.

Assistance provided by WHO during the year. (a) A public health nurse educator and a consultant; (h) supplies and equipment.

Work done during the year. Assistance was given by the assignment of a short-term consultant to advise the Government on the various aspects of the training of auxiliary health personnel and to draft a syllabus. The consultant, who was in the Maldives from January to April, also carried out a nutritional and maternal and child health survey. Her report was being processed in the Regional Office. SEA/RC26/2 Page 144

A WHO public health nurse educator has been in position since October 1972; she assisted in drafting a 8yllabus for the course for auxiliary nurse-midwives.

Maldives 0010 Malaria Control R (Jan. 1972 - )

Aim of the proiect. To eliminate malaria in progressive stages and to prevent its recurrence,and to develop and integrate malaria eradication programs within the general health services.

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

Probable duration of assistance. Some years.

Work done during the year. By the begiming of 1973, a population of 75 000 (63%) out of 119 000 inhabiting 11 of the 19 atolls of the Maldives had been protected by the residual spraying of DDT at least once: it is planned to undertake spraying in four further atolls during the year.

During 1972, a total of 348 positive cases (349 in 1971) were detected, out of which 255 were from Male Island, one from Kaaf Atoll and 92 from the other sprayed atolls. The species distribution was 126 (36.2%) P. falcipanun, 170 (48.9%) P.!Jium, 41 (11.8%) P.maZariae and 11 (3.1%) mixed. No indigenous cases were found in any of the sprayed atolls during the year.

Routine entomological surveys in Male continued and no anophelines, adults or larvae, were found. Anopheline adults and larvae of A. tessaZatus were found in some islands of Raa Atoll early this year during the survey.

The non-availability of sea-going transport continued to be a problem.

Maldives 0200 Fellowships R

>. >. Four two-month fellowships for study in the Philippines. S~A/Rc26/2 Page 145

6. MONGOLIA

PROJECT LIST

Project No. Sourcef Funds Co-operating Agencies -Title

Mongolia 0001 Strengthening of Health Services (Epidemiology) R (July 1963 - Dec. 1972)

Aim of the project. To undertake epidemiological surveys of prevailing communicable diseases in order to plan practical control measures; to advise on the use of epidemiological methods, and to train personnel.

Assistance provided by WHO during the year. (a) A laboratory technician and a consultant; (b) two fellowshi~s- one for five months and one for ten months - for studies in the USSR and czechosiovakia, a six-month fellowship for studies in the USSR and Hungary, and an eight-month fellowship for studies in Czechoslovakia, Hungary and the USSR; (c) supplies and equipment.

Work done. The WHO epidemiologist and the WHO laboratory technician who had been assisting the project since 1970 completed their assignments towards the end of 1972.

The project has shown satisfactory results. A number of staff have been trained in epidemiology and the control of comnunicable diseases. A national immunization programe covering smallpox, poliomyelitis, diphtheria, tetanus and pertussis has been developed and is being implemented through the maternal and child health services. A multi-purpose serological survey was carried out in the country with the assistance of the WHO Serum Reference Bank, Prague, which enabled the recognition of susceptible groups of children to various diseases, and these groups were immunized.

A field trial with measles vaccine, to assess the feasibility of launching a nation-wide programme of measles immunization, was carried out. A WHO consultant was assigned to the project from July to December 1972 to assist with the trial. He helped in the further development of the epidemiological services and with the training of national staff in the techniques of controlled field trials. In his report, which has been sent to the Government, the consultant has made detailed recomendations for the improvement of epidemiological services and for the organization of vaccinations among the child population.

It is expected that the Government will take steps to provide sufficient quantities of measles vaccine and organize a national pragrame far the imunizatian of susceptible groups among children as well as provide vaccine and logistic support to the systematic routine immunization of the newborn in the future.

Since 1973, assistance to this project is being provided through Mongolia 0018, "Epidemiological Services and Surveillance".

Mongolia 0002 Public Health Laboratory Services UNDP (May - Aug. 1964; Dec. 1964; Aug. 1965; Oct. 1966 - Sept. 1968; LWICEF Jan. 1969; May 1969; Sept. - Oct. 1969; Feb. 1970 - )

Aim of the project. To strengthen health laboratory services and to train personnel in medical laboratory technology. SEA/RC26/2 Page 146

Assistance provided by WHO during the year. (a) A microbiologist and a laboratory technician; (b) a six-month fellowship for studies in Bulgaria and the USSR; (c) supplies and equipment.

Proba6le duration of assistance. A number of years.

Work done during the year. The WHO technician completed her assignment in December 1972 and the WHO microbiologist in April 1973. The assignment report of the laboratory technician has been sent to the Government and that of the microbiologist was being processed.

The project document was revised, and consultants were being recruited to assist in upgrading clinical chemistry, sanitary chemistry, haematology and virology in the health laboratory set-up.

The bacteriological laboratory started its work as a Republican Central Labora- tory. The department of air-borne infections increased its activity, and new departments an enteric diseases and for the preparation of culture media were established. A two-month course for raising the professional qualification of bacteriologists was started. The staff of the laboratory held consultations with some aimak laboratories and carried out special examinations of 1 348 people for brucellosis in Gobi-Altaj Aimak. An orientation course on the diagnosis of streptococcal infections was organized for bacteriologists from Ulan Bator. Work with staphylococci and shigella phages was introduced into the laboratory of the Institute of Hygiene, Epidemiology and Microbiology (IHEM) and the Medical Institute.

The Central Bacteriological Laboratory of Ulan Bator moved into a new and spacious building and continued to serve the city medical institutions. The departments of sanitary bacteriology and hygiene chemistry were established in the IHEM.

In 1972, the Central Clinical Bacteriological Laboratory undertook 10 737 bio- chemical investigations (five different tests), 48 515 clinical analyees (five tests) and 1 751 bacteriological investigations of 1 376 patients.

The Central Tuberculosis Laboratory received some new (additional) rooms and extended its activities. Much attention was paid to the integration of the work of aimak and somon laboratories. The WHO microbiologist, together with the national authorities, visited seven aimak centres. All the aimak laboratories visited by the microbiologist have been more active since the attendance of their bacteriologists and biochemists at the two-month advanced courses. Attention was also paid to the training of the laboratory staff. The programme for the students of the Medical Technicm was revised and modernized. The laboratory classes of this techni- cum received additional rooms and the teaching staff has been increased (1 microbiologist and 1 laborant).

The Government decided to change the orientation of the project with emphasis on the clinical aspects.

Equipment received from UNICEF and WHO was distributed.

The problems of organization and work of public health laboratories were discussed at a meeting of the chiefs of health services from all aimaks.

Mongolia 0003 Tuberculosis Control UNDP (Dec. 1963 - Jan. 1964; Aug. 1965 - )

Aim of the project. To study the epidemiology of tuberculosis and to organize a national control programme.

Assistance provided by WHO during the year. (a) A consultant; (b) a Lour-month fellowship for studies in the USSR and Czechoslovakia; (r) supplies and equipment. SEAlRC2612 Page 147

Work done during the year. The Regional Training and Evaluation Team (SEAR0 0113), with the assistance of national staff, carried out an assessment of the national tuberculosis control prograuane in the latter half of 1972. The findings of the joint assessment team revealed that BCG vaccination had been carried out successfully and also that satisfactory results had been achieved in other components of the programme such as case-finding, treatment and health education. However, it was found that there was still room for improvement, particularly in regard to laboratory and statistical work, and the team has submitted recowendations in this connection. The report on the assessment has been sent to the Government.

At the request of the Government, a WHO consultant (specialist in pneumology) was assigned during October-December 1972 to advise the Government on the gradual conversion of the tuberculosis control programme into a national chest diseases programe (including tuberculosis).

Monnolia 0004 Maternal and Child Health Services UNDP (June - Sept. 1965; Nov. 1966; July 1967 - ) UNICEF

Aim of the project. To develop maternal and child health services and to establish referral services.

Assistance provided by WHO during the year. (a) A maternal and child health officer; (b) three fellowships - two for six months and one for eight months - for studies in the USSR and Bulgaria, and two fellowships - one for eight months and one for seven months - for study in the USSR; (c) supplies and equipment.

Probable duration of assistance. Some years.

Work done during the year. A review of the progress made in the maternal and child health programme was undertaen by a WHO consultant (paediatrician) assigned to the project from November 1972 to May 1973. In addition, with the assistance of the national counterparts, draft annual plans of action for the project for the period 1973 to 1975 were prepared.

Mongolia 0005 Environmental Health (Cornunity Water Supply) UNDP (June 1966 - May 1968; Sept. 1968; Sept. 1969 - Jan. 1970; March - May 1972; - )

Aim of the project. To assist in the development of water supply and sanitation, particularly in rural areas.

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

Probable duration of assistance. A number of years.

Aug. - Nov. 1972;

Aim of the project. To develop further and improve medical education.

Assistance provided by WHO during the year. (a) A project co-ordinator and a consultant; (b) six one-month fellowships for studies in the USSR, Denmark, United Kingdom and Yugoslovia, a ten-month fellowship for studies in the USSR and Romania, and two six-month fellowships - one for studies in the USSR and Hungary and one for studies in the USSR and Poland; (c) supplies and equipment.

Probable duration of assistance. A number of years. SEA/RC26/2 Page 148

Work done during the year. A project co-ordinator has been in position since January 1973. He has developed a work plan for the large-scale UNDP project which is under consideration at UNDP Headquarters, and is also preparing lists of equipment in collaboration with his national counterparts.

A WHO consultant undertook an assignment during September-November 1972 to assist with the teaching of microbiology. He has recommended continuous laboratory work in order to maintain the new capacity for the identification of streptococcal infections and has outlined the scope of this work. His report, which has been sent to the Government, also includes recommendations on the teaching of microbiology and epidemiology.

Two short-term consultants to assist the Ulan Bator Medical College were under recruitment.

Mongolia 0007 Health Statistics R (Aug. - Sept. 1967; Sept. 1968; Jan. - Sept. 1969; Jan. 1970: April - July 1971; April - July 1972; Sept. 1972; ~eh.- ~~ri11973; )

Aim of the project. To develop health statistical services and to train personnel.

Assistance provided by WHO during the year. (a) A consultant; (b) three fellowships - two for three and a half months and one for five months - for study in Czechoslovakia. and a three-month fellowship for studies in Czechoslovakia and the USSR; (c) supplies and equipment.

Probable duration of assistance. Until 1975.

Work done during the year. The consultant who had previously assisted this project in 1971 and 1972 was again assigned for a period of one month during March - April 1973 to advise on the further strengthening of the Statistical Unit in the Depart- ment of Planning and Statistics of the Ministry of Public Health.

The same consultant was expected to take up a further assignment for a period of two months starting from SeptemberIOctober 1973 to advise on the inter-relationship between the health statistics and general statistics systems in the country as well as health statistics and health planning.

iluring the year twenty calculating machines, an additional sorter and spare parts for the data processing equipment were provided. Action was in hand to procure 36 more calculating machines and another set of spare parts.

Efforts were being made to assign a consultant to assist in the maintenance of the data processing equipment and in the training of the concerned staff. It was expected that he would be able to join the project in September/October 1973.

Mongolia 0008 Nursing Services and Education R (Dec. 1966; June 1968 - ) UNICEF

Aim of the project. To develop schools of nursing; to strengthen existing training programmes for nursing personnel, and to improve nursing services.

Assistance provided by WHO during the year. (a) Two nurse educators; (b) two twelve- month fellowships for study in Poland, a five-month fellowship for study in the USSR, and two two-month fellowships - one for studies in the USSR and Bulgaria and one for studies in the USSR and Poland; (c) supplies and equipment.

Probable duration of assistance. Until 1977. SEA/RC26/2 Page 149

Work done during the year. The need far an organized plan for post-basic education has become more important with the increase in middle medical workers and greater emphasis on improving the quality of health care. During the year, many short courses were held. These included: (1) at Ulan Bator - a nine-month course for local teachers, feldshers and tutor nurses, a one-month course for thirteen nurses in medical-surgical nursing and a similar course far twenty-two nurses; (2) at South Gobi - a ane-month course for nineteen nurses working in paediatric wards and one in medical-surgical nursing for fourteen nurses; (3) at Nalajch, District of Ulan Bator - two one-month courses for thirty-four nurses working in medical and surgical wards as well as in the paediatric department; and (4) at Cecerleg - Arachanaaj Aimak - two courses similar to the ones held in Nalajch.

Many graduates of the Nursing School are now working as teachers in the Schools of Ulan Bator, Darchan, Dornogov and Gov 'Altaj'. They teach nursing subjects and conduct practical training in demonstration rooms and hospitals.

The decision of the Ministries of Education and Public Health that candidates for nursing should have full secondary education was implemented in 1972-1973: only fifty students admitted ta the Ulan Bator school had 8-9 years of general education: the other 372 were fully qualified.

A senior WHO nurse educator returned from study leave to assist with the development of a post-basic education programme. Initially tutor nurses and tutor fcldshers are to be prepared. A second nurse educator is under recruitment, primarily to assist the basic schools of nursing in curriculum revision to help prepare the graduates for the positions to which they are assigned.

A statistical report on health services was published and included data about the various categories of middle medical workers in Mongolia.

Mongolia 0010 Cardiovascular Diseases R (May - June 1967: Julv - Nov.1969: Julv 1970:. Seot.1970:. ~aich- April 1971; bct. - Nov.1971; july - Sept.1972;'- )

Aim of the project. To study the epidemiology of cardiovascular conditions and to advise on prevention and treatment with particular emphasis on streptococcal infections in rheumatism and hypertensive and ischaemic heart disease.

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

Probable duration of assistance. A number of years.

Work done during the year. A WHO consultant visited Mongolia in August to assist with and advise on the further development of the programe of cardiovascular disease control in its scientific, practical and epidemiological aspects, and also to help in the conduct of a national seminar on the prevention of rheumatism.

During July-September 1972, another consultant assisted the cardiological centre in Ulan Bator in organizing training programmes for physicians in the prevention and control of cardiovascular diseases. He also advised on clinical cardiology, organization of cardiovascular services and research. He has recommended, among other things, organization of a pilot study centre for rheumatic fever,co-ordination of all services in diagnosis, treatment and prevention by a research group, development of post-graduate medical education on the problems of cardiovascular diseases, and improvement of diagnostic procedures. The reports of both consultants have been sent to the Government.

Mongolia 0011 Cancer R (May 1968; March - Aug.1969; Aug. - Sept.1970: Nov.1970 - April 1971; March - April 1972; Dec.1972 - Feb.1973; - )

Aim of the project. To study and advise on the epidemiology, early detection and treatment of cancer. SEA/RC26/2 Page 150

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

Probable duration of assistance. A number of years.

Work done during the year. Two consultants visited Mongolia during December 1972 - February 1973 to assess the problem of liver cancer and advise on its prevention and control. They visited the hospitals and laboratories in Ulan Bator and the aimaks, collected data on hepatitis and liver cancer and obtained samples of serum from the population for analysis. The samples were expected to be investigated in Moscow.

Mongolia 0012 Strengthening of Radiological Services and Maintenance R of Electro-medical Equipment* (Nov. 1968 - Feh. 1969; April 1971 - )

Aim of the project. To train technicians to undertake the repair and maintenance of electro-medical equipment; to promote radiation protection practices in health institutions.

Assistance provided by WHO during the year. (a) A technical officer (electro-medical techniques); (b) a four-month fellowship for study in Czechoslovakia; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1976.

Work done during the year. The workshop for the training of technicians in the maintenance and repair of electro-medical equipment was reorganized in the spacious premises provided near the First Teaching Hospital. A laboratory for the demonstration of measurement techniques was established. The training activities progressed satisfactorily. A national seminar on medical techniques, technology and safety measures was conducted. A plan for the development of five peripheral workshops to serve aimak hospitals was approved by the Government, and the activities of these workshops would be co-ordinated and supervised by staff from the control workshop in Ulan Bator.

Mongolia 0013 Brucella Vaccine Production ~INDP (May - July 1970; June - August 1972; Feb. 1973; - )

Aim of the project. To produce freeze-dried BruceZZa vaccine and establish laboratory facilities for its testing.

Assistance provided by WHO during the year. (a) A consultant; (b) two fellowships - one for four months and one for six months - for studies in Iran, United Kingdom and Hunnarv.- ., and a four-month fellows hi^ for studies in Iran and the United Kingdom;. (c) supplies and equipment.

Work done during the year. The project document was awaiting approval by UNDP and the Government.

The starting of the project was delayed as the project manager could not he released by his Government and the microbiologist could not take up the assignment for personal reasons. Efforts continued to recruit a suitable candidate. Meanwhile, the building at Songino was nearing completion and supplies were ordered and received - three national staff members - the project co-manager and two bacteriologists - were being trained abroad.

The WHO epizootiologist who had taken up a short assignment in June 1972 to assist the Government in drawing up a plan of operation for the project, left in August.

A WHO microbiologist was recruited and, after a six-week visit to vaccine laboratories in the United Kingdom and the USSR, was expected to be in position early in September.

*Previous title: Strengthening of Radiological Services SEA/RC26/2 Page 151

Mongolia 0014 Health Education R (Nov. 1970 - March 1971:. Sept.. 1971 - Jan. 1972: UNICEF Sept. 1972; Feb. - May 1973; - )

Aim of the project. To develop and implement a health education programme.

Assistance provided by WHO during the year. (a) A consultant; (b) a ten-week fellowship for studies in the USSR and Czechoslovakia and a three-month fellowshio for studies in the USSR, Bulgaria and the German Democratic ~e~ublic;(c) supplies and equipment.

Probable duration of assistance. Until the end of 1980.

Work done during the year. A WHO consultant assisted the project from February to May 1973 in reviewing the action taken by the Government in implementing the recomendations made by the previous WHO consultant, and also provided assistance in the development of an effective health education component for the maternal and child health programme, including school health. The consultant also drew up proposals for the production of a book meant for health education of parents, entitled "Book for Parents". The Government was examining the proposals. His recornendations have been forwarded to the Government.

Mongolia 0015 Dental Health Services R (Mav - June 1970: Feb. - July 1972:

Aim of the proiect. To strengthen dental health services, particularly the paediatric stomatology services, train dental health personnel and study the feasibility of having a fluoridation programme.

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

Probable duration of assistance. A number of years.

Work done during the year. The consultant in stomatology provided to the Medical Institute, Ulan Bator, in March 1972,completed her assignment in early July 1972. In her report, which has been sent to the Government, she has recommended improvements in the training of stomatologists and introduction of fluoridation of drinking water in Ulan Bator.

A consultant in orthopaedic stomatology was also assigned to the project from December 1972 to May 1973; his report was under study.

Mongolia 0016 Quality Control of Drugs R (Feb. 1971; Sept. - Oct. 1971; - )

Aim of the project. To develop further the manufacture of pharmaceutical products and upgrade the services associated with their quality control, including the training of staff.

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

Probable duration of assistance. Some years.

Mongolia 0017 Integrated Maternal and Child Health Services R (Sept. - Oct. 1971; Feb. 1973; - )

Aim of the project. To develop integrated maternal and child health services and to establish referral facilities. SEA/RC26/2 Page 152

Assistance provided by WHO during the year. Four one-month fellowships for studies in the USSR, Poland and Sweden.

Mongolia 0018 Epidemiological Services and Surveillance R (Jan. 1972; - )

Aim of the project. To develop further epidemiological surveillance of diseases representing major public health problems.

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

Probable duration of assistance. Some years.

Work done during the year. This project was started as a continuation of the activities of Mongolia 0001 but with expansion towards the epidemiological surveillance of various diseases.

A WHO consultant was under recruitment to assist the Government in the conduct of a mass measles vaccination programme, following the trial carried out in 1972 with support from WHO.

Mongolia 0019 Education and Trainin R (March 1973; May 19738 - )

Aim of the project. To train medical professionals in fields of medicine not covered by other projects and to permit attendance at educational meetings.

Assistance ~rovidedby WHO during the year. Two six-month fellowships - one for studies in the USSR and Bulgaria and one for studies in the USSR and Poland.

Mongolia 0022 Community Health Services R (Feb. 1973; - )

Aim of the project. To train physicians in all aspects of cornunity health services; to permit attendance of Mongolian staff at educational meetings.

Assistance provided by WHO during the year. A four-month fellowship for study in the USSR.

Probable duration of assistance. Until 1980.

Rehydration Therapy (Production and Control) (June 1973; - )

Aim of the project. To produce rehydration fluids and train paediatricians in the practice of oral and parenteral rehydration therapy.

Assistance ~rovidedby WHO during the year. Supplies and equipment.

Probable duration of assistance. Until 1977.

Work done during the year. This new project is being developed in continuation of the assistance provided earlier under inter-country project SEAR0 0144. It aims at concentrating the production of intravenous infusion fluids in Ulan Bator, under a rigid quality control programme. With material assistance to be provided by UNICEF in 1973-74 and with technical guidance from WHO, it is estimated that the fluid plant will have a rated maximum capacity of 200 000 units (5 ml each) of infusion fluids s~A/RC26/2 Page 153

per year. Two persons are being trained in Czechoslovakia under the WHO fellowship programme, one in production and one in quality control; action is being taken for the recruitment of a pharmacist and a scientist for the quality control laboratory. A draft plan of operation is under preparation.

Mongolia 0200 Fellowships R

Clinical pathology. A five-manth fellowship for study in the USSR.

Health services management. A twa-month fellowship for studies in the USSR, Hungary and Bulgaria.

Organization and operation of blood transfusion services. Two three-month fellowships for study in Hungary.

Public health administration. Four ten-month fellowships for study in the USSR, and three two-month fellowships for studies in the USSR, Hungary and Bulgaria. s~A/RC26/2 Page 155

7. NEPAL

PROJECT LIST

Project No. Source of Funds Co-operating Agencies -Title

Nepal 0001 Malaria Eradication R (June 1954 - )

Aim of the project. To eradicate malaria.

Assistance provided by WHO during the year. (a) A malariologist, an epidemiologist, three sanitarians, an administrative assistant, a transport assistant and a clerk- stenographer; (b) four two-month fellowships for study in the Philippines and a four-month fellowship for study in Italy; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. The programe continued as planned. Out of a total population of 11.62 million, the malaria eradication programme covers 1.06 million, (17%) under the attack phase and 5.20 million (83.0%) under consolidation. A population of 5.36 million continues to be covered by the available health service structure.

The pilot projects in Kaski and Bara on the integration of malaria into the general health services are continuing.

The proposed WHO assistance for the provision of DDT for the next three years is encouraging for the programe prospects, particularly in view of the reduced budget brought about by the cessation of US AID assistance in 1972.

During 1972, 3 997 positive cases were detected, compared with 2 778 in 1970; 1 930 of these were from consolidation (561 in 1971) and 2 067 (2 217 in 1971) from attack phase areas.

There was an improvement in spraying coverage in the receptive belts of areas in the consolidation phase.

For the first time, P.fa2cipum.m infections not responding to standard chloroquine therapy have been observed in a few cases imported from Nagaland and Assam in India.

Nepal 0002 Nursing Education and Services UNDP (Nov. 1954 - ) UNICEF

Aim of the project. To assist the Directorate of Health Services in co-ordinating nursing activities; to set up a basic nursing school, organize courses for assistant nurse-midwives, upgrade nursing services in Bir Hospital; to improve clinical facilities for student nurses, and develop public health nursing services which will provide practice fields for nursing and assistant nurse-midwife students.

Assistance provided by WHO during the year. A nurse adviser, a nurse educator and a public health nurse.

Probable duration of assistance. Until 1974. SEAlRC2612 Page 156

Work done during the year. Assistance continued to be provided to (I.) the Nursing Section in the Directorate of Health Services, (2) the School of Nursing, Kathmandu, (3) the auxiliary nurse-midwife training programmes at Biratnagar, Bharatpur and Nepalganj, and (4) the development of public health nursing services, particularly where these services provide practice fields for nursing and auxiliary nursing students.

The WHO nurse educator left the project in October 1972 on reassignment. A WHO public health nurse educator joined the project in July 1972 to assist the auxiliary nurse-midwife programme and visited all the three ANM schools.

During the period under review, six nurses attended the public health nursing course in Calcutta and two nurses completed the post-basic B.Sc. progranw in public health nursing, also in India. Four nurses left in January 1973 on WHO fellowships for the one-year course at the WHO-sponsored Training Centre for Nurses, New Zealand.

All training programmes came under the University and Ministry of Education in accordance with the National Education System effective 15 July 1972, and the School of Nursing was renamed as Mahaboudha (Nurses) Campus, Institute of Medicine, Tribhu- van University. The Nursing Superintendent was appointed as campus head. The three ANM schools came under the Institute of Medicine as extension programmes and the three senior tutors were designated as "in-charge".

There was a marked increase in applications for the nursing and the ANM programmes. Admission to all programmes was, however, limited by lack of adequate hostel accamodation and good clinical practice areas in two of the ANM schools. New classes were admitted in 1972 to the three ANM schools - Bharatpur - 20, Nepal- ganj - 17, Biratnagar - 37.

The workbook for ANMs published by WHO was translated into Nepali with financial help from WHO. Copies were distributed to ANM schools.

With the assistance of the WHO public health nurse attached to project Nepal 0021, a revised syllabus for auxiliarv nurse-midwives was vrevared, with emuhasis on an educational programme which would provide more community health experience.

Nepal 0009 Smallpox Eradication R (Feb. 1962 - Dec. 1963; Aug. 1966 - ) UNICEF

Aim of the project. To assist in the national smallpox eradication programme.

Assistance provided by WHO during the year. (a) A public health officer and two operations officers; (b) a two-month fellowship for studies in India, Ethiopia and Afghanistan and a three-month fellowship for studies in India and Ethiopia; (c) supplies and equipment.

Probable duration of assistance. Until 1976.

Work done during the year. In March 1973, Nepal was officialy declared as non-endemic for smallpox. Since 1 July 1972 all outbreaks reported in the country (138 cases) have been due directly or indirectly to importations (mostly from India).

The programme was implemented throughout the country, all the 75 districts being engaged in smallpox activities at present. A new vaccination schedule, whereby vaccination is carried out only during four months, has given excellent results, with a high primary vaccination coverage. Local temporary vaccinators, trained and supervised by senior vaccinators, perform the vaccinations.

During the year under review, surveillance measures were strengthened in a number of ways. Four national surveillance teams, created at the end of 1972, SEA/RCZ6/2 Page 157

functioned in 1973 in many zones. Five training courses on surveillance, assisted by WHO, were given to supervisory staff and members of the national surveillance teams. All district SEP staff, temporary vaccinators, malaria workers and permanent senior vaccinators were involved in surveillance activities; all of them received the new postcard-size recognition card and during their house-to-house visits in the panchayats enquired about smallpox cases or "fever with rash" infections. The notification of cases was improved and the most vulnerable districts, i.e., those in the Terai, are now sending their weekly reports by cable. In order to step up the reporting of cases by the population, awareness posters, overprinted in Nepali, were distributed throughout the country.

A pilot project for the simultaneous administration of BCG and smallpox vaccines was begun in 1973, and pilot projects on integration into the health services have been giving promising results as regards smallpox eradication activities.

Freeze-dried smallpox vaccine continued to be provided through WHO.

Nepal 0010 Health Laboratory Services R (May 1967 - ) UNICEF

Aim of the project. To develop health laboratory services, to support an epidemiological unit, and to train personnel.

Assistance provided by WHO during the year. (a) A laboratory technician; (b) three fellowships - two for twelve months and one for five months - for study in India, and a five-month fellowship for study in Hungary; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. The WHO technical officer completed his two-year assignment in October 1972. The two-year training course for laboratory assistants is now well established under the auspices of Tribhuvan University. The course is being run competently by the national staff of the Central Health Laboratory, Kathmandu. All the 12 trainees who took the final examination in January 1973 came out successful. The technical officer made a number of recommendations to enhance the training programme for laboratory assistants. The Regional Adviser on Health Labora- tories also assessed the situation in January 1973, me recommendations, which have been forwarded to the Government, were as follows: appointment of a review committee for periodic assessment of the course and curriculum development; stabilization of the teaching staff by the appointment of two full-time tutor technicians (B.Sc. graduates in medical technology); the granting of auniversity certificate or diploma to facilitate an upgraded technician training course.

In the light of the importance which is being attached to the development of an integrated health service in rural areas, the new draft addendum to the plan of operation lays emphasis on the organization and functions of a system of rural laboratories. To start with, experience needs to be acquired in the operation of the laboratory component of the integrated health service in the Bara-Kaski pilot area. UNICEF will provide the equipment for upgrading eligible district and zonal laboratories; technical staff qualifying from the laboratory training course of Tribhuvan University will be appointed to the upgraded laboratories; from 1974 a WHO technician will help in organizing the work and in setting forth the functions of district and zonal laboratories which have received UNICEF assistance. A list of standard laboratory equipment and a set of criteria for each of the district and zonal laboratories were prepared for submission to the Government.

Nepal 0013 Leprosy Control R (March 1967; Dec. 1968; Sept. 1969; July 1970; May 1971; Oct. 1972 - Jan. 1973; - ) Aim of the project. To develop leprosy control services and to train health personnel. SEA/RC26/2 Page 158

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

Probable duration of assistance. Some years.

Work done during the year. A WHO consultant visited Nepal during October 1972 - January 1913 and assisted in the following activities: (1) preparation of a national plan for leprosy control services in the country; (2) conduct of two training courses - one for auxiliary health nurses and one for medical officers of a district, and (3) carrying out of an assessment of the leprosy control programme in three main areas of development (in certain areas af Bagmati Zone where a mobile team is undertaking case-finding, and in two districts where pilot prcjects on integrated health programmes are being attempted). His report has been forwarded to the Government.

It is planned to assign a leprosy control officer to the project.

Nepal 0014 Community Ware r Supply R (June 1964 - June 1967; March - May 1968; UNICEF Sept. 1968 - June 1970; Oct. 1970; Sept. 1972; - )

Aim of the project. To plan and co-ordinate the development of comaunity water supplies.

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

Nepal 0016 Tuberculosis Control R (March 1965 - Sept. 1970; April - May 1971; UNICEF Feb. 1972; June - Aug. 1972; Dec. 1972; - )

Aim of the project. To develop a tuberculosis control programe as part of the basic health services, and to train personnel.

Assistance provided by WHO during the year. (a) A consultant; (b) four three-month fellowships - three for study in India and one for studies in Burma, India, Sri Lanka, Singapore and Kenya; (c) supplies and equipment.

Probable duration of assistance. Saw years.

Work done during the year. A review of the activities of the project was undertaken by a WHO consultant during June - August 1972. It is estimated that the prevalence of bacillary tuberculosis in Kathmandu Valley and the Terai region is about 11%, while it is very low in the hilly areas. It is proposed to establish a national tuberculosis program which will he gradually implenented through the existing health services. The consultant has suggested the establishment of four regional tuberculosis control centres in the country.

Ihe report containing the consultant's recommendations has been forwarded to the Government. At the request of the Government, it is planned to assign a WHO medical officer later in 1973.

Nepal 0019 Health Education R (May - Aug. 1967; Sept. 1968; Nov. 1968 - Feb. 1969; UNICEF Sept. 1969: April - May 1970: Julv 1970: Dec. 1970 - ~ai.1971;.~a; 1971; ~;l~- ~ept.~l971;~.Jul~ - Aug. 1972; Dec. 1972; -

Aim of the project. To start health education in the basic health services, special prajects, and in schools and teacher training institutions. SEAlRC2612 Page 159

Assistance provided by WHO during the year. (a) A consultant; (h) a three-month fellowship for studies in Thailand, Malaysia, Singapore and India; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1977

Work done during the year. The same WHO consultant who had assisted the project during 1970 and 1971 was again assigned in July-August 1972. He has recommended, among other things, that (i) a periodic review, revision and modification of the health education curriculum and the teaching units for grades 1 - 10 should he undertaken in accordance with the health needs of the individual and the community, and (ii) the personnel responsible for curriculum development should be health education specialists and educationists with knowledge of curriculum development and possessing teaching skills. His report has been sent to the Government.

At the request of the Government, action was taken to assign a WHO health education specialist to the project from September 1973.

Nepal 0021 Development of Health Services R (Sept. - Nov. 1968; Jan. 1970 - )

Aim of the project. To strengthen the development of the basic health services in conformity with the development plans of the Government, placing particular emphasis on the training of all categories of health workers and eventually leading to the establishment of an integrated comprehensive health care service; to conduct health surveys, health manpower surveys and relevant studies; to co-ordinate associated projects operating in the country.

Assistance provided by WHO during the year. (a) Two medical officers, a public health nurse. a medical records officer and a sanitarian:. (b).. a six-week fellowshio for studies in Sweden and the USSR and a three-month fellowship for studies in Denmark and Sweden; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. Assistance was given in the planning and conduct of: (1) intensive in-service training courses for auxiliary health workers, field supervisors and junior auxiliary health workers, (2) an orientation seminar far the senior officials of Bara District, and (3) a workshop in in-service training methodology for the integration of maternal and child health, including family planning, into the basic health services. The project staff participated in the Sixth All-Nepal Medical Conference, which, among other things, discussed integrated basic health services and health manpower; in the Fifth Seminar-cum-Workshop on Development Planning, and in the First Civil Surgeons' Seminar held in Pokhara. A reconnaissance of the Bara and Kaski pilot projects to assess the feasibility of testing the combined water supply, latrine and garbage disposal scheme in schools and health posts was completed and a health post and a school in Kaski District were selected as suitable sites for experimentation.

Surveys were conducted in connection with the establishment of regional medical stores,and the new syllabus for the auxiliary health workers' school for the training of chree types of health workers was revised. Further assistance was given in the preparation of detailed job descriptions for auxiliasy nurse-midwives in relation to maternity and child healthlfamily planning work and other tasks to be performed in a health post and in the preparation of a draft master plan of operation for the development of maternal and child healthffamily planning services. Help was given in the development of a regional health plan in connection with a UMIP exercise by collecting all the data and figures in relation to population, development of health institutions, staffing patterns, "categorical" programmes and predicted costs.

A consultant assigned under an inter-country project visited Nepal in November- December 1972 to advise the Government on the various aspects of the training of auxiliary health ~ersonneland to help in drafting a syllabus. SEA/RC26/2 Page 160

Nepal 0025 Development of Water Su~plyand Sewerage in Greater UNDP Kathmandu and Bhaktapur* 73uly 1969; Nav. 1970 - )

Aim of the project. To prepare a plan for the development of water supply and sewerage in Greater Kathmandu and Bhaktapur.

Assistance provided by WHO during the year. (a) A sanitary engineer; (h) a six- month fellowship for study in Malaysia and a twelve-month fellowship for studies in the Netherlands and the United Kingdom; (c) supplies and equipment.

Work done during the year. The WHO sanitary engineer attached to an inter-country project visited Nepal in November 1972 and reviewed the activities of the project, which continued to develop as planned.

A detailed report on the mid-term review was submitted to the Government. The LNDP approved an additional expenditure for the sector study work, the scope of which was extended to ensure greater coverage of rural areas. In addition, the "Immediate Works" programme was also expanded to include the work during stage I of the construction. The agreement for stage I (master plan), construction phase, was signed on 1 December between the Government and the firm of sub-contractors.

During the period under review, all the field work was completed in Kathmandu. Some additional work was accomplished on the survey of the distribution system. Activities relating to the orpanization and management studies were, for the most part, completed by the management consultant. In February, the Government constituted a Development Board to deal with the stage I construction prograwne, to be financed by the World Bank.

Comments on most of the draft reports submitted by the firm of sub-contractors were despatched to them in time for final printing.

Goad support and necessary facilities were provided to the project by the Govern- ment counterpart engineers. At the Nepal Engineering Institute, eighteen plumbers of the Department of Water Works and Sewerage were given in-service training, which was sponsored by the Swiss Association for Technical Assistance and UNDP.

Strengthening of Epidemiological Services (April - July 1970; Feb. - May 1972; - )

Aim of the project. To establish an epidemiological unit in the Directorate of Health Services and to train personnel in epidemiology,

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

Nepal 0029 Community Water Supply and Sanitation** R (Jan. 1971 - ) UNICEF

Aim of the project. To plan, organize and administer a national environmental health programme; to assist the government agencies concerned in the planning, organization and implementation of a long-term comprehensive national program of community water supply and waste disposal.

*Previous title: Water Supply and Sewerage in Greater Kathmandu and Bhaktapur ** Previous title: National Cornunity Water Supply and Sanitation SEAIRC2612 Page 161

Assistance provided by WHO during the year. (a) A sanitary engineer; (b) two two- month fellowships for a study tour of Thailand, Philippines, Malaysia and Sri Lanka, and two fellowships - one for nine months and one for eight-and-three-quarter months - for study in the United States of America; (c) supplies and equipment.

Probable duration of assistance. A number of years

Work done during the year. The WHO sanitary engineer attached to an inter-country project visited Nepal in November 1972 and reviewed the development of the project.

The seven rural water supply schemes of Phase I under the Ministry of Home and Panchayat were completed. Overseers were sent to five districts of Phase I1 for pre- construction survey. In addition, all field surveys under Phase 111 were completed.

Ten new United States Peace Corps volunteers, after completion of training, were assigned to different regions to assist in the field operations.

The major order of UNICEF for PVC pipes required in Phase I1 arrived in Nepal. A list of supplies and equipment, which also included high density polyethylene pipe, fittings and reservoir liners, was completed and submitted to UNICEF for procurement in 1973.

The Government provided full support to the project and enhanced its material and financial conmitment at every stage.

Nepal 0032 Medical Stores Management R (Nov. 1972 - )

Aim of the project. To develop and expand medical stores and supply services.

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

Probable duration of assistance. Until 1977.

Work done during the year. A WHO consultant (medical stores management officer) was assigned in November 1972 to: (1) advise and assist in the organization and management of the medical stores system, (2) advise on the establishment of a proposed zonal stores system and help in its implementation; (3) advise on the eventual integration of the stores systems of the malaria, family planning and smallpox programes into the existing public health stores system; (4) assist in the training of requisite personnel, and (5) advise on and supervise the production and quality control of infusion fluid. At the end of the period under review, he was continuing to provide assistance in this connection.

Nepal 0033 Prevention of Rabies R (Nov. 1972 - Feb. 1973; - )

Aim of the project. To prevent rabies.

Assistance provided by WHO during the year. (a) Two consultants; (b) a nine-month fellowship for studies in India and the United Kingdom; (c) supplies and equipment.

Work done during the year. Two WHO consultants - one an expert in rabies vaccine and the other a specialist in small laboratory animals - visited the project during the year to advise the Government on the design needs and requirements of a project for the prevention of rabies. Their reports have been sent to the Government. WHO has prepared the documentation on the project, including the draft plan of operation, the lists of basic supplies, the plan of action and lay-out plans, all of which have been sent to the Government for review.

The project aims at making Nepal self-sufficient in the control and prevention of rabies. The Central Veterinary Laboratory will manufacture a single-brain vaccine - SEA/RC26/2 Page 162

5% BPL-inactivated sheep-brain vaccine - for man and animal; a network of rabies clinics will provide treatment to expose persons and animals in zonal and district areas; provision has been made for control measures such as free vaccination. licensing of dogs, destruction of street dogs and legislation to back the enforce- ment of control measures.

Nepal 0200 Fellowships R

Anaesthesiology. A tvelve-month fellowship for study in India.

Coronary care and general medical intensive care. Four fellowships - two for six and a half months, one for nine and a half months and one for ten months - for study in Australia.

Drug control administration. Two three-month fellowships for studies in the United Kingdom, United States of America and WHO Headquarters.

Nursing and midwifery education. An eleven-month fellowship for study in New Zealand.

Nursing and midwifery services and administration. An eleven-month fellowship for study in New Zealand.

Nursing in Infectious Diseases. An eleven-month fellowship for study in New Zealand.

Practical training in medical librarianship. A three-month fellowship for studies in the United Kingdom and WHO Headquarters.

Public health nursing. Two ten-month fellowships for study in India.

Radiotherapy. A three-month fellowship for study in India. SEA/RC26/2 Page 163

8. SRI LANKA

PROJECT LIST

Agencies Title

Sri Lanka 0005.2 Venereal-Disease Control R (Sept. 1964; Sept. 1966; Oct. - Dec. 1967; July 1968: March - Mav 1969:. Sent.. - Oct. 1969; ~ug;1970; ~ec.-1970; July 1971; - ) Aim of the project. To develop laboratory diagnostic facilities for the national venereal-disease control progranme.

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

Sri Lanka 0026.2 Leprosy Control R (Oct. - Nov. 1967; Dec. 1968 - Aug. 1969; Nov. 1969 - Sept. 1970; Jan. 1971 - Aug. 1972; - )

Aim of the project. To assess the extent of leprosy, develop an integrated control programme, and to train staff.

Assistance provided by WHO during the year. (a) A consultant leprologist; (h) a twelve-month fellowship for studies in the United Kingdom, India, Burma and Thailand; (c) supplies and equipment.

Work done during the year. The WHO leprologist-consultant assigned in February 1972 left in July. In his report, which has been forwarded to the Government, he has stated that the minimum prevalence of leprosy is about 100 per 100 000 population, i.e., about 12 000 cases. He has suggested (i) integration of case-finding and treatment, (ii) treatment by primary health centres, under the periodic supervision of leprosy teams, of all cases among children of the 0-14 year age-group (except lepromatous ones), and (iii) care of leprosy patients by the general health services. Integration of treatment and follow-up activities into the general health services has been initiated.

Sri Lanka 0037 Mental Health R (Nov. 1955 - Jan. 1956; Aug. 1960; Nov. - Dec. 1961; Jan. - May 1963; June - July 1966; March 1967; Sept. 1969; Nov. 1969; Aug. 1970; Oct. - Dec. 1970; Feb. 1971; Dec. 1972 - March 1973; - )

Aim of the project. To develop mental health care within the framework of comprehensive health services, to strengthen the teaching of mental health in the undergraduate medical curriculum; to prepare for post-graduate teaching programmes, and to train various categories of health personnel.

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

Probable duration of assistance. A number of years.

Work done during the year. During December 1972-February 1973, a WHO consultant visited the Departments of Psychiatry in Colombo and Peradeniya, reviewed the current status of teaching, training and research programmes, and advised on and SEAlRC2612 Page 164

assisted in developing curricula and syllabi in mental health at the undergraduate and post-graduate levels in Colombo. He visited the hospitals and related health institutions concerned with the care of psychiatric patients and recommended measures for strengthening services for mental health care. He also investigated the problem of drug abuse, illegal traffic in opium and illicit cultivation of cannabis in the country. The report containing his recomnendations has been sent to the Government.

Sri Lanka 0045 Health Statistics UNDP (April 1957 - Dec. 1961; Sept. 1964 - Dec. 1966; March - April 1967: June 1967: Aue. - 0ct.1967: Sept. 196'8 - Dec. i969; Dec. i970; ~ug.1972 -')

Aim of the project. To assist in developing an information system geared to the requirements of national health planning and to monitoring the performance of the health services; to assist and participate in data processing as related to national health manpower statistics; to assist in training staff.

Assistance provided by WHO during the year. (a) A statistician; (b) a twelve- month fellowship for study in Australia.

Work done during the year. The WHO statistician joined the project in the last week of August 1972 and had, throughout the reporting period, been assisting project Sri Lanka 0101, "National Health Manpower Study", in regard to its statistical aspects.

He helped with data processing and presentation of the results of the sub- studies for which the field work had been completed and also assisted with and advised on the various statistical aspects of the sub-studies under way during the period. He also participated in discussions on a plan for the education of the family health prograuane.

Sri Lanka 0047 Medical Education R (June - Aug. 1959; Nov. 1963 - April 1964; Oct. 1964 - Dec. 1965; Sept. 1966; Nov. 1967; Sept. 1968 - Aug. 1969; Jan. - March 1970; May 1970; Aug. 1970 - March 1971; May 1971; Oct. - Dec. 1971; Feb. - April 1972; Aug. 1972 - March 1973; May 1973; - )

Aim of the project. To develop further undergraduate and post-graduate teaching programmes and to assist teacher training at the two Faculties of Medicine in Sri Lanka.

Assistance provided by WHO during the year. (a) Two consultants; (b) a five-month fellowship for study in India, a twelve-month fellwship for study in the United Kingdom, and two six-month fellmaships - one for studies in the United Kingdom and the-lhlited States of America and one-for study in the United States of AmeGica; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. Lhring August-November 1972 a consultant visited Sri Lanka to advise and assist in the conduct of the sub-study on "education process - medical education" of the Comprehensive Health Manpower Study in the country.

A further WHO consultant (epidemiologist) was assigned to the Faculty of Medicine, University of Sri Lanka, Colombo, in December. He also assisted at the Peradeniya Campus during the assignment, which lasted four months. His report containing recommendations on undergraduate and post-graduate training in epidemiology as well as on research, has been sent to the Government. SEA/RC26/2 Page 165

Sri Lanka 0053 Nursing Advisory Services R (July. 1960 - Feb. 1966: Aua. - Oct. 1966: Sept. - Dee. 1967; Dec. 1969;.FebT 1970; May 1970; . July 1970; Sept. 1970; Feb. - June 1971; Feb. - July 1972; Sept. - Dec. 1972; Feb. - March 1973; - )

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

Assistance provided by WHO during the year. (a) Two consultants and temporary assistance from a nurse educator assigned to project SEAR0 0139; (b) a twelve-month fellowship for study in New Zealand; (c) supplies and equipment.

Probable duration of assistance. Until 1975.

Work done during the year. A nurse educator from the inter-country project "Short Courses for Nurses and Other Health Personnel", was assigned responsibility for the organization and management of the "sequential learning activity" in paediatric patient care. An evaluation tool for this activity was developed and utilized to obtain baseline data against which the effectiveness of the total activity can be measured. The course component (Phase 1) of the activity was conducted at the Lady Ridgeway Hospital, Colombo. A paediatrician and a paediatric nurse acted as consultants and seven paediatricians and fourteen paediatric nurses from the participating paediatric units took part. Phase 2 of the activity is well under way and the concerned nurse educator is paying follow-up visits to the participants in order to encourage the collection of data by utilizing the evaluation tool.

From 28 May to 30 June 1973, a course on "Strengthening the Integ~ationof Community Health in the Basic Curriculum" was conducted by a WHO nurse educator of the inter-country project mentioned above at the Post-Basic School of Nursing, Colombo; 22 nurse tutors/senior nurses attended this course.

Sri Lanka 0056 Filariasis Control UNDP (Dec. 1959; April - July 1961; Sept. 1961; Aug. - Sept. 1963; June 1965 - )

Aim of the project. To control filariasis.

Assistance provided by WHO during the year. An epidemiologist/parasitologist.

Work done during the year. A new plan of operation was prepared for the project under Sri Lanka 0103, Vector Control.

The special blood filming SuNeyS at Kataragama and Kelaniya were completed; 12 097 slides were examined.

Sri Lanka 0058 Malaria Eradication R (Aug. 1960 - )

Aim of the project. To eradicate malaria.

Assistance provided by WHO during the year. (a) Two malariologists, a parasitologist, an entomologist, a sanitary engineer, a sanitarian and a clerk-stenographer; (b) two three-and-a-half-month fellowships for study in the Philippines, two two-month fellowships for study in India, a three-week fellowship for study in Japan, and a one-week fellowship for study in the United Kingdom; (c) supplies and equipment.

Probable duration of assistance. A number of years. SEA/RC26/2 Page 166

Work done during the year. The Anti-malaria Campaign continued to carry out Dm spraying of houses in a population of 5.8 million, supplemented with passive case- detection, limited active case-detection and treatment of suspected clinical and positive cases. A population of four million continued to be covered with passive case-detection, drug administration of positive cases and focal spraying.

A significant stability in the levels of incidence of malaria during the last two years was observed with only a slight overall reduction, but with an upward trend towards the end of the year, in the positive cases in 1972 as compared to 1971. The total number of positives recorded in 1972 was 132 605 as compared with 145 368 in 1971 and 468 199 in 1970. The first two months of 1973 took a turn for the worse from the past two years, there being 33 419 positive cases in this period of the year as compared with 21 161 and 30 720 in the corresponding two months of 1972 and 1971 respectively.

Two monthly,l gm/m2 DDT spraying cycles in the delimited P. falcipam areas continued as planned, but the proportion of P. faZcipam cases (of the total cases in those areas) continued to rise, the percentage being 1.1, 5.0 and 5.2 in 1970, 1971 and 1972 respectively.

The National Malaria Eradication Training Centre, assisted by WHO staff, supplies and equipment, besides conducting a number of refresher and orientation training courses for various categories of staff, bas, so far during the period under report, completed two courses for medical officers of health and superintendents, two courses for public health inspectors, and one intensive training course, extending over three months, for microscopists.

Sri Lanka 0063.2 Medical Rehabilitation 8 (Nov. 1968 - Feb. 1969; Feb. - June 1970; Jan. - March 1972; March 1973; - )

Aim of the project. To assist the medical rehabilitation services and to train staff.

Assistance provided by WHO during the year. A nine-month fellowship far study in the United States of America.

Probable duration of assistance. Until 1975.

Sri Lanka 0064 Community Water Supply and Sanitation R (Oct. 1963 - 1 UNICEF

Aim of the project. To develop programmes of comunity water supply, sewage dis- posa1,storm-water drainage and general sanitation, and to train personnel.

Assistance provided by WHO during the year. (a) A sanitary engineer; (b) a twelve- month fellowship for study in the United Kingdom and two three-month fellowships - one for studies in the United Kingdom, Ghana and Uganda and one for studies in the United Kingdom, Federal Republic of Germany and Sweden; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1977.

Work done during the year. Work on 100 comunity water supply schemes to be constructed under the project continued as planned. Final designs and cost estimates for the first group of 15 water supply systems were completed and initiation of construction was awaiting the arrival of UNICEF supplies and materials. The Department of Water Supply and Drainage introduced progress meetings in order to strengthen planning and progress reporting procedures and to ensure special assistance and attention to the areas facing bottlenecks. WHO continued to render assistance in formulating a national plan for a rural water supply programme for the country. SEAlRC2612 Page 167

Collection of information such as names of communities, population statistics and on water supply and sanitation in medical, educational and commercial institutions, was in progress. Steps were taken to provide additional staff for the recording and classification of information.

A proposal for the holding of a national course in preventive maintenance of water distribution systems during the last quarter of 1973 was accepted by the Government. A consultant was being recruited to assist in the preparations and conduct of this course.

On the initiative of the WHO sanitary engineer the Department of Water Supply and Drainage carried out negotiations with the Health Education Section of the Ministry of Health on health education aspects of the rural water supply programme.

Sri Lanka 0066.3 Strengtheninn of Laboratory Services R (Aua.. 1966 - March 1969: Oct. 1969: Dec. 1969: May 1970; Aug. - Sept.'1970; ~ov.1970; ~~ri1.1971; July 1971; Oct. 1971; Dec. 1971; Feb. 1972; June 1972; Aug. 1972; March 1973; - )

Aim of the project. To develop further specialized diagnostic and reference functions in support of conmunicable-disease control and prevention, and to train staff.

Assistance provided by WHO during the year. (a) Three fellowships - two for twelve months and one for six months - for study in the United Kingdom, and a one-month fellowship for studies in the United Kingdom and the Regional Office; (b) supplies and equipment.

Probable duration of assistance. Until 1977.

Sri Lanka 0071 Radiation Health R (Nov. - Dec. 1966; Aug. - Sept. 1969; Aug. - Sept. 1970; April 1971; Oct. - Nov. 1971; Nov. - Dec. 1972; Feb. 1973; - )

Aim of the project. To strengthen radiation protection services and to train staff.

Assistance provided by WHO during the year. Three three-month fellowships - two far study in the United Kingdom and one for studies in Sweden, United Kingdom and the United States of America.

Probable duration of assistance. Until 1975.

Sri Lanka 0072 Health Education* R (Nov. 1966 - Feb. 1967; Feb. - May 1969; Sept. 1969; June 1970; Dec. 1970; Jan. 1971; March 1971; July - Sept. 1971; July 1972 - )

Aim of the proiect. To strengthen health education services, including school health education, and to evaluate health education activities; to strengthen health education teaching in medical colleges, teacher training institutions and in other training centres.

Assistance provided by WHO during the year. (a) A consultant (health education specialist); (b) a twelve-month fellowship for study in the United States of America; (c) supplies and equipment.

*Previous title: Development of Health Education SEAlRC2612 Page 168

Probable duration of assistance. Until the end of 1975.

Work done during the vear. A WHO health education specialist joined the project in July 1972. He assisted in working out the plan of action for 1973; in the strengthening of supervision and reporting of health education programmes; in implementing the recommendations made by the previous WHO consultants; in holding monthly staff meetings of the Health Education Division, and in co-ordinating the work with the Family Health Bureau through the Working Commlttee on Health Educa- tion/Communication.

Co-ordination of the health education activities of the Ministry, including those of special campaigns such as tuberculosis, venereal diseases, leprosy, filariasis, and malaria control, was brought about by having joint meetings. The health education specialist also assisted in organizing health education in hospitals and in introducing it in ongoing training programmes.

Action was taken to recruit a consultant to assist in developing the health education component of the teacher training programme and to conduct a seminar on family health education for the teaching staff of a pilot institution. He was expected to join the project in July 1973.

Sri Lanka 0075 Tuberculosis Control R (Jan. 1966 - ) UNICEF

Aim of the project. To control tuberculosis through a comunity-oriented programme,

Assistance provided by WHO during the year. (a) Three three-month fellowships for study in India, an eight-month fellowship for studies in the United Kingdom, India and Burma, and a two-week fellowship for study in Norway; (b) supplies and equip- mmt.

Sri Laoka 0077 Quality Control of Biological and R Pharmaceutical Products (March 1966:, Seot.. 1966: Dec. 1967: Jan. - April 1971; April 1972; - )

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

Assistance provided by WHO during the year. (a) Three six-and-threc-quarter-month fellowships for studies in India and Japan and two six-month fellowships for study in the United Kingdom; (h) supplies and equipment.

Probable duration of assistance. A number of years.

Sri Lanka 0078 Strengthening of Epidemiological Services R (July - Oct. 1967; Dec. 1970; Sept. 1971; July 1972; Sept. 1972; - )

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

Assistance provided by WHO during the year. (a) A consultant; (h) a twelve-month fellowship for study in the United Kingdom; (c) supplies and equipment.

Probable duration of assistance. Until 1976. SEA/RC26/2 Page 169

Work done during the year. Infectious hepatitis was a major comunicable disease in Sri Lanka in 1972 and about 6 000 cases were registered. The number of poliomyelitis cases registered was 272. Typhoid fever, which also remains a problem, accounted for 1 500 cases. In addition, mcre than 400 cases of diphtheria and tetanus were reported.

It was estimated that about 10%of the cases of virus encephalitis hospitalized in various hospitals in the country were considered to be Japanese encephalitis. A WHO consultant visited Sri Lanka in Septeaber 1972 to study this problem. In order to clarify the etiology of these cases, he has suggested closer collaboration among the epidemiological, clinical and laboratory services, in addition to expansion of the laboratory work in virology. The report containing these and other recomendations has been sent to the Government.

Sri Lanka 0082 Occupational Health and Industrial Hygiene* R (Aug. 1968: July 1969; Dec. 1969 - Feb. 1970:

Aim of the project. To control health hazards in industry.

Assistance provided by WHO during the year. (a) A consultant; (b) a twelve-month fellwship for study in the United Kingdom; (c) supplies and equipment.

Probable duration of assistance. Some years.

Work done durin~the year. Towards the end of the period under review, a WHO consultant took up a six-month assignment to advise on specific problems affecting the health of workers in small industries, to assist in conducting courses for occupational health personnel, and to assist in framing legislation.

Sri Lanka 0083 Port Health Services R (Seot.. . 1969:. Seot.. 1970: Aue. 1972: March 1973; - )

Aim of the project. To strengthen port health services.

Assistance provided by WHO during the year. Two six-week fellowships - one for studies in Japan, Hong Kong and Singapore and one for studies in Hong Kong, Singapore and India.

Probable duration of assistance. Until 1976.

Sri Lanka 0085 Public Health Nutrition R (Oec. 1969 - Jan. 1970; Dec. 1971 - Jan. 1972; Sept. 1972; - )

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

Assistance provided by WHO during the year. A three-month fellowship for studies in the Philippines, Thailand and India.

Probable duration of assistance. Until the end of 1976.

Sri Lanka 0086 Public Water Supply, Drainage and Seweraxe UNDP for the South-West Coastal Area (Aug. 1967 - Dec. 1971; July - Aug. 1972)

The project concluded in December 1971. During the period under review, two twelve-month fellowships were awarded for study in the United Kingdom and supplies and equipment provided.

*Previous title: Industrial Hygiene SEA/RC26/2 Page 170

Sri Lanka 0087 Dental Health R (April 1970 - Aug. 1972; - )

Aim of the project. To develop further teaching and training programmes for dental personnel and to expand integrated dental health services as part of the general health services.

Assistance provided by WHO during the year. (a) A consultant in dental prosthetics; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1975.

Work done during the year. The WHO dental mechanic tutor who had been assisting the project from time to time since April 1970, completed his work in August 1972. He helped in teaching dental prosthetics, in providing instruction to post-graduate dental surgeons in advanced dental technology and in training dental technicians. His recommendations were forwarded to the Government.

A consultant to assist the Dental Faculty in the teaching of preventive dentistry was under recruitment.

Sri Lanka 0092 R (June - Aug. 1970; Sept. - Dec. 1971; June 1972 - )

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

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

Probable duration of assistance. Until 1975.

Work done during the year. Assistance was given in the development and strengthening of the Health Planning and Prograing Division in the Ministry of Health. A draft plan of operation was prepared for the project, which aims to develop a suitable health planning methodology, strengthen the national health planning capacity, develop a health information system, and train planners for work at national and divisional levels. Most of the period under review was devoted to the provision of assistance in the conduct of the Comprehensive Health Manpower Study (see Sri Lanka 0101).

Sri Lanka 0093 Veterinary Public Health Services R (Zoonoses Control) (March 1972; - )

Aim of the project. To develop zoonoses control services.

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

Probable duration of assistance. Some years.

Sri Lanka 0094 Stren~theninp,of Electro-medical Division R (June - Sept. 1972; Feb. - March 1973; - )

Aim of the project. To train electro-medical repair technicians and improve maintenance workshops to undertake repairs to X-ray equipment and other types of electrical and electronic instruments found in health institutions. SEA/RC26/2 Page 171

Assistance provided by WHO during the year. (a) A consultant; (b) three six-month fellowships - one for studies in the United Kingdom, Netherlands and Japan, one for studies in the United Kingdom and the Netherlands, and one for studies in the United Kingdom and the Federal Republic of Germany; (c) supplies and equipment.

Work done during the year. A WHO electro-medical engineer (consultant) was assigned from June to September 1972 to advise on the maintenance of electro-medical equipment in the various hospitals in the country and to train technicians in the maintenance and repair of X-ray and other electro-medical apparatus. His report containing recommendations on the maintenance of X-ray equipment and on the training of technicians has been sent to the Government.

Sri Lanka 0101 Health Manpower Study UNFPA (Feb. - April 1971; Dct. - Nov. 1971; April 1972 - )

Aim of the project. To undertake a study of the activities of personnel employed by the Ministry of Health in rural areas and delivering health care to the community in the context of family health services; to conduct a health manpower study.

Assistance provided by WHO during the year. (a) A consultant, two nurse consultants (one provided under project SEAR0 0178) and temporary assistance from staff assigned to other projects; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1973.

Work done during the year. Assistance was given in carrying out the Comprehensive National Health Manpower Study by the whole-time involvement of a medical officer, a statistician and a consultant (medical educator), all assigned under other projects in Sri Lanka. A nurse administrator and a statistician assigned to inter- country projects also participated in this exercise. During the year the protocols for the eleven sub-studies were finalized and the collection of data completed. Interim reports have been written for six of the sub-studies. The Study Directorate has drawn up plans for the final phase of the project and has identified the disciplines in which consultants will be required in order to assist in designing alternative health service delivery and health manpower systems based on information generated from the various sub-studies.

Sri Lanka 0102 Training of Anaesthesiologists R (Aug. 1972; - )

Aim of the project. To establish a national training centre in anaesthesiology.

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

Probable duration OF assistance. Until 1975.

Sri Lanka 0103 Vector Control UNDP (Dec. 1972 - )

Aim of the project. To control insect vectors of communicable diseases of public health importance.

Assistance provided by WHO durinn the year. An epidemiologist/parasitologist.

Work done during the year. The activities started in December 1972 with the reassignment of the WHO epidemiologist from project Sri Lanka 0056, "Filariasis Control"; an entomologist was under recruitment. SEA/RC26/2 Page 172

A new plan of operation was prepared for the project.

Sri Lanka 0104 Health Education in Family Health UNFPA (July - Oct. 1971; March - June 1972; (UNESCO) Nov. - Dec. 1972; June 1973 - )

Aim of the project. To promote family health through health education.

Assistance provided by WHO during the year. (a) A consultant and assistance from two staff members assigned to other projects; (b) a twelve-month fellowship for studies in India, Thailand, Philippines, Malaysia and Singapore; (c) supplies and equipment .

Probable duration of assistance. Until the end of 1976.

Work done during the year. The health education specialist assigned to an inter- country project visited Sri Lanka during November-December 1972 to assist in asaess- ing local resources, identifying problems for behavioural studies and in organizing a conference of agencies interested in studies. With his assistance a study was initiated and plans were made for five more studies. His report was forwarded to the Government.

The WHO health education specialist assigned to project Sri Lanka 0072 assisted in the preparation of the plan of operation for the project. Programme details and a calendar of activities for 1973 were formulated. Work was progressing with regard to training in family health education, behavioural studies, reorganization of audio- visual aids production and prompt utilization of supplies received.

Towards the end of June 1973, a consultant in studies took up a three-month assignment with the project, and one in training was expected in August.

Action was under way for the recruitment of a third consultant - a specialist in media - who will examine the planning, production and utilization of family health education media and help in the maximum utilization of the equipment received under the project.

Sri Lanka 0105 Family Health UNFPA (Nov. - Dec. 1971; Feb. - June 1972; Aug. 1972 - March 1973; April 1973 - )

Aim of the project. To promote family health as an integral part of the general health services.

Assistance provided by WHO during the year. (a) A medical officer and a consultant; (b) three nine-month fellowships for study in Australia; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1976.

Work done during the year. A WHO medical officer was assigned to the project from August 1972 to March 1973.

In September, the Government submitted a draft proposal for UNFPA assistance to the project. Following a review by the medical officer of the proportion of deli- veries in the country taking place in medical institutions, an addendum to this draft was submitted in December, laying more stress on the post-partum family planning component. SEAlRC2612 Page 173

In February, after the signing of an agreement between the Government and UNFPA, a national project planning committee, assisted by a temporary adviser, the Regional Advisers on Nursing and Maternal and Child Health, and two field staff members, met under the chairmanship of the WHO representative to Sri Lanka and prepared a four- year plan of action. This plan is based on the recommendations of a WHO-assisted national seminar an family health,held earlier in February with the participation of several WHO staff members.

A national nursing seminar on family health was held in May 1973. Meanwhile, a national task force has been convened by the Government to (a) advise on a curriculum for in-service training programes for family health workers. and (b) explore and identify a role far Ayurvedic practitioners in the national programme. This task force receives assistance from a WHO nurse consultant, a WHO temporary adviser and a staff member assigned to an inter-country project.

Sri Lanka 0106 Strengthening of NursingIMidwilery Education UNFPA (Feb. 1972; - )

Aim of the project. To strengthen the nursinglmidwifery education offered in the eight schools of nursing, the Mulleriyawa affiliation school and the Post-basic School of Nursing, Colombo, with emphasis on public health, midwifery and child care; to produce nursing and midwifery texts and other reference material in the local languages.

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

Work done during the year. A plan of operation for the project was prepared.

Work on renovating the School of Nursing at Galle and the basic and post-basic schools of nursing, Colombo, was started. Cost estimates were determined for the renovation of some of the other schools. Some books, supplies and equipment were received. A WHO nurse educator was expected to join the project in July 1973.

Sri Lanka 0200 Fellowships R

Diplama in public health administration, A nine-month fellowship for study in the United Kingdom.

Medical stores management. Two three-manth fellowslrips for study in the United Kingdom.

Sanitary engineering. A twelve-month fellowship for studies in the Netherlands and the United Kingdom.

Social medicine and occupational health. A twelve-month fellowship for study in the United Kingdom. SEA/RC26/2 Page 175

9. THAILAND

PROJECT LIST

Agencies Title

Thailand 0002.2 Strennthening of Health Services (Integration UNDP of Specialized Programmes) UNICEF (Jan. 1964 - Dec. 1968; Feb. 1969; July - Sept. 1970; June 1971; Dec. 1971 - July 1972; - )

Aim of the project. To promote the integration of specialized communicable-disease control programmes into the general health services.

Assistance provided by WHO during the year. A consultant.

Work done durinp, the year. The WHO consultant assigned from December 1971 to July 1972 (briefly reported in the last annual report) assisted the Government in carrying out an assessment of the tuberculosis control programme and recommended steps for its future development as well as integration into the basic health services. In his report, which has been sent to the Government, he has, among other things, suggested that (i) priority of the preventive component in tuberculosis control should be re-emphasized and re-established at all levels, (ii) representatives of the tuberculosis control centres should be in close vorking contact with the officers in charge of public health in the respective provinces of their area, (iii) knowledge of the feasibility and compatibility of simultaneous BCG and smallpox vaccination should be spread at all professional levels, and (iv) scar prevalence surveys should become the responsibility of the regional tuberculosis control centres,

Thailand 0037 Vital and Health Statistics R (Aug. 1957 - July 1959; Oct. 1959 - April 1960; Nov. 1968 - Jan. 1969: Feb. - Oct. 1971: Dec. 1971; Sept. 1972 - )

Aim of the project. To develop a co-ordinated health statistics system and to train the staff required for this purpose and for the development of medical records.

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

Probable duration of assistance. Until the end of 1974.

Work done during the year. The statistician joined the project in September 1972.

During the first three months, she was involved in preparations for and conduct of the WHO Headquarters-sponsored Workshop on Statistical Methods in National Family Planning Programmes, held in Bangkok from 15 to 28 November (project SEAR0 0192). She also participated in the first part of a project systems analysis (PSA) workshop held in October and assisted the Working Group on Population Projections in preparing the projections for Bangkok and Chonburi Province for the planning horizon. She participated in two ECAFE-sponsored meetings - an inter-agency Meeting on Indicators of Social Development and one on Country Co-ordinatars of Family Planning Service Statistics. SEA/RC26/2 Page 176

The statistician prepared a draft plan of action to link the activities of the project with those of Thailand 0098, 'Health Planning and Administration"; since the basic purpose of her assignment was to assist and advise on the collection and use of health statistical data for health planning and monitoring of health programmes, as well as on the application of modern statistical techniques in the planning and evaluation of such programmes. She worked on a draft outline for two proposed studies: a sample area study on vital registration and a study on causes of death reported by lay persons. She also helped the WHO staff assigned to the Asian Insti- tute for Economic Development and Planning in the design of retrospective and longi- tudinal studies on morbidity pattern in some areas of Thailand.

Preparation of material for an epidemiological surveillance syatem for the training of staff working in the Mobile Health Service Strategy in Chonburi Province was completed. Similar material on the registration and training of traditional midwives was also prepared.

Thailand 0057 Faculty of Tropical Medicine R (Aue. - Se~t.1959: June - Aua. 1961: June 1962: June - ..lUiy1963- Jan. -.~ec. 1964;- an. 1967; Aug. 1967; July 1968; June - Dec. 1969; May 1970; July - Sept.1970; kc. 1970; March - June 1971; Dec. 1971; July 1972; Nov. 1972; Jan. - March 1973; - )

Aim of the project. To continue to strengthen the Faculty of Tropical Medicine of Mahidol University.

Assistance provided by WHO during the vear. (a) A consultant; (b) two two-month -fellowshins ------one for studies in the United States of America. Guatemala and Mexico. and one for studies in the United Kingdom and the Federal ~epiblicof Germany; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1973.

Work done during the year. A consultant was assigned to the Faculty during January- March 1973 to assist with the development of the curriculum and teaching programmes in clinical chemistry. His recommendations, which are contained in a report sent to the Government,relate to the expansion of inter-departmental activities in order to enable the pooling of resources, both intellectual and material, improvement in the efficiency and scope of research work, updating of hospital laboratory facilities, continuation of training programmes for both academic staff and laboratory technicians, and periodic assessments of the teaching and research programmes by relevant specialists from outside.

Thailand 0059 Epidemiology R (Oct. 1966; Dec. 1966 - Aug. 1967; July 1968; UNDP Aun. 1969:. May. - June 1970; June - Sept. 1971; NO;. 1971; Jan. 1972; arch - Aug. 1972; - )

Aim of the project. To organize and strengthen a national epidemiological service, undertake studies of specific health problems, and train personnel.

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

Work done during the year. The WHO consultant assigned from March to August 1972 (briefly mentioned last year) assisted in an assessment of the leprosy control programme in Khon Kaen Province and made recommendations for the future development of the programme as a part of the general health services. His report, which has been sent to the Government, contains the findings of the assessment in regard to Khon Kaen Province and their implications for other provinces in North-east Thailand. SEA/RC~~/~ Page 177

Another WHO consultant assisted the Government in the further development of epidemiological services and in the strengthening of the surveillance programme for denguelhaemorrhagic fever. This assignment, which lasted from June to July 1972, was the consultant's fourth visit to the project, and the relevant report containing his recomnendations on various aspects of denguelhaemorrhagic fever control such as surveillance, data processing and epidemiological reporting, as well as the administrative organization, has been sent to the Government.

The report of a further WHO consultant who, during May-June 1972, had carried out a study of V. parahaemolyticus infection in connection with cases hospitalized in the Infectious-Disease Hospital, Bangkok, was also forwarded to the Government.

Thailand 0065 Malaria Eradication R (Jan. 1962 - )

Aim of the project. To eradicate malaria.

Assistance provided by WHO during the year. (a) A malariologist, an entomologist a scientist (technical officer), two sanitarians and a translator-typist; (b) a one-month fellowship for study in Italy; (c) supplies and equipment; (d) payment of local costs (salaries for drivers).

Probable duration of assistance. A number of years.

Work done during the year. The population of Thailand has been divided into two categories, viz., a population of 31 million with a malaria eradication programme and 6.8 million under a control programme with only attack measures. Of the 31 million population covered by the eradication programme, 27.8 million are under surveillance, including 7.2 million in areas in the process of integration into the general health services and 3.2 million in the late attack phase.

The second regular spray round for 1972 protected a population of 2.712 million with DDT spraying; 9.1% of the houses remained unsprayed.

The malaria case incidence has been on the increase ever since 1968; the annual parasite incidence per thousand population both in consolidation and attack phase areas, continued to increase up to 1971 - the percentages of increase in the incidence in the consolidation phase being 6.2 from 1968 to 1969, 33.3 from 1969 to 1970 and 45.5 from 1970 to 1971 respectively. The number of positive cases detected during the first nine months of 1972 was 63 615 49.8% of them coming from areas in the consolidation phase. P. faZcipam continued to be the predominant species.

Three cycles of DLlI spraying in the study area of Wangtong District are planned for 1973, to counter effectively the seasonal disturbances in the prevalence of A. bazabacensis.

The training Centre at Prabudhabat, in addition to training different categories of malaria personnel during the period under report, provided facilities for holding a seminar on malaria epidemiology (under project SEAR0 0114) early in 1973.

Thailand 0066 Food Control Administration R (Aug. - Oct. 1964; Feb. - April 1971; Oct. 1971; Aug. 1972; - )

Aim of the proiect. To assist the Department of Medical Sciences, Ministry of Public Health, in establishing a national food control administration and in training staff in food control. SEA/RC26/2 Page 178

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

Probable duration of assistance. Until 1976.

Thailand 0067 Radiation Protection Services R (April - May 1963; Feb. - March 1965; Nov. - Dec.1965; Dec. 1966 - Feb. 1967; Nov. 1967 - Feb. 1968; Feb. - May 1969; July 1969; Sepr. - Dec. 1969; April - June 1970; Sept. 1970; July 1971; - )

Aim of the project. To establish a radiation protection service in the Department of Medical Sciences, Ministry of Public Health, and to train staff.

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

Thailand 0070 Vectar-borne Disease Control R (June 1963; June 1964; March - May 1965; June 1967; Dec. 1968; Feb. 1970; Sept. 1971; - )

Aim of the project-. To assist the Department of Medical Sciences in training staff in medical entomology and vector-borne disease control.

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

Thailand 0071 School for Medical Radiographx UNDP (Jan. 1965 - Jan. 1973; April 1973; - )

Aim of the project. To train radiographers.

Assistance provided by WHO during the year. (a) A radiography tutor; (b) three three-month fellowships for studies in the Federal Republic of Germany, Netherlands and the United Kingdom, and a twelve-month fellowship for study in the United Kingdom; (c) supplies and equipment.

Work done during the year. The WHO tutor radiographer who had been assisting the School since October 1968, completed his assignment at the end of January 1973 and submitted a report, which has been sent to the Government. The project has been a successful one, in that the School of Medical Radiography is now well organized and has graduated double the number of candidates originally envisaged. As against only eleven trained radiographers in Thailand in October 1968, a total of 109 candidates had graduated by the end of 1972 and 162 were under training. The national staff have been adequately trained and are continuing the training activities competently. At the current rate of progress it is expected that by 1981 all X-ray units in the country will be operated by adequately trained radiographers.

Thailand 0075 Strengthening of Laboratory Services R (April - May 1968; March 1969; Sept. 1969; Dec. 1969; UNICEF March 1970; Oct. - Dec. 1970; May 1971; Aug. 1971; Oct. 1971; May - June 1972; Aug. - Sept. 1972; Feb. 1973 - )

Aim of the project. To organize national health laboratory services; to strengthen the teaching of laboratory sciences and the training in medical laboratory technology. SEA/RC26/2 Page 179

Assistance provided by WHO during the year. (a) A microbiologist; (b) three twelve- month fellowships - one for studies in the United Kingdom and the Regional Office, one for studies in Czechoslovakia and the Netherlands and one for study in the United States of America - and a three-month fellowship for study in Hungary; (c) supplies and equipment.

Probable duration of assistance. Until 1977.

Work done during the year. A WHO microbialagist took up duties in January and spent much time initially in reviewing the existing situation, assessing the immediate needs and getting acquainted with the national plans for the development of the project. In consultation with the national authorities, a draft plan of operation was drawn up, covering activities up to 1979. A co-ordinating committee for the development and integration of laboratory services was reactivated and a scheme for the laboratory quality control o£ clinical bacteriology was being rested; the scheme will cover 39 collaborating rural laboratories. Initial tests were done to assess the proficiency of these laboratories in the isolation and identification of bacteria like cholera, shigella, streptococcus and staphylococcus. In June- July 1972, a consultant microbiologist assisted in drawing up a plan for the bacteriological surveillance of diseases like cholera, typhoid, dysentery, etc. and provided guidance to provincial and district health laboratories in the preparation of laboratory manuals. The draft plan of operation and the consultant's recommendations were sent to the Government.

Thailand 0079 Quality Control of Pharmaceutical Preparations R (May 1970; Sept. 1970 - )

Aim of the project. To strengthen legislation and laboratory competence in the quality control of pharmaceutical preparations and train drug analysts and drug inspectors.

Assistance provided by WHO during the year. (a) A pharmaceutical chemist; (b) three twelve-month fellowships for study in the United Kingdom; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1976.

Work done during the year. The pharmacists from the Division of Drug Analysis regularly undertook sampling duties in collaboration with the inspectors of the Food and Drug Control Division.

The WHO pharmaceutical chemist participated in some of the factory inspections as they formed part of the programme of inspector training and development of inspection techniques. These visits indicated varying degrees of success in an effort to upgrade the pharmaceutical industry in the country.

Comprehensive inspection guidelines, oriented to the code of good manufacturing practices, were developed,based on the experience gained in the formulation of similar guidelines a year ago.

There was progress in activities concerning product registration (policy), product registration (records) and the development of inspection procedures.

The WHO pharmaceutical chemist assisted in the conduct of an inter-country Workshop on the Quality Control of Drugs held in Djakarta, Indonesia, from 4 to 8 June 1973 (see SEAR0 0154).

Thailand 0082 Venereal-disease Control R (Feb. - Aug. 1967; Oct. - Dec.1967; May 1969; Aug.1969; Jan. 1970: Nov. 1970: July 1971: Nov. 1971 - Jan.1972; April 1972; NOV. 1972 - in. 1973; - ) Aim of the project. To control venereal diseases and to train staff in the clinical 2nd laboratory aspects. SEA/RC26/2 Page 180

Assistance provided by WHO during the year. (a) Two consultants; (b) a three-month fellowship for studies in the United Kingdom, Italy and Denmark.

Probable duration of assistance. Until the end of 1974.

Work done during the year. A WHO consultant (laboratory technician) was provided from November 1972 to April 1973 to assist the Government in the improvement of laboratory techniques at various levels of the health services. His report was under study.

In January, a further consultant (clinician) paid a visit to Thailand as a follw up of the assignment undertaken by him from November 1971 to January 1972, and recorded progress in venereal-disease control. His report includes recommendations for further development, specifically relating to organization and administration of the activities, facilities and services, clinical work, laboratory services, treatment schedules, training and research. The report has been sent to the Government.

Thailand 0086 Dental Health R (Jan. 1967; Nov. 1967 - April 1968; April 1969; Aug. 1969 - July 1970; Feb. 1971; April 1971; March 1972; Aug. - Sept. 1972; - )

Aim of the project. To improve dental services and to train dental health personnel.

Assistance provided by WHO during the year. (a) A consultant; (b) a two-month fellowship for studies in Denmark, Sweden, Switzerland and the United States of America; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1975.

Work done during the year. A consultant was assigned in August-September 1972 to review the training of school dental auxiliaries and evaluate dental health programmes for school children. His observations on the development of a national dental health programme integrated within the national health services have been forwarded to the Government.

Thailand 0089 Nursing Education and Services R (Jan. 1968 - )

Aim of the proiect. To study nursing needs and resources; to strengthen nursing services and education; to develop university-level courses for nurses, and to organize and conduct studies related to nursing services and education.

Assistance provided by WHO during the year. (a) Two nurse educators; (b) five eleven-month fellowships for study in New Zealand, three twelve-month fellowships for study in the United States of America, and a twelve-month Eellavship for study in Israel; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. Assistance with the development of practice areas for basic nursing students from the Faculty of Nursing, Khon Kaen University ,was given by the WHO nurse educator, who returned to Thailand in September 1972 after a year's study leave. She organized in-service education programmes in supervision and ward management for supervisors and head nurses and a similar programme for staff nurses. The Chief Nurse at Khon Kaen Provincial Hospital went on a WHO fellowship to New Zealand. SEA/RC26/2 Page 181

A nursing committee working on the production of educational material in Thai met and selected a textbook on medical-surgical nursing for translation. The publishers' agreement in principle for the translation of selected units of the book has been obtained.

A plan for an in-service education programme for chief nurses and provincial public health nurses was prepared and submitted to the Department of Medical Services and Health for approval.

The WHO senior nurse educator joined the project towards the end of March 1973. Assistance was given to the development of a course in nursing service administration at the Department of Nursing, Faculty of Education, Chulalongkorn University. Out of 48 applicants, I7 wcre admitted to the course; 79 students wcr~ enrolled in the post-basic bachelor's degree programme.

Thailand 0090 National Community Water Supply, Drainage, UN DP Sewerage and Pollution Control UNICEF (Jan. 1969 - )

Aim of the project. To plan, organize and administer a national environmental health programme, and more specifically, to provide technical advice and guidance far the expansion of the national community water supply and other environmental health programmes.

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

Probable duration of assistance. Until the end of 1976.

Work done during the year. The project document, covering UNDP assistance to community water supply far the years 1972 through 1975,was signed on 28 March 1973.

The WHO sanitary engincer continued to provide technical advice and guidance in the maintenance of existing water supply systems, which showed a marked improvement in all the nine working regions of the country. He also assisted in preparing a report for UNICEF assistance to the community water supply programme.

Two agreements were concluded between the Department of Health i'romotion and the Asian Institute of Technology - one for studying thc impact of water supply systems in rural villages, and the other for the investigation of the use of local materials for filtration. Another agreement was reached between the Departmcnt of Health Promotion and the Department of Public Works in respect of a joint deepwell programme involving the drilling of 25 deep wells annually in the central area of the country.

In December, the WHO sanitary engineer attended two important meetings in India: the WHO Regional Seminar on Air l'ollution Control, held at Nagpur and Bombay, and the meeting of WHO field engineers, which took place in New Delhi.

In-service training courses for waterworks operators were developed and two courses were held - one at Khon Kaen from 25 January to 1 February with 25 participants, and the other in Lampang from 8 to 15 March for the same number of operators.

The WHO sanitary engineer of an inter-country project stationed in Bangkok also assisted the project.

Thailand 0093 Medical Rehabilitation R (Oct. 1968 - ) Aim of the project. To develop rehabilitation services in selected hospitals in the provinces and in Bangkok, and to train staff. SEh,'RC26/2 Page 182

Assistance provided bv WHO during the year. (a) A physiotherapy tutor and a consultant; (b) supplies and equipment.

Work done durinp; the year. The Department of Medical Sciences opened eight physiotherapy units in provincial hospitals by assigning a physiotherapist to each of the hospitals. The WHO technical officer and a senior physiotherapist from Lerdsin Hospital visited seven of the above hospitals to assist in the planning of Eacili- ties, designing of equipment and selection of patients.

Textbooks and other items of supplies and equipment supplied by WHO were received.

In May 1973, a consultant was assigned for three months to assist in assessing the existing situation of occupational therapy in the hospitals in Bangkok and the provinces and to help in providing in-service training in occupational therapy to non-medical personnel of the medical rehabilitation services. She was also expected to provide assistance in the orientation of social workers assigned to physiotherapy units in the early detection and identification of potential social obstacles to rehabilitation among hospitalized patients.

Thailand 0095 Education in Public Health R (Dec. 1968 - Jan. 1969; Oct. - Nov. 1969; Jan. 1970; Nov. 1970; Dec. 1971 - Jan. 1972; March - May 1972; - )

Aim of the Droiect. To assist the Faculty of Public Health, Mahidol University, in further developing its teaching and training programmes.

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

Probable duration of assistance. Same years

Thailand 0097 Medical Education and Training R (May 1971 - )

Aim of the project. To develop further the teaching and training programme of the existing four medical faculties at Chiengmai, Chulalangkorn and Mahidol Universities, including the Faculty of Post-graduate Studies of the latter, and to plan the Faculty of Medicine at Prince of Songkhla University.

Assistance provided by m0 during the year. (a) Two consultants; (b) three three- month fellowships for study in the United Kingdom, a three-week fellowship for studies in Denmark, Algeria and Sudan, a two-month fellowship for studies in Australia, New zealand-and Japan, and a three-month fellowship for studies in Australia, New Zealand, Indonesia and Malaysia; (c) cost of attendance of participants in the meeting (see belaw); (d) supplies and equipment.

Probable duration of assistance. Some years.

Work done during the year. A consultant in virology was assigned to the Chiengmai MedicalCollege in June-July 1972 to advise and assist in the teaching of virology and rickettsiology in undergraduate and post-graduate courses. His report,which contains recommendations for the improvement of teaching methods and research facilities and for the development of a routine virological service for the hospital, has been sent to the Government.

A consultant in accident survey visited the Siriraj Medical School and Hospital from January to April 1973. He advised on improvement of the services and outlined specific measures which could be adopted to bring it about. SEA/RC26/2 Page 183

In co-ordination with an architect provided under project SEARO 0104, assistance was given in the planning of the Medical Faculty of Prince of Songkhla University.

As a follow-up, at the national level, of the inter-country Workshop on Commu- nity Health Aspects of Medical Education held under project SEARO 0171, a national workshop was organized in Bangkok from 14 to 18 May for 60 participants. The same two consultants who had assisted with the inter-country activity also helped with the workshop,for which the Regional Adviser on Medical Education served as one of the resource persons.

Thailand 0098 Health Planning and Administration R (Oct. 1970 - )

Aim of the project. To assist in national health planning and in health administration, on a broad basis, with primary emphasis on the phased integration of disease- control and special health programmes, eventually leading to the development of a comprehensive health care service in the country.

Assistance provided by WHO during the year. (a) A public health administrator; (b) two six-month fellowshipsfor studies in Czechoslovakia and India and a twelve- month fellowship for studies in the United States of America, Sri Lanka, India and Burma; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. Assistance was given in the establishment of a Division of Health Planning in the Ministry of Public Health. A project systems analvsis exercise, with the aim of developing medical and health services in Chonburi Province by improving and revising the existing health administrative systems and by establishing a suitable management system for integrated health services, was carried out by the Division in collaboration with staff me-bers from WHO Headquar- ters and the Regional Office.

The WHO public health administrator who had been with the project since December 1971,left in March 1973. His report, which has been sent to the Government, includes recommendations relating to the overall responsibility of the Ministry of Public Health for the nation's health, control of the government health ser;-ices by the Office of the Under-Secretary far State, adjus:ments between the departments to provide a more rational administrative and health delivery system, need for a methodology of health planning consistent with the socio-economic planning process, and development of a regionalized health service.

Thailand 0105 Production of Biologicals (June 1971; April 1972; Oct. 1972 - Jan. 1973; - )

Aim of the project. To assist the Department of Medical Sciences and the Government Pharmaceutical Organization in (i) building up capacity in the production of vaccines and sera, (ii) testing the sera and vaccines, and (iii) preparing national standards and reference reagents for vaccines and sera.

Assistance provided by WllO during the year. (a) A consultant; (b) a six-month fellmship for studies in India, Czechoslovakia and Yugoslavia.

Work done during the year. A consultant from Lister Institute (provided under project SEARO 0117) followed up the progress made in the production of DPT vaccine. The release of the vaccine is well below the installed capacity of the plant and is due in part to the inadequacy of advance planning in production and co-ordination between the different departments; also, a fermenter was found to be lying idle for lack of maintenance. Greater efforts need to be made in quality control in order to improve the potency of the vaccine. SEAlRC2612 Page 184

Another consultant, assigned in the last quarter of 1972, reviewed the status of vaccine and sera quality control with a view to developing a project for biological standardization. She proposed a three-phased scheme based on close co- operation between the Department of ~edicalSciences, the Government Pharmaceutical Organization and the Institute of Immunology, Zagreb, Yugoslavia. The consultant also advised on anti-venins. There is a demand for purified anti-venin to be produced; also, the present turn-out of anti-venin does not meet the day-to-day requirements. The consultant drew up a scheme and a plan of action for the establishment of a pilot plant for the purification of anti-venin in the Government Pharmaceutical Organization. The reports of the consultants have been submitted to the Government.

Thailand 0106 Improvement of Anaesthesiology R (July 1971 - )

Aim of the project. To assist the University of Mahidol in developing training programmes in anaesthesiology.

Assistance provided by WHO during the year. A consultant.

Work done during the year. Early in 1973, a consultant from the Anaesthesiology Centre, Copenhagen, advised the national authorities on the development of anaesthesiology.

Preliminary steps were being taken to facilitate the organization of an anaesthesiology training centre in Bangkok, with the intention of developing a Regional Anaesthesiology Centre eventually.

Thailand 0107 National Institute of DermatoloRY R (Feb. - March 1972; Jan. - March 1973; - )

Aim of the project. To establish a national institute of dermatology which will provide facilities for diagnosis, treatment, research and training.

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

Probable duration of assistance. Until 1975.

Work done during the year. Two consultants were provided to this project during the period under review. One, assigned in January-February, advised the National Institute of Dermatology on the mycological aspects of skin disease and assisted in the teaching programme of the Institute. She has recommended specialized training for the technical/professional personnel in a mycological reference and diagnostic laboratory and designation of the Institute as the centre for mycological diagnostic research activities in Thailand.

The other consultant, who was in Thailand in March 1973, assisted in the establishment of a contact dermatitis clinic in the National Institute of Dermatology. She gave lectures to the staff on the investigation of cases of contact dermatitis. Measures for strengthening the clinic have been suggested by this consultant.

The reports of both consultants have been sent to the Government.

The progress of construction of laboratory facilities was rather slow. SEAlRC2612 Page 185

Thailand 0108 Faculty of Dentistry. Chiengmai* R (March 1971; Sept. - Oct. 1971; April 1973; - )

Aim of the project. To establish a new School of Dentistry as part of Mahidol University and to train staff of the Chiengmai Medical College.

Assistance provided by WHO during the year. A three-month fellowship for studies in the United States of America, United Kingdom and Denmark.

Probable duration of assistance. Until the end of 1974.

Thailand 0109 School for Medical Physicists UN DP (Jan. 1971 - Jan. 1973; - )

Aim of the project. To teach and train medical physicists.

Assistance provided by WHO during the year. (a) A medical physicist; (h) a twelve- month fellowship for study in the United Kingdom; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1974.

Work done during the year. All the objectives of the plan of operation having been achieved, the WHO physicist who had been assisting the project since January 1971, left in January 1973. When the project was started in 1971, there were seven medical physicists employed in three hospitals; at the end of 1972, twenty-two were in employment in seven hospitals in Thailand. New premises for the School, with air-conditioned teaching and demonstration classrooms equipped with modern teaching aids, an experimental laboratory, and facilities for staff and students, were made available adjacent to the Division of Radiotherapy and Nuclear Medicine. In collaboration with the Thai Atomic Energy for Peace Establishment, the Thai Radiation Protection Services, the Faculty of Science, Mahidol University, and the Faculty of Engineering, Chulalongkorn University, an undergraduate course in medical physics leading to the B.Sc. degree was developed. The current two-year Master's degree course takes six candidates annually for training. This number is expected to be raised by two or three to accommodate candidates from neighbouring countries. The School has a well qualified team of national lecturers to conduct the courses at a high level of competence.

Thailand 0114 Role and Functions of Nursing and Midwifer]! UNFPA Personnel in Family Planning Services (March 1973; - )

Aim of the project. To provide assistance in developing a methodology for evaluating the activities of the indigenous midwife, including her present involvement in family planning, and her potential for use in this area.

Assistance provided by WHO during the year. Supplies and equi~ment. Work done during the year. In July 1972 a nurse consultant assigned to the ~egional Subsequently, an nffire------viaired-.-. - - Thailand. -- - - to discuss the status of this project. exchange of letters was initiated and signed. Further activity in this project has been in abeyance pending clarification of the relationship to other studies concern- ina the traditional birth attendant that are to be undertaken in the country. Thailand 0115 Teaching of Human Reproduction, Family Planning UNFP A and Population Dynamics in Medical Schools (Nov. - Dec. 1970; Aug. - Oct. 1971; Feb. 1972; July - Aug. 1972; Dec. 1972 - Jan. 1973; - )

Aim of the project. To strengthen the teaching, research and service functions in departments of paediatrics, obstetrics and gynaecology, preventive and social medicine and in other departments involved in the teaching of human reproduction.

*Previous title: Phyathai School of Dentistry SEA/RC26/2 Page 186

Assistance provided by WHO during the year. Two twelve-month fellowships for study in the United States of America, a six-month fellowship for studies in the United Kingdom, Sweden and the United States of America, and a nine-month fellowship for studies in the United Kingdom, Uganda and India.

Probable duration of assistance. Some years.

Thailand 0117 Faculty of Veterinary Sciences R (Nov. 1972 - Feb. 1973; - )

Aim of the project. To assist the Faculty of Veterinary Sciences, Chulalongkorn University.

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

Work done during the year. From November 1972 to February 1973, a WHO consultant assisted the Faculty of Veterinary Sciences in the development of food microbiology. He also participated in the teaching programme at the Faculty. He has recommended that the Department of Bacteriology and the Faculty of Science should co-ordinate their teaching so as to provide a better course in microbiology, and that lectures and laboratory classes on food hygiene should be included in the microbiology course for third-year students. He has also suggested the organization of symposia on selected aspects of microbiology. The consultant's report has been sent to the Government.

Thailand 0120 Bio-environmental Engineering UNDP (Oct. 1971 - July 1972)

Aim of the project. To assist the Sanitary Engineering Department, Faculty of Engineering, Chulalongkorn University, in carrying out a review and study of the current curriculum and the existing teaching and laboratory facilities with a view to recommending improvements in teaching and research in bio-environmental engineering.

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

Work done. The WHO consultant assigned to Chulalongkorn University in October 1971 to assist in the development of a training programme in bio-environmental engineering, completed his work in July 1972. In collaboration with the Department of Sanitary Engineering, Faculty of Engineering, Chulalongkorn University, he carried out a review and study of the current curriculum and the existing teaching and laboratory facilities. He also assisted and advised the Government in establishing facilities for engineering students who wished to specialize in a broader field of public health engineering. The report containing his recomnendations and findings relating to improvements in teaching and research in bio-environmental engineering, was submitted to the Government.

Some technical books were provided to the Department of Sanftary Engineering of Chulalongkorn University.

Thailand 0123 National Laboratory Animal Centre UNDP (Feb. - April 1973; - )

Aim of the proiect. To establish a national laboratory animal centre to provide small laboratory animals of standard quality to the teaching and research fnstftu- tions as well as biological laboratories. SEA/RC26/2 Page 187

Assistance provided by WHO during the year. A consultant.

Work donc during the year. Subsequent to the approval of the project document by UNDP in December 1972, a WtlO consultant in small laboratory animals was assigned from February to April 1973 to advise on the development of the National Laboratory Animal Centre, Bangkok. During the consultant's visit, it was possible to (i)draw lay-out plans of the buildings; (it) provide the technical specifications for drawing up detailed plans far the construction, and (iii) review the budget and formulate a long-term plan of action. The Centre will consist of an inter-connected group of buildings, and in drawing up the building plan adequate attention has been paid ta the control of the environment, the maintenance of high standanis of cleanli- ness and hygiene, the control of movements, and space requirements for breeding and other activities to be carried out by the Centre. The Centre will be concerned primarily with the breeding of a range of small laboratory animals according to specif Led standards and thc traininp of animal tec\micians and veterina~iansuper- visors who will be in charge of animal houses, and will provide information, advise and guidance to medical and health institutions in organizing animal houses and in stocking them with breeds drawn from the Centre.

The consultant's recommendations have been forwarded to the Government.

Thailand 0200 Fellowships R

Clinical pathology. A twelve-month fellowship for studies in the United Kingdom, Sweden and Denmark.

Radiotherapy. A five-month fellowship for studies in the United States of America, Canada and Swedrn.

'Tuberculosis control. A two-week frllowship for studies in the Republic of Korea and India. SEAlRC2612 Page 189

10. INTER-COUNTRY*

PROJECT LIST

Protect No. Source of Funds Co-operating Agencies Title

SEARO 0007 Assessment Team on Malaria Eradication R (May 1959 - Dec. 1961; Nov. 1963 - )

Aim of the project. To make an independent assessment of malaria eradication programmes, including any special aspects, in countries of the Region.

Assistance provided by WHO durinx the year. (a) Two consultants and temporary assistance from a Headquarters staff member and a malariologist assigned to a field project; (b) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. Early in 1973, independent assessments were carried out in two countries to determine the readiness of areas for the withdrawal of spraying and their phasing from consolidation to maintenance.

In Bangladesh,two WHO staff members who assisted with the re-phasing of the prograrme,recommended withdrawal of spraying from areas with a population of 5.242 million in the attack phase and entry into the pre-maintenance phase of areas in consolidation with a population of 9.827 million. Of a total population of 66.292 million, 25.368 million are now in the pre-maintenance phase, 32.697 million in consolidation and 8.227 million in areas in the attack phase.

The services of two consultants were also provjded for an independent assessment of the programme in Nepal. The assessment team recommended withdrawal of spraying from areas under attack with a population of 221 000; thus 83.1% of the population at malaria risk is now under the consolidation phase.

SEAR0 0030 Smallpox Eradication and Epidemiological R Advisory Team (Oct. 1962 - )

Aim of the project. To assist in the smallpox eradication programmes, in the develap- ment of epidemiological services, and in training.

Assistance provided by WHO during the year. (a) Two epidemiologists, an administrative officer (consultant), two consultants, two temporary advisers, a clerk- stenographer, and temporary assistance from Headquarters and Regional Office staff members and from field staff; (b) cost of attendance of participants; (c) supplies and equipment.

Probable duration of assistance. Several years.

*This list includes some meetings, seminars, etc., with participation from other regions but for which the Regional Office had the main administrative and financial responsibility. SEAIRC2612 Page 190

Work done during the year. The medical officers of the team visited Bangladesh and the following States in India; Andhra Pradesh, Assam, Bihar, Madhya Pradesh, Meghalaya, Rajasthan. Uttar Pradesh and West Bengal. During their field visits, they provided assistance mainly with regard to epidemiological investigation, outbreak containment, active search for cases and the training of staff. Following their assessment of the different components of the programme, they reviewed their findings with the concerned national officials and made specific recommendations for further improvement.

An inter-country Training Course in the Laboratory Diagnosis of Smallpox was held at the National Institute of Comunicable Diseases, Delhi,from 23 to 31 October 1972, with the assistance of two consultants. The Regional Adviser on Health Laboratory Services also took part. The course was attended by participants from Bangladesh, Burma, India, Indonesia, Nepal, Sri Lanka and Thailand.

The two epidemiologists actively participated in the preparations and conduct of the inter-country Seminar on Surveillance in Smallpox Eradication, which was held in the Regional Office from 30 October to 2 November. There were fifty participants from Bangladesh, India, Nepal and Bhutan as well as WHO staff from Headquarters, the Regional Office and field projects. The WHO staff also assisted in the conduct of and attended the Indian State Programme Officers' meeting held on 2 November in New Delhi.

A consultant was assigned to Burma, Indonesia and Thailand to assist and assess the production of freeze-dried smallpox vaccine in those countries (see SEAR0 0038.2)

With the Senior Medical Officer acting as Regional Adviser at the regional level, the team co-ordinated the smallpox programes in the Region, especially in the sphere of intcr-country cross notification, and additional steps were taken to enhurt a uniform and prompt reporting system in the Region. More than two m~llioncopies of reporting and other forms, teaching material, surveillance aids, etc., were distributed throughout the Region during the year.

SIIARO 0038.2 Production of Freeze-dried Smallpox Vaccine R (Nav. - Dec.1967; Nov. - Dec.1968; Dec. 1969 - Jan.1970; UNICEF Dec. 1970 - Jan. 1971; Dec. 1971; Dec. 1972 - Jan. 1973; -)

Aim of the project. To assist with the production of freeze-dried smallpox vaccine.

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

Probable duration of assistance. Until 1974.

Work done during the year. A WHO consultant, in a follow-up visit during December 1972-January 1973, has reported on the status of the production of freeze-dried smallpox vaccine in Burma, Indonesia and Thailand. The consultant's observations confirm that the objectives which were set forth under this project have been fully achieved. All three countries have well established capacities to meet the recur- ring requirements of their respective national smallpox eradication programmes and also have developed capability and technical competence to produce vaccine which meets the prescribed WHO requirements for potency and stability. Problems exist, however, particularly with regard to the contamination of pulps and their low virus yields; the non-availability of replacement parts locally is also a problem.

There is an awareness in all the three countries that as a result of the pra- gress made in the smallpox eradication programme, the pressure on the indigenous vaccine will ease substantially in the near future. Consideration Is therefore given to utilizing the surplus manpower and machinery capacity for the production of other vaccines which are amenable to lyophilization such as rabies vaccine, DPT and RCG. SEAIRC2612 Page 191

Minor items of equipment (replacements and spares) were provided to Burma, Indonesia and Thailand.

SEARO 0042.2 Radiation Protection R (Sept. - Dec. 1968; April 1969; Sept. 1969 - Jan. 1970; Nov. - Dec. 1971; - )

Aim of the project. To train personnel concerned with the use of ionizing sources of radiation and promote the development of radiation protection practices in health institutions by improved measures to guard against the harmful effects of radiation.

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

Probable duration of assistance. Until the end of 1977.

SEARO 0064 Community Water Supply and Sanitation R (April 1965 - )

Aim of the project. To assist countries of the Region in developing urban and rural conmunity water supplies and sanitation programmes.

Assistance provided by WHO during the ycar. (a) Tt.rre sanitary engineers and two clerk-stenographers; (b) supplies and equipmcnr.

Probable duration of assistance. A number of years.

Work done during the year. The team leader and one of the two sanitary engineers stationed in New Delhi continued to provide assistance to the Regional Adviser on Environmental Health. The former assisted in matters relating to programmes for training and education and in other related aspects. He also helped in the preparations and conduct of a regional seminar on air pollution control held under project SEARO 0150 at Nagpur, India. The sanitary engineer gave necessary technical advice to the UNDP-assisted programme of water supply and sewerage for Greater Kathmandu and Bhaktapur in Nepal and assisted in the preparation of a project document for a UNDP water supply and sewerage project for Male in the Maldives. He made a detailed evaluation of the progress of the WHO/UNICEF-assisted community water supply and sanitation programme in Nepal in order to suggest ways and means of improving and accelerating implementation. He also studied the environmental health activities in Bangladesh and discussed with the Government the possibility of a programme for conversion of dry latrines into water-borne ones and solid waste disposal in Dacca City.

The sanitary engineer stationed in Bangkok made visits to Burma and Indonesia from time to time to provide further assistance in the development of rural water supply schemes in these countries. In Burma he visited the WHOlUNICEF-assisted rural water supply project in Hlegu. In Thailand, he assisted the Provincial Water Supply Division in the preparation of a long-term urban vater supply scheme, which aims to cover the remaining urban communities by 1980. He also gave help in the development and conduct of in-service training courses for waterworks personnel in the techniques of operation and control of water treatment plants.

He participated in the project systems analysis study on rural water supply in West Java, Indonesia, conducted by a WHO team during the first quarter of 1973 and also assisted in the preparation and conduct of a WHO regional seminar on training and utilization of sanitary personnel in Djakarta in early May (under project SEARO 0165).

A team of two staff members from WHO Headquarters assisted the Government of Indonesia in a feasibility study of sewerage in Djakarta and in the preparation of a project document for UNDP assistance in this field. Preliminary steps were SEA/RC26/2 Page 192

taken for the recruitment of two consultants, one to be assigned to Thailand to assist in the management of existing water supply systems, and the other to Nepal to help in the implementation of a rural water supply scheme and organize a training programme for those engaged in such projects.

The post of team leader, which fell vacant in December on account of the sudden death of the engineer holding it, was filled in March by the promotion of the sanitary engineer stationed in New Delhi; action was initiated to fill this latter post.

External Cross-Checking of Blood Films (Sept. 1968 - )

Aim of the project. To develop facilities in the countries of the Region for independent cross-checking of blood films from malaria programmes.

Assistance provided by WHO during the year. A laboratory specialist.

Probable duration of assistance. Until the end of 1977.

Work done during the year. The WHO laboratory specialist, who had been stationed in Sri Lanka since September 1968, was reassigned to Indonesia in February 1973.

Decentralization of the laboratory services in Sri Lanka, planned for 13 regional laboratories, was in progress with eight laboratories now functioning, staffed with 135 microscopists and four medical laboratory technicians; a further 35 microscopists were under training. There are 314 microscopes available in different laboratories, with a microscope maintenance service for their periodic check-up and maintenance.

The number of blood slides examined has been consistently above 1.5 million slides a year since 1969, with an average daily examination rate steadily improving from 38.2 in 1969 to 42.0 in 1972, though it remained below the daily maximum of 65 blood films per microscopist owing to high rates of absenteeism. The backlog of examination, which stood at 85 727 blood slides at the end of 1969,was reduced to 7 549 at the end of 1971; in 1972, however, it increased again to 35 741.

In the absence of an effective and frequent on-the-spot supervision of the laboratory service, the main supervision is carried out indirectly through the cross-checking laboratory established in February 1969. The laboratory aim to confirm all positives recorded and to re-examine 10% of all negatives. From 1969 through 1972, error rates in positives were,respectively, 0.73%, 1.06%, 0.10% and 0.22%; error rates in negatives were 2.84%. 2.78%, 0.96% and 0.49%. With the introduction of the 'wide-angle' system, the cross-checking staff are now able to double the volume of blood examined without impairing the quality or rate of daily examination.

During his assignment, the WHO laboratory specialist imparted, through various training courses, basic training to 93 microscopists, refresher training to 100 microscopists and training in medical laboratory technology to 8 laboratory technicians.

Regioilal Health Manpower Development* (March 1969 - )

Aim of the project. To develop medical education at all levels; to adjust teaching and training programmes to the needs of the countries in the Region and to the progress of educational science; to train medical educators, with particular emphasis on educational science, and to promote inter-country exchange of experience in educational matters.

*Previous title: Medical Education SEAlRC2612 Page 193

Assistance provided by WHO during the year. (a) Seven consultants and temporary assistance from a Regional Office staff member; (b) four three-month fellowships for candidates from Thailand - three for studies in the United States of America and Canada and one for studies in the United States of America, Israel, Iran, Sri Lanka, Indonesia and Australia - a twelve-month fellowship for a candidate from Sri Lanka for studies in the United States of America and Japan, a ten-week fellowship for a candidate from Thailand for studies in the United Kingdom and India, a five-month fellowship for a candidate from Sri Lanka for studies in the United States of America, Canada and the United Kingdom, and a twelve-month fellowship for a candidate from Thailand for study in the United States of America; (c) cost of attendance of participants; (d) supplies for Sri Lanka and Thailand-

Probable duration of assistance. A number of years.

Work done during the year. A long-term medical officer was assigned to the project in May 1973 as project co-ordinator.

Two regional medical teachers' training courses were organized during the period under review. The third course took place at the Faculty of Medicine, Chulalongkorn University, Bangkok, in July 1972 with 25 participants from Indonesia and Thailand. The faculty consisted of three WHO consultants drawn from the Center for Educational Development, University of Illinois, USA. The report on this course has been issued.

The fourth medical teachers' training course, which took place at the Faculty of Medicine, University of Sri Lanka, Peradeniya Campus, in January 1973, had 17 participants, who came from Bangladesh and India in addition to Sri Lanka. AWHO consultant assisted in the conduct of this course. The Chief of Education and Training from the Regional Office took part in both courses.

Plans were under way to hold a refresher course on "Care of the Newborn" at two centres in Indonesia in Septemher-October 1973. The course, which is the first of its kind to he held in South-East Asia, is in the form of continuing education and is designed to give an opportunity to doctors in service in the public sector and those in the private sector, together with nurses and other health personnel, to attend a learning experience in the latest methods of the care of the newborn.

SEAR0 0097 Nutrition Training and Advisory Services R (Dec. 1963 - ) UNICEF

Aim of the project. To assist with the training of health personnel in nutrition and to advise on public health measures in nutrition.

Assistance ~rovidedby WHO during the year. (a) A consultant; (b) five three-month fellowships for candidates from Bangladesh (1) and Thailand (4) for participation in the certificate course in nutrition, a three-month fellowship for a candidate from India for studies in Switzerland, United Kingdom and the United States of America, a six-month fellowship for a candidate from Mongolia for studies in the USSR and Bulgaria, a four-month fellowship for a candidate from India for studies in the United States of America,Guaternala,Japan and Thailand,and a nine-month fellowship for a candidate from Thailand for study in India; (c) supplies and equipment.

Probable duration of Assistance. Until the end of 1975.

Work done durin~the year. A WHO consultant visited Thailand for a few days in February to provide assistance in the preparation of guidelines for a national food and nutrition policy.

Preparations were made to hold, in October 1973, a meeting of experts to review the present knowledge of nutritional anaemias in the Region and to recommend measures for their prevention and control. SEAlRC2612 Page 194

SEARO 0099.3 Epidemiology of Virus Diseases R (Aug. - Oct. 1967; Jan. 1969; Aug. - Sept. 1969; Feb. - March 1971; June 1971; July 1972; - )

Aim of the protect. To assist in the development of regional epidemiological surveillance of haemorrhagic fever and in national and international studies to find effective methods of control.

Assistance provided by WHO during the year. A consultant and temporary assistance from a Headquarters staff member.

Work done durina the year. In July 1972, a WHO consultant assisted the Government of Burma in strengthening the haemorrhagic fever surveillance programme in that country. His report was sent to the Government. Another consultant (a staff member from WHO Headquarters) assisted Indonesia in an assessment of a dengue/haemorrhagic fever outbreak in Semarang and also visited Burma to review the situation relating to denguelhaemorrhagic fever in that country.

It is planned to undertake a more concerted sumeillance programme against denguelhaemorrhagic fever in collaboration with WHO Headquarters and the Regional Office for the Western Pacific.

SEARO 0102 Asian Institute for Economic Development R and Planning, Bangkok EC AFE (Jan. 1964 - ) UNICEF

Aim of the project. To assist the faculty of the Asian Institute for Economic Development and Planning with the health component of training courses and research.

Assistance provided by WHO during the Year. (a) A public health administrator and an economist; (b) supplies and equipment.

Probable duration of assistance. Until 1974.

Work done during the year. Assistance was given to the Mahidol Public Health Faculty and the Ramathibodi Hospital at Bangkok in respect of the health planning aspects of the MPH course at the Faculty, and in plans for conducting a seminar on principles and techniques of health planning at Mahidol University in September 1973.

The WHO public health administrator and the WHO technical officer (economist) assigned to the Asian Institute took an active part in the conduct of its various courses. The WHO technical officer organized a session on programme evaluation and review technique (PERT) and another on appraisal of health projects, and the public health administrator arranged a session on the effect of influenza epidemics on the economics of rice growing. Assistance was also given in planning for the Institute's General Course in the Techniques of Development Planning, organized between February and June 1973. The Institute's faculty members received advice and assistance on various papers written by them, two in connection with a seminar on health planning held in Manila, and one on "Control of the Working Environment in a Centrally Planned Economy".

The public health administrator assisted the First Regional Conference on National Health Planning held in the Western Pacific Region. He also attended, on behalf of WHO, a United Nations inter-regional Workshop for Directors of Centres Engaged in Research and Training in Regional Development, held in Nagoya, Japan. Assistance was given to WHO Headquarters in preparing a programme for the WHO Representatives' Training Course held in Alexandria in February-March 1973. SEA/RC26/2 Page 195

The WHO technical officer took part in an assessment of the malaria eradication programme in the British Solomon Islands Protectorate in the Western Pacific Region.

SEARO 0104 Organization and Administration of Hospital R and Medical Care Services (AUK.- - Oct. 1968; Dec. 1968; Feh. 1969; July 1970 - Jan. 1971; Sept. - Dec. 1971; Feb. 1972; May - July 1972; Nov. 1972 - June 1973; - )

Aim of the project. To assist in the development of regionalized health services, in the organization of systems of medical care, and in hospital administration, including the planning and development of facilities for the diagnosis, treatment, care and rehabilitation of the sick; to assist in the development of uniform systems of record-keeping for health centres and hospitals.

Assistance provided by WHO during the year. (a) Three consultants, a temporary adviser, and temporary assistance from a Headquarters staff member as well as Regional Office and field staff; (b) four two-month fellowships for candidates from Mongolia for studies in the USSR, Bulgaria and Hungary; (c) cost of attendance of participants; (d) secretarial assistance.

Probable duration of assistance. A number of years.

Work done durinr; the year. An important activity under this project was the holding of a three-day Discussion Group Meeting on Medical Care, which took place in the Regional Office from 18 to 20 Apxil 1973. The fifteen participants were senior policy makers in health or planners in health and planning ministries, and came from Bangladesh, Burma, India, Indonesia, Mongolia, Nepal, Sri Lanka and Thailand. The objective of the meeting was to formulate guidelines on the major elements of WHO'S programme and plans for assistance in the strengthening and development of comprehensive health services, especially the medical care component. Two consultants, one temporary adviser, and a staff member from Headquarters assisted in the planning, conduct and evaluation of the meeting.

Assistance was given to the Government of Thailand by the assignment of a consultant-architect to advise on the design of a new teaching hospital to be constructed on the campus of Prince of Songkhla University.

SEARO 0113 Tuberculosis Traininr; and Evaluation Team R (Dec. 1967 - )

Aim of the project. To provide training in tuberculosis control; to assist with operational research related to the assessment and evaluation of integrated tuberculosis control programmes in the Region and to give practical assistance to national tuberculosis programmes.

Assistance provided by WHO during the year. (a) A medical officer, a statistician, a laboratory technician, a public health nurse and a consultant; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1977.

Work done during the year. The team, which consists of a medical officer (team leader), a statistician, a nurse and a laboratory technician, assisted in carrying out an assessment of the national tuberculosis control programme in Mongolia during July-September 1972. A WHO consultant also assisted with the assessment and in the conduct of a national seminar at which the assessment findings were reviewed and discussed. The report on the assessment has been sent to the Government. SEA/RC26/2 Page 196

Based on the experience gained in the assessment of programmes in various countries, the team has started work on the preparation of an assessment methodology and a suitable manual for this purpose.

In Sri Lanka, where the team is stationed, assistance and co-operation were extended to the National Tuberculosis Institute, especially in training activities and in the assessment and supervision of the integration of the tuberculosis programme into the health services.

Seminar on Malaria Epidemiology (21 February - 2 March 1973)

Aim of the project. To exchange information on the changing epidemiological patterns of malaria in the Region.

Assistance provided by WHO during the year. (a) A temporary adviser and assistance from Regional Office and field staff; (b) cost of attendance of participants.

Work done. The WHO Seminar on Malaria Epidemiology was conducted at the Malaria Eradication Training Centre at Prabudhabat in Thailand from 21 February to 2 March 1973. Two participants each from all countries in the Region, except the Maldives and Mongolia, and five additional participants from Thailand, attended the Seminar. The faculty consisted of a temporary adviser and staff members drawn from the Regional Office as well as from the malaria project in Thailand. The Regional Office provided the services of an administrative assistant.

Various aspects of malaria epidemiology were discussed and experiences gained in the malaria programmes exchanged. The seminar was considered a success.

SEARO 0116 Inter-Country Nursing Meetings R (Aug. - Sept. 1967; Nov. 1969; Nov. - Dec. 1971; Dec. 1972 - Feb. 1973; - )

Aim of the project. To hold biennial meetings for the purpose of studying problems in nursing that are of interest to all countries of the Region.

Assistance provided by WHO during the year. (a) ltro consultants, a temporary adviser,and temporary assistance from a staff member assigned to an inter-country project; (b) cost of attendance of participants; (c) secretarial assistance; (d) supplies for thc meeting.

Probable duration of assistance. Until 1977

Work done during the year. The Meeting on the Role of Operational Studies in Health Senices and Education for these Services (the first to be organized by the Regional Office on this subject). was held in Bangkok from 12 to 21 December 1972. It was attended by 22 participants from six countries of the Region - eight nurses and 14 doctors, all holding senior positions in health administrations, educational or health research institutions in their own countries. Three observers - two from the Rockefeller Foundation and one from LWICEF - were present on a part-time basis.

Two consultants, assisted by three temporary advisers, the ?ragramme management officer from the Regional Office, and the nurse administrator attached to project SEARO 0148 conducted the meeting. One of the Regional Nursing Advisers attended the last four days of the meeting.

The method of approach adopted at the meeting was to introduce participants to the elements of operational research studies in the health field and dealing with each of these elements in lectures and exemplifying the broad aspects by means of SEA/RC26/2 Page 197

real case studies. To ensure that the participants had the opportunity to test the methodology of operational studies, a number of group activity sessions were utilized to work out prepared examples and others were concerned with the development of a practical operational study for the solution of real health problems which the participants themselves had brought up at the meeting. All participants expressed the need for holding further serninars/workshops on operational studies every one or two years at both country and inter-country levels to impart new knowledge and skills in this field.

SEARO 0117 Di~htheria/Pertussis/TetanusVaccine R Production UNICEF (July 1968; Feb. 1970; June 1972;

Aim of the project. To assist in the production of diphtherialpertussisltetanus vaccine consistent with WHO minimum requirements.

Assistance provided by WHO during the year. A consultant.

Probable duration of assistance. Until the end of 1977.

Work done during the year. A WHO consultant was assigned to Thailand during November-December 1972 to follow up the action taken on the recommendations made by him after a visit in 1970, and also to review the status of DPT vaccine production and potency testing in Thailand. The consultant found that the Government Pharmaceutical Organization had the necessary staff, "know-how" and equipment to increase the production. He has suggested that the Department of Medical Sciences and the Ministry of Public Health should find out whether pertussis is a real health hazard in children and whether tetanus is not a disease of public health importance in Thailand. He has also noted that very little potency testing is being done. The report containing his findings has been sent to the Government.

SEARO 0128 Training Courses in the Management of R Infectious-disease Hospitals (Oct. 1967 - )

Aim of the project. To assist in improving infectious-disease hospitals so that they may provide adequate facilities for the diagnosis, treatment and teaching of infectious diseases.

Assistance provided by WHO during the year. (a) Trio Consultants and two temporary advisers; (b) cost of attendance of participants; (c) secretarial assistance.

Work done during the Year. An inter-country Training Course on the Management of Infectious-disease Hospitals was conducted at Hyderabad (India) from 13 to 25 November 1972. The 20 participants came from Bangladesh, Burma, India, Indonesia, Mongolia, Nepal, Sri Lanka and Thailand. Of the participants, eleven were clinicians, four nurses, three epidemiologists and two medical administrators.

The course was assisted by two WHO consultants (a clinician and a nurse). in addition to two temporary advisers. The WHO consultants later visited Burma, Indonesia, Sri Lanka and Thailand to undertake an evaluation of the impact of the courses held in 1967 and 1970 as well as to review the management aspects of selected infectious-disease hospitals in those countries. Their reports on the course and on the visits have been issued. SEA/RC26/2 Page 198

Workshops and Seminars in Health Education (June 1967 - ) UNICEF (UNESCO)

Aim of the oroiect. To promote the technical standard of health education and its future development in the Region by providing opportunities to acquire latest knowledge, experience and skills in different aspects of health education and behavioural sciences.

Assistance provided by WHO during the vear. (a) ltro consultants and five temporary advisers; (b) cost of attendance of participants; (c) supplies for the workshop.

Work done durinp the year. The inter-country Workshop on Field Training in Health Education was held in the Regional Office from 23 October to 4 November 1972. Twenty participants and five temporary advisers from the countries of the Region attended it. There were also four representatives - one each from UNESCO and UNICEF and two from US AID.

The workshop developed a guide for field training in health education, apart from making recommendations for the follow-up. Each of the participating countries also developed a plan for improving their field training activities related to health education. The temporary advisers presented papers on their experiences in specialized areas of the field training programme.

The report of the workshop was sent to the participants.

Plans were under way for an inter-country workshop on the role of social, cultural and educational factors in effective planning and programming for infant health care, to be held in Kathmandu, Nepal, from 2 to 9 October 1973. This workshop will identify the most important social, cultural and educational factors for developing effective infant health services and examine their significance for planning and programming.

SEAR0 0139 Short Courses For Nurses and Other R Health Personnel UNICEF (Jan. 1967 - )

Aim of the project. To assist in conducting short courses for nurses and other health personnel in order to develop new concepts and skills with particular reference to patient care and family health; to assist in preparing reference and teaching materials; to develop new educational techniques useful to the implementation and evaluation of short courses; also to participate in studies of nurs- inn services and education.

Assistance provided by WHO during the year. (a) Five nurse educators, five consultants and two clerk-stenographers; (b) cost of attendance of participants; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the vear. During the period under review two inter-country courses were conducted under the project,the subjects being "Paediatric Patient Care" and "Effective Leadership and Management by Objectives in Public Health Administration and Supervision". Thirty-five nurses and twenty-five doctors from Bangladesh, Indonesia, Sri Lanka and Thailand attended these two courses. Assistance was also provided to five country-level courses on a variety of subjects; three of these courses were conducted by the project staff and two by consultants. SEAlRC2612 Page 199

A nurse educator from the project visited the nurses in Thailand who had attended the WHO-sponsored Training Centre for Nurses in Wellington, New Zealand. The purpose of the visit was to confirm that the New Zealand progralmne was appro- priately meeting the needs of Thailand. A structured evaluation tool was developed in the project and used during the follow-up of thr fellows.

henurse educator has been fully occupied with the sequential learning activity in "paediatric patient care" during the period under review. (The development of this activity, which is being conducted in 5ri Lanka, was mentioned in the last Annual Report.) The tool for evaluating the level of paediatric patient care has been applied in all the paediatric units which are conducting nurse training. The data already collected were being supplemented by the information being sent directly from Sri Lanka to the Regional Office at monthly intervals. The course component of phase 1 of the activity was conducted as planned, with fourteen paediatric nurses and seven paediatricians participating. The nurse educator responsible for the overall activity, together with a doctor and a nurse consultant, conducted the course.

Increasing assistance was being provided by the staff of this project to WHO staff from ather projects, consultants, and national health staff in the organization of short courses and associated matters. A re-organization of the reference material available with the project was undertaken in order to facilitate the ready identification of required source materials.

Rehydration Therau (Feb. - March 1967; March 1970; March 1971 - )

Aim of the project. To assist in producing rehydration fluid and in establishing rehydration centres in children's hospitals and at peripheral centres, and to train staff.

Assistance provided by WHO during the year. (a) Four consultants and a temporary adviser; (b) cost of attendance of participants; (c) secretarial assistance; (d) supplies for Mongolia and Sri Lanka.

Probable duration of assistance. Until the end of 1977.

Work done during the year. An inter-country course on rehydration therapy centres was held at the Post-graduate Medical Studies Institute, Rangoon, from 19 to 24 March. The course was intended for senior paediatricians and other medical officers engaged in the practice of rehydration therapy and clinical management of dehydration caused by diarrhoea1 diseases. Emphasis wds given to the development of rehydration centres and training and the most effective use of paramedical personnel in the conduct of such centres. Twenty participants, 16 from Burma and 4 from Nepal, attended the course, which was assisted by a WHO consultant and a WHO temporary adviser.

A WHO consultant undertook a follow-up visit to Indonesia for two weeks in March 1973 to evaluate the progress made in rehydration therapy since 1971 and to advise on future development.

Nepal and Mongolia received advice on plans for the production of intravenous infusion fluids. In Mongolia, following an assessment made by the consultant who visited Ulan Bator in November-December 1972, a new project is being developed (see Mongolia 0027, "Rehydration Therapy - Production and Control"). His findings have been sent to the Government.

On the basis of a brief assessment undertaken by a WHO consultant provided to Nepal in September 1972, it was estimated that the medical services would require 117 000 units (half litre) of fluids every year - 84 000 units for Kathmandu and 33 000 units for the four zonal hospitals visited by the consultant. Financial and SEA/RC26/2 Page 200

logistic considerations place serious limitations on the capacity of the Directorate of Health Services to meet the hospitals' demand for fluids, though the fluids are produced locally at the Royal Drug Research Laboratory. The situation could be improved if production was decentralized and a cluster of smaller units could operate within the medical service. Plans were in hand to establish a pilot unit in Kathmandu which would meet the immediate needs of the hospitals in Kathmandu Valley; it was also expected to be used as a training centre for the development of smaller units in the zonal hospitals of Biratnagar, Birganj and Nepalganj.

The consultant has provided a lay-out plan of the central and zonal units, a list of supplies and equipment and specifications for the building of the pilot unit in Kathmandu; he has also prepared a schedule of production, a list of recommended fluids and their respective formulae and necessary criteria for quality control. His report has been forwarded to the Government.

SEARO 0148 Strengthening and Development of Health Services R (June 1970 - )

Aim of the project. To constitute a resource group and field arm for the Programme Support and Co-ordination Unit of the Regional Office, which will (1) assist in the analysis of WHO-assisted health projects and programmes; (2) help to identify areas in which operational and cost-benefit studies are needed; (3) participate in the design, conduct and evaluation of such studies, and (4) assist in co-ordinating all operational studies undertaken by the Regional Office.

Assistance provided by WHO during the year. (a) A nurse administrator, an economist, two consultants and a clerk-stenographer; (b) supplies and equipment.

Probable duration of assistance. A number of years

Work done during the year. The project has continued to give assistance to the National Health Marpower Study in Sri Lanka. In July and August 1972 a consultant- statistician assisted with the data processing aspects of sub-study "G", "Activities of Health Personnel Working in Rural Areas". On completion of this assignment the same coosultaot reviewed statistical methods used in health service studies in South-East Asia.

The economist recruited under the project joined in September 1972 and became a resource person within the Programme Support and Co-ordination Unit of the Regional Office. He visited Indonesia and Thailand in November 1972, spending one week with the Headquarters project systems analysis team. Documentation was prepared for the meeting of the Sub-Committee formed by the Regional Comittee to advise the Regional Director on the collection of information for a proposed health charter for Asia. Proposals were prepared for the information base for the Regional Office strategy, the revision of strategy guidelines and inter-agency co-ordination. The major activity of the economist during the latter part of the period under review has been the preparation of background papers for the technical discussions on "Application of Modern Management Methods and Techniques for Improved Delivery of Health Services", to be held during the twenty-sixth session of the Regional Committee.

The nurse administrator has assisted with some aspects of the national health manpower study in Sri Lanka. She participated for one month in the project systems analysis exercise in Thailand. Assistance was given to the preparation and conduct of the Meeting on the Role of Operational Studies in Health Services and Education for these Services (project SEAR0 0116),held in Bangkok in December. Plans have been made for the follow-up of this meeting by the team. In February she particpated in a seminar on nursing services held at the National Institute of Health Administration and Education, New Delhi.

Assistance has been given to project formulation within the Regional Office. SEAlRC2612 Page 201

A consultant economist was recruited for a period of five weeks during August 1972 to assist in the preparation of a document on "Health in the Senice of Asian Development" for the twenty-fifth session of the Regional Committee.

Recruitment was under way for the vacant posts.

SEARO 0150 Education and train in^ of Environmental R Health Personnel (Sept. 1970 - April 1971; Oct. - Dec. 1972; - )

Aim of the project. To assist in the training and utilization of engineers and other personnel in various aspects of environmental health requiring urgent attention.

Assistance provided by WHO during the year. (a) Three consultants, two temporary advisers and temporary assistance from a scientist from Headquarters and a sanitam engineer assigned to a project; (b) cost of attendance of participants; (c) secretarial assistance.

Probable duration of assistance. A number of years.

Work done during the year. A Regional Seminar on Air Pollution Control was held at the Central Public Health Engineering Research Institute, Nagpur (India), from 4 to 15 December 1972. The object of this seminar, which was the first of its kind to be organized by WHO in this region, was to provide an opportunity to the engineers and other officials engaged in air pollution control activities to exchange views on common problems and to explore jointly ways and means of solving them. Twelve participants from different countries of the Region attended the seminar and, in addition, the WHO field sanitary engineers in the Region also took part. The seminar was greatly appreciated by all the participants, who considered it a timely development in view of the growing concern of governments over the increasing problems of air pollution arising from rapid industrialization and urbanization.

Two consultants and two temporary advisers assisted in organizing and conducting the seminar. One of the consultants also studied the air pollution problems in some countries in the Region before the seminar.

A proposal to hold a regional seminar on training in sanitary engineering in October 1973 in Bangkok was under consideration by the Government of Thailand.

A consultant was recruited under this project to assist in the preparation and conduct of a meeting of IJHO field sanitary engineers, which was held in the Regional Office from 18 to 20 December 1972. The purpose of the meeting was to discuss the long-term planning for WHO assistance in environmental health during the period 1975-1980.

SEARO 0153 Training in Imunolo~y R (Oct. - Dec. 1969; Nov. 1970; Feb. - March 1972; Aug. - Sept. 1972; - )

Aim of the project. To review progress in immunology, particularly as related to communicable diseases, and to contribute towards increasing the competence of national immunologists.

Assistance .provided by 15110 during the year. (a) Two consultants and three temporary advisers; (b) Cost of atLendance of p3rticipants; (c) secretarial assistance.

Probable duration of assistance. Several years.

Work done during the year. A WHO-organized workshop in immunology was held in the Department of Microbiology, Mahidol University, Bangkok, from 21 August to 1 September, SEA/RC26/2 Page 202

1972, for 15 participants from India, Indonesia, Nepal, Sri Lanka and Thailand. The workshop, which was assisted by two WHO consultants and three temporary advisers, reviewed recent developments in imunology and provided demonstrations on immunological techniques to the participants. The workshop was considered as very useful by the participants, who felt that similar workshops should he organized at frequent intervals.

A WHO Meeting of Investigators on Immunological Problems in Leprosy Research, organized by WHO Headquarters, was held in the Regional Office from 30 November to 5 December. The thirteen participants, who came from well known laboratories dealing with immunology, reviewed the present status of the results of research in the subject and also discussed plans for future co-operation.

SEAR0 0154 Oualitv Control of Biological R and Pharmaceutical Products (Oct. - Nov. 1968; Jan. - Aug. 1969; Jan. - Feb. 1971; Jan. - Feb. 1973; June 1973; - )

Aim of the project. To assist countries of the Region in establishing or strengthening their quality control services and in improving laboratory competence, and to organize seminars on the quality control of biological and pharmaceutical products.

Assistance provided by WHO during the year. (a) A consultant and temporary assistance from a pharmaceutical chemist assigned to a field project; (b) cost of attendance of participants.

Probable duration of assistance. For some years.

Work done during the year. A WHO-sponsored Workshop on Quality Control of Drugs was held in Djakarta from 4 to 8 June 1973 for thirteen participants from Bangladesh, India, Indonesia, Nepal, Sri Lanka and Thailand. The purpose of the Workshop was to bring together the most knowledgeable authorities from the drug control agencies in different countries of the Region for discussing the various aspects of drug quality control and legislation and for developing a mutually agreeable set of procedures and recommendations for surveillance of drugs marketed in the Region. The programme of the Workshop also included a field visit. A WHO consultant,together with a WHO pharmaceutical chemist assigned to Thailand, assisted in conducting the Workshop, which was also attended by the Regional Adviser on Public Health.

SEARO 0159 Health Laboratory Services R (Aug. 1970 - )

Aim of the project. To review the progress achieved in the re-organization of national health laboratory services; to consider the administrative and technical operation and management of these services; to determine ways of standardizing methods, equipment, teaching, recording and reporting in order to formulate guidelines for co-ordination with recipient services such as epidemiological and health services, and to assist in the training of laboratory personnel.

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

Probable duration of assistance. A number of years.

Work done during the year. As a follow-up of the recommendations arising from the inter-country meeting of health laboratory administrators organized by the Regional Office in 1970, the status of the health laboratories in India and Sri Lanka was assessed by a WHO consultant from October 1972 to January 1973. In Sri Lanka, the laboratories were functioning well and their development was proceeding on sound lines, SEA/RC26/2 Page 203

emphasis being placed on bacteriology; referral services were developing gradually. The training of technicians was progressing satisfactorily and the educational standards of the trainees was also satisfactory. There remained some obstacles in the way of more rapid progress.

In India, implementation of the recornendations of the inter-country meeting mentioned above has been limited to the establishment of chairs of microbiology in medical colleges and the holding of a national seminar in New Delhi to urge the State governments to upgrade their respective health laboratory systems. The findings of the consultant call for important measures to increase the effectiveness of the health laboratories in the States. His report has been sent: to the governments concerned.

In view of the interest shown by governments in improving the microbiological aspects of food control and food hygiene, it is planned to provide assistance to projects in this field.

Seminars on Training and ULilization of Sanitary Personnel (June 1968; April 1973 - )

Aim of the project. To review the training of auxiliary personnel and their utilization in environmental health services, and to consider improvements in training programmes.

Assistance provided by WHO during the year. (a) A consultant and assistance from field staff; (b) cost of attendance of participants.

Work done during the year. A WHO-sponsored Regional Seminar on Training and Utiliza- tion of Sanitary Personnel was held in Djakarta from 9 to 18 May 1973. It was a follow-up of a similar conference held in 1968, and its purpose was to review further the training of auxiliary sanitation personnel and their utilization and exchange views on the best methods to be adopted for the proper utilization of the trained personnel. Fourteen participants from different countries of the Region attended the Seminar.

A consultant assisted in the preparation and conduct of the Seminar. In addition, the field staff in environmental health projects who attended the Seminar also provided necessary help.

The project is expected to be merged with SEAR0 0150 from 1974.

SEAR0 0168 Training in Veterinary Public Health and R Promotion of Veterinary Public Health Services (Aug. - Sept. 1968; March - June 1969; March - May 1970; Feb. - March 1972; May 1972; March - April 1973; - )

Aim of the project. To assist in training veterinary public health officers.

Assistance provided by WHO during the year. (a) A consultant; (b) a tuelve-month fellowship for a candidate from Indonesia for study in the United States of America.

Probable duration of assistance. A number of years.

Work done during the year. A WHO consultant visited Bangkok in April 1973 to assist with preliminary arrangements for a seminar on veterinary public health, to be held in October 1973. The seminar, which is to be combined with an inter-regional seminar on epidmiological surveillance and zoonoses, is expected to be attended by 30 participants,of whom 15 will be from the South-East Asia Region. SEA/RC26/2 Page 204

SEAR0 0169 Port Health R (Feb. - April 1969; Feb. - Sept. 1970; Nov. 1972 - April 1973; - )

Aim of the project. To assist in strengthening port health services.

Assistance provided by WHO during the year. (a) A consultant; (b) a three-month fellwshir, for a candidate from India for studies in the United Kingdom.-. Netherlands. Federal Republic of Germany, USSR, Japan, Hong Kong, Singapore, Thailand and Sri Lanka.

Work done during the year. A WHO consultant (public health officer) was assigned to Thailand for about five weeks to assist the Government in the re-organization of international quarantine services and the provision of accident services and isolation facilities at Bangkok Airport (Don Muang). He also studied and suggested improvements in the working conditions of dock labourers and in regard to port sanitation, pest control, and the working of the international quarantine services at Bangkok seaport (Klong Toe). His recommendations have been forwarded to the Government and the report was being processed.

SEARO 0171 Community Health Aspects of Medical R Education (March - April 1970; Oct. 1972; -

Aim of the project. To assist medical schools in developing inter-departmental teaching and training programmes in health care for the community.

Assistance provided by WHO during the year. (a) Four consultants and temporary assistance from a consultant assigned to another project; (b) cost of attendance of participants; (c) secretarial assistance.

Work done during the year. An inter-country Seminar on Community Medicine for Medical Teachers was held in Rangoon from 16 to 21 October 1972. There were 27 participants from four countries of the Region - Bangladesh (3), Burma (13), Indo- nesia (6). and Sri Lanka (5). The faculty consisted of three WHO consultants and three temporary advisers, in addition to two WHO staff members. The report of the seminar was brought out as a printed document and has been distributed.

Another inter-country workshop on "Comnunity Health Aspects of Medical Education" was held in Bangkok in May 1973 for 26 participants. WHO provided two short-term consultants. Both consultants and the Regional Adviser on Medical Education served as resource persons for a national workahop on the same subject which was held at Pattaya, Thailand, follwing the inter-country workshop (see also Thailand 0097).

SEARO 0172 Mental Health R (Sept. 1970; Oct. 1972; -

Aim of the project. To organize seminars on various aspects of mental health, and to train personnel.

Assistance provided by WHO during the year. (a) Tvo consultants and temporary assistance from a staff member from Headquarters.

Probable duration of assistance. Until 1977.

Work done during the year. The third WHO Seminar on the Place of Psychiatry in Medi- cal Education was held at Colombo from 17 to 21 October. There were 20 participants from Bangladesh, India, Indonesia, Sri Lanka and Thailand. The faculty of the Seminar consisted of two WHO consultants and two staff members. The seminar made recommendations dealing with various aspects of the teaching of psychiatry in medical schools SEA/RC26/2 Page 205

and made suggestions for improvement. It also advocated the formation of a "South- East Asian Association of Psychiatrists".

SEARO 0174 Rehabilitation of Handicapped Children R (Oct. 1968 - Jan. 1969; April - June 1970; March - April 1971; Feb. - March 1973; - )

Aim of the project. To study the problems relating to handicapped children, the facilities available for rehabilitation, and to advise on the importance of these services.

Assistance provided by WHO during the year. Three consultants.

Work done during the year. A team of three WHO consultants - a medical officer in the field of medical rehabilitation, a physiotherapy tutor and a prosthetist - paid a preliminary visit to Indonesia early in 1973 in connection vith a proposed inter- country project on medical rehabilitation (SEARO 0226) and to give lectures and demonstrations an the integration of various components of medical rehabilitation at the Prof. Dr Suharso Rehabilitation Centre in Solo. The report of the team was being processed in the Regional Office.

SEARO 0176 Courses on Health Laboratory Techniques R (April 1969; Sept. - Oct. 1970; Oct. - Nov. 1971; Nov. - Dec. 1972; - )

Aim of the project. To assist with courses in health laboratory techniques.

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

Probable duration of assistance. A number of years.

Work done during the year. The activities initiated by the inter-country Course on Immuno-haematological Procedures in Blood Banking held in Bombay in 1971 were followed up by two consultants, who, in late 1972, reported on the status of the blood transfusion services in India, Indonesia, Nepal and Sri Lanka. In most of the countries visited by the consultants, blwd was in short supply and greater reliance was placed on professional donors, resulting in a higher prevalence of hepatitis among recipients. In the absence of legislation to control cowercial donations, the quality of blood had deteriorated. The growth and development of blood banks and blood transfusion units and their laboratories had been irregular and facilities in regard to the premises, staff, cold storage, and competence in testing inadequate. The shortage in supply of blood reagents and the lack of a scheme for their distribution from a central laboratory had lowered the standard of testing. In the absence of mobile units and an organized health education programme to motivate the community to donate blood, outdoor collection of blood was insignificant. The consultants have made a number of suggestions to improve the situation, and these include draft criteria for the establishment of blood banks and blood transfusion units, the establishment of a central cowittee to advise on the development of blood transfusion services; the organization of regional and central blood transfusian laboratories to provide reference and facilities for training staff, and the establishment of a scheme for the distribution of reagents and for testing the proficiency of the technical staff. They have also suggested that governments should give encouragement and support to socially active organizations to prepare and organize regular programmes for the outdoor collection of blood.

The assignment reports of the consultants were sent to the respective governments. SEA/RC26/2 Page 206

SEARO 0178 Team in Health Planning. Training and Related UNDP Study Methodologies* (March 1969: July - Sept. 1969; Nov. 1969 - Feb. 1970; -.Iune- 1970 - )

Aim of the project. To develop further national health planning in the countries of the Region through regional and national training courses, meetings and study groups and consultants to formulate national health plans, to delineate the health aspects of development plans, and to strengthen health planning units.

Assistance provided by WHO during the year. Two consultants.

Probable duration of assistance. Until 1977.

Work done during the year. The consultant assigned to Sri Lanka in April 1972 (briefly mentioned in the last Annual Report) helped with the field collection of data for various phases of the National Health Manpower Study and provided assistance in the editing and coding of the data before processing. She completed her work in September.

Another consultant, assigned to work in the Regional Office, assisted in developing a preliminary systems model of health service development, including manpower training capacities, financial and other relevant indicators for long-term development, which can serve as a frame for country programming for health, and to identify llnks between the various major development components of health services. A project document in the format required by UNDP, prepared for the years 1973-77, was submitted to Headquarters.

SEARO 0180 Seminars on Immunization Services R (July - Sept. 1972; - )

Aim of the project. To hold seminars periodically an the planning and organization of immunization services.

Assistance provided by WHO during the year. (a) A consultant and temporary assistance from Regional Office and field staff; (b) cost of attendance of participants; (c) secretarial assistance.

Probable duration of assistance. Until the end of 1974.

Work done during the year. An inter-country Seminar on the Development of Immuniza- tion Services was held in the Regional Office from 17 to 24 July 1972. It was attended by 23 senior medical officers from Burma, India, Indonesia, Mongolia, Nepal, Sri Lanka and Thailand. It discussed the concept of prevention of comunicable diseases by means of immunization, reviewed the methodology and outlined recommendations for the development and strengthening of immunization programmes.

The Seminar was assisted by a WHO consultant as well as by one of the Regional Advisers on Communicable Diseases and other Regional Office and field staff members.

The WHO consultant later visited Burma, India and Sri Lanka to study the implementation of imunization programmes in those countries. The reports on these visits as well as on the Seminar have been distributed.

SEARO 0181 Seminars on Methods of Epidemiolo~icalSurveillance R (Dec. 1972; - )

Aim of the project. To evolve methods applicable in the Region for the epidemiologl- cal surveillance of communicable diseases.

"Previous title: National Health Planning and Manpower Studies SEAIRC2612 Page 207

Assistance provided by WHO during the year. (a) Four consultants, two temporary advisers, and assistance from a staff member from Headquarters; (b) cost of attendance of participants; (c) supplies for the seminar.

Probable duration of assistance. Until 1974.

Work done during the year. A Regional Seminar on Methods of Epidemiological Surveil- lance~ was held in the Regional- Office from 11 to 16 December 1972. It was attended by 21 participants from Bangladesh, Burma, India, Indonesia, Mongolia, Nepal, Sri Lanka and Thailand, in addition to 8 observers from India. The Seminar was assisted by four WHO consultants and two temporary advisers,in addition to WHO staff members from Headquarters and the Regional Office.

The Seminar covered the surveillance methodology in general, as well as the surveillance of diseases subject to the International Health Regulations.

Education in Public Health (Jan. 1971; March 1971; Jan. - Feb. 1973; - )

Aim of the project. To promote post-graduate education in public health.

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

Work done during the year. In connection with preparations for two travelling seminars on education in public health, a consultant was assigned under this project to pay visits to selected schools of public health in Singapore, Philippines and Thailand.

The Regional Director and the Regional Adviser on Medical Education attended the Fifth Meeting of Directors or Representatives of Schools of Public Health, which took place in Brazzaville in March 1973. Participants from Bangladesh, India, Indonesia and Thailand also attended.

Control of Hazards to Man from Pesticides (Jan. - March 1970; Sept. 1972; - )

Aim of the protect. To assist in assessing the problems relating to the importation, storage, transport, handling, labelling and sale of pesticides; to recommend measures to prevent or minimize hazards to man arising from the use of pesticides; to assist in preparing suitable legislation and to advise on the establishment of laboratory competence in this field; to develop studies to investigate this problem in depth.

Assistance ~rovidedby WHO during the year. (a) A consultant and temporary assistance from a Headquarters staff member.

Work done during the year. In September, a WHO consultant visited Thailand to advise on the analysis of pesticide residues in food. His report has been sent to the Government.

A further consultant (a staff member from Headquarters) visited Bangladesh, Burma, Indonesia, Sri Lanka and Thailand for about six weeks during February - March and held discussions with the national health authorities and those concerned with the control of pesticides in agricultural administrations. He also paid visits to the appropriate laboratories and undertook field trips to observe the application of pesticides. His recommendations were forwarded to the respective governments. SEAlRC2612 Page 208

SEARO 0192 Regional Team on Family Health UNFPA (Aug. 1970 - )

Aim of the project. To support country and inter-country activities in family health with regard to services, training, evaluation and research embracing family health.

Assistance provided by WHO during the year. (a) A medical officer, two health educators, a statistician, a nurse and two clerk-stenographers; (b) for the meeting (see below), two consultants (provided by Headquarters), two temporary advisers and assistance from Headquarters, Regional Office and field staff; (b) cost of attendance of participants; (d) secretarial assistance; (e) supplies and equipment.

Work done during the year. The team members have provided assistance in the organization of training programmes at national and inter-councry levels. The medical officer assisted Sri Lanka in the preparation of project requests for UNFPA assistance, and, in Indonesia, the health education programe in family health received assistance from the health education specialist. The statistician was involved in the Health Manpower Study in Sri Lanka and also in the organization of the Workshop on Statisti- cal Methods in National Family Planning Programmes, held in Bangkok in November. The nurse provided assistance to project India 0277, "Strengthening of the Teaching of Human Reproduction, Population Dynamics and Family Planning in NursingIMidwifery Education".

The medical officer and the nurse left the project on completion of their assignments in AugustlSeptember 1972, and the health education specialist, with duty station in Bandung, has been assisting project Indonesia 0121. The statistician was trans- ferred to a project in Thailand in October 1972. A second health education specialist has been in position since September 1972 and has assisted in planning and conducting the inter-country Workshop on Field Training in Health Education (SEARO 0130) and also provided assistance to the WHO/UNESCO Consultation held in the Regional Office in December. He paid a visit to Sri Lanka to assist in the planning of behavioural studies under project Sri Lanka 0104. He has also helped with preliminary planning in respect of group educational activities in health education to be held later in 1973.

In 1973 the team is being reconstituted and plans to participate in all activities in the Region related to family health - training, service, research and evaluation, with the emphasis on training in the initial stages.

Under this project, assistance was given to the Government of India in connection with the proposal for improvement of maternity hospitals in rural and semi- rural areas.

Follow-up action is being taken for the implementation of fellowships for training national staff in advanced techniques in medical termination of pregnancy and related fields.

Under this project, a WHO Headquarters-sponsored Workshop on Statistical Methods in National Family Planning Programes was held in Bangkok from 15 to 28 November. There were thirteen ~articipantsfrom Bangladesh, India, Indonesia, Nepal, Sri Lanka and Thailand, in addition to one from Mauritius. Two Headquarters consultants and two temporary advisers, assisted by Headquarters, Regional Office and field staff, conducted the Workshop, for which the Regional Office provided secretarial assistance.

SEARO 0193 Regional Epidemiological Surveillance and Training R (Sept. 1966 - )

Aim of the project. To assist in strengthening epidemiological surveillance programmes directed towards priority diseases, in introducing epidemiological surveillance activities into the functions of local health services, and in training staff. SEAlRC2612 Page 209

Assistance erovidcd-- hy lr710 during ~hcyear.(a) A hactcriologist, a virologist, n consultanr, and n sLenographcr; (b) supplies and equlpmenr.

Probable duration of assistance. A number of years.

Work done during the year. The WHO staff assigned to the team paid visits to a number of countries in the Region to review the progress made with regard to epidemiological surveillance and to take part in seminars and training courses an cholera and other communicable diseases.

The WHO virologist who had been working with the strengthening of health services (epidemiology) project in India (India 0182), was reassigned to this project as from 1 January 1973. He visited Burma far two weeks in January to explore the possibility of establishing an entero-virus laboratory as well as to review the problem of poliomyelitis in that country. Later in the same month, he attended a seminar on enteroviruses in India, organized by the Indian Council of Medical Research and held in Bombay. For two weeks during February-March he went to Nepal to organize a serological survey of polio antibodies and excretion of entero-viruses among the pre-school population. Some sera and rectal swabs were brought back from Nepal and were being examined at the National Institute of Communicable Diseases, Delhi. The national authorities were expected to continue the survey and send further samples for examination.

The WliO bacteriologist continued his work at the National Institute of Comuni- cable Diseases, Delhi.

Towards the end of December, a consultant (epidemiologist) was assigned to the team for six months. He carried out a retrospective analysis and collected data on cholera in the countries of the Region. An analysis of data pertaining to haemorrhagic fever and poliomyelitis was also made. The epidemiologist also collected information from available reports concerning the organization of epidemiological surveillance programmes in the Region. Together with one of the Regional Advisers on Communicable Diseases, he visited Bangladesh during February-March to see various institutions concerned with the surveillance of communicable diseases.

WHO-sponsored Training Centre far Nurses, Wellington (New Zealand) (Jan. 1970 - )

Aim of the project. To provide a training programme for nurses from the Region who cannot obtain admission to other post-basic courses because of lack of the secondary education and/or the language skills required for admission.

Assistance provided by WHO during the year. Two nurse instructors.

Work done during the year. In 1972 eleven fellows completed the programme and returned to their countries, i.e., three to Indonesia, two to Nepal, one to Sri Lanka, and five to Thailand. One fellow from India had to discontinue training earlier. All eleven had at least five weeks' experience working and observing in their om special fields in hospitals or health agencies. This was in addition to their earlier clinical experiences, part af which included a family visiting programme, an introduction to psychiatric concepts in nursing and various types and methods of nursing education.

In January, fourteen fellows - six from Indonesia, three from Nepal and five from Thailand - arrived at the Centre. This is the largest number of students enrolled since the Centre opened in January 1970. As a result of the evaluations carried out by the students in last year's course, several changes have been made in the programme. It is hoped that the community health experiences this year will be much more closely integrated into the progranme. Course outlines were prepared and it is expected that these, together with selected reading lists, will enable the students to utilize their study time more effectively. SEA/RC26/2 Page 210

A "Prospectus and Syllabus" was published by the Centre. A brochure for prospective students was also prepared in New Zealand and was subsequently printed by the Regional Office.

SEARO 0196 Education in Paediatrics R (May 1973; - )

Aim of the prolect. To organize meetings of teachers and research workers from medical schools in the Region in order to review paediatric education and methods for its improvement.

Assistance provided by WHO during the year. (a) A consultant; (b) cost of attendance of participants; (c) supplies and equipment; (d) secretarial assistance.

Work done during the year. An inter-country Seminar on Education in Paediatrics was held in Dacca, Bangladesh, from 11 to 16 June. There were twenty-three participants, who came from Bangladesh, India, Indonesia, Mongolia, Sri Lanka and Thailand. The Seminar made recamendations regarding minimal standards for organization, staff and teaching hours for child health, following a review of existing practices in the countries concerned. It emphasized the need for departments to be autonomous and for students to be examined by paediatricians in the final examination. The importance of training in delivering child health care (as part of maternal and child health1 family planning programes) was stressed.

The Seminar was assisted by a WHO consultant. The Regional Office provided secretarial assistance.

SEARO 0198 Regional Centre for Documentation on Human Repro- UNFPA duction, Family Planning and Population Dynamics (Jan. 1971 -

Aim of the project. To set up, in the Regional Office, a regional centre to reproduce basic reports and documentation on various aspects of human reproduction, family planning and population dynamics for wide distribution, particularly to schools for professional and auxiliary health workers, to the health services, to the main health institutions in the Region and to international documentation centres.

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

Work done during the year. A consultant was assigned to the Centre in December 1972 for a period of six months. She visiced government departments and family planning and demography institutions in India and Thailand to explain the activities of the Docu- mentation Centre and to request the supply of published and unpublished documentation on the subjects of human reproduction, family planning and population dynamics. The Centre issued its first bibliography of material published in the South-East Asia Region on the above subjects without annotations and distributed it to Member States and institutions in and outside the Region. A revised bibliography with annotations was under preparation.

As part of the activities of the Centre, "An Aid to the Teaching of Human Reproduction, Family Planning and Population Dynamics1', was published and distributed to all medical colleges, schools of public health, schools and colleges of nursing. and directorates of health services in the countries of the Region. The "Aid" has been favourably received, and it is proposed to revise it on a yearly basis to incor- porate new developments in the various subjects covered. SEA/RC26/2 Page 211

SEARO 0199 Group Education in Service, Teaching and UNFPA Research Aspects of Human Reproduction, Family Health and Population Dynamics (July 1971; Nov. - Dec. 1971; Oct. 1972; Jan. - Feb. 1973; - )

Aim of the project. To assist in the development of education and studies in human reproduction, family health and population dynamics.

Assistance provided by WHO during the year. (a) Two consultants, five lecturers and temporary assistance from the Regional advisers on Medical Education and Maternal and Child Health; (b) a six-month fellowship for a candidate from Sri Lanka for studies in India, Burma and Thailand; (c) cost of attendance of participants; (d) secretarial assistance; (e) supplies for the seminar.

Probable duration of assistance. A number of years.

Work done during the year. Originally planned far 1972, a Seminar on Application of Surgical Procedures in Human Reproduction and Family Planning was held in the Regional Office from 12 to 16 February. There were 14 participants from Bangladesh, India, Indonesia and Thailand. The Seminar was assisted by a short-tern consultant, a nursing consultant and five lecturers. A medical officer from the Family Health Division at WHO Headquarters and four members of a WHO task force on prostaglandin research on a visit to New Delhi also participated. The Regional Advisers on Medical Education and Maternal and Child Health provided assistance in conducting the Seminar. The report on the meeting was being processed, but some of the suggestions it contained were incorporated in a memorandum to the Government of India on the structuring of the international fellowships in abortion care which are being offered to senior Indian obstetricians during 1973.

Two further group educational activities under this project, a course on the health aspects of family planning and a seminar on medical education and family health, were being planned for December 1973.

SEARO 0206 Medical Education in Human Reproduction, UNFPA Family Planning and Population Dynamics (March 1972 - )

Aim of the project. To assist in the planning, preparation, conduct and evaluation of short training courses for senior medical teachers in order to improve further the teaching of human reproduction, family planning and population dynamics in medical schools of the Region.

Assistance provided by WHO during the year. (a) A medical officer and two consultants; (b) three four-month fellowships for candidates from Indonesia for study in Thailand, a twelve-month fellowship for a candidate from India for studies in Sweden, United Kingdom and the United States of America, and a five-month fellowship for a candidate from India for studies in Turkey, USSR, Czechoslovakia, Sweden, United States of America, Guatemala,Mexico, Japan, Philippines and Singapore.

Probable duration of assistance. Same years.

Work done during the year. At a request from UNICEF,an orientation course on family planning for senior UNICEF staff was organized in the Regional Office on 30 and 31 March. There were 26 participants from the UNICEF Regional Office in New Delhi as well as in offices from other parts of India. It was suggested that more such colnrses should be organized for wider coverage. Guidelines on the teaching of human reproduction, family planning and population dynamics in medical schools were brought out and distributed.

Under this project, a WHO consultant was assigned to Nepal during November- December to advise the Government on the (1) development of a curriculum for training SEA/RC26/2 Page 212

auxiliary health workers, (2) implementation of a training programme,and (3) recruitment and selection of trainees. The report containing his recommendations was under study.

Preparations were completed in connection with an inter-country course on the teaching of human reproduction, family planning and population dynamics, scheduled to be held at Dacca from 16 to 28 July. Three consultants and two temporary advisers have been recruited, and 15 guest speakers have been invited to participate.

SEARO 0209 Course in Health Planning for MCH/ UNFPA Family Planning Administrators (Nov. - Dec. 1972; - )

Aim of the project. To orient public health administrators responsible for maternal and child health and family planning programmes in the principles of health planning and management of integrated maternal and child health and family planning services within the overall organizational structure of the general health services.

Assistance provided by WHO during the year. (a) A temporary adviser; (h) cost of attendance of participants.

Work done during the year. A Course in Health Planning for Ilaternal and Child Health/ Family Planning Administrators took place at the National Institute of Health Adminis- tration and Education, New Delhi, from 15 November to 15 December. A total of 17 participants attended the course (3 from India, 5 from Indonesia, 2 from Nepal, 3 from Sri Lanka and 4 from Thailand). The course was assisted by a WHO temporary adviser.

Public Health Advisory Services, Mekong Committee (Sept. 1968 - )

Aim of the project. To provide technical advice to the Co-ordinating Committee for the Development of Lower Mekong River tlasin; to advise on the prevention of comunicable diseases resulting from the changes in environment due to man-made lakes and other irrigation works.

Assistance provided by WHO during the y5al. A sanitary engineer.

Work done during the year. The sanitary engineer assigned in June 1970 to render advice and assistance to the Division of Economic and Social Studies of the Mekong Committee Secretariat, left in September 1972. The special entomological studies carried out in the Mekong tributary project areas of North-east Thailand, on the effect of impoundment of water on the mosquito vectors and malaria incidence in the resettlement areas, reveal no evidence that the water resources development projects either in impounded water or in irrigated areas, have contributed to any worsening of the malaria situation. The studies are to continue further.

The project has been taken over by Headquarters as an inter-regional activity.

SEARO 0213 Health Education Materials and Communications UNFPA Media with Particular Reference to Family Planning,. (Aug. - Nov. 1971; Oct. 1972 - Jan. 1973; - )

Aim of the project. To assist in developing and improving the effectiveness of the health education component of family health programmes in the Region; to assist in improving the quality and utilization of informational, educational and teaching materials used for family health education; to assist in providing continuing educa- tian in different aspects of family health for faculties of training institutions SEAlRC2612 Page 213

and key health education personnel, and to develop capabilities in family health education research.

Assistance provided by WHO during the year. (a) A consultant; (b) supplies.

Work done during the year. A WHO consultant, assigned from October 1972 to January 1973, visited Thailand and Indonesia and assisted in reviewing the follow-up activities undertaken in those countries after the inter-country workshop on health education held in 1971. He also assisted in developing a research design for studying the channels of communication in a rural area of Thailand.

Under this project two inter-country activities were planned:(l) a consultation on the development of health education teaching and traininx resource materials suitable to the countries of the Region,to take place in August, and (2) a training course on social science research methodology as applied to health education (to be held in Bangkok in November - December). The specific objectives of the meetings have been comunicated to governments, which have been requested to form inter- disciplinary national study groups to collect relevant data on the subjects of these activities.

SEARO 0215 Advisory Services R (March - Elay 1973; - )

Aim of the project. To provide consultant services in various subjects upon specific requests of governments.

Assistance provided by WHO during the year. Three consultants.

Work done during the year. Two consultants - one in epidemiology and one in the pathology of cancer - visited Bangladesh, Burma, Indonesia, Nepal, Sri Lanka and Thailand during March-May 1973 to evaluate the pattern of cancer morbidity and mortality and to assess existing facilities for epidemiological studies, prevention, early detection, treatment, training and research in cancer control. Their visit was in preparation for a meeting to discuss problems in and formulate plans For cancer control in the countries of the Region. The report of the consultants was under study.

Towards the end of the year under review, a further consultant provided under this project took up a four-week assignment to review WHO assistance in the development of medical care in the countries of the Region and the impact of this assistance, in order to prepare a document on "Organization of Medical Care" for the Regional Committee.

SEARO 0219 Developrent of Natemity-centred UNFPA -Aspects of Family Ile~lthServices (Ian. 1972 - )

Aim of the project. To slipport country and inter-country activities in family health with particular emphasis on the maternity-centred approach; to assist with the further development of, and provide technical advice and support to, the rapidly expanding post-partum family planning services in the Region.

Assistance provided by WHO during the year. A medical officer, and a temporary adviser.

Probable duration of assistance. Some years.

Work done during the year. The main activity of the project has been to assist in (1) preparing teaching material, (2) reviewing the post-partum family planning SEA/RC26/2 Page 214

programes, (3) drawing up a comprehensive bibliography for the Regional Documenta- tion Centre, and (4) organizing various meetings.

In September-October, the medical officer visited Nepal to assist a WHO team in drafting a request and a plan of operation for the development of a Family planning programme in that country. He reviewed the request in the light of the comments received and later assisted in the preparation of a final draft request.

Among the meetings attendedlassisted by him were, the First Bangladesh National Family Planning Seminar (Dacca, 21-25 December), the Indian Ocean Regional Conference of the International Planned Parenthood Federation (Bombay, 9-14 December), and the UNESCOIWHO Consultation on Communication and Education in Family Planning (New Delhi, December). He also assisted in co-ordinating an orientation visit to the Regional Office in December by trainees of the Indian Institute of Population Studies, Bombay, and in planning and organizing the orientation course on family planning for UNICEF staff.

He visited Dacca in January-February to review, with the WHO Representative and the national authorities, the needs in the field of family health in preparation for the visit of a UNRA Mission. Following the signing of a project agreement between the Government of Sri Lanka and UNFPA, he proceeded to Colombo in March 1973 to assist in preparing the necessary plans of action for UNFPAprojects.

A WHO temporary adviser visited Nepal during the period 16-20 November to study the maternity and gynaecological services at the Maternity Hospital in Kathmandu and to identify the important problems.

Collection and Utilization of Health Statistics, Records and Reports (Jan. 1972 - )

Aim of the project. To assist in developing consistent systems of record keeping and reporting for health centres and hospitals; to assist in the collection, proress- ing and presentation of statistical data arising from these systems; to assist in the gradual development and application of electronic data-processing techniques in the field of health statistics, and in training staff required at various levels of their operation.

Assistance provided by WHO during the year. (a) A statistician, two consultants and a clerk-stenographer, and temporary assistance from three staff members from Head- quarters; (b) cost of attendance of participants; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. An important activity during the year was the meeting of the Working Group on the Ninth Revision of the International Classification of Disea- ses, which took place in New Delhi from 7 to 10 November 1972, in which all the countries of the Region except the Maldives participated. Three staff members from Headquarters assisted in the conduct of the meeting, the aim of which was to afford an opportunity to exchange the experiences of the countries of the Region on the present utilization and usefulness of the ICD and to discuss changes proposed for its next revision.

The WHO statistician visited Indonesia in June - July 1972 to assist in analysing the results of a trial which had been carried out in two provinces to find out the feasibility of a proposed routine hospital reporting system consisting of simple monthly administrative reports and cross-sectional in-patient morbidity statistics. A consultant (statistician) was assigned to Indonesia from July to December to assist in the implementation of the proposed hospital reporting system on a national scale. She also advised on the reorganization of the medical record system in a SEA/RC26/2 Page 215 medium-size government hospital. A further consultant took up a three-month assignment in May 1973 to continue this work.

The statistician also visited Bangladesh, where he reviewed the vital and health statistics activities in the country and made suggestions for WHO assistance. In addition, he undertook a study of the medical record activities of the Dacca Medical College Hospital and drew up proposals for their reorganization.

He prepared and presented a paper on "Utilization of Hospital Statistics in Medical Care Administration System" to the Discussion Group Meeting on EIedical Care held in the Regional Office in April. A lecture on the subject of construction of abridged life tables end their application to demography and public health was given by him at the Training Course an Statistical Methods in Medicine and Public Health held at the Indian Council of Medical Research, New Delhi, in December.

In furtherance of the health statistics services provided to countries in the Region, two meetings are being planned towards the end of 1973 and the beginning of 1974 - one on sample survey methodology and the other on electronic data processing. The medical statistician (medical officer) assigned to this project left in May 1973 and is being replaced by a health statistician (mathematician). A reformulation of the project took place in mid-1973. It is now equipped to offer highly specialized advice on health statistical methodology. It also offers expertise in fields such as sample surveys and the development of mathematical models, which was until now available only at WHO Headquarters. The project will also assist in the computeri- zation of demographic and health information. SEAlRC2612 Page 217

11. INTER-REGIONAL (PROJECTS WITHIN THE REGION)"

PROJECT LIST

Agencies -Title

Inter-regional 0188 Economic Commission for Asia and the R Far East (July 1970 - )

Aim of the project. To carry out liaison functions with ECAFE.

Assistance provided by WHO during the year. (a) A liaison officer.

Work done during the year. The WHO liaison officer to ECAFE remained in position until April, when he left on reassignment. He attended a number of meetings of ECAFE, including its 29th session, which was held in Tokyo in March 1973, as well as the meetings of the Mekong Secretariat and Committee on behalf of WHO Headquarters and three Regional Offices. In addition to presenting the Organization's policies and views at the meetings attended, he continued to promote exchanges of views and co-ordination of activities of mutual interest and advised on the health aspects of jaintly-assisted projects. He worked also in co-ordination with the WHO sanitary engineer assigned to the project "Public Health Advisory Services, Mekong Committee" (SEAR0 0211).

Inter-regional 0190 Leprosy/BCG Trial Team, Burma R (April 1964 - )

Aim of the project. To carry out a trial to assess the value of BCG vaccination in the prevention of leprosy in the child population and obtain information on epidemiology, immunology, bacteriology, therapy and clinical aspects of leprosy.

Assistance provided by WHO during the year. A medical officer and a statistician.

Probable duration of assistance. Until the end of 1974.

Inter-regional 0306 Aedes Research Unit, Bangkok R (April 1966 - )

Aim of the project. To carry out research on the ecology and population dynamics of the Aedes vectors of haemarrhagic fever and dengue, particularly A. aegypti and A. albopictus, with the objective of developing effective methods of interrupting transmission of these diseases; also to carry out field trials on control of A. aegypti, using organophosphorus, carhamate and other insecticides and biological control procedures; and to examine new techniques which are now only at an experimental stage.

*This list includes meetings and seminars held within the Region for which the main responsibility was that of WHO Headquarters. However, assistance in their organization has often been given by the Regional Office, which also has sometimes financed its om participation. Meetings of this nature for which the Regional Office has the main responsibility are listed in Section 9. SEA/RC26/2 Page 218

Assistance provided by WHO during the year. A medical officer, an entomologist and an ecologist.

Inter-regional 0308 Epidemiology and Biology of Mental R Disorders (1971 - )

Aim of the project. To assist prograwes of research in the epidemiology and biology of mental disorders and to work with the WHO Regions in evaluating the effectiveness of mental health services and in training personnel.

Assistance provided by WHO during the year. A consultant.

Work done during the year. A consultant was assigned in March 1973 to review the progress made in the implementation of the recommendations of the various consultants assigned in the field of mental health to the countries of the South-East Asia Region. He visited Burma, Indonesia and Thailand to evaluate the developments and discuss plans for the strengthening of mental health activities and training in the public health services.

Inter-regional 0529 Research Unit on the Genetic Control K of Mosquitos (India) (Oct. 1969 - )

Aim of the project. To conduct research into the feasibility of controlling CuZez fatigans and Aedes aegypti on an operational scale by genetic manipulation.

Assistance provided by WHO during the year. A medical officer, an entomologist, an ecologist, four consultants, an administrative assistant, a senior assistant and four assistants.

Work done during the year. During the period under review, the project continued its field experiments and laboratory investigations with regard to CuZez fatigans and Aedes aegypti. A nmber of WHO short-term consultants were assigned to assist the project in its research programmes.

Arrangements were made for a scientist from the Indian Council of Medical Research to visit the Aedes Research Unit in Bangkok.

The sixth and seventh meetings of the Technical Planning and Review Group of the project were held during the year.

Icttcr-regional 0711. --In~er-Keml Seminar un Planning, Organization Re~ular and Administration of Mcdi~ehabilitati~~Services (L-15 September 1972)

Aim of the project. To enable medical doctors responsible for medical rehabilitation services in developing countries to study the planning, organization and administration of such services, to help them in establishing efficient comprehensive services in their own countries.

Assistance provided by WHO duringthe year. (a) Two consultants, two temporary advisers, and temporary assistance from Headquarters and Regional Office staff; (b) cost of attendance of participants.

Work done. The Inter-regional Seminar on Planning, Organization and Administration of Medical Rehabilitation Services was held at the All India Institute of Medical Sciences, New Delhi, from 4 to 15 September. It was attended by 15 participants SEAIRC2612 Page 219

from 12 countries. Two consultants, four temporary advisers and staff members from WHO Headquarters and the Regional Office assisted in the conduct of the Seminar. In addition, specialisrs in medical rehabilitation from various institutions in India and WHO staff membecs delivered lectures on different topics.

The programme df the Seminar included lectures on the different topics, presentation of papers on 14HO's programme in medical rehabilitation and the services in the various countries rgpresented, discussions on matters concerned with nedical rehabilitation and visits to the Departments of Rehabilitation of the All India Institute of Medical Sciences and Safdarjang Hospital, the Home for the Blind and the Lady Noyce School for Deaf and Mmh in nelhi.

Sixty-five papers were prepared and presented by the participants and the faculty members.

Inter-regional 1029 Research Team on Evaluation of Fertility UNFPA Regulating Agents, Bangkok (April 1972 - )

Aim of the project. To evaluate the health impact of fertility control methods by direct field studies, by assisting in national clinical trials, and by short-term training programmes in clinical trial methodology.

Assistance provided by WHO during the year. A pharmacologist, a gynaecologist, an administrative officer and a consultant.

Probable duration of assistance. Uncil the end of 1976.

Work done during the year. Following a consultation held at Bangkok in the third week of April 1972 and consideration of the proposals formulated at this consultation by the Clinical Research Review Committee at WHO Headquarters in May, five projects suggested by the team members were selected for work. These projects are: (1) Base- line hormonal levels in Thai women; (2) Metabolic effects of the injectable, Depot Provera; (3) A comparative study of the effects of different contraceptive agents on liver function; (4) Estimation of frequency of post-operative vascular thrombosis, including occult thrombosis in Thailand and later in other regions, and (5) Phase I1 clinical trials with two new low-dose contraceptive agents (Duphar 41164 and Duphar 41165).

A Seminar on Clinical Trial Methodology was held in Bangkok from 16 to 21 April 1973. Most of the participants in this seminar were members of the Asian Clinical Research Centres which had made important contributions to their research training needs. The objective was to instruct clinicians and biostatisticians in the first principlrs and the more sophisticatecl analyses involved in multi-centre collaborative clinical trials.

The WHO Research Tcam on the Evaluation of Fertility Regulating Agents, in collaboration with the llepartment of Obstetrics and Gynaecology, Chulalongkorn University, also organized a Course on Recent Advances in Reproductive Biology and Family Planning from 30 May to 1 June 1973. The course was intended to acquaint young scientists and clinicians who have an interest in research in reproduction with recent developments, particularly in contraceptive research.

WHO Headquarters recruited several consultants from time to time to assist the Team. SEA/RC26/2 Page 221

12. INTER-REGIONAL (PROJECTS OWSIDE THE REGION WITH PARTICIPANTS FROM THE SOUlTI-EAST ASIA REGION)

Project No. and Number of Source of Funds -Title Participants Inter-regional 0097 Refresher Course in Human Genetics for 4 (1 from Bangladesh 6 Voluntary Fund Teachers in Medical Schools, Denmark 3 from Thailand) for Health (6-26 November 1972) Promotion/DANIDA

Inter-regional 0113 Twelfth International Training Course 6 (1 from Bangladesh, UNDP in the Epidemiology and Control of 2 from India, Tuherculosis, Czechoslovakia (Prague 1 from Indonesia, 4 April - 7 July 1973) and Sri Lanka 1 from Mongolia and (10-13 July 1973) 1 from Thailand)

Inter-regional 0120 Twenty-third Anaesthesiology Training 6 (1 from Bangladesh, Voluntary Fund Course, Copenhagen (15 January - 1 from Burma, for Health 7 December 1973) 1 from India, Promotion/DANIDA 1 from Nepal and 2 from Thailand)

Inter-regional 0120 Tenth Refresher Course in Anaesthe- 2 from Thailand Voluntary Fund siology, Copenhagen (3-23 June 1973) for Health Promotion

Inter-regional 0239 Fifth Advanced Course in Clinical 6 (1 from Bangladesh, Voluntary Fund Chemistry, Copenhagen (2 April - 2 from India, for Health 19 June 1973) 1 from Indonesia, Promotion/DANIDA 1 from Nepal and 1 from Thailand)

Inter-regional 0285 Third Inter-regional Course for 1 from Sri Lanka Voluntary Fund Clinical Instructors in Physiotherapy, far Health Denmark (11 September - 9 Decemher 1972) Promotion/DANIDA

Inter-regional 0287 Fifth Advanced Training Course in the 2 (1 from Mongolia and Voluntary Fund Diagnosis, Treatment and Prevention of 1 from Thailand) for Health Major Cardiovascular Diseases, Copenhagen Promotion/DANIDA (2 January - 30 June 1973)

Inter-regional 0537 Seminar on Methods of Epidemiological 6 (1 from India, Regular Surveillance of Camunicahle Diseases, 2 from Indonesia, including Zoonoses and Food-Borne 1 from Nepal, Diseases, Nairobi (9-20 October 1972) 1 from Sri Lanka and 1 from Thailand

Inter-regional 0567 Course on Cellular Immunity at the WHO 1 from Thailand Regular International Reference Centre for Immunoglohulines, Lausanne, Switzerland (4-16 September 1972)

Inter-regional 0581 Fourth UNDP/WHO Training Course in 1 from India UNDP Epidemiology, USSR/Egypt (5 September 1972 - 5 January 1973) SEA/RC26/2 Page 222

Project No. and Number of Source of Funds Title Participants

Inter-regional 0693 Course on Modern Methods of Manage- 3 (1 from Indonesia, Voluntarv Fund ment of Nursing Services, Denmark 1 from Nepal and for ~ealth (3 September - 14 October 1972) 1 from Sri Lanka) Promotion/DANIDA

Inter-regional 0696 Second Training Course in Malacology, 1 from India Voluntary Fund Copenhagen (18 September - 13 October for Health 1972) Promotion/DANIDA

Inter-regional 0721 Training Course on the Organization of 2 (1 from India and Regular Genetic Counselling Services, Ferrara, 1 from Thailand) Italy (9-22 October 1972)

Inter-regional 0722 Training Course on Biological Standardi- 3 (1 from India, Regular zation, London (3-29 July 1972) 1 from Sri Lanka and 1 from Thailand) SEA/RC26/2 Page 223 ORGAXIZATIONAI STRUCTURE

(As at 30 June 1973)

I REGIONN DIRECTOR I

1 DIRECTOR. HENTH SERVICES I

...... ASSISTANT DIREC'iWR ASSISTANT DIRECTOR ASSISTANT DIRECmR *IIIINISTR*TION 6 FINANCE REPRESENTATIVES --

8, m 8, 8 8, 8 m, 8 8, 8 1, 1 - EDUCATION AND TXAINING w >,c, , 8 <,7 7 ...... I ...... d 8, 8 8 m, ,8 8 , .I! . 8, 8 8 8 8 8 8 8 8 BUDGET 6 FINANCE t 1 FELLOWSHIPS 8, XEGIObAL ADVISERS I!. . ,< ,6 ,. ,. 1 / Communicable Diaearer ,8 m8 1 Community Health Services (Family Xealrh) ;m 8 Enviranmenfal Health No"-comuniceble Diseases ...... ~ealfhEducation Nurainp

HEDICN. SUPPLIES

ADMINISTRATIYE

...... FIELD PROGRAMME ...... 2 SEA/RC26/2 Page 226 Annex 2

GEOGRAPHICAL DISTRIBUTION OF INTERNATIONAL STAFF ASSIGNED TO THE SOUTH-FAST ASIA REGION AS OF 30 JUNE 1973

SOUTH-EAST ASIA REGION WHO (Global) Country Regional Regional Field Total Total Office Advisers Staff

Australia - - 5 5 33 Belgium - - 2 2 38 Bolivia - - 1 1 8 Brazil - - 1 1 16 Bulgaria 1 - 1 2 5 Burma 1 1 2 5 Canada - . 5 5 69 Czechoslovakia - - 2 2 17 Denmark - - 3 3 25 Ecuador - . 1 1 10 Egypt . 2 3 5 39 Finland - - 1 1 9 France 1 - 3 4 140 Germany, Federal Republic of - 3 2 5 52 Greece - - 1 1 12 Guatemala . . 1 1 4 India 2 3 12 17 67 Indonesia . 1 3 4 7 Ireland 1 - - 1 14 Italy 2 - 2 4 46 Jamaica 1 - 1 2 7 Japan - - 2 2 19 Malaysia - - 1 1 5 Mexico . . 1 1 9 ,Vepi.pn 1 . 1 . 1 5 Netherlands 2 3 5 30 New Zealand - - 2 2 14 Philippines . 1 3 4 22 Poland - 2 4 6 26 Republic of Korea 1 - 1 2 14 Sri Lanka 1 1 6 8 15 Sweden 1 - 1 2 30 Switzerland . - 1 1 5 1 Thai land 1 1 1 3 7 Union of Soviet Socialist Republics . - 9 9 42 United Kingdom 4 3 22 29 174 United Republic of Tanzania - - 1 1 4 United States of America 4 1 22 27 207 Viet-Nam . . 1 1 5 Yugoslavia 1 1 6 8 37 Other countries - - - - 430

Grand Total 24 20 138 182 1 769

Not included: (1) Staff on study leave (2) Staff on leave without pay (3) Staff on leave under insurance cover (4) Staff who have left the Region and whose posts are only technically shown as filled (5) Staff assigned to SEARO 0188 (Liaison with ECAFE) and SEARO 0211 (Mekong Committee) SEAlRC2612 Page 227 Annex 3

MEETINGS AND COURSES ORGANIZED BY WHO AND HELD IN THE SOUTH-EAST ASIA REGION* (1 July 1972 - 30 June 1973)

-1972 3-15 July Medical ~eachers' Training Course (SEARO 0096.2) Bangkok

10-28 July Clinical Teaching Course (Nursing) (SEARO 0139) Bangkok

17-24 July Seminar on Development of Immunization Services New Oelhi (SEARO 0180)

31 July - Workshop for Researches in Dukun Activities Djakarta 2 August (Indonesia 0113)

7-25 August Clinical Teaching Course (Nursing) (SEARO 0139) Bangkok

21 August- Workshop in Imunology (SEARO 0153) Bangkok 1 September

4-15 September Inter-regional Seminar on Planning, Organization and New Delhi Administration of Medical Rehabilitation Services (IR 0714)

11 September- Course on Orthopaedic Nursing Care (Burma 0056) Mandalay 4 November

23 - 27 Seminar on Tuberculosis Control (SEARO 0113) Ulan Bator September

9 - 14 National Course in Nutrition for Public Health Rangoon October Officials (Burma 0093)

16 - 21 Seminar on Community Medicine for Medical Teachers Rangoon October (SEARO 0171)

16 - 27 WHO/DANIDA Course on the Control of Urban Mosquito Bangkok October Population, Urban and Village Rodent Population and Houseflies

16 October- Short Course on Paediatric Patient Care Hyderabad 17 November (SEARO 0139) (India)

17 - 21 Seminar on the Teaching of Psychiatry in Medical Colombo October Colleges (SEARO 0172)

18 - 24 Workshop on the Problems and Techniques of Community Hyderabad October Studies in Child Health and their Relationships to (India) Post-graduate education (India 0114)

23 - 28 Seminar on the Training of Medical Officers in Rural Najaf garh October Areas (India 0185) (Delhi)

fgIncluding national courses or meetings Ear which WHO assistance consisced of more than the provision of consultants. SEA/RC26/2 Page 228 Annex 3

23 - 31 Regional Course in the Laboratory Diagnosis New Delhi October of Smallpox (SEARO 0030)

23 October- Inter-country Workshop on Field Training in New Delhi 4 November Health Education (SEARO 0130)

30 October- Inter-country seminar on Surveillance in New Delhi 2 November Smallpox Eradication (SEARO 0030)

31 October- Sixth Meeting of the Technical Planning and New Delhi 3 November Review Group (IR 0529)

7 - 10 Working Group Meeting on the Ninth Revision of New Delhi November the International Classification of Diseases (SEARO 0220)

9 November- Care of the Paediatric Patient (Sri Lanka 0053) Colombo I1 December

13 - 25 Workshop on Management of Infectious Disease Hyderabad November l{aspitals (SEARO 0128) (Indid)

13 November- Course on Health Aspects of Hman Reproduction Djakarta 10 December (Indonesia 0112)

15 - 28 Workshop on Statistical Methods in Natianal November Family Planning Programme (SEARO 0192)

15 Navember- Course in Health Planning for Maternal and Child New Delhi 15 December Health and Family Planning (SEARO 0209)

20 - 29 National Workshop on Camunity and Family Health Medan November for Health Teams (Indonesia 0114) (Indonesia)

4 - 15 Regional Seminar on Air Pollution Control Nagpur December (SEARO 0150) (India)

4 - 22 Training Course on Statistical Methods in New Oelhi December Medicine and Public Health (Ifidia 0121)

11 - 16 Regional Seminar on Methods of Epidemiological New Delhi December Surveillance (SEARO 0181)

12 - 21 First SEARO Meeting an the Role of Operational Bangkok December Studies in Health Services and Education for these Services (SEARO 0116)

18 - 22 UNESCOIWHO Consultation on Comunicatian and New Delhi December Education in Family Planning (IR 1046)

26 - 30 Workshop on Methodology of in-service Training New Delhi December of Maternal and Child Health Services (including Family Planning Services) into General Health Services (India 0278)

-1973

8-20 January Medical Teachers' Training Course (SEARO 0096.2) Peradeniya (Sri Lanka) SEA/RC26/2 Page 229 Annex 3

22 - 26 Seminar on Family Health Services (Sri Lanka 0105) Colombo January

5 - 24 Effective Leadership and Management by Objectives in Djakarta February Public Health Administration and Supervision (SEAR0 0139)

5 - 28 Course on National Health Planning (Burma 0094) Rangoon February

12 - 16 Seminar on Application of Surgical Procedures to New Delhi February Human Reproduction and Family Planning (SEAR0 0199)

21 February- Seminar on Malaria Epidemiology (SEARO 0114) Prabhudhabat 2 March (Thailand)

19 - 24 March Course on Rehydration lberapy Centres (SEARO 0144) Rangoon

10 - 14 April Seminar on Medical Pedagogy (India 0221) Calcutta

18 - 20 April Discussion Group Meeting on Medical Care (SEARO 0104) New Delhi

30 April - Short Courses on Nursing Care of Surgical Patients Rangoon 23 June (Burma 0056)

8 - 12 May Workshop on Community Health Aspects of Medical Bangkok Education (SEARO 0171)

9 - 18 May Regional Seminar on Training and Utilization of Djakarta Sanitation Personnel (SEARO 0165)

28 May - Short Course on Strengthening the Integration of Colombo 30 June Cornunity Health Care in the Basic Curriculum

4 - 8 June Workshop on Quality Control of Drugs (SEAR0 0154) Djakarta

11 - 16 June Seminar on Education in Paediatrics (SEARO 0196) Dacca

25 June - Inter-regional Training Course on Cholera Control Surabaya 4 July (IR 0228) (Indonesia) SEA/RC26/2 Page 230 Annex 4

CONFERENCES AND MEETINGS IN THE SOUTH-EAST ASIA REGION CALLED BY THE UNITED NATIONS AND ITS RELATED SPECIALIZED AGENCIES AT WHIM WHO WAS REPRESENTED (1 July 1972 - 30 June 1973)

7 - 12 ECAFE: Expert Group on Role of Voluntary Bangkok August Organizations in National Family Planning Programmes

29 August- ECAFE: Regional Group Meeting of the United Bangkok 1 September Nations Advisory Committee on the Application of Science and Technology

18 September United Nations: Meeting of Heads of United New Dclhi Nations Agencies

12 - 17 November ECAFE: Fifty-eighth Session (Special) of the Bangkok Mekong Committee

9 - 10 UNICEF: Programme Policy Meeting New Delhi November

13 - 17 FAOIIAEB: International Symposium on Radiation Bombay November Preservation of Food

27 Navember- ECAFE: Working Party on Operational and Technical Bangkok 4 December Aspects of Asian Shipping Development

1 December ECAFE: Meeting on Study Design for an ECAFE Bangkok Project on Administration of Family Planning Programs in the ECAFE Region

14 - 20 ECAFE: Conference on Social Development Bangkok December

19 December ECAFE: Meeting on Regional Co-operation Bangkok

11 January ECAEE: Ninth Regional Inter-Agency Meeting on Bangkok Social Development

21 - 28 ECAFE: Meeting on Developing Indices, Assess- Bangkok January ment of Training Needs and Facilities in the Field of Population in the ECAFE Region

22 - 30 ECAFE: 16th Session of the Comnittee on Trade Bangkok January

24 - 29 ECAEE: 60th Session (Plenary) of the Mekong Bangkok January Committee

5 - 16 United Nations: Third Session of the Cornittee New Delhi February on Natural Resources SEA/RC26/2 Page 231 Annex 4

8 - 14 ECAEE: 25th Session of the Committee on Industry Bangkok February and Natural Resources

26 - 28 ECAFE: Meeting on Nutrition in Lower Mekong Basin Bangkok February

2-9 United Nations: Regional Meeting of Resident Bangkok March Representatives

29 - 30 ECAFE: Meeting on Indicators of Social Development Bangkok March

2-7 ECAEE: Meeting of Country Co-ordinators on Family Bangkok April Planning Services Statistics System

9 April ECAFE: Cr,nsultative Committee of United Nations Bangkok Specialized Agencies and other United Nations Bodies

23 - 24 ECAFE: Meeting on the Schistosomiasis Programme in the Bangkok April Mekang Area

1LO: Sub-regional Seminar on Labour Management Kandy Co-operation in Population and Family Planning in (Sri Lanka) the Plantation Industry

18 - 23 UNICEF: Eleventh Regional Staff Meeting, East Asia Bangkok June and Pakistan Regional Office

20 - 30 United Nations: Regional Seminar on Status af Women Jogjakarta June and Family Planning (Indonesia)

28 - 29 ECAEE: Tenth Regional Inter-Agency Meeting on Social Bangkok June Development SEAlRC2612 Page 232 Annex 5

CONFERENCES AND MEETINGS OF GOVERNMENTAL, NON-GOVERNMENTAL AND OTHER ORGANIZATIONS HELD IN THE SOUTH-EAST ASIA REGION AT WHICH WHO WAS REPRESENTED (1 July 1972 - 30 June 1973)

28 - 29 Delhi Administration: Inter-disciplinary Seminar New Delhi July on Drug Ahuse and Youth

19 September World Health Foundation of Ceylon: Seminar on Colombo Alcoholism

19 September Indian Council of Medical Research: Meeting of New Delhi Expert Ad hnc Cornittee on Pharmacology and Toxicology

9 - 10 India Council of Medical Research: Meeting of Expert New Delhi October Ad hoc Committee on Environmental Hygiene and Occupational Health

1 - 2 Government of India: Meeting of the Central Family ltyderabad Novemhc r Planning Council (India)

2 November Indian Council of Medical Research: Meeting of New Delhi Expert Ad hoc Cowittee on Cardiovascular Diseases and Hypertension

3-9 Federation of Asian Pharmaceutical Associations: Bangkok December Fourth Asian Congress of Pharmaceutical Sciences

6-9 Indian Council of Medical Research: Seminar on Long- New Delhi December term Effects of Cannabis Use in India

9 - 15 International Planned Parenthood Federation: Bombay December Indian Ocean Region Conference

12 - 17 Indian Space Research Organization: Meeting on the New Delhi December Role of Satellite Cornunication Development

2-4 Indian Council of Medical Research: Seminar on New Delhi January Physical Medicine and Rehabilitation Services for Physically Handicapped in India and its Role in the Modern Health Care Programme

4-7 Indian Academy of Paediatrics: Tenth National Trivandrum January Conference (India)

12 - 14 Indian Association for the Advancement of Medical Ahmedabad January Education: Twelfth Annual Meeting (India)

29 - 31 Government of India: Seminar on Financing and Manage- Trivandmm January ment of Water Supply and Sewerage Schemes (India) SEA/RC26/2 Page 233 Annex 5

22 - 28 Indian Agricultural Research InstitutelIndian Society New Delhi February of Genetics and Plant Breeding: Second Congress of the Society for the Advancement of Breeding Research in Asia and Oceania

3 - 7 March National Parent-Teacher Association of India: New Delhi Second Asian Symposium and the Fifth National Parent-Teacher Convention

12 - 17 International Union of Official Travel Organizations: New Delhl March International Seminar on Physical Planning and Area Development for Tourism

23 - 25 Indian Public Health Association: Seventeenth Annual Calcutta March Conference

26 - 29 Bangladesh Medical Association: Second National Dacca April Conference

11 June Government of India/UNICEF/WHO: Tripartite New Delhi Meeting an UNICEF's Participation in India's Fifth Five-Year Plan

11 June Planning Commission, Government of India: Meeting on New Delhi Applied Nutrition Programme in India

18 June Government of India (Ministry of Agriculture): New Delhi Meeting of the Co-ordination Committee on the Applied Nutrition Programme SEA/RC26/2 Page 234 Annex 6

FELLOWSHIP TABLES

Table 1. Fellowships Awarded,by Sources of Funds, Type of Fellowship and Country of Origin of the Fellow (1 ~uly1972 - 30 June 1973)

Country of 1 Regular UNDP Inter- Period Total Regional Origin Funds Funds Funds regional

1972 5 2 - 7 2 5 Bangladesh 1973 11 - 3 14 5 9 TO tal 16 2 3 21 7 14

1972 Burma 1973 Total

1972 India 1973 Total

1972 34 2 14 50 15 35 Indonesia i 1 I :: I ; I 1 i :: I :: I 1: I 1972 8 - - 8 4 4 Maldives 1973 - - - . . - Total 8 . - 8 4 4

1972 I Moneolia- 11973 1 1 1 :: 1 1 :: I Total 1 49 1 10 1 - 1 59 1 - 1 59

1972 24 2 1 27 7 20 Nepal 1973 15 - - 15 3 12 Total 39 2 1 42 10 32

1972 38 4 2 44 6 38 Sri Lanka 1973 14 1 3 18 2 16 Total 52 5 5 62 8 54

1972 38 10 3 51 6 45 Thailand 1973 8 2 1 11 - 11 Total 46 12 4 62 6 56

Grand Total 410 63 48 521 65 456

'=he figures for the reporting year are broken down into two parts: for the periods from 1 July to 31 December 1972 and from 1 January to 30 June 1973. SEA/RC26/2 Page 235 Annex 6

Table 2. Fellowships Awarded by the WHO South-East Asia Region, by Subject of Study and Country of Origin of the Fellow (1 July 1972 - 30 June 1973)

Sanitation

Maternal and Child Health

Biological standardization

Health education Health statistics Mental health Medical rehabilitation

Occupational health Orthopaedic surgery

Communicable Diseases and

Airport health and quarantine

Filariasis Gastra-enterology Haemorrhagic fever

Laboratory techniques Leprosy control Plague epidemiology Smallpox eradication Trachoma control Tuberculosis control Tropical medicine Vaccine production Venereal diseases Veterinary public health SEA/RC26/2 Page 236 Annex 6

Table 2 (continued)

171Clinical Medicine Blood transfusion Cancer Coronary care Haema tology Histology Medical physics Neurology Oto-rhino-laryngalogy Radiation medicine Radiography Radio-immunoassay Surgery Rheumatology Urology

Total

Basic Medical Sciences

Anatomy Anaesthesialogy Hospital physics Medical education Medical electronics Pathology Pharmacology Physiology

Total

Grand Total SEA/RC26/2 Page 237 Annex 6

Table 3. Fellowship Progranrmes Arran~edby the WHO South-East Asia Region in Other Regions and Vice Versa (1 July 1972 - 30 June 1973)

Total No.of African Region European Eastern Western fellowships Region of the Region Nediter- Pacific involved Americas ranean Region Region

From the South-East 456 Asia Region to: 9 125 269 7 133

To the South-East 95 Asia Region from: 5 7 17 9 5 7 SEA/RC~~/~ Page 240 Annex 7

~ - Document Title Author

Assignment report an the epidemiology and Dr V.I. Vasiljev & serological diagnosis of primary liver Dr Chernov cancer in Mongolia (Mongolia 0011), 21 December 1972 - 14 February 1973

Cholera

Assignment report on rehydration Lherapy production and control (~on~olia0027), October - November 1972

Communicable Diseases

Report on the in~munizationprogramme and Or J. Falisevac clinical aspects of some communicable diseases in Burma (SPAR0 0180), 4-11 September 1972

Report on implementation of immunization Dr J. Falisevac programmes and communicable disease surveillance activities in Sri Lanka (SEARO 0180), July - August 1972

Assignment report on the management of Dr W.M. Jamiesan & communicable diseases in Djakarta, Miss M.M. Morrison Indonesia (SEARO 0128), 17-24 December 197

Assignment report on Infectious-Disease Dr W.M. Jamieson & Hospital, Rangoon, Burma (SEARO 0128) Miss M.M. Morrison 12-16 December 1972

See SEAIEoidI53

:EA/c~/41and Corr. Assignment report on Infectious-Disease Dr W.M. Jamieson & Hospital, Dacca, Bangladesh (SEARO 0128), Miss M.M. Morrison 5-10 December 1972

Assignment report on Bamrasnaradura Dr W.M. Jarnieson 6 Infectious-Disease Hospital, Bangkok, fiiss M.M. Morrison Thailand (SEARO 0128), 26 December 1972 - 1 January 1973

Report on regional training course on the Dr W.M. Jamieson & management of infectious-disease hospitals Yiss M.M. Morrison Hyderabad, India (SEARO 0128), 13-25 November 1972

Assignment report on the teaching programm, 9r Y.M. Clayton at the National Institute of Dermatology, Bangkok, Thailand (Thailand 01071, 9 January - 9 February 1973 ~EAlRC2612 Page 241 Annex 7

Document Title Author

SEA/CD/45 Assignment report on the establishment of Dr Etain Cronin a contact dermatitis clinic in the National Institute of Dermatology, Bangkok (Thailand 0107), 4-30 March 1973

SEA/CD/46 Enteroviral Infections - report on a visit Dr N.N. Nossik SEA/Epid/57 tu Rangoon (SEAR0 0193), 11-25 January 1973

SEA/CD/47 Field visit report on communicable diseases Dr T. Olakowski in Maldives, 26 January - 1 February 1973

Dental Health

SEA/DH/23 Add.1 Some data relating to the dental health Sir Robert Bradlaw situation in Burma - Addendum to the assignment report on dental diseases, dental health services and dental education in Burma (Burma 0090), August- October 1971

SEA/DH/25 Report on a visit to Maldives to assess Prof. S.B. dental health requirements (Maldives 0005), Dissanayake 20-21 May 1972

SEA/D11/26 Assignment report on the training of Prof. T.F. stomatologists in Mongolia (Mongolia Vinogradov 0015), 4 April - 1 July 1972

SEA/DH/27 Assignment report on dental health, Dr Odd P. Lind Indonesia (Indonesia 0079) (UNDP), January-March 1973

Economics - llealth

SEA/Econ./Z Rev.1 Report on the status of health economics Prof. N.A. in Mongolia (SEAR0 01781, 16-31 May 1972 Vinogradov

Environmental Sanitation

SEA/Env.San./l07 Assignment report on a simplified water Mr V.I. Kataev supply system in Jargalant, Mongolia (Mongolia 0005), March-April 1972

SEA/Env.San./l07 Assignment report an proposals for a Mr V.I. Kataev Add.1 sewerage system in Jargalant, Mongolia (supplement to assignment report SEA/Env.San./l07)

SEA/Env.San./llO Assignment report on water pollution Mr Glen J. Hopkins control in India (India 0226), 24 October - 10 December 1971 SEA/RC26/2 Page 242 Annex 7

1 Document Title Author

SEA/Env.San./lll Assignment report on bio-environmental Dr Wilfredo L.Reyes engineering (Thailand 0120 (UNDP) and SEARO 0150), 23 October 1971 - 22 July 1972

SEA/Env.San./llZ Assignment report on urban water supplies, Mr J.C. Mendieta West Irian (Indonesia 0066), January- Mercado April 1972

SEA/Env.San./ll3 Assignment report on community water supply Mr Hans W. Bahr in Indonesia (Indonesia 0071), February- June 1972

SEA/Env.San./ll4 Assignment report on control of hazards to Dr G.O. Guerrant man from pesticides (SEARO 0190), 6-28 September 1972

SEA/Env.San./llS Assignment report on the teaching of Prof. N. Majumdar sanitary engineering, Burma (Burma 0089), 25 April - 31 October 1972

SEA/Env.San./ll6 Assignment report on Medical Toxicology Dr Franklin D. Unit at the Industrial Toxicology Research Aldrich Centre, Lucknow, Uttar Pradesh (India 0279), 5 October - 13 December 1972

SEA/Env.San./ll7 Assignment report on public health engineer- Prof. R.S. Mehta ing in Bangladesh (setting up of a public health engineering research institute and study public health laboratory facilities available for water quality and pollution control) (~angladesh0007), 27 December 1972 - 26 January 1973

SEAIEnv.San.lll8 Report on the Regional Seminar on Air Prof. Henry C. Pollution control(he1d at Central Public Wohlers Health Engineering Research Institute, Nagpur)(India 0176), 4-15 December 1972

SEA/Env.San./llg Assignment report on marine disposal of Mr B. Sterregaard waste water at Baroda (Gujarat) (India 0176), 29 December 1972 - 28 February 1973

SEA/Env.San./lZO Assignment report on water pollution Mr H.E. Allen control in India (India 0226), 11 December 1972 - 16 February 1973

SEA/Env.San./lZl Assignment report on post-graduate training Dr K. Kawata programme in sanitary engineering at Bangladesh University of Engineering & Technology, Dacca (Bangladesh 0007), 29 January - 18 February 1973 SEA/RC26/2 Page 243 Annex 7

- -- Document Title Author

SEAIEnv.San.1122 Assignment report on air pollution training James L. Dicke and research at Central Public Health Engineering,Research Institute, Nagpur (India 0176), 6 February - 23 March 1973

Epidemiology

SEAIHLMI~~ See SEA/HLM/65 SEAIEpid/45

SEA/Epid/46 Assignment report on epidemiological Dr 7.. Bencic services, Thailand (Thailand 0059), 6 May - 9 June 1972

SEA/Epid/47 Assignment report on strengthening of Dr J. Pecenka health services (epidemiology), Burma (Burma 0044) (IJNDPITA), 24 February - 25 March 1972

SEA/Epid/48 Report on a visit to Poona, Maharashtra Dr Soemiatno (India) (SEAR0 0193), 1-8 March 1972

SEAIEpidI49 Assignment report an strengthening of Dr S.B. Halstead health services (epidemiology) (Thailand 0059), 5 June - 7 July 1972

SEA/Epid/50 Assignment report on strengthening of Dr Akira Oya epidemiological services (Sri Lanka 0078), 1-29 September 1972

SEA/Epid/51 Assignment report on strengthening of Mr Josef Adamec health services (epidemiology) (Mongolia 0001), March 1970 - December 1972

SEA/Epid/52 Assignment report on strengthening of Dr P.C. Basu epidemiological services (Indonesia 0091), September-November 1972

SEAlEpidl53 Assignment report on the International Dr M.I.D. Sharma SEA/CtI/40 Training Course in Epidemiology and Control of Communicable Diseases (Prague/ Delhi) (India 0259), 25 September - 25 October 1972

SEA/Epid/54 and Assignment report on the strengthening of Dr Suchitra Rev.1 epidemiological services (Indonesia 0091), Nimmanitya 4 April - 4 May 1972

SEA/Epid/55 Assignment report on strengthening of Dr V.M. Andreevskij health services (epidemiology), Mongolia (Mongolia 0001), July-December 1972 SEA/RC26/2 Page 244 Annex 7 - - Document Title Author

SEA/Med.Educ./207 See SEA/Med.Educ./ZO7 SEA/Epid/56

SPA/CD/46 See SEA/CD/46 SEA/Epid/57 Filariasis SEA/Fil/l2 Assignment report on entomological aspects Dr F.L. Lambrecht OF the filariasis control project, Sri Lanka (Sri Lanka 0056), June 1970 - June 1972

SEA/Fil/l3 and Assignment report on filariasis control in Dr J.J. Lartigue Corr. 1 Burma (Burma 0087), July 1970 - September 1972 Haemorrhagic Fever SEA/Haem.Fever/lO A follow-up assignment report on haemorr- Dr S.B. Halstead hagic fevers, Burma (SEARO 0099), 2-5 July 1972 Health Education SEA/IIE/53 Assignment report on health education in Dr John T. Fodor Nepal (Nepal 0019), 7 July - 25 August 1972

SEAIHEI54 Assignment report on health education, Mr Norman Scotney Burma (Burma 00661, 16 June - 22 August 1972

SEA/HE/55 Assignment report on training in health Dr(Mrs) Sarah S. Kao Education (Sri Lanka 01041, 1 March - 30 June 1972

SEA/ttE/56 Assignment report on health education Dr J.J. Simmons 6. (behaviaural studies) (Indonesia 0120) Dr G.8. Krishnamurty June - September 1972

SEAIHEI57 Assignment report on State Health Education Dr Ibrahim M. Wassef Bureau, Tamil Nadu (India) (India 0108), 2 October - 30 December 1971

SEA/HE/58 Assignment report on health education in Miss M.F. Patterson strengthening national health services, (~ndonesia0086), 30 December 1969 - 31 October 1972

SEAIHEI59 Report of the workshop on field training Dr Wirjawan & in health education, New Delhi Dr Louis Philip (SEARO 0130), 23 October - 4 November 1972 . SEA/RC26/2 Page 245 Annex 7

Document Title Author

SEA/HE/60 Assignment report on health education Dr Ian M. Newnan (behavioural studies) (Sri Lanka 0104), 7 November - 7 December 1972

SEA/HE/61 Assignment report on health education, Prof. Williams India (diploma course in health education Griffiths of the Central Health Education Bureau, New Delhi) (India 0190), 30 December 1972 - 31 March 1973

Health Laboratory Methods

SEA/HLM/65 Assignment report on the strengthening of Dr V. Bardas SEA/Epid/45 health services (epidemiology), with special reference to laboratory aspects, Burma (Burma 0044), December 1971 - June 1972

SEA/HLM/66 Assignment report on strengthening of Dr C.W. Chacko SEA/VDT/ZO laboratory services for venereal disease and treponematoses control, Burma (Burma- 74), 31 December 1971 - 28 June 1972

SEAIHLM~~~ Assignment report an new freeze-drying Mr David T. equipment at smallpox vaccine institutes Sutherland (India 01741, August - September 1972

SEAIHLMI~~ Assignment report on the production and Mr W.H. Thomas control of rehydration fluids at the various hospitals in Kathmandu, Nepal (SEARO 0144), September 1972

SEA/HLM/~~ Assignment report on public health labora- Mrs Teresa Teisseyre tory services (Mongolia 0002). 15 August 1970 - 31 December 1972

SEA/HLM/70 Assignment report an health laboratory Dr R.J. Henderson services in Sri Lanka (SEARO 0159), 13 - 27 October 1972

SEA/HLM/71 Assignment report on blood transfusion Dr R.A. Zeitlin service in Sri Lanka (SEARO 0176), 23 - 30 November 1972

SEA/HLM/72 Assignment report on blood transfusion Dr R.A. Zeitlin service in Indonesia (SEARO 0176), 3 - 22 November 1972

SEA/HLM/72 Add.1 Blood transfusion services of the Indo- Dr R.A. Zeitlin nesian Red Cross Society (Addendum to assignment report on blood transfusion - services in Indonesia)(SEARO 0176) SEA/RC26/2 Page 246 Annex 7

t Document Title Author

SEAIHLM173 Assignment report on health laboratory Dr L.M. Prescott services (Indonesia 0060), August 1970 - December 1972

SEA/HLM/74 and Assignment report on breeding centre for Mr G.J.R. Hovel1 Corr. 1 small laboratory animals in Rangoon (Burma 00741, 12 November - 4 December 1972

SEAIHLMI75 Assignment report on the laboratory animal Mr G.J.R. Hovel1 SEA/Vaccine/53 situation in connection with the production and Corr. 1 of rabies vaccine in Nepal (Nepal 00331, 20 October - 10 November 1972

SEAIHLM176 Assignment report an health laboratory Dr R.J. Henderson services in India (SEARO 0159), 6 October 1972 - 6 January 1973

SEA/HLM/77 Assignment report on biological standardi- Dr L. Higy-Mandic zation and quality control of biological products hailan and 0105), 19 October - 21 December 1972

SEA/HLM/78 and Assignment report on production of anti- Dr L. Higy-Mandic Corr. 1 venins (Thailand 0105). 19 October - 21 December 1972

StAIHLMI79 and Assignment report on courses on health Dr S.O. Seidl Corr. 1 laboratory techniques, Nepal (SEARO 0176), 30 November - 3 December 1972

SEAIHLNIBO Assignment report on courses on health Dr S.0. Seidl laboratory techniques, India (SEARO 0176), 3 - 29 November 1972

SEA/LEP/SO and Assignment report on leprosy control Dr F.M. Noussitou Add. 1 programme (Sri Lanka 00261, 10 February - 26 July 1972

SEAILEPI51 Assignment report on assessment of leprosy Dr K.S. Seal Rev. 1 control services in Thailand (Thailand 0059), April - July 1972

SEA/LEP/~Z Assignment report on leprosy control Dr K.S. Seal project, Nepal (Nepal 0013), 14 October 1972 - 7 January 1973 Malaria SEA/Mal/92 Assignment report on malaria eradication Mr William Rooney (laboratory aspects), Indonesia, (SEARO 0094), 3 April - 1 July 1972 SEAlRC2612 Page 247 Annex 7

Document Title Author

SEA/Mal/93 Assignment report on malaria eradication Mr William Rooney (external cross-checking of blood films) (SEARO 0094), October 1968 - February 1973

SEA/Mal/94 Assignment report on malaria eradication, Or D.N. Popovic India (Regional Co-ordination Organization, Baroda) (India 0153), February 1972 - May 1973

SEA/Mal/95 Assignment report on malaria eradication Dr H.A.H. Mashaal programme in Thailand (Thailand 0065). 20 February 1968 - 31 March 1973

Maternal and Child Health

SEA/Med.Educ./l98 See SEA/Med.Educ./l98 SEA/MCH/81

SEAlMCHl82 Report an a workshop on problems and tech- Dr F.J.W. Miller SEA/Med.Educ./200 niques of community studies in child health and their relationship to post-graduate education, Hyderabad (India 0114) , 18-24 October 1972

SEA/MCH/83 Report on the regional seminar on health Dr Graham & aspects of the care of normal children in day-care centres and institutions,Chiengmai (Thailand) (SEARO 0197), 19-24 June 1972

Maternal and Child Health and Family Planning

SEA/MCH/FP/20 Assignment report on paediatric services in Dr R. Lightwoad Sri Lanka (Sri Lanka 0105), 1-28 June 1972

SEA/MCH/FP/21 Report on the training course in human Dr Barns 6 reproduction, family planning and popu- Dr Arre Somboonsuk lation dynamics, New Delhi (SEARO 0206), 3 April-2 May 1972

SEA/MCH/FP/22 Report on the national seminar on family Regional Office healthlfamily planning, Colombo (Sri Lanka 0105), 22-26 January 1973

SEA/MCH/FP/23 Guidelines for teaching human reproduction, Regional Office SEA/Med.Educ.1201 population dynamics and family planning in medical schools (SEARO 0206) (UNFPA) April 1973

SEA/MCH/FP/24 Assignment report on strengthening the Dr A.M. Salaheimo SEA/Med.Educ. 1203 teaching of humam reproducation, family planning and population dynamics in medical schools (Indonesia 0114), 1 March 1971 - 28 February 1973 SEAlRC2612 Page 248 Annex 7

Document Title Author

SEA/MCH/FP/ 25 Assignment report on family health in Sri Dr R.M. Bernard Lanka (Sri Lanka 0105), 15 August 1972 - 2 March 1973

Medical Education

SEAIMed.Educ.ll85 Report on a national workshop on teaching Regional Office methodology of community medicine and family planning, Surabaya (Indonesia) (Indonesia 0114), 6 - 11 DecemDer 1971

SEA/Med.Educ. 1186 See SEAlAnaesth13 SEA/Anaesth/3

SEAIMed.Educ.1187 Report on the regional seminar on community Regional Office medicine for medical teachers,(held at the National Institute of Public Health, Sura- baya)(lndonesia) (SEAR0 0096), 29 November- 4 December 1971

SEA/Med.Educ./l88 Assignment report on medical education, Prof. W.D. Furneaux Sri Lanka (SEAR0 0096), November 1971 & Dr P.H. Sanderson

SEA/Mcd.Educ./l89 The teaching of community medicine in Regional Office undergraduate medical education - report on the technical discussions held during the twenty-fifth session of the WHO Regional Committee for South-East Asia (12 - 18 September 1972), Colombo, Sri Lanka

SEA/Med.Edue./l90 Assignment report on medical education, Prof. Furneaux & Corr. 1 Add. 1 Burma (SEARO 0096),~ovember-December 1971 Dr Sanderson

SEA/Med.Educ./l91 Assignment report on psychiatric education Dr Tsung-Yi Lin and training in Thailand (SEARO 0096), 12 June - 10 July 1972

SEA/Med.Educ./l92 Assignment report on the teaching of medi- Dr Triloke Khosla cal statistics in Burma (Burma 0028), 1 May - 31 August 1972

SEA/Med.Educ.1193 Assignment report on the Development of Dr Richard K.C. Lee School of Public Health, University of Indonesia, Djakarta (Indonesia 0097), 30 June - 8 August 1972

SEA/Med.Educ./l94 Assignment report on medical education and Dr A.D. Evans training, Faculty of Medicine, Chiengmai University, Thailand (Thailand 0097), 27 June - 27 July 1972 SEA/RC26/2 Page 249 Annex 7

Document Title Author 1 SEAIMed.Educ.1195 Assignment report an assistance to the Dr Z.S. Szreniawski Department of Pharmacology, Faculty of Medicine, University of North Sumatra, Medan (Indonesia 0062), 12 January 1971 - 3 December 1972

~~~/~ed.~duc./l96Assignment report on teaching clinical Dr James A Kirkland pathology at Gadjah Mada University, Jog- jakarta (Indonesia 0062), 11 September - 10 November 1972

SEAIMed.Educ.1197 Report on seminar on community medicine Drs Love & Jha for medical teachers with particular reference to strengthening the teaching of maternal and child health (SEARO 0171), Rangoon, 16 - 21 October 1972

SEA/Med.Educ./l98 Assignment report on paediatric education, Dr J.N. Pohowalla SEAIMCHI81 Burma (Burma 0079 & Burma 0028/UNDP), April 1971 - February 1972 and April 1972 - January 1973

SEA/Med.Educ./l99 Assignment report on establishment of Dr R.A. Barter SEA/~ancerll3 cytology services and training (Indonesia 0107), 29 January - 22 February 1973

SEA/MCH/B~ See MCH/82 I SEA/Med,Educ./200 I SEA/Med.Educ./ZOl See MCH/FP/23 SEA/MCH/FP/~~

SEA/Med.Educ.I202 Assignment report on establishment of Dr E.D. Wilson SEA/Cancer/l4 Cytological Services and Training (Indo- nesia 0107), 26 December 1972 - 6 March 1973

SEA/Med.Educ./203 See SEA/MCH/FPI24 SEA/MCH/FP/24

SEA/Med.Educ./204 Assignment report on Faculty of Medicine, Dr B.J. Andrew & University of Ceylon, Peradeniya, Sri Dr W.L. Millard Lanka (SEARO 0096), 17 November - 21 December 1972

SEA/Med,Educ./205 Report an medical teachers' training Dr Thomas V. Telder, course(he1d at the Faculty of Medicine, Dr Philip G. Chulalongkorn University, Bangkok, Bashook end Thailand) (SEARO 0096), 3 - 14 July 1972 Dr Martin A. SEA/RC26/2 Page 250 Annex 7

I I Document Title Author

SEA/Med.Educ./206 Assignment report on medical education in Dr J. Sramek Mongolia (SEARO 00061, 7 September - 24 November 1972

s~~/~ed.Educ.1207 Assignment report on the teaching of Dr A.I. Adam8 SEA/Epid/56 epidemiology at the University of Sri Lanka (Sri Lanka 0047), December 1972 - March 1973

SEA/Med,Educ./208 Assignment report on assistance in the Dr Norman S. Track teaching of endocrinology in medical schools, India (India Olll), 15 December 1972 - 2 February 1973

SEA/Med.Educ./ZO9 Assignment report on assistance in clinical Dr K.A. Fletcher chemistry to the Faculty of Medicine, Mahidol Oniversity, Bangkok (Thailand 0057), 5 January - 30 March 1973

SEAiMed.Educ./210 Assignment report on medical education in Dr Z. Sestak Bangladesh (Bangladesh 0019), 1 December 1972 - 31 January 1973

Mental Health

SEA/Ment/LO Report on mental health and psychiatry Dr Edward Lambert services education and research in Sri Margetts Lanka (Sri Lanka 00371, 14 December 1972 - 14 February 1973

SEAiNurst238 Report on a study of activities of health Miss M. Reid personnel working in health centres in Miss G. Richardson Thailand (Thailand 0089), January - May Miss M. Lochore 1971

SEAiNursl239 Report on a course on administration of Miss Marianne T. nursing service in hospitals(he1d at the Spause Post-basic School of Nursing, Colombo) (SEARO 0139), 21 February - 24 March 1972

SEA/Nurs/240 Report on a short course on nursing care Misa Belga of surgical patients(he1d at the Post-basic Guerrieri School of Nursing, Rangoon)(Burma 00561, 14 February - 8 April 1972 SEAiNursl241 Information on short course for nursing Miss Christabel care of patients with eye, ear, nose and Hignett throat disorders (held at Eye, Ear, Nose & Throat Hospital, Rangcon) (~urma0056), 1 November - 11 December 1971 - SEA/RC26/2 Page 251 Annex 7

Document Title Author

SEA/Nurs/242 Assignment report on post-basic nursing Miss Marion Pool education, Madras (India 0136), July 1970- July 1972

SEA/Nurs/243 Final report on post-basic nursing educa- Miss H. Wilson tion, Chandigarh (India 0136), March 1964 - July 1972

SEA/Nurs/244 Assignment report on nursing advisory Miss H.A. Milton services (Sri Lanka 0053), February - July 1972

SEA/Nurs/245 Assignment report an nursing services and Mrs Mirjana Brzic education in Mongolia (Mongolia O008), 6 October 1970 - 31 October 1972

SEAiNucsi246 Assignment report on nursing in clinical Miss Mary Powell specialties in the Central Institute of Orthopaedics, Safdarjang Hospital, New Delhi (India 02691, 4 January - 1 December 1972

SEA/Nurs/247 Assignment report on strengthening of Mr R.L. Swann national health services (Indonesia 0086), October 1910 - August 1972

SEA/Nurs/248 Assignment report on nursing education and Miss M.I. Tabbanor services (Nepal 0002), August 1969 - November 1972

SEA/~urs/249 Assignment report on sequential learning Miss Mary Clementsd activity, paediatric patient care (Phase I) Mr I.S. Kirkland (held at Lady Ridgeway Hospital ior Children, Calombo)(Sri Lanka 0053), 6 November - 8 December 1972

SEA/Nurs/250 Assignment report on post-basic nursing Miss H.D. Ten education, Gujarat (India 0136), 7 February Brink 1970 - 26 October 1972

SEA/Nurs/251 and Assignment report on strengthening of Mrs M.M. Dadds Corr. 1 family planning aspects of nursing administration (India 0276) (uNFPA), 20 March 1972 - 19 February 1973

SEA/~urs/252 Assignment report on nursing education and Mr Ernest W. training, Province of Irian Jaya (Indone- Lindf ield sia 0084) (UNDPIFUNDWI) , 1 May 1971 - 30 April 1973 SEA/RC26/2 Page 252 Annex 7

Document Title Author

SEA/Nura/253 Assignment report on post-basic nursing Miss Janet L. education, Ahmedabad (India 01361, Erickson January 1970 - March 1973

SEA/Nurs/254 Final report on post-basic nursing educa- Miss B. Guerrieri tion, Madras (India 0136.5),June 1364 - May 1973

SEA/Nurs/255 See SEA/PHA/107

Nutrition

SEA/Nut/39 Rev. 1 Assignment report on the applied nutrition Dr J.F. De Nijn programme, Indonesia (Indonesia 0125), 17 October 1971 - 19 January 1972

SEAINutl40 Add. 1 National course on the role of the health Dr R. Buzina services in the prevention and treatment of nutritional diseases, held in Rangoon, Burma (October 1972) - Sumary of papers presented and brief notes on the discussions (Supplement to Dr R. Buzina's assignment report, ~EA/~ut/40,(Burma 0093))

SEA/Nut/41 Assignment report an blindness prevention Dr Wadie W. Kame1 programme, Bangladesh (Bangladesh 0016), November - Deceaber 1972

S~A/Nut/42 Assignment report on a study on growth Dr J.V.G.A. Durnin and developrent (~urma0095), 28 November 1972 - 9 January 1973

SEA/Nut/43 Assignment report on dental legislation Sir Robert Bradlaw and ethics in Indonesia (Indonesia 0079) (UNDP), 21 November 1972 - 20 February 1973

SEA/Nut/44 Assignment report on a nation-wide study Dr 0. Bar-or on the physical fitness and work capacity in the Union of Burma (Burma 0095), 20 December 1972 - 31 January 1972

SEA/Nut/45 Assignment report on implementation of the Dr W.W. Kame1 blindness prevention programme in Bangla- desh (Bangladesh 0016), 12 February - 15 March 1973

Organization of Medical Care

SEA/OMC/~Rev. 1 Assignment report on organization and Mr H.M. Thielmann administration of hospital and medical Mr O.A. Vergeiner care services (SEAR0 0104/Nepal 0021) July 1972 SEA/RC26/2 Page 253 Annex 7

4 Document Title Author

SEA/OMC/~O Assignment report on the Accident Unit Dr P.S. London Siriraj Hospital, Bangkok (Thailand 0097), 5 January - 4 April 1973

SEA/Plague/lO Assignment report on the epidemiology and Dr M. Bahmanyar control of plague in Burma (Burma 00781, 16 December 1971 - 25 February 1972

SEA/Plague/ll Report on plague ecology in Central Java Lim Boo Liat (Indonesia 0099),16 March - 8 April 1973

Public Health Administration

SEA/PtlA/103 Repart on a visit to Bangladesh, 5-15 July A WHO Team 1972

SEA/PHA/104 Assignment report on research projects in Dr W.A. Reinke public health practice, Indonesia (Indone- sia 0086), 30 May - 25 July 1972

SEA/PHA/~O~and Assignment report on strengthening of Dr Robert N. Grosse Corr. 1 national health services, Indonesia (planning aspects) (Indonesia 0086), July - August 1972

SEA/PHA/106 Report an a seminar on the training of Dr P. Diesh medical officers in rural areas of India Dr B.N. Bhattacharya (held at the Rural Health Training Centre, Dr R.K. Seth & Najafgarh, New Delhi (India 0185), Miss A.M. Pae 23 - 28 October 1972

SEA/PHA/107 Report on a meeting on the role of opera- Miss Muriel Skeet SE~/~urs/255 tional studies in health services and education for these services, Bangkok (SEAR0 0116), 12-21 December 1972

SEA/PHA/ 10i Assignment report on strengthening of Dr D.J.M. McKenzie national health services (Indonesia 0086), 8 - 30 March 1973

SEA/pHA/109 Assignment report on pharmaceutical and Mr F.S. Bisharah medical stores management, Bangladesh (Bangladesh 0011), 8 August 1972 - 7 February 1973

SEA/PHA/~~O Assignment report on public health Dr O.H. Killen administration (Thailand 00981, December 1971 - March 1973 SEA/RC26/2 Page 254 Annex 7

1 Document Title Author

-Rabies SEA/Rabies/4 Assignment report on prevention of rabies Dr N.Veeraraghavan SEA/Vaccine/56 in Nepal (Nepal 0033), 30 November 1972 - 28 February 1973

Radiation

SEA/Rad/61 See SEA/TB/121 SEA/TB/121

SEA/Rad/62 Assignment report on training in and Mr C. Hutchinson maintenance of electro-medical equipment in hospitals in Sri Lanka (Sri Lanka 0094), 25 June - 21 September 1972

SEA/Rad/63 Assignment report on the establishment and Mr S.R. Hillier development of a school of medical radiography in Bangkok (Thailand 0071), October 1968 - December 1972

SEA/Rad/64 Assignment report on course in hospital Mr J.E. Turner physics at the Bhabha Atomic Research Centre, Trombay, Bombay (India 0232), 2 January - 22 February 1973

SEA/Rad/65 Assignment report an school for medical Mr E.J. Browne physicist8 at Ramathibodi Hospital, Mahidol University, Bangkok (Thailand 0109) (UNDP) , 9 January 1971 - 31 January 1973

SEA/Rad/66 Assignment report on Radiation Medicine Dr J. Matovinovic Centre, Bombay (India 0192), 2 January - 28 February 1973

SEA/Rad/67 Final report on the training of radiogra- Mr R.B. Webb phers at the Post-graduate Institute of Medical Education and Research, Chandigarh (India 0187), 5 August 1970 - 4 May 1973

Rehabilitation

S~A/~ehab/l5 Assignment report on medical rehabilitation Dr A. Seyfried (Ceylon 00631, 3 January - 4 April 1972

SEA/Rehab/l6 Assignment report on medical rehabilitation Mr J.A.E. Gleave in India (India 0194), October 1970 - September 1972 SEA/RC26/2 Page 255 Annex 7

Document Title Author

SEA/Rehab/l4 Rev.1 Assignment reports on development of Miss E.M. Stanley and Corr. 1 physiotherapy school and services, Baroda (India 02571, 1 July 1.970 - 31 January 1.972, 7 February - 7 May 1972 and 20 July - 18 August 1972

SEA/Rehab/l7 Assignment report on training of occupa- Miss V.M. Fearne tional therapists and rehabilitation of the handicapped (Burma 0088), 3 January - 23 February 1973

Smallpox

SEAISmallpoxl60 Assignment report on smallpox eradication Dr K. Markvart in Uttar Pradesh (India 0233), 16 January - 16 March 1972

SE~/Small~ox/61 Report on a visit to Kerala Stare (India Dr I. Arita 02331, 3 - 22 February 1972

SEA/Smallpox/62 Report on a visit to the smallpox vaccine Dr R.C. Kent production laboratory, Institute of Public Health, Noakhali, Dacca (Bangladesh 0003), 25 May - 19 July 1972

SE~/~mall~ox/63 Assignment report on smallpox control in Dr Alfred Somer Bangladesh (Bangladesh 0003), 12 March - 5 June 1972

SEAiSmallpoxi64 Report on field visit to Nyderabad District, Dr 2. Jezek Rev. 1 Andhra Pradesh (SEAR0 0030), 17-26 Novem- ber 1972

SEAISrnallpoxl65 Assignment report on smallpox eradication Dr I. Lsdnyi programme in Madhya Pradesh (India 0233), 25 December 1972 - 2 February 1973

SEAlSmallpoxi66 Assignment report on smallpax eradication Dr K. Markvart in Bihar, India (India 0233), 13 January - 8 March 1973

SEAISmallpoxI67 Assignment report on smallpox eradication, Dr 6. Meiklejohn Uttar Pradesh (India 0233), 28 November 1972 - 12 January 1973

SEA/Smallpox/68 Assignment report an smallpox eradication, Dr A.N. Slepouchkine Bangladesh (Bangladesh 00031, 3 October - 26 December 1972

SEA/Smallpox/69 Report on a visit to West Bengal (India Dr I. Arita & 02331, 5 November - 3 December 1972 Dr Y. Selivanov SEA/RC~~/~ Page 256 Annex 7

Document Title Author

SEA/Smallpox/70 Report on smallpox emergency campaign in Dr A.N. Slepouchkine Uttar Pradesh (India 02331, February - & Dr I. Arita April 1973

Trachoma

SEA/Trach/29 Report on a visit to the trachoma control Dr M.L. Tarizzo programme, Burma (~urma00691, 21 June - 4 July 1972

Tuberculosis

SEA/TB/121 Assignment report on radiological aspects Mr C. Nelson SEA/Rad/61 of National Tuberculosis Programme, India (India 0103), August 1970 - December 1971

SEA/TB/122 Assignment report on tuberculosis control Dr N.K. Menon pilot project, Nepal (Nepal 0016), 2 June - 15 August 1972

SEA/TB/123 Assig~lentreport on tuberculosis control, Dr Milan Kubin Mongolia (Mongolia OOO~/UNDP/TA), 15 January - 15 April 1972

SEA/TB/124 Assignment report on tuberculosis control Dr K. Toman in Thailand (Thailand 0002), December 1971- June 1972

SEA/TB/125 Assignment report an assessment of tuber- Dr 3. Leowski Rev. 1 culosis control, Mongolia (SEAR0 0113), Mr A.G. Beer 14 July - 13 October 1972 Miss Blocher & Miss Meagher

SEA/TB/126 Assignment report on tuberculosis control, Dr Maria Belcheva Mongolia (Mongolia 0003), 7 October - 28 December 1972

SEA/TB/127 Assignment report on assistance to the Dr G. Kann tuberculosis baseline survey, Burma (~urma0065), 27 July - 14 January 1973

SEA/TB/128 Report on tuberculosis baseline survey in Dr J. Radkovsky and Ceylon by the Tuberculosis Training and other members of Evaluation Team (SEAR0 0113), August 1970 - the team April 1971

Vaccines SEA/Vaccine/50 Assignment report on production of anti- Dr Donald J. Dean rabies vaccine of tissue culture origin in Thailand (SEARO 0168), 26 February - 2 March 1972 sEA/~C26/2 Page 257 Annex 7

, Document Title Author

SEA/Vaccine/51 Assignment report on vaccine and sera Dr Paul van Hemert production in Indonesia (Indonesia 0083), 5 - 28 May 1972

S~~/~accine/52 Assignment report on production of DPT Dr Paul van Hemert vaccine in Kasauli, India (SEARO 0117), 5 - 13 June 1972

SEA/Vaccine/53 See SEA/HLM/75 SEA/HLM/75

SEA/Vaccine/54 Assignment report on visit to P.N. Bio Dr C. Kaplan Farma, Bandung, Indonesia (SEARO 0038), 29 December 1972 - 5 January 1973

SEA/Vaccine/55 Assignment report on a visit to the Burma ~r C. ~apla~ Pharmaceutical Industry, Rangoon (SEARO 0038), 19 - 20 December 1972

SEA/Vaccine/56 See S~~/Rabies/4 SEA/Rabies/4

SEA/Vaccine/57 Assignment report on diphtheria, tetanus Dr A.F.B. Standfast and pertussis vaccine production in Thailand (SEARO 0117), November-December 1972

SEA/~accine/58 Assignment report on production of freeze- Dr C. Kaplan dried smallpox vaccine in Thailand (SEARO 0038), 22 - 27 December 1972

~EA/Vaccine/59 Assignment report on vaccine production, Dr A.F.B. Standfast Burma (Burma 0077), 9 November - 3 December 1972

SEA/Vaccine/60 Assignment report on a visit to the Dr A.F.B. Standfast Haffkine Institute, Bombay (SEARO 0117), 13 December 1972 - 4 January 1973

Venereal Diseases and Treponematosis

SEA/VDT/~O See SEA/HLM/~~ SEA/HLM/66

SEA/VDT/~~ Assignment report on venereal-disease Dr R.S. Morton control in Bangladesh (Bangladesh 00151, 10 October - 18 November 1972

SEA//VDT/22 Assignment report on venereal-disease Dr A.J. King control in Thailand (Thailand 0082), . 1 - 31 January 1973 SEA/RC26/2 Page 258 Annex 7

Document Title Author

Veterinary Public Health

SEA/VPH/~~ Assignment report on training in veteri- Dr Donald J. Dean nary public health (India) (SEAR0 0168), 3 - 25 February 1972

SEA/VPH/12 Assignment report on training in food Dr R.J. Gilbert hygiene in the Faculty of Veterinary Science, Chulalongkorn University, Bangkok (Thailand 0117), 8 November 1972 - 31 January 1973

Vital and Health Statistics

SEA/VHS1134 Assignment report on health statistics, Dr D.B. Shestov Mongolia (Mongolia 0007), 25 April - 29 June 1972

SEAIVHSI135 Assignment report on health statistical Mr D. Gajaraj aspects of the development of health services, Nepal (Nepal 0021), 14 January - 18 December 1971 and 17 January - 16 April 1972

SEA/VHS/136 Report on the working group on the ninth Regional Office revision of the International Classifica- tion of Diseases, New Delhi (SEARO 0220), 7 - 10 November 1972

SEAIVHSI137 Assignment report on hospital reporting DK Daw Yin Mya and medical recording in Indonesia (SEARO 0220), 26 July - 1 December 1972

SEA/VHS/ 138 Proposal for reorganization of medical Dr M. Ishida records activities in Dacca Medical College Hospital (Bangladesh 00091, January - February 1973