WORLD I-IEALTH ORGANIZATION REGIONAL OFFICE FOR SOUTH-EAST ASIA
'I'W1:NTY-ISIGIITIl ANNIJ \L I~I~l'Ol~~ OF THE REGION \L DIRECTOR TO TIIE: REGION 11, (:O~lMI'lTb~EFOR SOI"r11-EAST /\St 1
1 JULY 1975 - 30 JUNE 1976 SEA/RC29/2 Page iii
CONTENTS
Pase
INTRODUCTION vii
PART I - GENERAL REVIEW OF ACTIVITIES
1 STRENGTHENING OF HEALTH SERVICES
Planning and Development of Health Services Health planning, programme formulation and evaluation Organization of basic health services Medical care Operational studies Rehabilitation Family Health Nursing Health Education Nutrition Oral Health Mental Health Drug Dependence Quality Control of Pharmaceutical and Biological Products Medical Stores Management
2 DISEASE PREVENTION AND CONTROL - COh?WNICABLE DISEASES
Epidemiological Surveillance Malaria Tuberculosis Diseases Subject to the International Health Regulations Smallpox eradication Cholera and other enteric diseases Plague Bacterial Diseases Leprosy Sexually-transmitted diseases Diphtheria, pertussis and tetanus Meningococcal meningitis Virus Diseases Trachoma Poliomyelitis Haemorrhagic fever Influenza and other virus diseases Parasitic Diseases Schistosomiasis Filariasis Veterinary Public Health Expanded Programme of Immunization Immunology Vector Biology and Control SEAIRC29 12 Page iv Page
3 DISEASE PREVENTION AND CONTROL - NON-COMNUWICABLE DISEASES 37
3.1 Cancer 3.2 Cardiovascular Diseases 3.3 Blindness
4 HEALTH LABORATORY SERVICES 40
4.1 Reference Laboratories 4.2 Quality Control 4.3 Laboratory Animals 4.4 Laboratory Instrumentation
5 PROMOTION OF ENVIRONMENTAL HEALTH 4 3
5.1 Environmental Health 5.2 Occupational Health 5.3 Radiation Health 5.4 Hazards to Man from Pesticides
6 HEALTH STATISTICAL SERVICES AND INFORMATION SYSTEMS 4 7
DEVELOPMENT OF HEALTH MANPOWER
Medical Education Paediatric and Obstetric Education Teaching of Human Reproduction, Family Planning and Population Dynamics Nursing Education Education in Sanitary Engineering Training of Auxiliaries Group Educational Activities Fellowships The Regional Office Library
8 BIOMEDICAL RESEARCH 6 3
9 TECHNICAL INFORMATION AND REFERENCE SERVICES 64
PART I1 - ORGANIZATIONAL AND ADMINISTRATIVE MATTERS
1 THE REGIONAL COMMITTEE 67
2 REGIONAL PROGRAMME PLANNING AND DIRECTION 69
3 ADMINISTRATION
3.1 General 3.2 Organizational Structure 3.3 Personnel 3.3.1 Staffing SEA/RC29/2 Page v Page
3.3.2 Briefing 3.3.3 Staff training 3.3.4 Employment conditions 3.4 Finance, Budget and Accounts
4 PROCUREMENT OF SUPPLIES AND EQUIPMENT
COLLABORATION WITH OTHER AGENCIES
United Nations United Nations Development Programme (UNDP) United Nations Children's Fund (UNICEF) United Nations Fund for Population Activities (UNFPA) Economic and Social Commission for Asia and the Pacific (ESCAP) World Food Programme (WFP) International Atomic Energy Agency (IAEA) United Nations Industrial Development Organization (UNIDO) 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 Bilateral and Other Agencies
6 PUBLIC INFORMATION
PART 111 - ACTIVITIES UNDERTAKEN BY GOVERNMENTS WITH THE HELP OF WHO
PROJECT LIST
Bangladesh Bhutan Burma Democratic People's Republic of Korea 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
2 Geographical Distribution of International Staff Assigned to the South-East Asia Region as of 30 June 1976 SEAIRC29 12 Page vi
Page
3 Meetings and Courses Organized by WHO and Held in the South-East Asia Region (1 July 1975 - 30 June 1976) 219 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 (1 July 1975 - 30 June 1976) 223 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 1975 - 30 June 1976) 224 6 Fellowship Tables 225 7 List of Technical Reports Issued by the Regional Office (1 July 1975 - 30 June 1976) 8 Budget Performance 255
GRAPHS
1 Population at Malaria Risk and Detected Malaria-Positive Cases in Areas Under Different Categories of Anti-malaria Operations in the South-East Asia Region (1967-1976)
2 Fellowships Awarded by WHO in the Last Five Years (1971-1975). South-East Asia Region
3 Obligations Incurred on Field Activities in the South-East Asia Region (1971-1975)
The following abbreviations are used in the Annual Report:
DANIDA Danish International Development Agency ESCAP Economic and Social Commission for Asia and the Pacific FA0 Food and Agriculture Organization of the United Nations FUNDWI Fund of the United Nations for the Development of West Irian IAEA International Atomic Energy Agency IARC International Agency for Research on Cancer IBRD International Bank for Reconstruction and Development ILEP International Federation of Anti-leprosy Associations ILO International Labour Organisation NORAD Norwegian Agency for International Development SIDA Swedish International Development Authority UNADI United Nations Asian Development Institute, Bangkok UNDP United Nations Development Programme UNEO United Nations Emergency Operations UNEP United Nations Environment Programne UNFDAC United Nations Fund for Drug Abuse Control UNFP A United Nations Fund for Population Activities UNICEF United Nations Children's Fund UNIW United Nations Industrial Development Organization US AID United States Agency for International Development WFP World Food Programme SMALLPOX ZERO ! Three-year old Rahima Banu of Kuralia village, Bangladesh: the last ease of smallpox in South-East Asia. 16 October 1975. (Photo by P. Claquin) SEA/RC29/2 Page vii
INTRODUCTION
This year has seen unprecedented success with the elimination of smallpox from the Region, but this achievement continues, unfortunately, to be overshadmed by the fact that most countries are still persevering to meet merely the minimal health needs of the people. This task is, moreover, of such magnitude and the resources are so meagre that it has become difficult to make really significant progress in finding solutions to the varied health problems facing our countries.
The resources of WHO also are limited, and the recent financial crisis faced by UNDP has added to the problem. To maintain some of the on-going priority projects hitherto supported by UNDP, funds from the WHO ~cgular budget had to be diverted, with the result that some of the programnes under the regular budget had to be adjusted.
Country Health Programming
It is now quite evident that to solve the health problems of the millions of people in the countries of the Region who are still underserved, the attitude to health development must undergo a change. Priorities and strategies must be rearranged and reoriented to overcome or circwnltent the existing constraints on resources. We must develop down-to-earth, broad, action programnes,rather than isolated vertical projects,to meet the basic health needs within the limits of available resources. There is.an urgent need for the application of modern management methods and scientific techniques of planning. These can help in the sharper definition of priority health problems, in the more careful setting of attainable goals and objectives, in developing more realistic health programmes and ensuring their effective implementation in order to achieve these goals. The old, stereotyped approaches to solving complex problems haue to be modified or replaced by innovative ideas to suit the needs of the times. As far as practicable the health programnes should not only be for the people but also of the people and by the people. We must realize that the success of a progrme will greatly depend on the participation of the people through its integration into the social fabric. Sophistication may thus have to be partly sacrificed, but the desired degree of effectiveness will be more easi ly achieved.
In this context, the Sixth General Programne of Work of WHO for the period 1978-1983 is certainly an improvement over the previous five General Programnes in its more precise definition of priorities and targets, approaches and activities, and output indicators. This programme, which has been approvedby the 29th World Health Assembly, reflects and complements the national priority goals, as it has been formulated in close consultation with Member countries. To facilitate its implementation,a &tai led progrme for the medium term (also 1978-1983/, elaborating the programne activities, is also under preparation. In these activities, there is a shift from isolated vertical projects to composite programmes, with a view to broadening scope, increasing viability, and enhancing effectiveness and efficiency. This shift will plrther open the way to innovative approaches for sharpening the existing strategies and at the same time stimulating newer ones. SEA/RC29/2 Page viii
It has become clearer that health development efforts cannot succeed in isolation but must be seen and planned in the context of total socio- economic development. Moreover, in view of the insufficiency of resources to satisfy all health needs, there is an urgent need for judicious investment of what is available. Systematic planning and efficient management must be used to solve especially those problems that deserve priority attention. A growing understanding of these realities has led many countries of the Region to reorganize their health progrmes by adopting systematic planning. Country health progrming (CHPI, which is essentially a continuous national effort with WHO participation, has proved to be a very useful tool in this process. Through this, health planning in the countries of our Region will be vastly improved. There is no doubt that country health progrming has helped to mould the national health development programnes around the priority health needs of the people and to harmonize them with other socio- economic development progrmes. WHO'S technical co-operation with the countries in these efforts has thus becae more meaningfit. Country health programing, including project fomlation, has already been completed in Bangladesh, Nepal and Thailand. In Burma, project formulation is nm in progress. Country health programring is expected to take place in Mongolia, Sri Lanka and Indonesia during the coming year. This is an encouraging trend. Also, there is increasing demand from countries for expertise in the field of systems analysis and operational research to improve the implementation and management of progrmes. WHO has welcomed these trends and extended its co-operation whenever needed.
Development of an Information System
For proper planning as well as for efficient management, adequate information is essential. In order to become mom effective and responsive to countries' needs, WHO'S inforrmtion and reporting systems are now being reorganized on the basis of experience gained through the testing of potential systems in Bangladesh, Nepal and Thailand. In addition, easily applicable techniques of evaluation have been developed and applied in a nuder of projects in these countries. These efforts will, in the near future, help in the establishment of a system for monitoring and evaluating the WHO propomme, which should improve the quality of the programnes, their management and delivery.
Allocation of Resources
The basis for the allocation of resources to different WHO activities in the Region has been reviewed and further ratiomZized by devising appropriate criteria. It is expected that adoption of these criteria will lead to a more equitable aZlocation of scarce resources for corntry and regional progrmes. On the subject of resources, I wouZd like to point out, as I have done repeatedly in the past, that the national budgets for health continue to be low in most countries of the Region in contrast to the provisions made for other developmental sectors. I strongly feel that decision-makers in the economic field rmt not ignore the fact that the ultimate aim of a22 econanic efforts is the well-being of man, cmd that both his well-being and his economic upliftment are complementary. The proActivity in a population which is not healthy is lad, and similarly there can be no health and well- being in a static economy. This inter-relationship must be recognized and SEA/RC29/2 Page ix seen in its proper perspective. I therefore fervently appeal to the governments of our Menher countries to consider seriously the urgent need for adequate investment in health as an important component of socio- economic development. Failure to so invest is bound to perpetuate ill health, retarding productivity and economic progress.
The problem of bridging the yawning gap between needs and resources demands serious consideration from all possible angles. Governments are aware that an effort has been made to develop a mechanism for enhancing investment in health from internat as well as external sources through the establishment of a Health Charter for the Region. It is gratifying to report that five countries of the Region have already expressed their agreement to the draft Health Charter, which was circulated to governments after incorporating the views expressed during the twenty-eighth session of the Regional Committee. It is hoped that the remaining govements mill also consent to the principles outlined in the Health C"narter in the near future, thereby paving the way for its implementation as an important example of international solidarity in the pursuit of our goal.
Primary Health Care
Health services in the countries of the Region, especially in the rural areas, are still far from satisfaetory except in the DPRK and Mongolia. One of the major reasons for this is the scant attention given in the past to the balance between curative, preventive and promotional components of health services, and between personal health care ad community-oriented hcaZfh activities. In recent years,govemunents hare become increasinglv mare of this imhaZance and have been laying greater emphasis on the development of appropriate primary health care progrmes to rectify it. The basic strategy of these progrmes is to shift the emphasis from curative to preventive and promotive health services so as to bring the two into balance and to provide integrated and comprehensive comnunity health services, especially to the rural people. This is a mejor shift in the right direction. Conmiunity involvement in the provision of primary heaZth care is, however, still inadequate. As the acceptance of many health measures involves a change in personal and community habits, participation by the community is extremely important in developing and implementing health measures and in evaluating the benefit accruing from them. This will not only enhance the chances of lasting acceptance of these measures by the community but will also encourage mobilization of comnity resources for supporting and enlarging the scope of the programme. I would, therefore, urge governments to pay special attention to this aspect in their efforts to attain greater coverage with scarce resources.
In addition to promoting primary health cam in general, WHO has collaborated in training rural health workers from the conmtunity to encourage public participation in the provision of primary health care.
Another important component in the development of balanced health services is the provision of a sound referral system supported by appropriate medical care facilities. The recently created Unit for MedicaZ Care in the Regional Office has been supporting the efforts of governments in this field. The problem of rehabilitation has also been given due attention through support SEA/RC29/2 Page x
to preventive and rehabilitation services rather than hospital-based activities. Here again, work on the prevention of disabilities which would require rehabilitation has been undertaken in most countries as a comnity effort rather than on an individual basis. The development of dependable health labomtory services is important not only to provide diagnostic support for medical care but also to strengthen the surveillance of diseases. Hence most countries of the Region have developed progrmes for strengthening these services as part of the general health services. In addition, efforts are being made, at least in tuo countries, to establish systems for the quality control of laboratory procedures and reagents in clinical chemistry and microbiology. It is expected that this type of quality control will also be introduced in other countries in the near future. To stimulate such developments, the Regional Office has taken several steps, including the organization of workshops and courses, support to laboratory surveillance, establishment of reference laboratories, and distribution of manuals on laboratory methods and techniques.
Family Health
The Organization is deeply involved in family health programnes in several countries of the Region, a number of which are supported by funds from UNFPA. WHO'S family health programme lays special emphasis on maternal ond chiM health, including family planning, and on school health services.
Nutrition
In spite of sustained efforts by governments and many internationai! agencies including WHO, the problm of nutritional deficiency still persists in many countries of the Region. This has been so acutely perceived by governments that the twenty-eighth session of the Regional Committee decided to take up the topic "Development of national nutrition pmgramnes with special reference to the vulnerable sectors of the population" for technical discussions during this year's session. It is nm wiversaZly recognized that the problem of malnutrition cannot be tackled by the health sector alone as it involves many other sectors of the economy, and hence many of our governments are trying to solve it by co-ordinated efforts through the establishment of inter-ministerial nutrition councils at national level. WHO'S collaborative efforts in this field have always been directed mainly tmards training manpmer at different tiers of the health services to support national nutrition pmgrmes. It is my firm beZief that the deliberations in the technical discussions during this session will result in fhrther useful guidelines for improving nutrition progrmes in the future.
Health Education
Health education is now considered an integral part ofgeneral health work by all health workers in most countries of the Region, health education specialists taking responsibility mzinly for technical support and guidance. The impact of a number of variables in health education pmgrmes such as Level of education, anthropoZogica2 backgmund and socio-cultural situations SEA/RCZ9/2 Page xi on different cmnities has been studied so as to provide guidance for better planning and implementation of health education activities. WHO'S effort in this field has been focusedmainly on the strengthening of effective health education activities within the general health services and on the development of appropriate manpower to meet the needs of countries.
Research
In response to the increasing interest shown by both the Regional Conmrittee and Member countries of the Region in biomedical research in recent years, the Regional Office has asswned wider responsibilities in this field. An important step in this regard was the establishment of a Regional Advisory Committee on Medical Research (RACMR) in January 1976. A Research Unit and a Research Promotion and ~evelopmentConnittee have also been set up in the Regional Office to assist the Regional Director in planning, implementing and co-ordinating research activities in the Region. Depending on the interest evinced by Member Governments, it is expected that research activities will be further expanded in relevant fields to tackle health problems of high priority in the Region.
Communicable Diseases The achievements in the control of comnicable diseases have been by and large significant, the most spectacular being the attainment of smallpox- free status by our Region. I must congratulate the governments concerned and the various agencies which contz-ibuted to this success, which gives one the intense sense of relief that our people will no longer fall victim to this dreaded disease, which has been plaguing humanity since ancient times. What is more, this accomplishment has given LLS valuable experience which indicates that it will be possible in future to solve similar health problems by careful planning, innovative approaches, dedicated work by national and international workers, and by the effective co-ordination of national, biZateraZ and international resources. It has also convincingty demonstrated the undeniable value of the co-ordinating role of WHO in harnessing national and international efforts for the improvement of the health and well-being of mankind.
In contrast to this success, our efforts to solve some other health problems have met with difficulties, which are a challenge to the adequacy of existing scientific knowledge and manageriat skit2 and our capacity for mobitizing sufficient resources. Last year I referred to the deteriomting malaria situation in the Region. This situation has been further aggravated by the emergence of resistant strains of mosquito, and the rising costs of insecticides and prophylactic and curative drugs, leading to serious shortages in the field. A meeting on malaria was organized this year to review the malaria control efforts in the Region. The meeting urged the establishment of nationat malaria cdttees for the better planning and co-ordination of all activities influencing the control of malaria, the mobilization of increased resources to ensure adequate supplies of insecticides and antimalarials, and the strengthening of research activities to find alternative and better solutions for controlling maZaria. SEA/RC29/2 Page xii
WHO has been collaborating with the countries of the Region for the last two decades in controlling tuberculosis. Leprosy, too, is causing growing concern, as a result of which leprosy control activities have been strengthened and integrated with the general health services in several countries. Late in 1975, a meeting on leprosy was organized in the Regional Office to consider the various aspects of this priority problem and recommend guidelines for the future. In this connexion I feel that, since the etioZogicaZ agent of leprosy has now been grown successfully in laboratory animals, vigorous research should be undertaken to try to develop an effective vaccine against the disease.
The initial threat of rapid and widespread dengue haemorrhagic fever involving many countries of the Region appears to have been averted. The disease still persists, however, in Burma, Indonesia and Thailand and the threat of its spread in future therefore still exists. In view of this situation, epidemiological surveillance of the disease has been strengthened so that adequate measures can be taken not only to limit its incidence in these three countries but also to prevent its further spread. The WHO Technical Advisory Committee on Dengue Haemorrhagic Fever has already developed guide lines for the diagnosis, treatment and prevention of this disease. Further research on the clinical, pathological and preventive aspects of the disease has also been undertaken, especially in Thailand.
The countries of the Region are showing increasing interest in expanding their progrmes of imnunization. Although in many countries there are regular progrmes for inmnization against smallpox and tuberculosis, immunization against diphtheria, tetanus, pertussis and poliomyelitis is limited. Of late, several govements have indicated their intention to increase their present imnunization programmes. The success of any immunization progrme wilt, however, depend on maintaining its continuity and an adequate supply of potent innnunizing agents supported by a reliable storage and logistic system. WHO has been assisting the governments in progrme planning and in training personnel, as well as in achieving setf- sufficiency in the production of imnizing agents and in their quality control. Since the use of imnunizing agents of the prescribed quality is of crucial importance to the success of these progrmes, I should like to urge governments to make full use of the services of the WHO reference laboratories.
In the field of veterinaq public health,WHO has been assisting governments in developing antirabies programmes, especially the production of antirabies vaccines, in a number of countries. In Mongolia, lJHO has a260 coZ2aborated in producing bruce ZZa vaccine.
Epidemiological Surveillance
It is encouraging to note that the countries of the Region are paying due attention to improving their epidemiological surveillance systems. Already the reporting systems have shown improvement. IvKO will continue to support these efforts since the identification of cases of comnunicable diseases and their timely reporting are the basis for pmmpt app'lication of control measures. In response to the wishes expressed at the twenty-eighth session of the Regional Comnittee, the Regional Office has already reinstated SEA/RC29/2 Page riii
the inter-country project ESD 003 with a view to promoting and improving epidemiological surveillance and intelligence in the Region.
Since a nunher of vector-borne diseases such as malaria, filaria and dengue haemorrhagic fever continue to pose problems in the Region, a new unit of vector biology and control has been established in the Regional Office as recomnended by the Regional Comnittee at its last session. This unit has already taken a number of steps to strengthen activities in vector biology and control. Non-communicable Diseases The prevention or control of cancer, cardiovascuZar diseases, drug dependence and radiation hazards continued to get WHO support in a nunher of countries of the Region, with the major thrust being towards surveillance and control. Governmenk have also been attaching increasing importance to the development of mental health services in recent years. WHO has been helping with the training of manpower for comnity-oriented mental health activities integrated with the general health services. The Regional Office has recruited a full-time adviser on mental health to organize and strengthen these activities. Blindness and visual impairment are serious health problems in a number of countries and are being given special attention through specific progrmes to deal with prevention, control, treatment and rehabilitation. A high-level inter-country meeting held this year reviewed the problem and the existing progrmes with a view to evolving appropriate strategies. Environmental Health
The provision of safe water and the level of sanitary services in the countries of the Region are still far from satisfactory. Lack of these services is one of the major reasons for the high incidence, prevalence and spread of conmunicable diseases. Governments, which are fully mare of these problems, are striving hard to improve the situation by implementing programmes for safe water supply. WHO has assisted them in preparing assessment reports, especially in respect of rural and urban water supply and urban sewerage systems. In collaboration with UNICEF and UNDP, the Organization continues to support the development of basic sanitary services. WHO'S collaboration has also attracted agencies such as the IBRD to invest in national water supply and sanitation progrms. It is expected that Wther financial support will be forthcoming frm international and bilateral agencies as a result of the technical and co-ordinating efforts of WHO in this important fie ld. In addition to environmental sanitation, the Organization has been collaborating in a number of progrmes to tackle the emerging problem of environmental pollution in the Region. The major effort in this respect has been directed towards strengthening the surveillance and control of air and water pollution. Health Manpower Development With the integration of vertical progrmes into the general health services in order to provide primary health care, training has become practicaz, SEA/RC29/2 Page xiv
task-based and comnity-oriented. A three-tier system of manpower, with emphasis on peripheral and intermediate levels, has been conceived in many countries. This changed concept has emerged because of the realization that the conventional doctors and nurses by themselves will not be able to provide the required services to attain the goal of health care for all. Hence there is urgent pressure for developing health manpower suited to the needs of the people, particularly at local and intermediate levels. While large numbers of multipurpose health workers and auxiliary nursing personnel are being trained for work at local level in most countries,medical assistants, or health assistants, are being prepared for the intermediate level. Simultaneously, the cmicula and sylZabi for medical and nursing graduates are also being remodelled and adapted to suit the needs of the changed system, WHO has been collaborating in the development of curricula, guidelines, manuals and procedures and providing subsidies for training local and intermediate-level health workers. In pursuance of a resolution ofthe Regional Conmrittee, the Regional Office has surveyed training programmes and job descriptions of various multipurpose, primary health care workers in different countries of the Region ad developed a guideline for evaluation and feeaack for these training programmes. To support the preparation of future physicians for comunity-oriented work, a number of comnity-oriented training programmes were reviewed. An inter- country seminar was also organized to discuss medical education suitable for developing countries of this region. The tuo regional teacher training centres have already held a number of training pmgrmes for teachers of medical and other health professionals. In nursing education, basic nursing and mihifery curricula are being revised to emphasize comity health, family health, family planning and nutrition, together with in-service continuing education. Short courses in such subjects as surgical and orthopaedic nursing and the impmvement of hospital nursing services have been heZd,and an experimental progrannne is being planned for the training of nurses in a comnunity setting rather than in the hospital. The nwnber of new fellowships awarded during the year under review has not significantly changed, but an attempt has been made to find a balance between the tmo components of the awards, namely: fdllmships purely for obtaining academic degrees and those relevant to pmctical work or field experience. It has been possibte to shift the emphasis toward8 the latter type of fellowship, with only 20% of fellowships being degree-oriented. Moreover, a further attempt has been made to increase the number of fellowships for training within the Region, with a view to providing work ezperience in socio-cultural and economic situations similar to those obtaining in the home camtries of the fellows. The introduction of this nm trend in the fellowship programme has been made possible through the fuZZest co-operation of our Menber Gouemunents.
The projects to which WHO has given assistance in the period under revia, are briefly described in Part 111 of this report. SEA/RC29/2 Page xu
It is gratifying to report that we have been able to strengthen further our co-operation with other United Nations agencies as well as with biZateral and multilateral organizations to mobilize resources for health development in the Region.
In Consequence of improved planning, monitoring and management, it has been possible to attain a delivery level of $2.4 million from UNDP sources at the end of 1975. Because of the recent financial difficulties of UNDP referred to earlier we do not, hmever, expect to deliver more than $2.7 million by the end of 1976 as against the originally planned figure of around $5.8 million. This is only a marginal increase in the UIVDP progrme. Inadequate increment due to the liquidity crisis has affected our regular budget programme, mainly because we have been compelled to divert some funds from the regular budget in order to sustain the basic activities of a number of on-going UNDP projects,leading to readjustment of our regular programmes. In fact, currently planned activities of a22 UNDP programnes hme nm been spread over future years. The greatest difficulty, however, is the fact that the future prospects of UNDP funding are still not bright, making the fate of UNDP projects rather uncertain. I fervently hope that the efforts of UNDP to sort out this problem will meet with success and that the present uncertain phase will soon be over. In this connexion, I should like to reiterate the fact that the extent of support from UNDP in the field of health depends greatZy on the degree of priority given by the governments themselves to the health sector in the UNDP country prograrnne vis-a-vis the other sectors.
In respect of UNFPA-supported family health progrmes, the Regional Office has now assumed the responsibility for direct liaison with the UNPA co- ordinators at country level as well as with UNFPA headquarters. This has minimized delays in comunication and has improved the progrme delivery. In addition to its support to family health progrmes in Bangladesh, Sri Lanka and Thailnnd, it is expected that UNFPA funds will be available for the maternal and child health progrme in Burma in the near future.
Co-ordination with UNICEF has been further strengthened, both at the country and the regional level. During last year, representatives of the two organizations maintained a close relationship at corntry level to co-ordinate their work on integrated child care services, nutrition services and training, family health, and water supply. UNICEF is now eager to explore the possibility of developing health progrmes jointly with WHO, especially in the field of primaq health care, and has been co-operating in immunization progrmes by supplying vaccines and imnization kits.
As regards collaboration with other United Nations agencies, closer relationships have been built up with FA0 and IU). Organizations such as WFP, IBRD and bilateral agencies such as US AID, SIDA and DANIDA are working closely with us in several countries. WHO highly appreciates this mutual co-operation, which has contributed greatly to the achievement of meaningful results in the health field. SEA/RC29/2 Page mzvi
During the year, I had the privilege of visiting various parts of India and Nepal and, together with the Director-General, Burma, Sri Lanka, and Thailand. I took the opportunity of these visits for discussing with ministers and senior goverwnent officials WHO'S collaborative activities in these countries. These discussions provided me uith a deeper insight into the probZems of these countries, uhich will be extreme Zy useful for improving WHO'S collaboration in their solution. In addition, I paid a visit to the People's Republic of aina at the invitation of the Coverwnent.
Finally, I would like to express, on behalf of all WHO staff in the Region - both in the Regional Office and in the field - sincere thanks to all governments in the Region for their extremely valuable support, co-operation and understanding which have contributed continually to the pmgrese achieved during the year. I am confident that this continuing co-operation, support and understanding extended to the Organization will go a long way tarards stimulating the efforts of WHO still further in the future years and will act as a great source of inspiration in our arduous task of providing adequate health care to all the people of our Region.
V.T.H. Gunaratne, F.R.C.P., D.P.H., D.T.M. & H. Regional Director PART I GENERAL REVIEW OF ACTIVITIES 1. STRENGTHENING OF HEALTH SERVICES
1.1 Planning and Development of Health Services
The interest of governments in planning for health as a component of overall socio-economic development has been maintained, with a growing application of country health programming to the formulation of health plans and projects. The development of integrated rural health services continued to receive attention, with emphasis on primary health care and increased coverage. Ways and means of reaching the rural population, which accounts for approximately 80% of the total, have received the active consideration of governments in those countries which have not yet been able to achieve full coverage. Some of the steps which have been taken to increase coverage include: the establishment of multipurpose health workers schemes; the education of village health workers, selected and supported by the community; the training and utilization of practitioners of traditional systems of medicine; community participation and involvement, and the establishment of new health centres and upgrading of the existing ones. WHO has collaborated in these activities at both national and regional levels.
The Joint WHO/UNICEF Study on Community Participation in Health Services, organized on a global scale, selected three projects in the Region, but the study was conducted in only one project - the Kottar project in Tamil Nadu, India. The findings of this study will be incorporated in the joint WHO-UNICEF report and submitted to the Joint Committee on Health Policy in 1977.
1.1.1 Health Planning, Program Formulation and Evaluation
In collaboration with WHO, more and more countries of the Region are planning their health development programmes through country health programming. Systematic planning and efficient management, combined with the judicious investment of available resources, are being improved.
Following the completion of country health programudng in IVepal and Thailand respectively in 1974 and 1975, the formulation of projects in all priority health sectors was undertaken in the two countries. A similar exercise was completed in 1976 in Bum, where the formulation of projects is now under way.
In Bangladesh, work continued on the development of a planning cell in the Ministry of Health and Family Planning and the building up of a health information system on sound lines.
WHO collaborated with Indonesia's Planning Bureau in reviewing the guidelines used for annual planning, and in formulating the first step of Pelita I11 (Third Five-Year Development Plan). In addition, a systems analyst assisted in the selection of the method for the formulation of the Third Plan, with special reference to the formulation of individual programmes and projects at provincial and SEA/RC29/2 Page 2
central levels and their synchronization with the national framework. An expert in health systems management and an economist have been assisting the Planning Bureau in health centre progradng, annual planning and the improved management of health services.
Nepal also received assistance in the further development of a national health planning unit and in the conduct of a national workshop on health planning for senior health personnel.
In Thailand, following project formulations, the National Five-Year Development Plan for the health sector was prepared and submitted to the National Social and Economic Development Board. Assistance is being given in the planning, management and development of a health information system encompassing three Divisions in the Ministry of Health - Planning, Vital and Health Statistics and Epidemiology. The attempt is not only to introduce modem management methods but to adapt them to the country's administrative structure and social and cultural background. A WHO systems analyst and a management officer from the Swedish International Development Authority (SIDA) also provided assistance.
An inter-country project for the strengthening of health services through training in planning, which helped with the country health programming exercise in Bunna, also assisted with national training courses in health planning and/or management in Indonesia, India and Mongolia. In addition, the team assisted MongoZia with a two-day seminar for senior government officials to familiarize them with the concepts of country health progradng. A medical educator visited Burma, India, Indonesia, Sri Lanka and Thailand and another was assigned to ~on~otiato advise the teaching and training institutions in these countries on developing need-based and effective training courses in health planning and health systems management with a view to strengthening the administration of the health services.
An inter-regional training seminar on health project analysis was organized at the Asian Development Institute, Bangkok, with the support of the WHO team at the Institute. To provide material for courses on health planning, the team also assisted in the preparation of a report on "Assessment of a Least Developed Country's Health Situation - The case of Nepal".
The Charter for Health Development in the countries of the Region, a draft of which was presented to the Twenty-eighth Session of the Regional Committee in August 1975, was revised in order to incorporate the suggestions made at the session. Subsequently, it was sent to governments for comments; so far five countries - Bangladesh, Mongolia, Maldives, Sri Lanka and Thailand - have expressed their agreement to the draft Health Charter.
The Regional Committee at its twenty-eighth session discussed with critical interest the Sixth General Programme of Work of WHO (1978-1983). SEA/RC29/2 Page 3
This discussion led to further elaboration of the Programme in terms of defining regional priorities and targets, approaches and activities as well as output indicators. A medium-term programme is in the process of preparation in the lightof the Sixth General Programme of Work, for implementation during the period 1978-81.
1.1.2 Organization of Basic Health Services
There has been increasing concern over the lack of health coverage for the rural population, and both governments and WHO continued to attach high priority to plans for the organization and development of rural health services and primary health care. A regional plan of action for the development of primary health care was finalized, and the Regional Office participated in the second HeadquartersIRegional Meeting on Primary Health Care, which took place in Manila in March.
The situation in the various countries was as follows:
Assistance continued to be given to Bhutan in the establishment of basic health units and the training of auxiliaries to man these units. The Government also received advice on the role of the health services in nutrition.
In collaboration with WHO, the National Institute of Health Administration and Education in India undertook a study of the problems of implementing the multi-purpose health workers scheme. The study was progressing in the States of Uttar Pradesh, Andhra Pradesh and Maharashtra.
In Indonesia, a three-week seminar was organized on methods of planning and health centre programming at kabupaten (regency) level. 'Itro consultants were provided - one to assist with the child care "package" and in the further development of the manual on "The Child in the Health Centre", and the other to advise on the creation of a nucleus of national expertise to undertake training activities for the establishment of a health care delivery system. Work was initiated on the preparation of another manual (in Indonesian) entitled "Home Care Manual", considered useful for family health work, especially for primary health nurses and less qualified personnel such as village health workers. WHO also assisted in the formulation of a programme for the training of the primary health nurse.
At the Annual National Health Conference, held in Jakarta in January and attended by provincial health officers and the staff of the Ministry of Health, the main points discussed included: the present policy on community health services, including primary health care; the programming of health centre services for the third, fourth and fifth years of the Third Five-Year Development Plan; the training of primary health nurses and sanitarians, and the reorganization of health services at the provincial level. As a follow up of the Conference, further improvements were made in the health centre programme in relation to manpower and financial resources. The research project "Strengthening of Kabupaten Health Services" and the training of village SEA/RC29/2 Page 4
health promoters recorded further progress. Courses in research methods were organized in Jakarta and Surabaya. The Joint WHO/Indonesia Co-ordination Committee met twice during the year - in November 1975 and April 1976 - to review the progress of the three components of the project - health planning and evaluation, research and development and the health care delivery system. The April meeting was preceded by a two-day seminar on primary health care which was attended by representatives of several ministries and international and bilateral agencies.
Health services in the MaZdives received support through the assignment of a team of two consultants - a surgeon and an anaesthetist - twice during the year. Also, a number of short-term consultants were assigned in other special fields described elsewhere in this report. Health centres were opened in a further two atolls during the year, bringing the number of atolls served to 16.
In MongoZia, a plan of operation for the strengthening of emergency health services was finalized in October and one for the management of health services was initiated. The services of a toxicologist were made available. In addition, two public health administrators assisted the national authorities in evaluating the emergency medical care services.
In Nepal, as a follow up of country health programming, a project formulation for basic health services was finalized in January. A preliminary survey of the state of health was made in the mountainous district of Kaski to ascertain the percentage of the population using the services of traditional practitioners and birth attendants, in order to estimate the needs for primary health care services. Also, a proposal was drawn up to train Ayurvedic practitioners to provide selected aspects of basic health services. Assistance was provided to the Institute of Medicine, Tribhuvan University, Kathmandu, in the teaching of anaesthesiology.
In ThdZand, further financial assistance was provided for the development of primary health care through the training of tambon doctors and traditional midwives. In 1975, 320 tambon doctors and 1200 traditional midwives were trained.
1.1.3 Medical Care
Two important meetings took place in this field: an inter-country Seminar on Peripheral Medical Care Services was held in Thailand in September with participants from seven countries of the Region. The other activity, which was also regional in nature, was a Seminar on ways to achieve increased health coverage, which was organized in February in the Regional Office with 16 participants from seven countries.
Bunna and Indonesia received assistance with short training courses for medical record keepers as well as in the establishment of model medical records departments. SEA/RC29/2 Page 5
With WHO assistance, two further national orientation courses for hospital administrators from provincial, base and district hospitals were organized in Sri Laaka in October 1975 and MarchfApril 1976.
The card system for stock-accounting in health institutions was introduced in Nepal.
Electro-medical engineers assisted Nepal and Sri kmka in the repair and maintenance of health equipment. In-service training of national technicians and artisans in the maintenance and repair of such equipment was also undertaken.
1.1.4 Operational Studies
In Indonesia, assistance continued to be given to training courses in operational research and systems analysis. A nuder of case studies on health and health-related management problems is under preparation, to strengthen training in operational research.
1.1.5 Rehabilitation
The inter-country medical rehabilitation project located in Dr Kariyadi Hospital, Semarang, Indonesia, assisted in the organization of a comprehensive rehabilitation programme for the orthopaedically handicapped, for patients with cardiovascular diseases, neurological disorders and for post-mastectomy cases. The Academy of Physiotherapy and the Rehabilitation Centres in Solo and Fatmawati Hospital in Jakarta also received assistance in strengthening their services and training programmes. The team devised a method for surveying disability in a community and, based on the information collected, developed a community-oriented programme for disability prevention and rehabilitation. The protocol developed is being adopted by the Faculty of the Medical School in Denpasar, Bali, for similar rehabilitation activities. The team continued to assist in the development of community-oriented rehabilitation programmes with adequate referral services at the provincial level - a direct result of a national course organized by the team for rehabilitation personnel in Indonesia.
The team also organized a three-week inter-country course, which was held in Semarang, Solo and Jakarta during February-March. The course, which was attended by orthopaedic surgeons, psychiatrists and physiotherapists from six countries of the Region, discussed orientation in community surveys to determine the pattern of disability and morbidity, the development of services employing local resources with community participation, the establishment of comprehensive referral services for larger population groups in the provinces, the organization of training for health and allied personnel, and the planning of services for the prevention of disability.
The services of an expert in occupational therapy were made available to Bum to train personnel and assist in the organization of occupational therapy services in Rangoon. Efforts were made to mobilize SEAIRC2912 Page 6
resources from international and non-governmental agencies for the development of rehabilitation programmes.
In India, a corporation for the manufacture of orthotic and prosthetic components (ALIMCO) went into production in Kanpur. Also, the National Institute for Orthotist and Prosthetist Training (NIPOT) started the training of specialists to meet the manpower requirements of the six regional centres in Jaipur, Lucknow, Madras, Trivandrum, Calcutta and Nagpur. A national workshop is scheduled for July-August 1976 to plan the development of a comprehensive and co-ordinated rehabilitation programme in the country. The School of Physiotherapy in Baroda continued to receive assistance in its training programme.
In Indonesia, in addition to the promotion of programmes in Semarang, Solo and Jakarta, an inter-country team is assisting with the development of rehabilitation services in other provinces. Programmes for the rehabilitation of crippled children will also be promoted.
A team of specialists in physical medicine, orthotics and prosthetics and physiotherapy was assigned to MongoZia to assist in the organization of training and services.
In Sri Lanka, a consultant in physical medicine assisted in the organization of training and rehabilitation facilities in Ragama Hospital and other provincial hospitals. A notable feature of these efforts is the involvement of local expertise and the use of local material in the design of orthotic and prosthetic appliances.
1.2 Family Health
During the period under review, assistance continued to be given to governments in the planning, implementation and evaluation of family health programmes, covering maternal and child health, school health and family planning services. Family health programmes also received support from the United Nations Fund for Population Activities and other United Nations agencies, particularly UNICEF, with all of which WHO worked in close collaboration.
The main thrust in family health in all countries has been in the development of primary care as an integrated package, including nutrition, immunization and health education, and the strengthening of referral services in maternal and child health and family planning in support of the peripheral health services.
The various meetings and educational activities in family health which were organized during the year are described elsewhere in this report (see 7.2, Paediatric Education, and Annex 3).
Progress recorded in different countries is described below, with special reference to the achievement of milestones and evaluation.
In Bangladesh, the WHO medical officer in family health continued to assist the national authorities in planning and implementing the family SEAIRC29 12 Page 7 health programme. The implementation of the programme was somewhat hampered in the latter part of 1975, resulting in modification of the milestones and a shortfall in achievements. By the early part of 1976 more vigorous steps had, hmever, been taken by the Government in the field of family planning. In keeping with national efforts, therefore, the UNFPA project documents were reviewed and the activities were rephased, and, at the time of writing, action for achieving planned targets was progressing satisfactorily. Additional projects for UNFPA support with a view to strengthening the family health programme further were also developed.
In Burma, family health was identified during country health programming as one of the priority health programmes to be carried out during the period 1977-1982. Action was, therefore, initiated for the assignment of a specialist in maternal and child health to assist in the development of the family health programme along the lines of the strategies identified.
Also in Burma, a study on perinatal mortality and low birth-weight was initiated with WHO assistance. The pilot phase of this study, which consists of a community-based investigation of perinatal morbidity and mortality patterns and the incidence of low birth-weight babies, has already begun.
Assistance in the development of health manpower for maternal and child health and school health services was provided by the award of training fellowships in maternal and child health administration, school health and neonatology. The extent of the achievement of targets in this activity can be considered very satisfactory.
Based on the work of a study group convened during 1975, senior educationists who met in the Regional Office in March 1976 framed a new course for the integrated teaching of maternal and child health to medical students. This is being pre-tested during 197611977; at the same time, a manual on maternal and child health is being developed as a companion to the course.
WHO continues to assist India in the development of a training base for the country's medical termination of pregnancy programme. Carried out under an inter-regional project and augmented also by funds at the regional level, this programme is co-ordinated by a WHO consultant, and sixty clinical teachers and ten administrators have completed an international study tour of European and Asian centres. Sixty national training centres in the medical termination of pregnancy have been equipped for teaching these procedures and additional sets of apparatus have been supplied to 65 physicians receiving training under this programme. This programe was also the subject of a workshop held in the Regional Office in July 1975 which brought together representatives of professional bodies and senior health officials.
A consultant was assigned to Indonesia to follow up the further development of school health services and to assist a national workshop SEAfRC29 12 Page 8 supported by WHO. Towards the end of the period under review (June 1976), a meeting on operational research for the delivery of family health services was held in Surabaya, with funds provided by UNFPA.
The long-term WHO staff member in obstetrics and gynaecology who had been assisting MongoZia since 1974 completed his assignment early in 1976; further assistance was provided through a short-term consultant. The plan of operation for the maternal and child health project was finalized and signed by the Government, WHO and UNICEF.
Assistance in the development of health manpower for maternal and child health and school health services was provided through fellowships in maternal and child health administration, school health, mental health and paediatrics. The overall achievements of the project have been satisfactory.
One of the priorities of the Fifth Economic Development Plan in NepaZ for the period 1975-1980 will be the implementation of the country-wide family planning and maternal and child health programme so as to control the increase in the population in order to maintain the balance of economic development.
Among the major health concerns identified during the country health programming exercise were the high mortality and morbidity among infants and preschool children, high fertility, high maternal morbidity and mortality, diarrhoea1 diseases, and protein-calorie deficiency.
After a long period of delay, the UNFPA-funded project to assist the family planning aspects of integrated health services got off the ground in 1975.
The UNFPA-supported family health programme in Sri Lmka continues to record satisfactory progress. An external review of the project was undertaken in October 1975 with assistance from Regional Office and field staff. The Government adopted the review team's recommendations, and appropriate reprogramming embodying these suggestions has been carried out for the remaining two years of the project.
In Thailand, based on the strategies identified during country health progradng in 1975, maternal and child health and family planning activities will be integrated into and carried out through the provincial health care and urban health care programmes during the next Five-Year Plan. UNFPA budgetary constraints posed problems to programme planning and management at the country level. A positive improvement in the health services has, however, resulted from these projects. In Bangkok Metropolis there has been an increase in the number of clinic services and domiciliary visits, improvement in referral services, and an expansion of services for the low-income population, including those in the slum areas. In the four north-eastern provinces improvement in the health services has resulted from increased training of personnel, better supervision, and provision of better supplies and equipment. Births among high-risk women have been prevented as a result of the expanded sterilization programme. SEAIRC2912 Page 9
At the request of the Government to extend the life of the four health- related projects funded by UNFPA through December 1976, the work plans for the projects were revised to modify the targets and, where necessary, to provide additional funds.
At the regional level, the activities of the inter-country Team on Family Health were reviewed and the team was reorganized during the year, in keeping with the technical requirements of the family health programme in the Region. The medical officer of the team has been assisting the national authorities in the various countries in the management and administration of the familv health projects and with the provision of technical advisory services.
1.3 Nursing
All over the world, attention is being given to rural populations, their needs for economic and social development, education and health services. Traditionally, nurses and midwives have comprised the largest category of health workers serving at the periphery, and the increasing attention being paid to the expansion and improvement of services in rural areas has necessitated reappraisal of the functions and responsibilities of nursing personnel. In many instances, national nursing leaders and WHO nurses have participated in planning and implementing major changes in the infrastructure, organization and management of health services, with parallel changes in systems of training. In several countries assistance has been given for the preparation of manuals, guides and teaching aids in support of the new trends.
In Indonesia, large-scale changes are under way for reorganizing the whole nursing system in the country so as to ensure equitable distribution and utilization of adequately trained nursing manpower. A major feature of the first phase of this reorganization, started in 197511976, is the amalgamation of several categories of nursing/ midwifery personnel into one category, the primary health nurse. In the second phase, university-based nursing education programmes will be established for the preparation of professional level nursing personnel.
In India, assistance was given in the organization of community health nursing services at all levels in two States. The aim is to improve staffing patterns, strengthen supervisory support, develop in-service education programmes, and improve the logistical operations of health centres and sub-centres.
In Bangladesh, where major changes in the staffing pattern and job function of nursing personnel are contemplated, the nursing service in the Directorate of Health was assisted in consolidating its administrative position, and the Government is now taking action to appoint a national nursing adviser to the Ministry of Health.
In Thailand, a new category of worker, the nurse practitioner, is being prepared to diagnose and treat minor illnesses and to recognize conditions requiring referral to other sources of medical care. SEA/RC29/2 Page 10
Throughout the Region, the trend is toward increasing the numbers of nursing personnel, expanding their functions into those of a multi- purpose worker, and devising means for more equitable distribution of personnel in peripheral areas. In order to ensure successful attainment of these aims, intensive efforts must be made toward the preparation of well-qualified teachers and supervisory level nursing personnel.
Assistance given for strengthening hospital nursing services has been directed towards administrative policies and procedures and the improvement of patient care in selected clinical areas.
The introduction of individual Kardex records for paediatric patients resulted in improvements in the planning and provision of nursing care and the saving of staff time. Teanwork between doctors and nurses, and applied epidemiological measures led to a reduction in cross-infection in a paediatric unit and in a premature nursery. In-service education programmes for staff and classes for mothers of hospitalized children were educational features introduced in one hospital in India.
Assistance has been given to several countries in the Region in orthopaedic and rehabilitation nursing, medical and surgical patient care, and ward management. In the Maldives, nurse-aides are being trained for hospital work, and in Burma a course was given on ward administration and ward teaching. An inter-country course on hospital administration was held in Indonesia, attended by teams consisting of medical superintendents and hospital matrons. In Thailand, a series of courses for chief nurses from hospitals and public health agencies begun in 1974 was completed in 1975.
In the field of mental health, where needs are great and which invariably receives minimal attention, it is encouraging to note an increasing trend toward introduction of mental health concepts into curricula for the training of nurses and other health workers. In India, assistance was given for revision of the programe for psychiatric nurse training, for in-service education, and for other measures designed to improve patient care. It is also encouraging to note increasing efforts at developing various types of community mental health programmes, in which nurses share responsibilities with other health workers.
The first major input for assistance in the field of nursing research became operational in June 1976 with the opening of a project based at the Rajkumari Amrit Kaur College of Nursing in New Delhi. This project is to aid the development of nursing research in other colleges of nursing in India, with emphasis on applied research which can lead to positive changes in standards of patient care, the delivery of services, and improvements in educational programs.
1.4 Health Education
A review of health education services in the countries of the Region carried out during the year has revealed a need for re-orientation of these services to enable them better to support health education SEA/RC29/2 Page 11
activities as an essential and integral component of different health programmes. This re-orientation has, in turn, called for changes in the present methods of health education, audio-visual aids and communication media, training of health professionals in health education, training of health education specialists, operational research and school health education. Since these changes should necessarily be brought about by health education services in each country, WHO has assisted the countries concerned in strengthening or reorganizing their present services. Such assistance has been given to India, Indonesia, Maldives, Mongolia, Nepal, Sri Lanka and Thailand.
Along with the intensification of efforts to make health education an integral part of health programmes, the need to adopt more effective participatory techniques as opposed to the methods currently employed was clearly recognized, and WHO collaborated with several countries in planning, developing, implementing and evaluating community action programmes through health education.
The emphasis on the integration of health education with health programmes requires greater attention to be paid to the preparation of health professionals in health education than to the training of health education specialists. WHO health education specialists assigned to India, Indonesia, NepaZ, Sri Lanka and Thailand assisted in these activities, and plans were being prepared to intensify such training in the future.
Assistance continued to be given to countries in the Region in the development of health education specialist manpower through WHO'S fellowship programme. These specialists, returning from post-graduate training in institutions both within the Region and outside, have helped to increase the available manpower in their countries. At the same time, with a view to training health education specialists within the Region itself, WHO has collaborated in the further development of the existing facilities - the master of public health (MF'H) Programme in Health Education at the University of Indonesia, Jakarta, and the diploma programmes in health education offered in India by the Institute of Rural Health and Family Planning, Gandhigram, the All-India Institute of Hygiene and Public Health, Calcutta, and the Central Health Education Bureau, New Delhi. The Organization also helped in the development of the curriculum for a new MF'H programme in health education at the Faculty of Public Health, Mahidol University, Thailand. It is to be noted that the integration of health education as a part of health programmes, and the corresponding responsibility which devolves on health professionals for health education, also calls for changes in the training of health educators so that they are better equipped to function in a mutually beneficial relationship, working with and through health professionals in the different health programmes. This implies that the curriculum, especially for the field training of health education specialists, needs changing, and the Organization is seeking to bring about this change through its staff at the regional and country levels. SEA/RC29/2 Page 12
In the field of research, emphasis is being placed on the operational aspects of health education rather than on theoretical issues. Of significance in this context was the WHO Headquarters-assisted operational research conducted in India, Indonesia and Thailand. Greater assistance to research on the operational aspects of health education is planned for the future.
Two specific health programmes which received the Organization's attention during the year were school health education and health education in family health. It was increasingly being recognized that health education should form an integral part of school curricula and that the Organization should assist its Member countries to do this. In this context, significant assistance has been provided to India, Indonesia, Nepal and Sri Lanka.
WHO also collaborated with countries in this region in the development of the health education component of family health programes. The UNFPA-supported projects in Indonesia and Sri Lanka made particular progress in this regard. Further assistance was provided through an inter-country health education project funded by UNFPA. In addition, an inter-country workshop on Assessment of Mass Cormunication Media in Family Health Education was held in the Regional Office with 19 participants from six countries. Preparations were in an advanced stage for two more inter-country workshops scheduled for the last quarter of 1976 - one on Health Education Services in Family Health and the other on a Manual for Audio-visual and Mass Communication Strategies in Support of Family Health Education.
It is expected that the changing needs of health education in the Region and the consequent reorientation of the Organization's efforts in support of health education in Member countries will result in greater involvement of the people in the development, delivery and evaluation of health services through their own efforts.
1.5 Nutrition
During the year, the Organization continued to impress upon governments in the Region the need for a concerted approach to solving nutritional problems and successfully promoted the idea that the health sector should be used as a base for establishing nutrition cells capable of initiating the necessary inter-aectoral co-ordination. Governments were assisted in reorienting the efforts of the health sector in order to strengthen the nutritional aspects of the basic health services. Special support was given to nutrition education in health, the use of feeding programmes as a vehicle for nutrition education, as well as the training of the necessary personnel in relevant nutrition education. Assistance was provided to other nutrition activities of the health services, such as nutrition surveys, the use of growth charts and nutrition rehabilitation of malnourished children.
In Burma, a consultant assisted with the training of township medical and health officers in nutrition and demonstrated the development of nutrition and health education programmes at the peripheral level with SEA/RC29/2 Page 13
the active participation of the community. An operational study was conducted, as a result of which nutrition rehabilitation programmes were established in Rangoon and Mandalay Divisions; also, a growth chart for children was devised. The activities of the nutrition project's laboratory were reviewed and recommendations were made for raising its status to that of a reference laboratory for the whole of the country.
In Bhutan, a consultant assisted the Government in identifying the nutritional problems in the country and also made recommendations on the future course of action, with particular reference to international assistance.
In India, a workshop for State nutrition officers was conducted in New Delhi in September 1975 under the joint sponsorship of WHO, UNICEF and the World Food Programme. The workshop reviewed the nutrition programmes in the various States, defined the role of State nutrition officers, considered measures for strengthening State nutrition units, and formulated plans for co-ordinating the nutrition activities in different States and securing the active participation of the community in nutrition programs.
Two guest lecturers were provided to the National Institute of Nutrition, Hyderabad, to deliver lectures at the two nutrition courses organized by the Institute annually - the three-month certificate course and the one-year degree course.
WHO collaborated with the World Food Programme and UNICEF in a workshop that reviewed the curricula of home science colleges in India in relation to the nutrition education component of the WFP's supplementary feeding programme in the country.
Plans were under way to assign a consultant to Indonesia to assist in developing community nutrition education programmes, in devising curricula and syllabi for the training of various community workers, in developing criteria for an evaluation and monitoring system, and in planning the training of manpower for this programme.
In Sri Lanka, a consultant reviewed the nutrition activities being carried out by the Family Health Bureau and the training courses in nutrition being conducted, and advised the Government on bilateral and international assistance. His main recommendations included the establishment of a nutrition training and education unit in the Ministry of Health, the development of a national food and nutrition policy and of a system for nutritional surveillance.
Preliminary steps were taken to hold an inter-regional meeting on the integration of nutrition and family planning programmes, scheduled to take place in New Delhi in October 1976 with the participation of four countries from the Eastern Mediterranean Region and five from South- Eaet Asia. SEA/RG29 12 Page 14
I: hs which visited India and . .' e.health components bf WFP project31 ratat5ttg nutrll.ll.tLon; &hrirobnneittal sanitation and malatie were !in#rodured;~ih:idi.fi5ecrenti $norjec~~~documentsfor, find lapproval by , .~ thei ..pouemments $-Cem&dl an&:~i': ' ,. . . . ,:I Support was given to WHO Headquarters-sponsored collaborative research activtH@? rhlsted.to3 ege-a*f.Lxcz &#iclien'eirsi prevalen4 in the Regidd, p:art~tculaw~p..~~eropht~&nda~mid;~ahe.ilutrit+&nal anaeinias; I , , . , . , , . ' r.i,; ! r . ,> ,,., . 1.6 Oral Health . , I,,
Asslshancsi,was provided!, fba the.:p.lanning.: and s trengttienkng of oral:' he~l~b:~serp.i~qri;land.~b~~~t~ein~ng:i6f:dencal'~health:tdnp&@t, ' a& wel'f' as withiepideaioXog&ceEi+nveqhigdtd~ns:i'forehe planing hnif.prdmo.tid'af community ,dental hebath jrierv8ce9,.6n, the, Countries. of ,t!h&'~egion;~. I' ; , . , .. , ,., > , .. ,,,. , i A dental tutor December. l'975. : Aftkt stud9llng the ghyatcal) ,:available ah the dental nir~&&:~ school in Rangoon, he prepared a revised curricuhum:,fol: the,trrllning of dental auxiliaries. ,. , ,:j ':, ..,- > ' ; ' . . ! : ! : 8' , . , , , ., . , , , . With lWHC! ,col~abormim";a:::natiidal isemixiar-'on public ;h&dithdentidtiy was qrganized, in [email protected]:!Sepbernbe$ :1-W5im iotder .,to abimlate ohe. : development of this discipline .ia:thp com:eiy's 'ilenr&l''&ll.&ges: The seminar reviewed the available facilities for services, training and research ,;in .p&llc ~hsalbhfjdwbiktry ,I discdsed the pub.1,'i.a ' h:eaith "' '.' aspec:ts o,£.~eriodon;tdl~ddseae8s~ dawldped iodrieula [email protected] of I~9~iC~Wnta~kiiealith~.i.;aplrl~,foIrmulat&d: reco~h~d~tida4 'fbr tbe ' teaching of public health dentistry in Aenxa1.-tollieps'iildd-lthe.: i' '~ organization of services within the public health delivery system. ,,.,. , , ..~,.: .. ..> . :: -\, ;,, A;::,., L:>.t2;,. , ;, ,,, ,;, . . . ,.. ., In Indoneeia, a b&O:,;~onqhanh3-lexrtewed. t%apragress.of..bral' heAlW as r.el&& to; the sacondi;fdxa-)imr; iprlak'(Pe4ita' TI)' atid! 'evdlliatdd 3he ' impliewntatioq, od: itbrderttral thedchHtpan for Pelita '11,with: s'pedlal' emphasis on edwc9r&pn* ;&8ngesi fmdevtsl schotfls ,anti dhtdl. rl~xili&~ training, progress recorded in projects on applied dental research,and cha9ges ; mde: in;.the delibeq' oEi ilearali care-;:th& centres ',hd scb.oql: H8:w&.+~nec~d6ribhs danc.eLaLi ,ser.&i@s~,!j e . . ,.I , . . ;.,i.~. m~dificat~a,,tet-hbr~aia.:,;ii:;! r. ., . , ., , ,. . , . . ; . ,; ! r,,, ,,,, , ., 1 : ,:, .,3;[,.~~>.,l,!:i,.! :, <::l,j,j .>:!, ,,. , . ' Mongotim ar1~0.1r@cerivefl.:asB&sitanqi~ 'from B cotlbltlt:anc, orhot irviewieh che magnitudg~df:~denh&l health maopbveE~.pmblemd,i* ' the:! tbd; try. and' (~s'sdated in organizing progmmkbi fnniahkcptre~hntioni'of ,aehrd ~akl&-wsthih the existing public health delivery system and in developing education, t.raindn@$is@aaikesr:iqhresearchn ihidriwall eriflee.-$tid.;pbb'liC h@81th'7'1
. . ,;, ,a .!,> ;I,, ;i !k;
implementation of an evaluation system for the preventive part of the national dental plan, and, in Thailand, assisted with a situational analysis and a preliminary outline of a national plan for the prevention of oral diseases.
1.7 Mental Health
The Regional Adviser on Mental Health, who took up his duties in September 1975, paid visits to several States in India and to Bangladesh, Indonesia and Thatand to obtain information about developments in the field of mental health and to explore possibilities for the further strengthening of mental health services. Following each visit, strategy guidelines and recommendations were prepared and sent to the governments concerned.
A draft que~tionnaire~designedto map the organization, administration and supervision as well as the extent and distribution of mental health services and manpower in the Region,was prepared for circulation to governments. The questionnaire will also elicit information on planned reforms in legislation governing involuntary admission procedures, and on actual or planned alternatives to traditional hospital-centred care.
A follow-up study of the effectiveness of a refresher course for general practitioners and nurses, held in Mandalay (Burma) in March 1975 as part of the health manpower development programme, was made. A study of the psychiatric component of basic nursing education in India was also undertaken.
A study was made of proposed research involving countries in the Region, on mental health legislation, studies of the long-term effects of cannabis abuse, monitoring of mental health needs as part of the health statistical system, teaching of psychiatry in schools of public health and the delivery of simple psychiatric care by non-professional workers. Priorities for further research, especially in the field of psychosocial factors and health, were considered.
The effectiveness of projects of long duration in Sri Lanka and Thailand was reviewed and modifications were made in two inter-country projects. In one of them provision was made for conducting, in collaboration with Headquarters, advanced training courses for selected professional and health administrative personnel in psychiatric epidemiology and allied subjects, as an approach to the strengthening of national mental health services. In the other project, the terms of reference, initially confined to assistance in the assessment and strengthening of services in drug dependency, were widened to include also other appropriate special clinical areas of significance in the Region, including mental retardation, child psychiatry and alcohol-related disabilities.
A new project to promote the refresher training of general physicians in India was formulated and the UNDP has been approached for financial support. A consultant, provided in March, has been assisting the National Institute of Mental Health and Neurosciences, Bangalore, in the development of psychiatric teaching. SEAl~C2912 Page 16
Sri Lanka also received assistance from a WHO consultant, who advised on the development of a course in psychopathology and psychotherapy at the Department of Psychiatry of the University of Sri Lanka, Peradeniya Campus.
The Region was represented at the First Meeting of the Co-ordinating Group for the Mental Health Programme, held at WHO Headquarters in February. A paper reviewing problem and listing the current and planned programmes in mental health was presented at the meeting. The Organization was represented at several other conferences and meetings on mental health topics.
The Department of Psychiatry at the Institute of Post-graduate Medical Education, Chandigarh, India, and Seth G.S. Medical College. Bombay, were nominated as WHO Collaborating Centres to participate in inter- regional research programmes sponsored by WHO Headquarters. The Mental Hospital, Agra (India), continued as a field research centre for the International Pilot Study of Schizophrenia. Also, the Post-graduate Institute, Chandigarh, was designated as a field research centre for the International Collaborative Study on Depression.
Fellowships were awarded to candidates from Bum, Indonesia, MongoZia, Sri Lanka and Thailand for training in centres of social psychiatry and clinical psychology in the United Kingdom, Netherlands, Canada. USSR and Australia. Fellowship placements in mental health were revised and greater use made of the co-ordinated training programmes in psychiatric epidemiology designed by WHO Headquarters.
1.8 Drug Dependence
The programme on drug abuse in Thailand, assisted by the United Nations Fund for Drug Abuse Control, continued during the year. An appraisal of the treatment and rehabilitation component was made by a consultant who made recommendations for strengthening research in these areas. A similar programme in Burma (United NationsIBurma Drug Abuse Control Programme) was formulated and accepted by the Government.
India and Indonesia received support for studies on, among other things, the long-term effects of cannabis and opium, side-effects and pharmacological action of commonly used fertility regulation agents and psychotropic drugs, and the developmnt of instruments for the reporting of drug dependency treatment programmes.
A seminar held in Jakarta in December 1975 for officers involved in the prevention and control of drug abuse was assisted by a WHO consultant.
1.9 Quality Control of Pharmaceutical and Biological Products
Areas receiving the attention of governments in this field were: the development of national drug policies; the preparation of medium and long-term plans for self-sufficiency in the therapeutic, diagnostic and prophylactic substances needed for primary health care; the SEA/RC29 12 Page 17
standardization and quality control of preparations; the strengthening of the machinery for supervision and distribution; studies in the bioavailability and biotransformation of pharmaceuticals, and the education and training of health and allied personnel in pharmacy, clinical pharmacology and biomedical research.
A WHO electro-medical engineer assisted the Government of Bangladesh in strengthening existing facilities for the repair and maintenance of equipment used in the Pharmaceutical Manufacturers Laboratory of the Central Medical Stores. He repaired and put into operation a number of items, trained technicians and advised on the planning of hospital workshops. A national seminar-cwworkshop on the repair and maintenance of electro-medical equipment was also organized. Another consultant was under recruitment to advise the Government on the formulation of a national drug policy, and a pharmaceutical chemist, also to be assigned shortly, will assess the current state of pharmaceutical manufacturing, distribution, drug control and legislation. and also advise on training.
A team of consultants in biologicals, vaccine production and pharmaceutical economics from Australia was being assigned to Bumta to review the existing facilities and formulate a plan of action for bilateral assistance towards enhancing national potential for the production and quality control of biologicals.
In Sri Lanka, a consultant studied the organization of pharmacy departments, the distribution of pharmaceutical products in national health services, the training of personnel and the system for the quality control of drugs. Considerable progress in establishing a national quality control laboratory, in training personnel, in implementing the policy of the National Formulary Codttee, and in rationalizing the import of medicines,was noted. It was observed, however, that there was a need for faster development of the pharmaceutical industry, improvement in the standard of education and training in pharmacy, and co-ordination of the authority and direction for the surveillance of all operations related to the quality of medicines.
Assistance provided to Thailand for improving the quality of medicines on the market and developing a training centre in Bangkok for pharmaceutical analysts contributed towards establishing a good national system for the quality control of legitimately produced or imported medicines. Most manufacturers have become aware of the meaning and requirements of the code of good manufacturing practice, and technical personnel have been trained for inspection. Automation of product registration records has improved the efficiency of planned sampling of pharmaceuticals. With the extension of these developments in Bangkok to the provinces, there should be improvement in the quality control of medicines and in the prevention of illicit manufacturing and trafficking in medicines.
In April 1976, an International Meeting on Transfer of Technology in the field of Drugs was organized in Lucknow, India, jointly by the SEAIRC2912 Page 18
United Nations Industrial Development Organization and the Council of Scientific and Industrial Research of the Government 05 India. Representatives from 22 developing countries took part in this meeting, which was also attended by a Regional Office staff member. The participants agreed to draw up a list of essential drugs to be manufactured in their countries and collaborate in the transfer of technology, provision of know-how and exploitation of indigenous resources in the manufacture of drugs.
1.10 Medical Stores Management
Assistance continued to be provided to Nepal in medical stores management. A number of steps were taken to bring about improvements in the supply and distribution systems in the medical stores. Training courses were organized; the record card system was introduced in many hospitals and health institutions and the indent and procurement procedure was streamlined and reorganized. It is planned to establish model stores in the country to serve as centres for the in-service training of medical storekeepers and personnel in charge of hospital pharmacies.
Supplies provided by UNICEF were very useful in the establishment of medical stores.
2. DISEASE PREVENTION AND CONTROL - COMMUNICABLE DISEASES
Communicable diseases have continued to pose health problems in countries of the Region, and governments have been encouraged to give these diseases appropriate priority in their programws. Epidemiological surveillance, which is steadily improving, has been an important factor in disease prevention and control.
Remarkable success was achieved in eradicating smallpox - Bangladesh, India and Nepal having become smallpox-free during the year. Malaria continues to show an upward trend, however, and an inter-country consultative meeting held in the Regional Office in April provided guidelines for developing policies for the ioplementation of anti- malaria programmes (see also Section 2.2).
The development of the WHO Programme of Expanded Immunization is being accorded high priority in this Region. Steps have been initiated to explore the feasibility of and possible scope for expanding the existing national immunization programmes and to identify national resources for such increased activities. A Regional Seminar on Epidemiological Surveillance of Communicable Diseases (Immunization Programmes) was organized in the Regional Office in November 1975.
Human plague continues to be reported from Burma, and tuberculosis control has been receiving the attention of governments. In view of the considerable concern of governments over the extent of leprosy in the Region, an inter-country consultative meeting was organized in the SEA/RC29/2 Page 19
Regional Office in December 1975 as a step towards finding solutions to this problem.
Surveillance of dengue haemorrhagic fever showed further improvement during the year, and a WHO Collaborating Centre for Research on the Immunopathology of Haemorrhagic Fever was established in Bangkok. Plans were made for holding in Bangkok, in October 1976, a meeting on dengue fever to review the present knowledge on the disease and to make recommendations for future research. As regards poliomyelitis, some countries have agreed to participate in the International Poliomyelitis Surveillance Programme.
The reporting of venereal diseases, diphtheria, pertussis, influenza and other viruses has not shown any significant improvement. Also, the problem of sexually-transmitted diseases needs the increasing attention of Member countries.
2.1 Epidemiological Surveillance
WHO has maintained its assistance to governments in further strengthening the epidemiological surveillance of communicable diseases. Reporting systems in the different countries continue to record steady improvement.
In India, one of the Regional Advisers on Communicable Diseases participated in the Fifth National Conference on Communicable Diseases held in Jhansi in February, which discussed various aspects of communicable diseases. The Delhi part of the International (Prague- Delhi) Training Course in the Epidemiology and Control of Communicable Diseases was held at the National Institute of Communicable Diseases, Delhi, from 8 December 1975 to 20 February 1976; there were five participants from Burma and three from India.
In Indonesia, a WHO consultant assisted with the epidemiological surveillance programme and the evaluation of the recording and reporting systems of communicable diseases at all levels.
The second Regional Seminar on the Epidemiological Surveillance of Communicable Diseases (Immunization Programmes) was held in the Regional Office from 19 to 26 November 1975 (see also 2.9. Expanded Programme of Immunization).
2.2 Malaria
The worsening malaria situation in the Region continued unabated with increasing incidence and mortality in all malarious countries except Indonesia; a notable exception, for the incidence of malaria in that country was more than halved in 1975.
There has been an almost four-fold increase in the number of malaria cases, from 1.4 million in 1970 to 5.26 million in 1975, which represents an increase of over 30% over the figure for 1974. The estimated deaths from malaria in 1975 are almost double the 1970 figure and are most SEA/KC29/2 Page 20
Population at Malaria Risk (in Millions)
I Not covered I Under I .. ~ ,~~. unaer "~.adicationn~ Measures v-.", i I , I (including I malaria I 1"L-A preparatory control Consolidation Maintenance at risk vhase phase I I I 1967 40.9 - 111.8 221.0 294.5 668.2 1968 48.5 - 197.5 198.8 253.4 698.2 1969 49.1 - 189.6 181.9 290.0 710.6 1970 49.3 - 239.3 126.9 300.9 716.4 1971 41.9 - 253.0 127.0 306.9 728.8 1972 40.5 83.5 151.4 136.1 319 .O 730.5 1973 42.6 87.9 163.2 165.0 358.3 817.0 19 74 43.6 90.8 165.0 161.8 376.2 838.4 1975" 45.3 115.2 157.2 157.9 377.4 853.0
Under Anti-malaria Measures Drug Extensive Discovery and Adminis- mosquito treatment tration control of cases 1975** 45.3 7.1 248.6 171.3 380.7 853.0 1976 46.4 7.7 256.7 172.0 394.9 877.7
"Reported in the previous Annual Report ""Regrouped figures
Detected Malaria Positive Cases (in thousands)
I I From Areas I Not covered Lhder Under Eradication Measures Year (including malaria Total preparatory control Consolidation Maintenance cases Attack phase ohase) measures phase phase
1967 0.7 - 222.6 150.8 12.9 387.0 1968 0.8 - 783.6 38.1 16.8 839.3 1969 0.2 - 1014.2 47.6 20.0 1082.0 1970 13.3 - 1290.5 79.8 44.8 1428.4 1971 62.9 - 1406.6 137.6 141.3 1748.4 19 72 115.5 128.8 1272.0 201.6 194.9 1912.8 1973 151.7 346.2 1499.3 444.3 395.1 2836.6 1974t 164.5 229.9 2210.2 786.5 771.3 4162.4
Under Anti-malaria Measures Drug Extensive Discovery and Adminis- mosquito treatment tration control of cases 1975+ 42.8 3386.3 1032.6 1453.5 5915.2 , Graph 1 - Population at malaria risk and detected malaria-positive cases in areas under different categories of anti-malaria operations in the South-East Asia Region (1967-1976) (mi 1 'lions)
r 0 .- I-' -nJ 2 a 0 a
1967' 1968' 1969. 1970. 1971 1972 1973 '1974 '1975 1976 LEGEND
jr: me^:: L%L~;CULonti-m Lurid operoti<~'2s not covered not covered (~ncludlngpreparatory phase) (including preparatory phase) In area; uith 0nci-ml.irla ijerccisns under control measures under organized drug prophylaxis mass drug administration only under 6,xtensive mosquito control under attack phase (including attack phase) under discovery and treatment of cases (thous under consolidationphase t_~ (includinq consolidation phase] :n ir,'u; o,,irLmi2uricr e~u.lirritioni: ,:lnimcd under maintenance phase 0 under nlaintenance phase
v w I-'" w I-' aw SEA/RC29/ 2 Page 21
marked in ThaiZand, deaths being more frequently reported from Bangtadesh, Bum, some States of India, Indonesia and Sri Lanka.
The prevalence of Ptaarnodiwn fatcipurwn in the Region shows widespread variation from,country to country and also within the countries. In the six-year period from 1970 to 1975, there have been fluctuations in the prevalence of P. faZcipanun, which has shown a distinct upward trend in Bangladesh, Buma, the eastern States of India, Nepal and Sri Lanka, and a decreasing prevalence in Indonesia, Maldives and Thailand.
Resistance of P. faZciparurn to the 4-aminoquinolines is a problem which is gaining ground in the Region, with the spectrum of resistance ranging from R-I to R-111. This phenomenon is country-wide in ThdZand with 90% of infections resistant, and widespread in B- with 26% of infections resistant. In Bangladesh, it is confined to the north- eastern and eastern areas bordering Buma and India, where it is restricted to the eastern States of Assam, Meghalaya and Arunachal Pradesh. In Indnesia, pockets of resistant P. faZcipamrm have been detected in East Kalimantan and West Irian. With the spread of this problem in the Region, regular monitoring of the sensitivity of P. fatciparwn assumes greater importance.
An equally disturbing situation is the expansion of areas of vector resistance to DDT and the development of incipient resistance of Anopheles cuZicifacies to malathion in India.
With the reversion to susceptibility of A. swldaicus in the south coast of Java and southern Sumatra.there are five major vectors in the Region resistant to DDT. The operational impact of vector-resistance to DDT is substantial because of the extent of the area of its distribution. particularly A. mrlicifacies in India and Sri Lanka and A. aconitus in Central and East Java, because of the population affected in six countries and the additional financial involvement for alternative insecticides. With limitations on the use of DDT in residual spraying because of the development of vector-resistance and the prohibitive costs of alternative insecticides, other methods of cpntrol in certain epidemiological and ecological conditions, such as biological, source reduction, larviciding and modification of the environment, have been tried and found effective in certain situations.
The anti-malaria organizations in some countries of the Region are losing their privileged position of independence with mounting pressure for their merger into the general health services. The ultimate integration of anti-malaria services into the general health services is, of course, desirable, but with the deteriorating malaria situation in many countries of the Region, it would be necessary to assess carefully the scope and strength of the available health infrastructure before integration is attempted. Much harm could come to the anti- malaria programmes if the process of integration were rushed through without careful and adequate planning.
The anti-malaria programmes in the countries of the Region are financed almost entirely from national funds, except in two countries, which SEA/RC29/2 Page 22
receive assistance from bilateral sources, whereby the national expenditure on the programmes has been reduced by nearly 50%. The anti-malaria budget varies from 3 to 35% of the health budgets, except in India, where it is over 75% of the central health budget.
The concern of governments over the deteriorating malaria situation in their respective countries is reflected in an increase of the malaria budgets of between 20% and 60% in most cases in the last four years, but this increase has still not met the rising operational costs of the programme, except in Nepal, where the malaria budget has been increased by over 200%.
WHO assisted the governments of Nepal and Sri hkaby providing consultants for a "situation analysis" of their respective programmes carried out together with government and US AID officials. The recormendations made follaring these analyses are under study by the governments concerned. Assistance was also provided to Burma in organizing a three-week training course on comprehensive malaria control operations.
WHO also initiated discussions for UNIDO assistance to India for the production of anti-malaria drugs; the draft project proposal of UNIW is under the Government's consideration.
The Organization's role in promoting inter-country co-ordination led to the Indo-Nepal Border Malaria Meeting, which was held in Kathmandu in January 1976, and the Indaesia-MaZaysia-Si~clpomBorder Malaria Co- ordination Meeting, which took place in Jakarta in February. Efforts were being made for organizing an inter-country border malaria meeting between Bangladesh, Burma and India and also an Indo-Pakistan border meeting to be held in the near future.
In pursuance of a resolution adopted by the Regional Committee at its twenty-eighth session (SEA/RC28/R12),a "Consultative Meeting on Malaria" was held in the Regional Office in April 1976 with the participation of representatives from eight malarious countries of the Region as well as consultant-malariologists from other regions and WHO staff from both Headquarters and the Regional Office. The meeting discussed several aspects of the problem of malaria such as training. research, the socio-economic impact, bio-environmental control of the vector, inter-sectoral co-operation at national level, and evaluation. Special attention was paid to the report of an ad hoe Conittee of the Executive Board and its reconmendations which included adequate funding, timely supplies, suitable strategies, community participation, and cautious integration of anti-malaria activities into the general health services. The meeting called for greater allocation of funds for the promotion of research, urged governments to redouble their efforts to control malaria and called on international and bilateral agencies to increase substantially their technical, material and financial assistance to anti-malaria programmes in the Region. It succeeded in highlighting the genuine concern of the participants about the worsening situation in the Region and in formulating recommendations for the development of national policies for the implementation of anti-malaria programmes. SEA/RC29/2 Page 23
Research related to malaria has been limited to operational trials and field studies of vector bionomics, insecticide-resistance, parasite- resistance to chloroquine and sero-diagnostic methods. In view of the present unfavourable situation in the Region, malaria has been listed as a priority research area by the newly established Regional Advisory Committee on Medical Research (see also Section 8).
With the changing strategies of programmes towards maintaining the gains achieved and the emphasis on long-term control operations in refractory areas, the overall status of malaria progranrmes in the Region is given in the following table:
Millions (Mid-1976)
Population in the Region
Population in originally malarious areas
Population in areas where eradication is claimed (maintenance phase)
Population in areas under anti-malaria operations
In areas under discovery and treatment of cases with focal spraying (including consolidation phase) 172.0
In areas under extensive mosquito control measures with case detection (including attack phase) 256.7
In areas where there is an organized effort at drug treatment 7.7
Population in areas with no specific anti-malaria operations 46.4
The developments in the different countries are sunrmarized below:
In BangZadesh, the Government early this year decided to dissolve the Malaria Eradication Board and integrate the malaria eradication services with the general health services, through which the malaria eradication operations will be carried out. At the end of 1975, a population of nine million was protected by residual spraying and 63.7 million was under surveillance. Though there has been an increase of cases in surveillance areas, nearly 79% of those detected are from areas under spray coverage.
A long-term WHO malariologist is to be provided to the project and short- term consultants will be made available in 1976 for carrying out a "situation analysis" as a prerequisite to bilateral assistance. SEA/RC29/2 Page 24
In Burma, the epidemiological situation, aggravated by the morbidity of the population and various operational problem, continued to be serious. There is circumstantial evidence that the frequency of P. faZcipamcmresistance to the 4-aminoquinolines is on the increase. The impact of the disease on the health of people living in forested and foothill areas was reduced as a result of the distribution of anti- malaria drugs (provided by UNICEF) through peripheral health institutions. The WHO Regional Malariologist and the Regional Entomologist visited the country to review the entomological activities and study the epidemiological situation of the malaria programme. The WHO Sanitary Engineer (Malaria) assisted the national authorities in starting bio-environmental control activities and in studying and evaluating the state of anti-malaria operations in the country.
The incidence of malaria has increased further in India, with mortality recorded in some of the eastern States. There is evidence of expansion of areas where A. cuzicifacies is resistant to both DDT and HCH. The studies of P. falcipanun-resistance to the 4-aminoquinolines are being continued in order to delineate areas where this phenomenon has appeared.
The Regional Malariologist visited the States of Karnataka, Kerala, Maharashtra, Madhya Pradesh, Orissa and Tamil Nadu to discuss the progress of anti-malaria operations and to study the epidemiological situation in the States vis-a-vis the plan of action for 1976. The Sanitary Engineer (Malaria) also visited some areas of Haryana State and recommended a comprehensive approach to malaria control in irrigated areas.
In Inlndonesia, anti-malaria operations are concentrated in Java and Bali and in areas of socio-economic importance and transmigration projects in the other islands. The present organizational pattern of decentralized programme execution, in which part of the malaria budget is subsidized by the provinces, despite central direction, results in lack of uniformity in anti-malaria activities in different provinces.
The programme suffered from delays in the procurement of regular supplies of insecticides, which resulted in non-spraying of areas where spraying had been planned. The spread of DDT resistance in A. aconitus from Central to East Java is also adversely affecting the programme. A. sundaicus, which had been resistant to DDT on the south coast of Java and southern Sumatra, has again, however, become susceptible.
A field trial (Stage VII) with malathion, which had been planned for early 1976, had to be postponed because of delays in obtaining adequate quantities of the insecticidei instead, only a village trial (Stage V) with malathion was undertaken together with a similar village trial using fenitrothion. WHO provided a subsidy for the training of malaria staff, which was intensified in 1975 with the active participation of WHO project staff.
Investigations in East Kalimantan and Irian Jaya have confirmed the presence of resistant strains of P. faZcipanun, but limited investigations in South Sulawesi did not reveal any resistance. MALARIA: TECHNICAL PROBLEMS AND ECOLOGICAL SOLUTIONS Above left : An uncontrolled artesian well creates breeding sites for mosquitoes. Above right : Wild vector mosquitoes become domesticated and breed in this village well in newly cleared forest land in Burma. Left : PWD, irrigation and malaria workers set grades for tide gates to eliminate brackish- watsr breeding places for mosquitoes. Bottom lerr : vecror conrrol oy warer management. Intermittent irrigation of this paddy field in Indonesia prevents maturing of mosquito larvae. Bottom right : Re-afforestation with mangroves will clear away this sand bar and prevent the accumulation of brackish-water breeding places. SMALLPOX ZERO IN INDIA
To celebrate the achievement f independence from smallpox. the Government of India held an award ceremony on 15 August 1975 (the anniversary of India's political independence).
-'ght : On behalf of the Regional Office, DI Gunaratne receives .om Or Karan Singh, the Union Health Minister, a wooden carving of an Indian temple scalpture "Presented to the World Health Organization, South-East Asia Regional Office. for its valuable contrihution to smallpox eradication".
Below : Dr D.A. Henderson. Chief of Smallpox Eradication, WHO Headquarters. and Or Nicole Grasset, Chief. Smallpox Eradication, SEARO, receive their personal awards. Or Mahler announces on Indian television the achievement of S 0.
.A Congratulations to Or Gunaratne from Or Karan Singh.
Or Mahler displays the personal replica which he receiverI of the bronze Nataraia presented by the Government Iof India to 1:he Organization. which is now on display at Head,..,..,,. n,,..ta.r "eneva.c,
And not forgetting the "back room boys", Or Mahler presents mementoes to staff of the smallpox unit in the Regional Office. FORESIGHT PREVENTS BLINDNESS
In the young. . Above : Nutritional blindness is prevalent among children in Bangladesh.This is now being prevented by the administration of vitamin A capsules, distributed by the team of malaria control workers who are already going from house to house in every village. Left : A Burmese medical team visiting a school to check the children for signs of trachoma, which is a major cause of blindness in Burma and several other countries of the Region. India has pioneered the assembly-line approach to eye treatment by holding camps in the countryside and doing on-the-spot minor operations for cataract and other eye ailments. referring more complicated cases to hospital. Right : A surgeon at an eye camp in South lndia examines a patient. Above : An elderly patient recovering from a cataract operation at the Gandhi Memorial Eye Hospital. Aligarh, India. PURE WATER FOR VILLAGERS
Above : Nepal-the same pond for bathing. washing. drinking and watering the animals.
Left : Burma-contaminated water has often to be carried laboriously over long distances.
Above right : Nepal-plastic pipe for a WHO-planned and UNICEF-assisted village water supply scheme. being delivered by ox. cart to an advance depot. . .
Above far right : . . . and carried up the mountainside by relays of porters.
Right : India-a UNICEF drilling rig installs a tube-well at the site chosen by the villagers-next to the temple.
Far right : Indonesia-clean, clear water spouts from the new pump.
EXPANDED IM PROGRAMME Countries in the South-East Asia Region arc showing increased interest in expanding th, programme of immunizat~on,and WHO assistance is being provided for several aspects such as planning. training, and the production and quality control of immunizing agents.
Since the eradication of smallpox from Indonesia the immunization of children against I/ other diseases has been increased.
In Nepal, direct BCG vaccination of children under 15 years of age is an important feature of the country's immunization programme.
Is there room for any more? Thai mothers flock to a clinic to have their children vaccinated. The feasibility of expanding the existing immunization programme is being explored. (photo by ~~~t~~i SEA/RC29/2 Page 25
There has been a further substantial reduction in the number of malaria cases detected in 1975, which is less than 50% of the number recorded in 1974. This may be attributed partly to better timing in spray operations and improvement in the treatment of cases and partly to less favourable climatic conditions for the vectors.
In spite of some local outbreaks, the general situation in the Matdives is very satisfactory. The limited resumption of transmission occurred in those islands where A. subpictus was again found. These outbreaks were contained and intensive follow-up measures were undertaken. With the expansion of the peripheral health services, there are good prospects of the country attaining a high and stable degree of malaria control.
In Nepal, with the renewal of bilateral support and also assistance from UNDP, a population of 2.2 million is protected by spraying operations and 4.4 million is under surveillance coverage, with a population of 0.63 million without any anti-malaria measures. There has been a decrease of casea detected, from 14 600 in 1974 to 11 800 in 1975, in addition to a 12% reduction in blood examinations.
In view of the encouraging results obtained in limited larviciding operations begun in pre-monsoon months in 1975 in an area with a population of 25 000, these activities are being extended in 1976 to cover an area with a population of 200 000 followed by two cycles of malathion spraying in that area where the vector ia resistant to both DDT and HCH.
Resistant strains of P. faZ&pamun have been encountered among imported infections, but investigations have not revealed the presence of such strains in indigenous infections.
The malaria situation in Sri Lanka in 1975 deteriorated further with the increase of the general incidence to 400 777 casea, of which 15.9% were P. faZcipam infections; the latter spread to the north-central provinces. The intensified efforts of the anti-malaria campaign and of the general health services were partially effective, that is, the mortality due to P. fatcipamun was extremely low. The changeover from DDT to malathion, tried on a limited scale, has produced encouraging results. Changeover to malathion in the entire country might, however, create a formidable problem for the Government.
The Regional Malariologist visited Sri Lmka during the year to assist the national authorities in formulating a plan for arresting the rapid increase of P. falcipam infections and also to review the programme and its future strategy.
Following the WHO-assisted country health programming exercise in Thailand, a new project entitled "Malaria and Vector Control" has been formulated. The objectives of this programme are the long-term control of malaria in border and mountainous regions covering a population of approximately 7 million and malaria eradication in the remaining areas, SEA/RC29/2 Page 26
and also the control of vectors of dengue haemorrhagic fever. The Government's malaria budget for 1975 and 1976 has been increased.
There has been a progressive decline in the ratio of P. faZcipanun infections, from 85% in 1970 to 65% in 1975, but resistant infections of this species account for 90%, which is affecting the programme. Recent reports of survivals among A. balabacensis and A. minimus to discriminating dosages of DDT are disturbing and need further investigation for confirmation of incipient resistance of these two vector species to DDT. The detection of 198 000 microscopically confirmed cases of malaria in the first nine months of 1975 does not provide any indication that the situation is not further deteriorating. Anti-malaria measures of chemical and biological control are being tried in gem-mining areas and some isolated islands.
A ten-day training course on mapping of "receptivity" and "vulnerability" of areas was conducted in January, and it is expected that this will be useful in carrying out an epidemiological assessment and making operational adjustments in the programme. Studies on vectors in the southern parts of Thailand have also been undertaken.
2.3 Tuberculosis
The national tuberculosis control programmes,carried out by the basic health services in the countries of the Region, continued to operate satisfactorily, with the emphasis on BCG vaccination, case-finding and treatment.
A notable trend was the decision to have combined tuberculosis and leprosy control projects in the Maldives and Bangladesh. In the Maldives, a survey of tuberculosis and leprosy patients was carried out in the various islands and, in BmgZadesh, training was given to staff involved in tuberculosis control activities. In Bm, a WHO consultant assisted in the training of the newly-established tuberculosis assessment teams and in a comprehensive assessment of the national programme. In India, WHO-associated studies continued satisfactorily at the Tuberculosis Chemotherapy Centre in Madras as did the WHO- sponsored tuberculosis prevention trials in Madras and Bangalore. A consultant reviewed the progress of current research being conducted at the Chemotherapy Centre, and a medical officer from WHO Headquarters visited Madras twice to observe the working of the Tuberculosis Prevention Trial. In Nepal, vaccination teams of the tuberculosis control project carried out BCG vaccination; mass direct BCG vaccination of children below 15 years of age and active case-finding by sputum microscopy continued.
2.4 Diseases Subject to the International Health Regulations
Of the diseases subject to the International Health Regulations, cholera and plague continued to be reported from countries of the Region. The "zero target" in smallpox was reached during 1975, with the last case reported in Nepal on 6 April 1975, in India on 24 May 1975, and in Bangladesh on 16 October 1975. DISEASES SUBTECT TO THF. INTERNATIONAL HEALTH REGULATIONS NOTIFIED BY COUNTRIES OF THE SOUTH-EAST ASIA REGION, 1973, 1974 AND 1975 (Information compiled from data made available ta WHO Headquarters by Member Governments)
"130 febrile cases were reported as suspect in the areas where ecological studies on plague have been carried out; none of these cases was proven to be that of plague. SEA/RC29 /2 Page 28
During 1975, the highest number of cases of cholera was reported from Indonesia, followed by India, Bangladesh, Burma, Sri Lanka, Thailand and Nepal. The case-fatality rate varied from 2% in Bangladesh to 11% in India. The incidence of cholera did not appear to affect adversely international trade and traffic.
There was an increase in the number of cases of plague reported from Burma.
2.4.1 SmaZ lpox Eradication
The smallpox eradication programme recorded outstanding progress during the year.
Of the three countries which had been endemic for smallpox until recently, India and Nepal detected no cases during the past twelve months in spite of intensive programmes of active surveillance. During the period under review, each State in India has carried out at least three house-by-house searches for possible cases, utilizing all health staff. Those States which had most recently suffered from large epidemics of smallpox have undertaken as many as eight such intensive searches.
Each search was carefully planned at meetings held at regional and State level, attended by epidemiologists from the Central and State levels. The decisions of these meetings and the method they formulated were passed down to similar meetings at district, municipal and primary health centre levels, at which training was given by senior staff assisted, as far as possible, by national and international epidemiologists and State surveillance teams.
By keeping the mthod as simple as possible and by informing the participants in the meetings about the progress of the national and global eradication programmes, health staff were kept fully cognizant of their duties and well-motivated.
Independent assessments of the search, based on whether villagers had seen a health worker, seen a recognition card, knew where to report and were aware of the reward for reporting cases, showed that the searches had been carried out conscientiously in almost all parts of India. In those areas where the assessment showed unsatisfactory work repeat searches were carried out.
In certain areas where factors such as climate or inaccessibility had made searches or their supervision difficult special searches were arranged. These were performed in border areas to the west, in Sikkim, in Bastar District of Madhya Pradesh, in the Sunderbans and in Arunachal Pradesh, and were supervised by experienced epidemiologists.
In between searches, surveillance through markets and schools has been carried out in all States. SEA/RC29/2 Page 29
In Nepal, continuous search by all health workers was practised, special emphasis being placed on the more populous terai ares. Two special surveillance teams hsve been created and are working in the field, assessing public awareness of the need to report smallpox and their knarledge of the reward for reporting such cases. Special searches of Tibetan camps have been performed, with the aim of detecting any evidence of active cases and the presence of pock-marked children, who could have suffered from the disease in previously unknown outbreaks; none have been discovered.
The only country in South-East Asia to report cases of smallpox during the past twelve months is Bangladesh. At the start of the year, cases were being reported from 17 out of the 19 districts, but efforts at early case-detection, baaed both on house-by-house searches by all health staff and on market searching by 60 special surveillance teams, followed by energetic and thorough containment, rapidly reduced the incidence of the disease to zero.
The last knm cases occurred on the Island of Bhola in Barisal District, the final date of attack being 16 October 1975. It is probable that the last case in Bangladesh, occurring on that date, represents the last case of Vario2a major in the world.
Since then, three intensive high quality searches in every part of Bangladesh hsve failed to reveal any further cases. A special search of the Chittagong Hill Tracts exposed no previously unknown outbreaks or cases.
WHO has continued to assist programmes through the provision of both national and international epidemiologists, through the payment of subsistence and travel allowances for senior stsff and surveillance teams, petrol, transport, publicity and printing costa. WHO stsff have actively participated in wetings at all levels, in training sessions, in improving reporting, in investigating doubtful cases and in arranginn for the laboratory confirmation of diagnoses.
The Regional Office organized an inter-country workshop on smallpox surveillance, which was held in Nepal in January, attended by representatives from Bangladesh, Bum, India, Nepal, Sri Lanka, and Thailand, as well as staff from WHO Headquarters and the Regional Office for the Eastern Mediterranean. At this workshop the surveillance policy for the next two years was formulated and agreement on the need for documentation of the programme obtained.
2.4.2 Cholera and Other Enteric Diseases
Cholera was reported from Bangladesh, Bumna,India, Indonesia, Nepal, Sri Lmzka and Thailand. As stated earlier, the highest number of cases occurred in Indonesia, followed by India, BangZadesh, Bumna,Sri Lanka, Thailand and Nepal. The number of cases reported in 1975 from the countries of the Region was over 80 000 with about 8% mortality, as compared to over 85 000 cases in 1974 with the same case-fatality rate. SEA/RC29/2 Page 30
Plans were under way to hold an Inter-regional Training Course on the Epidemiological Aspects of Cholera and other Acute Diarrhoea1 Diseases (postponed from 1975) in Dacca from 14 to 23 September 1976.
2.4.3 Plague
Bum continued to report outbreaks of plague during the year. There were 275 cases with 20 deaths reported in 1975 as compared to 699 cases and 18 deaths in 1974. In Indonesia, the processing of the sociological information on plague was continued with the help of the Statistical Unit of the National Institute of Medical Research.
2.5 Bacterial Diseases
2.5.1 Leprosy
Leprosy control programmes recorded further progress during the year.
Following a resolution adopted by the Regional Committee, which, at its twenty-eighth session, expressed great concern over the extent of leprosy and stressed the urgent need for co-ordinated and concerted efforts to solve the problem as early as possible, an Inter-country Consultative Meeting on Leprosy was held in the Regional Office from 18 to 20 December 1975. The meeting reviewed the national leprosy control programmes in the Region, identified their needs and laid down targets and strategies for implementation.
In BmgZadesh and Inhnesia, the leprosy control activities centred round the training of staff involved in the programme. In regard to India, the Chief of the Leprosy Unit from WHO Headquarters visited New Delhi in November 1975 and held discussions with the Government and WHO staff on assistance to the national leprosy control programme.
An agreement was signed for assistance from WHO Headquarters to the Central Leprosy Teaching and Research Institute, Chingleput, for research on anti-leprosy drugs (trials) and the chemoprophylaxis of leprosy. In Nepal, where training activities were continued, a project formulation exercise in leprosy was carried out.
In Bum, the leprosy-BCG trial, which had been operating as an inter- regional activity, was converted into a regional program under the mycobacterial disease control project (BUR MBD 003). Work on re-examination of villages and newly arrived population and the registration of the newborn was continued. A WHO consultant assisted in reviewing and studying the epidemiological picture of leprosy in the country and advised on improvements in the control measures, reporting systems, and clinical, pathological and epidemiological assessments.
In Thailrmd, a report on the integration of leprosy control activities into the general health services (1971-1975) was prepared by the Leprosy Division of the Department of Communicable-Disease Control. At the SEA/RC29/2 Page 31
request of the Government, a staff member from WHO Headquarters visited Thailand in March to assist in the planning of a leprosy survey. The objective of this survey, financially supported by the Sasakawa Memorial Health Foundation, Japan, is to determine the efficacy of leprosy control operations carried out by the public health service, by partly- integrated services, and by the specialized leprosy services.
In the MaZdives, a joint leprosy and tuberculosis control programme, assisted by the Danish "Scouts Help" Organization, was started, and a WHO consultant made a survey of leprosy and tuberculosis patients in the islands during the period October 1975 - May 1976.
2.5.2 SexuaZZy-Transmitted Diseases
The problem of venereal diseases and treponematoses in the countries of the Region, especially among younger population groups, req-*ires greater attention.
The Chief of the Venereal Diseases and Treponematoses Unit at WHO Headquarters visited ThaiZand in March and had discussions with the national authorities on the venereal-disease control programme under way and on the control of sexually-transmitted diseases in Thailand. He also visited Madras to attend the first conference of the Indian Association for the Study of Sexually-Transmitted Diseases. Visits were also aid to Colombo and New Delhi to hold discussions with the respective national authorities on the venereal-disease control programmes in Sri Lanka and India.
A WHO consultant, assigned to Indonesia during September-October 1975, assisted in assessing the existing activities for the eradication of yaws, suggested measures against the disease in areas not previously covered by the project, and advised on the planning of a serological survey. Advice was also given on the control of sexually-transmitted diseases.
2.5.3 Diphtheria, Pertussis and Tetanus
Against an annual requirement of 40 million doses from 1981 onwards, India, after stepping up production at the Central Research Institute, Kasauli, from its present level to 20 million doses annually by the year 1978, will still be facing a shortfall of 20 million doses. The Government of India is, therefore, considering alternative ways of meeting the requirements for DPT vaccine for the implementation of the integrated immunization programme during the Fifth Plan. Among these is the transfer of production of simpler vaccines from Kasauli to State laboratories and, with the capacity thus released, to step up further the production of DPT. In addition, laboratories that have the required potential would receive support and guidance from the Centre to supplement the production at the Central Research Institute, Kasauli. In this connexion, the Government's expert codttee on the expansion of production of vaccines and sera has recommended the Haffkine Institute, Bombay, and the Institute of Preventive Medicine, Hyderabad, as alternative laboratories for the production of DPT. SITUATION =?OPT ON THE OIIALITI COKlllOL OF DsT VACCINES PWDUCED LN SOUTH-EAST ASIA ile(ilON SEA/RC29/2 Page 33
In Thailand, the persistence of problems with regard to the potency of the pertussis component has put serious limitations on the availability of DPT vaccine from the Government Pharmaceutical Organization. During 1975, as much as 60% of the vaccine lots had to be rejected on account of low potency. In order to meet the increasing demand, the Government had to import 252 of its annual requirement of DPT vaccine in bulk. Following consultations with the Regional Office, action is being taken to reduce the rate of rejection of batches of pertussis vaccine and improve the yield of crude diphtheria toxin. A chemistry laboratory for checking media and toxin, a programme of research into methods and the establishment of reference preparations for DPT are among the important recommendations made during the consultation.
The state of control of DPT has been reviewed in the Region and the position of quality control is summarized in the table on page 32. In general, producers have independent laboratories for quality control, with trained staff in position. The weak points concern mice, which are in short supply, and also standards, which have to be developed in Indonesia and Thailand. The quality of the product has been assessed independently in Yugoslavia during 1974-75. The laboratory at Kasauli, India, submitted samples for testing regularly,and all the four submissions met the requirements with regard to potency; the other two manufacturers in the Region, namely Indonesia and Thdlmzd, should avail of the facility that is being provided free by WHO to improve their vaccine further and have their production tested at an international laboratory. (See also 2.9, Expanded Programme of Immunization.)
2.5.4 Meningococcal Meningitis
In Mongolia, where meningococcal meningitis is an important health problem, two WHO consultants and a medical officer from the Bacterial Diseases Unit at WHO Headquarters assisted the Government, in July- August 1975, in assessing the prevalence of serotypes of Neisseria meningitidis, in studying bacterial air pollution in yurtas and apartments with a view to devising air hygiene measures, and in assessing the reactions and immune response to the nev A+C combined vaccine.
A donation of 45 000 doses of groups A, C and A+C vaccine (11 000 each) was made to Mongolia by the Institut Merieux, France, for use in the controlled field trial against cerebrospinal meningitis. Early in 1976, three WHO consultants assisted in the formulation, in collaboration with the Government, of a long-term programme for the control of cerebrospinal meningitis through the Mongolian national health services.
Some cases of meningococcal meningitis were reported from TheiZand.
2.6 Virus Diseases
2.6.1 Trachoma Trachoma continued to pose a problem in some parts of the Region. The control programmes in Buma and India continued to be carried out by the national authorities. SEA/RC29/2 Page 34
Some countries of the Region have agreed to participate in the International Poliomyelitis Surveillance Programme. A new version of the form used for the reporting of poliomyelitis under this programme was sent to Mether countries.
As yet, the integrated immunization programme sponsored by the Government of India does not include the use of oral polio vaccine. The vaccine imported in bulk is used in some municipalities for the vaccination of the child and infant population in large cities. In 1974, a WHO mission had advised on the resumption of indigenous production at the Coonoor Institute after a batch of vaccine produced by that laboratory had not net the requirements for safety. Since the laboratory had not been able to re-establish consistency during the following two years, it was decided to discontinue production. rhe Government is therefore in the process of shifting the production of this vaccine to the Haffkine Institute. It is clear that, before e&arking upon the production of polio vaccine, governments must give very careful consideration to the many complex factors involved.
2.6.3 Haemorrhagic Fever
This disease, which continued to be a major public health problem, was reported from Thailand, Bum and Indonesia.
A WHO consultant made an assessment of the prevalence of dengue haemorrhagic fever in Bangladesh in August 1975. lko consultants assisted Indonesia in July-August 1975 - one with the epidemiology and control of DHF and the other with the clinical aspects.
One of the Regional Advisers on Communicable Diseases, together with a pathologist and a senior paediatrician from Thailand, visited Burma in August-September 1975 to observe the situation of dengue haemorrhagic fever, especially in Rangoon, and hold discussions with the national authorities on this problem and the necessary control measures.
In accordance with the recommendations of the WHO Technical Advisory Committee on Dengue Haemorrhagic Fever for the South-East Asia and Western Pacific Regions, a WHO Collaborating Centre for Research on the Innnunopathology of Dengue Haemorrhagic Fever was established at Mahidol University, Bangkok, initially for a period of three years. As one of the first activities of the Centre, a meeting on dengue fever is being organized in Bangkok for October 1976 to review the existing knowledge on the disease and to make recommendations for future research, to be co-ordinated by the Centre. The Committee also prepared technical guides for the diagnosis, treatment, surveillance, prevention and control of dengue haemorrhagic fever, and a periodical "dengue newsletter",both of which were distributed to the countries of the Region.
Five physicians from Burma actively involved in the control of the disease visited Thailand and Indonesia for two weeks for discussions SEA/RC29/2 Page 35
and to have an exchange of information on the diagnosis, treatment and control of the disease.
2.6.4 InfZuenza and Other Virus Diseases
The surveillance of influenza is not yet adequate in the countries of the Region.
2.7 Parasitic Diseases
2.7.1 Schistosomiasis
The National Institute of Medical Research in Jakarta has established a schistosomiasis control pilot project in Lindu Valley, Central Sulawesi. A WHO human ecologist assigned to Indonesia collected base- line data on molluscan, human and other mammalian hosts. The pilot control operations were initiated in September 1975 in the target village of Anca and its farming area. Peku. During the period December 1975 - March 1976 a WHO consultant engineer assisted with the planning and execution of agro-engineering methods of schistosomiasis control and in the training of staff of the Irrigation Department.
Assistance to filariasis control programmes continued during the year. In Sri Lanka, where an assessment of filariasis control activities was made, the anti-filariasis campaign is expected to be expanded further in order to include other vector-borne diseases of health importance, arbovirus diseases, etc. In Indonesia, a study was made of the epidemiology and transmission dynamics of Malayan filariasis.
2.8 Veterinary Public Health
In July-August 1975, a WHO consultant (food hygienist) assisted the All-India Institute of Hygiene and Public Health, Calcutta, in the development of a food hygiene laboratory at the Institute for the training of veterinary public health students and also for the determination of microbiological standards and the investigation of food-borne diseases. He also visited the Veterinary Research Institute, Izatnagar, India. It is proposed to assign a further consultant in the last quarter of 1976 to review the training and research activities of the Department of Veterinary Public Health at the Izatnagar Institute.
2.9 Expanded Programme of Immunization
Governments in the Region attach importance to the development of the programme of expanded immunization. A pilot project for expanded immunization was launched in the island of Sumatra in Indonesia. The Second Regional Seminar on the Epidemiological Surveillance of Communicable Diseases (Immunization Programmes), held in the Regional Office from 19 to 26 November 1975, reviewed the epidemiological situation of some of the communicable diseases and the immunization SFA/RC29/2 Page 36
programmes in operation in various countries. A medical officer from WHO Headquarters visited Burma in November 1975 to assist with poliomyelitis vaccination and to explore the possibilities of an expanded programme of immunization.
Another staff member from WHO Headquarters visited Burma, Nepal, Sri Lanka adndmland in February-March to explore the feasibility and possible scope of expanding the existing national immunization programes and to identify national resources for such programmes.
A WHO consultant was under recruitment to aesist Indonesia in the preparation of guidelines for supervisory staff in methods of supervision and assessment of vaccination activities, and in the training of national staff.
In India, a working committee was constituted at the national level for the execution of the integrated immunization programe; the Regional Office is represented on this committee.
A DANIDAIWHO-supported course held in November-December 1975 at the WHO-ICMR Training-cum+Research Centre in Imunology, All-India Institute of Medical Sciences, New Delhi, discussed the question of humoral and cellular immunity with special reference to the immunology of reproduction and parasitic diseases. Eleven teachers and investigators from the countries of the South-East Asian and Western Pacific Regions took part in the course.
2.11 Vector Biology and Control
With the change in the general approach to malaria, from eradication to control with emphasis on an integrated and flexible strategy; with the spread of dengue haemorrhagic fever, Japanese B. encephalitis aod schistosomiasis; with the increase in the incidence of filariasis in both urban and rural areas, and with the continued threat of the reappearance of plague in the known foci of the Region, it is expected that the recently established Unit on Vector Biology and Control in the Regional Office will be called upon to play an important role in the effective control of vector-borne diseases.
In recognition of the importance of vector biology and control, several governments in the Region have reconstituted the staffing pattern of their entomological units by creating a Division or Department of "Vector Biology and Control" or "Vector-borne Diseases Control" either within the malaria programme or separately.
At present the only vector control project in operation in the Region is in Sn' hkawhich is dealing with the control of Bancroftian filariasis and survey of the distribution of Ae. aegypti and Ae. atbopictm in relation to dengue fever. SEA/RC29/2 Page 37
3. DISEASE PREVENTION AND CONTROL - NON-COMMUNICABLE DISEASES
Three inter-country meetings were organized on: chronic liver diseases including liver cancer, the development of services for cardiac resuscitation and rehabilitation, and the prevention of visual impairment and blindness in countries of the South-East Asia Region. Assistance for the development of national programmes in the control of cancer and the promotion of cardiovascular health was provided or planned in Member States. The observance of World Health Day on 7 April 1976 on the theme of blindness helped to highlight the magnitude of the problem of visual impairment and blindness, increasing the awareness of countries of the social and economic aspects of the problem caused by the high degree of dependence of the blind on the community.
3.1 Cancer
An inter-country symposium on chronic liver diseases, including liver cancer, was held in New Delhi in October 1975 under the joint sponsorship of the Indian Council of Medical Research and the World Health Organization. The participants, who represented the disciplines of internal medicine, pathology, paediatrics, nutrition, epidemiology and biomedical research, indicated the need for the establishment of regional collaboration and of reference centres and the promotion of collaborative studies. The problem of nutrition and chronic liver diseases was also the subject of discussion.
A team of Burmese cytopathologists and cytotechnicians returned from Australia after having been trained under the auspices of the Colombo Plan. They will now establish a training programme and services in exfoliative cytology at the Women's Hospital in Rangoon. Assistance was provided for investigations on precancerous and cancerous lesions of the oral cavity.
Fellowships were awarded to a team of physicians, surgeons and radiotherapists from the DPRK to visit ontological centres in the USSR and other European countries to observe the latest developments in cancer control. The Oncological Institute in Pyongyang was supplied with documents on and equipment and drugs for the chemotherapy of cancer.
A consultant in oncology assigned to India visited Bombay, Ahmedabad, Bangalore, Trivandrum, Madras, Kancheepuram, Hyderabad, Calcutta, Kanpur and New Delhi to assess the existing facilities and advise on a phased programme for upgrading the institutions in these cities as regional cancer centres. The facilities in the cancer institutes in Bangalore and Kanpur and the Cancer Hospital in Kancheepuram continued to be improved. Action was taken to supply radiotherapy equipment to the Arignar Anna Memorial Cancer Hospital, Kancheepuram, where a consultant in cytopathology assisted in organizing the training of cytopathologists, and another consultant was under recruitment to give advice on cancer epidemiology. In addition, a fellowship was awarded SEA/RC29/2 Page 38
for the training of the oral pathologist from this institute. A programme of health education in cancer for the public has been developed at the Tata Institute of Fundamental Research, aimed at reducing the incidence of oral cancer due to betel chewing. It is hoped to develop this activity further in collaboration with the International Agency for Research on Cancer.
In Indonesia the Government constituted a group to advise on a national cancer control programme. It was proposed to entrust voluntary organizations with responsibility for cancer health education in the country.
A consultant was provided to MongoZia to train physicians in the management of cancer with chemotherapy.
In Sri Lanka, a consultant in radiotherapy advised on the organization of facilities in existing institutions for the treatment of cancer.
3.2 Cardiovascular Diseases
Following the workshop held in 1974 on stroke and rehabilitation of stroke patients, an inter-country Seminar on the Development of Cardiac Resuscitation and Rehabilitation was held in the Regional Office towards the end of 1975, among other things, to review existing facilities, prepare guidelines for the development of services, and promote regional collaboration in training, services and research. The main recommendations of the seminar included: the development of national programmes for promoting the cardiovascular health of the people; the organization of basic cardiovascular and pulmonary resuscitation and rehabilitation services as an integral part of primary health care systems; the establishment of referral centres with mobile services, and education and training of the community as well as health and allied personnel.
For the prevention of rheumatic fever and cardiovascular complications, assistance was provided for school health and community-oriented studies in &nna, India and MongoZio. Since 1976 has been designated as World Rheumatism Year by the International League Against Rheumatism, national collaborative activities for promoting programmes in the prevention and control of rheumatism will be developed. Further, in association with the American Heart Association, control programes against cardiovascular diseases will be promoted in Member States.
The Government of India has appointed a committee for developing a national programme for the control of cardiovascular diseases, and documentation was made available to the members of the committee. Assistance was provided for the training of cardiologists and cardiac surgeons to enhance the quality of training and service programs under development in a number of departments and institutes of cardiology in the country. In addition, on the basis of an evaluation of existing facilities for research, negotiations were initiated for collaborative research in rheumatic fever and hypertension. SEA/RC29/2 Page 39
In Indonesia, assistance was provided for studying the blood pressure profile in the population with a view to developing programmes for the control of hypertension.
MongoZia continued to receive assistance for programmes for the prevention and control of rheumatism and hypertension.
A three-member team from Nepal - a cardiologist, a nurse and a technician - after receiving training under the WHO fellowship programme, returned to Nepal and organized an intensive care unit in Kathmandu.
In Sri ~anka,where extensive facilities for the management of cardiac emergencies have been organized, the stroke registry continued to operate in collaboration with the globalUH0 programne.
3.3 Blindness
The resolutions adopted by the 'benty-eighth World Health Assembly and the twenty-eighth session of the Regional Committee in 1975 focused the attention of Member States on the need for taking action against visual impairment and blindness. In pursuance of the resolution adopted by the Regional Committee, a meeting was held in the Regional Office in March to assess the magnitude of the problem of visual impairment and blindness, to evaluate existing facilities for community- oriented eye care services, to formulate strategies for providing basic ophthalmic services at the peripheral level and comprehensive ophthalmic referral services at the intermediate level, and to recommend measures for training in public health ophthalmology. The participants identified the main causes of blindness as trachoma and allied infections, nutritional disorders and avitaminosis, injuries, cataract and glaucoma. Their recommendations included formulation of national programmes for the prevention of visual impairment and blindness; organization of community-oriented eye health services as an integral part of the existing public health services; development or strengthening of education and training of health and allied personnel in public health ophthalmology, and mobilization of community, national and international resources for comprehensive and well co-ordinated national programmes for the prevention of blindness.
In Bangladesh, the programme for the distribution of high potency vitamin A capsules progressed satisfactorily. An evaluation of the programme undertaken by the national authorities showed the beneficial nature of vitamin A administration in the prevention of xerophthalmia and blindness.
The trachoma control programme and the national survey for blindness continued to make good progress in Burma. The survey indicated the extent of the problem of blindness due to trachoma, injuries, cataract and glaucoma.
In India, a national plan for the prevention of visual impairment and control of blindness was formulated and a new post of Adviser in SEA/RC29/2 Page 40
Ophthalmology was created in the Ministry of Health with responsibility for the planning, implementation and evaluation of the programme. The recommendations of the Joint Councils of Health and Family Planning adopted in 1975 on training and services in community-oriented ophthalmic care are awaiting the clearance of the Planning Commission; meanwhile, a number of State governments have started implementing these programmes. Assistance was provided by the Central Government to voluntary agencies and non-governmental organizations for mobile eye camps to provide ophthalmic care, including cataract operations, to communities in remote rural areas. Nutritional activities were being developed to combat vitamin A deficiency. The Indian Council of Medical. Research instituted collaborative studies on the incidence and etiology of blindness.
A National Foundation for the Blind has been formed in Indonesia. A team consisting of a public health administrator, a nutritionist, an ophthalmologist and a representative of private practitioners has been constituted by the Government to advise on national strategies for the prevention of blindness. With a view to taking ophthalmic services to the community, nurses will receive upgrading courses of three months' duration in the management of eye diseases. A corneal bank is in operation in Jakarta. A consultant visited Indonesia, reviewed the existing situation and advised on education, training and services in public health ophthalmology.
In Nepal, voluntary organizations are taking an active interest in providing relief and rehabilitation services.
A consultant visited Sri Lunka, studied existing facilities and reconnnended their strengthening for education and training in public health ophthalmology.
The same consultant visited Thailand, observed the working of institutions offering service and training facilities, held discussions with the national authorities and recommended measures for promoting community-oriented ophthalmic services as an integral part of the health services.
The development of eye health services depends upon the mobilization of resources, co-ordination of services and training of manpower. Hence efforts were concentrated on establishing closer co-operation with national and international agencies interested in the promotion of programmes for the prevention and control of visual impairment and blindness.
4. HEALTH LABORATORY SERVICES
In the field of health laboratory services, particular attention was given to planning, which was pursued in four countries of the Region. In Bangladesh, a draft long-term plan was drawn up for a national service with the Institute of Public Health as the central laboratory. sEA/RC29/2 Page 41
together with four regional laboratories and a network of small district and thana health centre laboratories to support the medical and health services. In India, at the request of the Government, a new plan of operation was prepared with the aim of assisting twelve States in strengthening their respective laboratory services. In Mongolia, proposals were made for a new project for the production of biologicals from bi-products from the meat industry. In Nepal, WHO participated in a project formulation exercise for the medium and long-term planning of a national laboratory service which aims at correcting the present imbalance in the distribution of laboratories in the different regions and increasing the number of district laboratories from the present 18 to 49 by the year 1980; in support of the basic health services the health laboratories will carry out the laboratory work in the surveillance of malaria, tuberculosis and leprosy and in family planning in at least eleven districts by the year 1980, when full integration would have been achieved. In l'h'hdland, following country health programming a plan of action has been drawn up for project formulation during the period 1977-81. The extension of side-room laboratories to 338 medical centres in the districts is the main programme accorded national priority with a view to strengthening the health services in rural areas.
The health laboratory services in Bangladesh, India (State of Maharashtra), Nepal and Thailand were reviewed. The basic difficulties encountered in achieving a system of laboratories that can provide comprehensive services to health and medical care programmes were similar in all three countries. These are, inter alia, the lack of a well-defined career structure for various cadres of laboratory personnel; absence of a unified administrative structure or an established policy to ensure developnent of laboratories in a manner that would balance the development of hospitals and health services; the limited range and poor quality of equipment that is available; lack of facilities for servicing, and absence of training programmes oriented towards the needs of a comprehensive laboratory service.
4.1 Reference Laboratories
With a view to helping in the development of national reference services within the Region, the Regional Office has promoted the exchange of information among the national laboratories, and has assisted in extending the services of existing reference laboratories in the Region to national laboratories interested in developing such services in their respective countries. Training outside South-East Asia as well as in specialized laboratories within the Region was an additional feature of this regional co-operation, of which the following are some examples of activities which took place during the year: advanced technology in the microbiology of streptococcus was transferred to the pathology laboratory in Rangoon General Hospital, to the Central Health Laboratory, Kathmandu, and to the Medical Laboratory in Chittagong, Bangladesh; facilities were set up and tr~iningprovided in mycology at the National Health Laboratory, Rangoon; SaZmoneZZa @phi strains isolated in Bunna, Mongozia and Nepal were verified and phage-typed by the National Reference SEA/RC29/2 Page 42
Laboratory at Lady Hardinge Medical College, New Delhi; in India, the Salmonella Laboratory at the Central Research Institute, Kasauli, and the Shigella Typing Laboratory at Lucknow have been reactivated to operate on a country-wide scale; a programme was initiated, in co- ordination with the reference laboratories and the National Institute of Communicable Diseases, Delhi, for the surveillance of SaZmoneZza, ShigeZZa and Escherichiu coti, in India; work has been standardized in two more reference laboratories in India - on Pseudmonas aemginosa at the All-India Institute of Medical Sciences, New Delhi, and on StaphyZococcus phage-typing at Maulana Azad Medical College, New Dell~i; comments on laboratory design were provided to the Central Health Laboratory, Kathmandu, and the Vaccine Laboratory. Baroda (India). IL is hoped that more and more governments in the Region will take advantage of this programme, which is supported by WHO in order to enable countries to develop further their own reference services on the basis of regional co-operation.
4.2 Quality Control
In order to make the supportive role of health laboratories in curative and preventive health care more effective, health laboratories should be subjected to a system of quality control by a programme which should be built into the services and specially designed for this purpose; this important aspect of health laboratories cannot be neglected any longer. In regard to the resolutions on this subject passed by the 25th and 27th World Health Assemblies, it is encouraging to note thaL two countries in this region have already taken action and have made provision for the quality control of clinical chemistry and of microbiology in their national programmes for the 1978-79 biennium. 1L is hoped that this example will be emulated by other countries.
During the year under review, the Regional Office sponsored two group educational activities for the purpose of standardizing laboratory methods. One such activity related to the "microbiology of Streptococcus infection in hospitals and nosocomial sepsis control", which was held in New Delhi from 12 to 24 January; the other, also held in Delhi, was a course on the "Production and standardization of SaZmoneZta diagnostic antisera", which took place in April. A meeting of experts at WO Headquarters has recommended a list of reliable methods in clinical chemistry. Because of the simplicity of the technique which is involved, these tests will go a long way towards satisfying the needs of clinical laboratories in the developing countries which have limited resources and operate under constraints in medium-level hospitals. Material and references concerning these tests will be made available soon by WHO Headquarters. Meanwhile, advance information has been circulated to all health laboratory projects in the Region. Also, eight participants from this region attended a Headquarters-sponsored inter-regional course in quality control in clinical chemistry, which was held in Kuala Lumpur in MarchIApril this year. Arrangements are being made to follow up this course so as to enable the participants from this region to start a quality control programme in their respective countries. SEA/RC29/2 Page 43
4.3 Laboratory Animals
In pursuance of a resolution of the World Health Assembly (WHA28.23) concerning the use of and breeding of laboratory animals,there has been good response from countries within the Region to a Headquarters questionnaire regarding the availability and use of non-human primates. The Government of India has enacted legislation regulating the trade in primates, with a view to improving the standard of health of the rhesus monkey, which is exported for use in biomedical research. Plans are in hand for setting up a free-range farm for the breeding of non- human primates, and several institutions in India have either improved their facilities or have plans in hand for establishing new primate facilities. Late in 1975, under the auspices of several government agencies, an international s-r school on primates was held in Delhi. The recommendations passed by the school are along the lines of those made by the International Society on Primatology to evolve world guidelines for improving the standards of non-human primates in medical research.
As a follow up of the inter-country Seminar on Small Laboratory Animals held in Bombay in early 1975, a number of developments have taken place recently, of which an important one is the establishment of a specific pathogen-free colony for mice at the Central Research Institute, Kasauli (India). Also, institutions in Burma, BmgZadesh, and Sri Lanka, as well as in India, stepped up their mouse production capacity as the practice of animal care is expected to improve gradually in their establishments. Documents outlining the immediate requirements for animal facilities and concerning the training of laboratory animal staff were distributed to governments.
4.4 Laboratory Instrumentation
The Department of Sciences and Technology of the Central Drug Research Institute, Lucknow (India), operates a centre which has an excellent collection of laboratory instruments ranging from infra-red spectrophotometers to a scanning electron microscope. These instruments are made available to users from outside the Institute; also, the Institute accepts scientists for training in advanced chemical technology, whereby they can learn the operation of these specific instruments. It is hoped that other countries will take advantage of these facilities so as to promote the development of technology in advanced chemistry in the Region.
5. PR0K)TION OF ENVIRONMENTAL HEALTH
5.1 Environment a1 Health
The environmental health programre in the Region has continued as planned, with concentration of WRO assistance on community water supply and sanitation, education and training of sanitation personnel, pre- investment planning, and control of environmental pollution and health hazards. SEA/RC29/2 Page 44
Community water supply and sanitation still remains the major area of WHO assistance in view of the persistence of water-borne diseases as one of the most important public health problems in the Region. Programmes in this field in Bangladesh, India, Indonesia, the Maldives, Nepal, Sri Ldia and !Thailand have generally maintained satisfactory progress with material aid frm UNICEF. In Bunno, in addition to continuing technical support to the UNICEF-aided pilot project in rural water supply, WHO has collaborated in the preparation of proposals for a project in this field.
In addition to these country projects, supporting services have been provided through the inter-country project on the development of community water supply and sanitation prograws. Work is in progress on the preparation of country reports on urban water supply and sewerage and on rural sanitation, similar to that prepared in 1974 on rural water supply, to assist governments in setting realistic targets for service to urban and rural populations with due regard to the national targets recommended for the Second United Nations Development Decade. Data have been collected on typical drawings of various components of the engineering works in use in rural water supply in the Region for the purpose of preparing a guide on the standard designs which might prove more functional and economical uuder different conditions.
Pre-investment planning studies in the Region with funds from UNDP have increased. The tvo projects for sewerage and sanitation in Jakarta and for rural water supply in East Java, Indonesia, have progressed satisfactorily, and a project for water supply and sewerage for Madras City in Tamil Nadu, India, has been started. The proposal for UNDP assistance for the Water and Sewerage Authorities for Dacca and Chittagong in Bangladesh is under consideration by the Government, UNDP and WHO. Assistance has been provided to India and Sri Lmzka in the preparation of project proposals for UNDP assistance in rural water supply, and a further proposal for assistance in improving water supply and sewerage in Male, MaZdives, is under study.
Education and training of sanitation personnel, which forma an essential element of all on-going projects in community water supply and sanitation, has continued to receive consideration. Organization of in-service training, the award of fellowships and the development of academic training progranmres and organization of courses in various specialized disciplines of environmental health have been fields in which WHO has assisted (see Section 7.5, Training in Sanitary Engineering).
There has been growing awareness on the part of governments of the increasingly complex problems of environmental pollution resulting from overcrowding in urban slums, inadequate sanitation facilities, uncontrolled development of industries and difficulty in the enforcement of legislation. Technical advice has been given on the development of measures for the control of environmental pollution through various sources, and on the promotion and co-ordination of research in this field. Information is being collected on the major potential pollution SEA/RC29/2 Page 45
sources in the Region in order to facilitate the development of control programmes.
While WHO'S assistance is changing from ad hoe project support to that of stimulating and strengthening programmes within the framework of national development plans, in most countries emphasis continues to be placed OD assistance in the planning, delivery and evaluation of basic sanitary measures. In support of this, the Organization's role as a co-ordinating agency mobilizing external resources and promoting the formulation and implementation of projects by Member countries is increasing.
5.2 Occupational Health
In view of rapid industrialization, urbanization opening of mines and the large numbers of people working in agriculture, in tea estates and in plantations, the health hazards to working populations have attracted the attention of govempenta in this region to the need for promoting and maintaining a high degree of physical, mental and social well-being of the workers in all occupations. WHO collaborates with almost all countries in the Region in the field of workers' health.
A specialist in occupational health is being assigned to Bangladesh in September 1976 to review the present situation of occupational health and to study the implementation of the recommendations made by an earlier consultant in 1973. Be will also assist in the training of qualified technical personnel in occupational health and safety.
In &ma, WtlO assisted in the preparation of a LNDP project document, "Strengthening of Health Services in Newly Industrialized Areas (West Bank of the Irrawaddy River)". This project, for which WHO is the Executing Agency, was to have become operative in 1976 but had to be postponed to 1977 on account of the financial stringency in UNDP.
With WHO assistance, the Government of India organized a two-week National Training Course on Evaluation and Control of Industrial Environments at the National Institute of Occupational Health, Ahmedabad. The aim was to train the participants in initiating and developing programmes of hygiene in industries.
In Indonesia, a joint WHO/ILO mission undertook a reappraisal of the large-scale UNDP-assisted project "Dewloprent of Central and Regional Occupational and Industrfal Eygiene Laboratories" in order to bring its activities in line with national requirements.
As in Burma, the difficult financial position of UNDP resulted in the postponement of assistance in the fields of heat stress, noise, occupational nutrition, agricultural safety, experimental toxicology, etc.
The Government of Sri Lmzka continued to develop programmes in occupational health with the support of WHO and ILO. WHO is participating in a joint project with DANIDA and ILO for setting up SEA/RC29/2 Page 46
an institute of occupational health and safety. With WHO'S financial support, a national orientation programme in occupatioaal health was organized for practising nurses. Further assistance is envisaged in dealing with problems of occupational health and safety in agriculture and in identifying nutritional, health and socio-economic problems of women working in agriculture.
In ThaiZand, the Ministry of Public Health has established an occupational health unit at the Department of Health to co-ordinate activities in preventing hazards to the working population. A consultant will be provided in 1977 to evaluate the progress and achievements.
5.3 Radiation Health
Assistance was provided to countries for improving the use of X-ray and other sources of ionizing radiation for diagnostic, therapeutic and biomedical research. The Organization also continued to support the training of radiologists, radiotherapists, nuclear medicine specialists, medical physicists, radiographers, technicians in radiotherapy, and technicians in the repair and maintenance of electro- medical equipment. In addition, the organization of radiation protection services received support through the provision of free film badges, as did the promotion of national systems for radiation ), monitoring. The study of the level of stronti~90in human bones was continued in India, Indonesia and ThuXZand.
Films were supplied free to Bangladesh regularly for the monitoring of health workers exposed to radiation.
Assistance was provided to Bum in the development of medical physics, calibration of radiology and radiotherapy units and the strengthening of training facilities for various categories of personnel.
Supplies and equipment were provided for the organization of radiological protection services in the DPRK.
In India, a consultant assisted the Division of Radiological Protection, Bhabha Atomic Research Centre, Trombay. This centre was designated as a WHO Collaborating Centre for Secondary Standard Radiation Dosimetry, in collaboration with the International Atomic Energy Agency. Another consultant collaborated with the Radiation Medicine Centre in the investigation of thyroid diseases using radioisotopes in diagnosis and treatment, and advised on training in nuclear medicine and other matters. A further consultant advised on the use of computer programming, evaluated the training services, techniques and research at the Centre.
The training of radiographers and technicians in the repair of electro- medical, equipment continued satisfactorily in Indonesia. Technicians trained in the Academy of Radiography are assisting in the establishment of hospital workshops in the provinces. With assistance from the Federal SEA/RC29/2 Page 47
Republic of Germany, a hospital workshop is under development in Semarang. The WHO-assisted project for radiation protection services at R.S. Cipto Mangunkusumo (Hospital) is now well established, offering personnel monitoring services for all health staff working in radiology departments in the hospitals in Jakarta. The development of nuclear medicine is progressing well in Pertamina Hospital and in Cipto Hospital. The Department in Pertamina Hospital is making significant contributions to biomedical research in the field of chronic lever diseases.
Film badges and films were supplied to Nepal for the development of personnel dosimetric services in hospitals in Kathmandu and other areas.
In Sri Lmzka, assistance is expected from the International Atomic Energy Agency for the development of radiation protection, radiology, radiotherapy, and nuclear medicine.
The training of radiographers and medical physicists and the organization of secondary standard dosimetric laboratories progressed satisfactorily in lPhaiZmzd.
5.4 Hazards to Man from Pesticides
A consultant was assigned for a period of two months to the Industrial Toxicology Research Centre in Lucknow (India). He assisted with an international symposium on "industrial toxicology". WHO support was provided for the attendance of national participants at this symposium. The consultant also advised the Centre on its research projects and assisted in the training of national staff.
6. HEALTH STATISTICAL SERVICES AND INFORMATION SYSTEMS
During the period under review emphasis was placed on evolving the concept of national health information system and defining the role they should play in support of priority health programmes. It was strongly felt that country health programming was an appropriate means for formulating the WHO programme. Statisticians assigned to country and inter-country projects as well as Regional Office staff participated in the progradng of national health development plans and the subsequent formulation of projects, particularly in the planning of health information systems in Burma, Nepal and ThdZmzd.
A WHO statistician assigned to an inter-country project developed the training material for national workshops on country health progradng to be held during the next year. She also took part in the adaptation of the working guidelines for country health progradng developed in 1974 for use in such programming in the Region in the future. An attempt to identify a minimum list of items of information for use at the stage of data collection and analysis was made and detailed guidelines were prepared for future exercises in country health programing. SFA/RC29/2 Page 48
In pursuance of a resolution passed by the Regional Committee at its twenty-eighth session, the objectives and activities under an inter- country project on "Epidemiological Surveillance and National Health Intelligence Systems Development" were redefined.
Short-term assistance was provided to Burma and India for developing national health information systems.
The medical records officer assigned to the inter-country project "Organization and Administration of Hospital and Medical Care Services" assisted BangZadesh, Burma and Indonesia in strengthening the medical record activities in some hospitals in these countries. Another medical records officer continued to assist Nepal.
During the year, two long-term statisticians took up assignments - one joined the project "Organization of Health Services, Planning and Hospital Administration" in Bangladesh, and the other took up duties at the National Institute of Medical Research in Indonesia.
The inter-country project "Health Statistical Methodology" supported various activities such as preparations for the meeting of the Regional Cornittee's sub-committee on country allocations of regional resources and for the first meeting of the Regional Advisory Committee on Medical Research (see Section 8, Biomedical ~esearch). The statistician with this project was involved in the preparation of guidelines for evaluating training programmes for paramedical personnel and in programming the methods of computing the data for the WHO Project Management Information System.
Initial preparations were completed for the Working Group on Lay Reporting of Morbidity and Mortality Statistics, which is scheduled to meet in the latter part of 1976. This meeting will be a step towards implementing the recommendations of the International Conference for the Ninth Revision of the International Classification of Diseases held in October 1975, which stressed that WHO should assist countries in establishing or expanding the system of collecting morbidity and mortality data through lay or paramedical personnel.
7. DEVELOPMENT OF HEALTH MANPOWER
A major aim of the Organization is to promote the development of the types and numbers of health manpower adequate to provide health services to the majority of people. In order to meet the shortage of properly trained health personnel and to correct the imbalances among the different categories of workers available, most of the governments in the Region are planning the development and utilization of health manpower, in accordance with their needs and social and economic resources, as part of their national health plans. WHO has given assistance for promoting health planning and management practices, for integrating the training of health manpower with governments' efforts SEA/ RC29/2 Page 49
for the strengthening of the health services, and for adapting the educational objectives of the different categories of health personnel to the health needs.
In view of the importance of different categories of health personnel, working together as a team, in providing health care, studies on health teams are continuing. These studies include such aspects as the composition of the health team in various local contexts, their basic and continuing training, promotion of team work between health personnel of different educational levels, as well as the process of integrating the personnel of vertical disease control programes into multi-purpose health worker teams. Consideration is also being given in some countries to the appropriate training and use of community health workers, as well as the training of traditional health workers and their collaboration or integration with the health services.
Further, with a view to providing health care at the peripheral health centres and supervisory links between peripheral multi-purpose health workers and health centres, middle-level workers are being trained in Burma, Mongolia, Nepal and Sri Lanka. Such training is being initiated in Bangladesh this year, and India has made plans to start a similar programme from the coming year. An inter-country seminar organized in New Delhi in February worked out the details of the job specifications, training programmes and career structures for such workers.
In the field of nursing education, emphasis has shifted towards the preparation of peripheral health workers, and basic nursing and midwifery curricula are being revised with greater stress on community health, family health, family planning and nutrition. The provision of continuing education in the form of short courses is facilitating the training of nursing tutors, leaders and administrators. A project is being planned to study the feasibility of training nurses in the community setting rather than in a hospital.
Assistance was also provided with in-service training courses for public health engineers and sanitation personnel.
Medical education programmes are being reorganized for the better preparation of future physicians for community-oriented work, and a survey of such training programmes being undertaken by medical schools in the different countries of the Region led to the development of a suitable curriculum for the teaching of community medicine. Also, an inter-country seminar on medical education suitable for developing countries, organized in NepaZ in November, helped to highlight the importance of training medical students in a community environment rather than in the teaching hospital complex.
Teaching of human reproduction, family planning and population dynamics continued to receive further support, and the regional documentation centre prepared and distributed four more annotated bibliographies on certain special topics in this field. An experimental curriculum for SEA/RC29 /2 Page 50
training medical students in maternal and child health as a unified subject has been developed for pre-testing.
With the two regional teacher training centres at Bangkok and Peradeniya attaining a level of proficiency, support was provided for the establishment of national teacher training, educational technology and medical education centres in India, BangZadesh and Mongolia by holding national aeminara on educational sciences for teachers of health professionals. Such national courses are also planned for the other countries.
With a view to determining the future policy for the award of WHO fellowships according to the needs of the countries, a study has been undertaken to assess the impact of the fellowship programme in developing the required health manpower.
7.1 Medical Education
Long-term staff have continued to provide assistance to Bunna, Incbnesia and MagoZia; in addition, most of the countries of the Region received assistance through short-term consultants, the number assigned totalling 45 during the year.
In Bunna, three long-term staff members have continued to assist the three Institutes of Medicine. Since local expertise has been developed, short-term assistance in the fields of microbiology, inarmnohaematology and immunofluorescence was provided at the request of the Government. In Indonesia, there has been a reduction in the number of long-term staff in view of the availability of national expertise. Assistance in medical education has been provided only in planning, and further development initiated at the central level rather than in strengthening individual departments. Consequently, consultants were assigned to the Consortium of Medical Sciences for formulating educational programmes and to the School of Public Health for developing undergraduate and post-graduate courses. In Mongolia, in addition to the provision of a project manager and a medical educator (paediatrician) to the State Medical Institute, Ulan Bator, consultants were assigned for developing the departments of inorganic chemistry, cytology, genetics, human physiology, pharmacology, biophysics and endoscopic diagnostics for improving the training of undergraduates and post-graduates. In Thailand, following the national health planning exercise, health manpower programmes are being developed for providing training to health service staff at various levels. Further assistance is being given for developing teaching and training programmes in the medical faculties at Chiengmai, Chulalongkorn and Mahidol Universities. The Faculties of Medicine at Prince of Songkhla and Khon Kaen Universities continued to receive assistance for training new categories of staff. The Faculty of Graduate Studies receives a grant for the training of teachers in basic medical sciences for Songkhla and Khon Kaen Universities. SEAjRC2912 Page 51
Programmes and projects in medical education have been reconstructed in order to improve community-oriented training. This trend has continued in almost all the countries of the Region. In BmgZadesk, field practice areas are being developed for the training of medical students, and in Buma, medical students are being sent to rural areas to undergo comprehensive training in community health. In India, as a result of the report of the Government's Group on Medical Education and Support Manpower, medical education curricula are being considerably modified to provide community-oriented training to the undergraduates. In Indmssia, new curricula and programmes are being developed and channelized so as to provide health services to the community, particularly in the rural areas. In angoZia, efforts are being made to strengthen the teaching of undergraduates at the aimak hospitals with the provision of community-based training, and in Sri Lanka, field practice areas are being developed so as to train ~dergraduatesin a community setting. In the latter country, the Departments of Social and Preventive Medicine at both the Colombo and Peradeniya campuses are being strengthened to impart. community-oriented training to the students and to train post-graduates for the M.D. degree in community medicine, 1n ThcriZand, the Faculty of Public Health is being strengthened to provide training programmes for undergraduates and post-graduates in community health.
A team of two consultants visited five countries of the Region during September-November 1975 to study the teaching of community medicine in the medical schools and made recommendations for strengthening the teaching of community medicine in each of these countries. Further, a Seminar on Medical Education Suitable for Developing Countries was organized at Pokhra, IYepaZ, in November for 23 participants consisting of senior educators and health administrators from seven countries of the Region. The seminar recommended that the training of basic doctors should be oriented to their future functions in the community and that greater emphasis should be laid on community medicine in its broader aspects. The participants also felt that the teaching should be integrated, co-ordinated and problem-oriented, and that there should be continuous evaluation of the students in order to determine the effectiveness of the instructions as reflected in their performance in the field.
The WHO-assisted Regional Teacher Training Centres in Bangkok and Peradeniya have continued to play an important role in the development of programmes for medical teachers and teachers in allied disciplines in the fields of educational methods, medical pedagogy and medical technology. An inter-comtry Seminar on Educational Technology and Instructional Methods and an inter-country Course in Educational Science for Teachers of Health Professionals were held in Sri Lmka. A national course in educational sciences for teachers of health professionals was organized at the recently set up National Teacher Training Centre in Pondicherry, India, and similar courses also took place in BmgZadesh and MongoZia so as to help in the development of such centres in those countries. A centre is also being planned in Burma. SEAIRC2912 Page 52
In BrmgZadesh, three UNDP projects have been formulated for providing assistance to the Institute of Social and Preventive Medicine, for developing health manpower and for strengthening social paediatrics.
The Organization's efforts to develop post-graduate prograrmnes in health education within the Region continued during the year. Assistance was provided in the development of curricula for the proposed Master of Public Health programme in health education in Mahidol University, ThaiZand.
In view of the acute shortage of medical literature in the countries of the Region, the scheme of "student loan libraries", initiated in 1974 by the provision of assistance to six libraries, was further extended to cover six more libraries in India, Sri Lanka and Mongolia. In order to make the optimum use of the books in the "student loan libraries", governments were asked to select the books which they wanted to be provided to such libraries in their countries. Although it had been decided initially that students would be required to pay minimel charges for the books, these books will now be loaned free.
7.2 Paediatric and Obstetric Education
Five senior paediatricians from India, Indonesia and Thailand attended the Indian part of the UNICEF/WHO Course for Senior Teachers in Child Health in September 1975. !Iwo additional centres were included in the itinerary of the course this year - the Medical College in Madurai, where the participants followed a programme of applied nutrition and maternal and child health, using the nursery school teacher (Balsevika) as the primary health worker, and the comprehensive rural health project at Jamkhed (Maharashtra), where they observed the training given to village-level health workers.
The Second "Reunion" Meeting of past fellows of the Course took place in the Regional Office in October, where views and experiences were exchanged.
A Review Meeting of the Course was held in November 1975 at the Institute of Child Health, London. The meeting, which was attended by the Regional Director, re-examined the objectives of the course and discussed future developments.
The second phase of the progrannne of assistance to strengthen paediatric teaching at the mdergraduate level in one of the medical colleges in BangZadeak is being taken up.
In India, the new curriculum which has been remodelled by the WHO Ad Hoc Committee on Paediatric Education is being demonstrated in two medical colleges, in order to propagate new concepts of teaching child health at the undergraduate level. A programme enabling heads of departments from other medical colleges to visit these centres is being initiated.
Training in maternal and child health continues to focus equally on the training of professionals and of paraprofessionals, as has been done for many years. Three new trends are evident in the programmes: SEA/RC29/2 Page 53
There has been a shift in emphasis towards developing training centres within the countries themselves, to serve as a training base for intra- country fellowships. In India, all international fellowships in the field of maternal and child health planned for the next four years have been converted into intra-country programmes based on three demonstration centres at present under development. Under the training programme in abortion, 60 centres are being developed within the country to form a training base for the national programme for the medical termination of pregnancy. In Sri Lmka, there has been a reduction in international and regional study tours, and an extensive fellowship programme for all levels of maternal and child health workers is being organized within the country, based on special "intensive implementation districts" at present under development.
Also in Sri Lanka, the "one-shot", orientation, in-service training pattern is being replaced by a programme of regular monthly on-the-job training sessions at peripheral field level involving the total participation of all members of the health team.
In India, with increasing stress on maternal and child health and family planning in the Fifth Five-Year Plan, an experimental curriculum for training undergraduate medical students in maternal and child health and family planning as a unified subject has been developed for pre-testing.
Finally, two handbooks on child health and maternal and child health for the primary health centre physician and the medical undergraduate are being developed in India, and a maternal and child health manual for auxiliaries in Sri Lmka.
7.3 Teaching of Human Reproduction, Family Planning and Population Dynamics
The Fourth Training Course in the Teaching of Human Reproduction, Family Planning and Population Dynamics in Medical Schools was held at Chulalongkorn University, Bangkok, from 6 to 17 October with 31 participants from six countries. It was conducted by one of the Regional Advisers on Health Manpower Development with the assistance of three short-term consultants and two temporary advisers. Eight guest speakers from different faculties in ThdZrmd were invited to address the participants. There was a general consensus among the participants that there is a demonstrable need for a change in current undergraduate medical education. It was also emphasized that the current educational programws should be supplemented by self-learning. The efficiency of evaluation should be improved with a shift in emphasis away from terminal examinations towards more continuous assessment. The participants also discussed the many constraints which militate against this change.
In addition, a national Seminar on the Teaching of Human Reproduction, Family Planning and Population Dynamics was held in Peradeniya, Sri Lmka, from 19 to 25 November with 40 participants from the Peradeniya and Colombo Campuses of the University of Sri Lanka. Three WHO consultants working in Sri Lanka and six temporary advisers from the two SFA/RC29/2 Page 54
medical schools assisted in the organization of this seminar, which also received assistance from the Medical Education Unit of Peradeniya Medical School. Several guest speakers from Kandy and Colombo also took part. The purpose of this seminar was to examine the guidelines to ascertain whether there was any need to modify them in the national context, and to expose as many teachers as possible to discussions on this subject. It is hoped to organize similar seminars in 1976 again in Spi Lda and in Bangladesh.
The Regional Documentation Centre on Human Reproduction, Family Planning and Population Dynamics continued to bring out annotated bibliographies and documentation on various aspects of these topics. These have been widely distributed, particularly to institutions for professional and auxiliary health workers, to the health services, to the main health institutions in the Region and to international documentation centres. Four consultants assigned during the year assisted in the production of annotated bibliographies and a review of the current status of the following special topics: (1) Female Reproductive Biology; (2) Male and Female Sterilization; (3) Abortions, and (4) Demographic, Behavioural and Social Aspects of Family Planning. It is expected that tvo more specialty topics, immunology in the field of contraception and physiology and pathology of pregnancy, will be taken up in 1976. In addition, four general bibliographies were issued. In order to find out the views of the recipients regarding the usefulness of the bibliographies, a questionnaire has been sent to them.
A registry of specialists in the field of human reproduction, family planning and population dynamics in the South-East Asia Region was prepared.
7.4 Nursing Education
In WHO'S programne of collaboration with countries of the Region in the field of nursing there has been a perceptible shift towards the preparation of peripheral health workers. Some projects have this as their primary concern, as in Bangladesh, where the family welfare visitors are being trained to work in the thana health centres and plans are being completed for the training of village workers - family welfare workers, family welfare assistants and family planning assistants. In the MuZdiues, in addition to cornunity health workers, nurse aides are being trained. In Thdland, a programme to train village volunteer workers is about to begin, and other personnel, including midwives, vill be trained for rural health care. Wo projects will prepare the new category of nurse practitioner, a person who will replace doctors in district health centres whenever a doctor is not available. A WHO nurse-educator will be assisting with training programnes in the Faculty of Public Health at Mahidol University and another nurse educator is helping with the training of new nurse practitioners under the Ministry of Health. Thailand is the only country in the Region with this type of programme.
In Nepal, work progressed on planning the training schedules for health inspectors, health assistants, junior auxiliary health workers and SEA/RCZ9/2 Page 55
assistant nurse-midwives. In Bhutan, assistance is being given for training an auxiliary nurse midwife cadre, while in Sri Lanka, the midwifery curriculum was revised to make it more oriented to community health. Workshops and short courses were conducted for midwifery and public health tutors, midwifery ward sisters and public health nurse midwives to assist them in implementing the new curriculum. In Bm, group training in public health nursing was given to lady health visitors and midwives, and the midwives in the integrated health services of the Chaugzone area were given additional training for their expanded role.
There were other activities in nursing education which gave support to the training programmes for primary health care workers. Indonesia has embarked on a large-scale programme of training the primary health nurse. In Brmglndesh, the post-basic nursing school was responsible for the tj zlning of trainers of the family welfare visitors, and in Bhutan, India and Nepal particular attention was given to improving the working areas, that is, the health centres.
Manuals are considered essential for multi-purposelprimary health care workers to carry out their duties satisfactorily. In India and Indonesia the work on manuals made steady progress, and in Thailand the plans were in the beginning stages.
A continuing activity of nursing education in the Region is the preparation of tutors. Increasing numbers of tutors and supervisors are envisaged to staff the training centres, which must expand their teaching programmes for all categories of health personnel. Several post-basic nursing programmes in India still receive assistance, while those in Bangladesh, Bma and Sri Lanka are striving, with WHO help, to become self-sufficient and to assume greater responsibility for all aspects of the post-basic education of nurses.
Basic nursing education is being assisted in Nepal with attention to the obstetrics/gynaecology/midwifery portion of the curriculum. In Mongolia plans for the education of middle-level workers, including nurses, are receiving support. A plan to study the feasibility of an experiment in training nurses in the community setting rather than in the hospital is to be undertaken in Indonesia in the near future.
Though continuing education, in the form of short courses, has long had WHO assistance, it has received added impetus with the activities now taking place at the Rajkumari Amrit Kaur College of Nursing in New Delhi; twelve workshops have been organized in New Delhi and a first workshop outside Delhi at the College of Nursing in Bangalore. The inter-country project staff continue to carry out short courses, but are also working on plans to assist with in-service education in institutions in Sri Lanka and Thailand.
A continuing need in all countries is for educational material in the national language suitable for all levels of workers. Nurses in Sri Lmzka and other countries have produced study guides as one measure SEA/RC29 /2 Page 56
towards meeting this need. In ThaiZand, the first unit of a nursing textbook translated from English into Thai has been printed.
The report on the survey of nursing and midwifery education in the Region was completed and published in April.
7.5 Education in Sanitary Engineering
Education and training of public health engineers and sanitation personnel has continued to receive attention in WHO'S programme in environmental health, As an important element of community water supply and sanitation projects, assistance has been provided in organizing and conducting in-service training courses for national personnel. The WHO professor of sanitary engineering assisting the Institute of Technology in Bandung, Indonesia, since 1972 completed his assignment, but arrangements have been finalized with Oklahoma University, USA, to provide, on a contractual basis, consultant services to the Institute in order to continue assistance in 1976; similar arrangements are expected to be made for 1977 as well. A professor of sanitary engineering was under recruitment for the Institute of Technology, Rangoon, Bm. Consultant services were provided to Chulalongkorn University, Bangkok, Thailmd, for further strengthening the teaching programmes in sanitary engineering. In addition to technical personnel, fellowships for national teaching staff to pursue advanced study abroad and supplies and equipment were provided.
The study on manpower planning started in IndDnesia in December 1974 for the Ministry of Health staff in rural water and sanitation, using operational research staff from the Regional Office and WHO Headquarters, was completed in August 1975. The intention of the study was to establish a basis for further manpower planning activities by the relevant national officers.
The results of this study, together with those from the national manpower study in Sri Lanka (completed in 1974), in addition to their application in the relevant national contexts, were used as the basis for practical examples presented during an inter-country workshop on manpower planning, organized in Sri Lanka during December 1975 - January 1976.
7.6 Training of Auxiliaries
The training of auxiliaries has continued in almost all the countries of the Region, which are conscious of the low coverage of medical care and of the need to make it available to the maximum number of people. Except for the DPRK and MongoZia, where health services cowrage can be considered almost universal, no serious atteapts have been made in the past to correct this anomaly. Recently, however, there has been an encouraging trend to augment and strengthen the training programmes for auxiliaries in order to improve health coverage. SEA/RCZ9/2 Page 57
In Bangladesh, programmes are being developed to train auxiliary health personnel in a phased manner for providing health manpower to thana complexes, union sub-centres and peripheral units. Medical officers are being trained as thana health administrators and auxiliary health personnel as sanitary inspectors, health inspectors, laboratory technicians, compounders, family health visitors and family health workers for peripheral services. It is hoped that through these efforts it will be possible to develop comprehensive health care with the aim of implementing the national health plan for providing basic health services. TWO long-term staff have been assisting in organizing programmes for health auxiliaries. In addition, 200 health personnel are being trained as medical assistants at four schools located in semi-rural areas. WHO assistance is to be provided through a UNDP project on medical assistants.
In Burma, where the rural health centre is the key element for the delivery of health care to the rural population, the development of a sound health infrastructure with an integrated approach and provision for referral services and technical supervision, has resulted in a comprehensive programme for the training of auxiliaries.
In India, a WHO public health officer and a public health nurse have prepared a teaching manual for male health workers, and it is hoped to issue this shortly. Progress has been made in drafting a teaching manual for female rural health workers.
WHO has been collaborating with the Government of Indonesia, in the planning, implementation and evaluation of the training courses for health auxiliaries.
In the Maldives, the Government has been organizing, with assistance from a WHO public health officer and a public health nurse, training programues for community health workers. Two groups of auxiliary health personnel have so far been trained and posted to island and atoll health centres, and the third group is undergoing training. In addition, training is being given to nurse-aides.
In Mongolia, too, support is being given for training auxiliary staff. The State Medical Institute, Ulan Bator, which undertakes this training, is to receive further assistance for strengthening the training of feldshers.
In Nepal, assistance is being provided for the training of auxiliary health manpower in different fields needed for the comprehensive health care system. Curricula are based on educational and instructional objectives with the use of educational technology. The Government has decided to start a new diploma course in medical sciences, to be followed later by a graduate course.
In Sri Lmka, as a result of the recent decision of the Government to integrate the health and curative services at the peripheral level, efforts are being made to improve the primary health care system. The SEA/RC29/2 Page 58
Government has restarted the training programme for assistant medical practitioners (AkQ), which was discontinued some years ago.
The Government of Thailand is making efforts to expand the health services in the rural areas. Aa a result of the country health programming exercise, it is hoped to expand the in-service training of midwives and create a new cadre of nurse practitioners.
WE0 has assisted Member countries in including social sciences and health education in the curricula for the training of various health professionals. Apart from the training of health education specialists and health professionals for their health education responsibilities, the need for continuing education for these personnel was recognized. Material relevant to current health educational problems and programmes was collected and distributed to health personnel in various countries. With the advancement of programmes for the delivery of primary health care services, the health education component of training programmes for multi-purpose health workers is receiving greater attention.
An important inter-country activity organized during the year was the Seminar on Medical Assistants, which was held in the Regional Office in February for 24 participants from 8 countries of the Region. The aim of the seminar was to highlight the role of middle-level workers and their importance, and the participants underlined the need for the utilization of medical assistants in the countries of the Region in the delivery of curative, preventive, promotive and rehabilitative health services as well as in managerial and co-ordinative roles. It was also emphasized that the medical assistant should deal with problems within his competence and that there should be a referral system, which is an indispensable component of any health service. They defined the medical assistant as an "extender of doctor's services" irrespective of the presence or absence of a doctor,and felt that he should have an identity separate from other categories of health workers. They also recommended that as far as possible the trainees should be chosen from the community and that a balanced codination of theoretical and practical field training should be given to them.
7.7 Group Educational Activities
Training courses, workshops, seminars, etc., have provided not only an important input for the continuing education and training of national health personnel but also a good opportunity for them to exchange experiences and share findings with colleagues, both national and international, working in the same or allied fields. Group educational activities have proved extremely useful in reviewing technical and related problems, in strengthening present ideas and in suggesting new techniques. These have made a valuable contribution to the health programmes of the Region.
During the period under review, 76 such meetings were organized - 50 at the national level, 21 at the regional level and 5 at the inter-regional level. National activities have increased by almost one hundred per cent over the previous year, reflecting the trend of focusing WHO'S SEA/RC29/2 Page 59
efforts directly on the needs of the countries (the corresponding figures for 1974-75 being 26, 20 and 6 respectively). The contribution of national activities towards the health services of the countries of the Region is exemplified by the repetition of some activities at the specific request of Member Governments in order to offer training to new groups of people.
Education and training, health planning and administration, communicable diseases, "patient care" and family health were areas which received most attention during the year. In the field of education and training, an emerging trend is the training of health professionals as a whole with greater emphasis on peripheral health workers and auxiliaries. The activities conducted in the fields of health planning, administration and hospital management have increased the capability of national health administrators in their efforts to improve the quality of health services.
Participants have been actively involved in the preparation of group educational activities, and their contributions in the form of answers to specific questionnaires and country reports received in advance have helped in making the meetings relevant to the needs of the Region. Periodic questionnaires directed to former participants and on-the-spot observations of their institutions have revealed changes in their attitudes and behaviour which improve the services for which they are responsible.
Primary health care, expanded immunization programmes and the training and retraining of health professionals are expected to receive greater emphasis within the overall programme of group educational activities in the years to come.
The development of a method of evaluating group educational activities has continued on various fronts. Several WHO seminars have been used during the last year as testing grounds for examining the mechanics rather than the theory of evaluation in respect of the impact of educational activities on job performance. It is expected that the results of these tests will be available next year. In line with this development, an initial set of guidelines for the evaluation of training programmes for multi-purpose health workers has been drawn up.
7.8 Fellowships
During the twelve-month period, 1 May 1975 - 30 April 1976, 528 new fellowships were awarded, and 80 extensions were arranged.
Of 113 fellowships in communicable-disease control and laboratory services, 14 (12%) were for malaria, 39 (35%) for laboratory services, 17 (15%) for tuberculosis control, 12 (11%) for epidemiology and 31 (27%) cholera and dengue haernorrhagic fever, gastro-enteritis,hepatitis, immunology, leprosy, medical entomology, parasitology, plague, port health, vaccine production, venereal diseases and veterinary public health. Of the total number of awards made during the year, 129 (24%) were for training within the Region. Annual Distribution of Fellowships by Country and by Type of Fellowships, 1971 to 1975 (Calendar Year), For Studv Within and Outside the South-East Asia Region (Inclusive of extensions)
Bangladesh Bum India Indonesia Maldives Mongolia Nepal Sri Lanka Thailand Total
4 3 4 3 4 4 3 4 4 3 3 " 4 4 3 4 3 + 3 3 10 0 Grand Year m m m 80 m 0 0 m c L2 L2 c LC 2 Total a0 0 wo g L.2a. 0 4: g zg g g 4; U wo kg : r( L1.d r( II s 4; s L)r( r( U.3 r( 1)- r( Y.4 .d Ur( .* ,,., r( U.+ + m m .,.,,em w cw m cw cw CM w CM em m Cm c M w 2 HW 2 2 *a w "a 2 "W "W *w w r(a r(w L. CG M CG LI a Y ""Y Y 2 Y a a a Y a Y a 2 2
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
1973 14 15 3 38 - 183 28 49 8 - - 78 10 22 22 72 2 76 87 533 620
1974 17 18 11 67 8 170 24 59 19 2 - 68 25 17 30 99 - 91 134 591 725
1975 13 16 7 64 - 168 31 36 5 - - 67 24 11 63 126 - 72 143 560 703
46 58 32 247 18 826 126 250 50 2 4 308 92 99 137 398 21 443 526 2631 3157 Graph 2 - Fellowships Awarded by WHO in the Last Five Years (1971-1975), South-East Asia Region 2004
, #"
1SO- 170-
160- 150.-
140- 130- 120-
110- 100- 90 -
40 30 20
10
BANGLADESH BURPiA INDIA INDONESIA MALDIVES MONGOLIA NEPAL SRI LANKA THAILAND Fellowships* Awarded bv the WHO South-East Asia Region, by Subject of Study and Country of Origin of the Fellow (1 May 1975 - 30 April 1976)
Subject Bangladesh Burma DPRK India Indonesia Maldives Mongolia Nepal Sri Lanka Thailand Total
1. Public health adminis- - 2 5 - 15 2 5 1 14 4 48 tration
2. Environmental health - - - 49 4 - 2 6 10 1 72
5. Other health services
7. Clinical medicine 2 5 13 13 3 0 5 1 2 2 46
8. Basic medical sciences 1 3 0 1 0 0 7 - 7 3 22 and education
TOTAL 18 55 18 127 46 4 55 35 136 34 528
'bxtensions not included SEA/RC29/2 Page 62
Out of the new awards, 107 fellowships were awarded to doctors, engineers and nurses for one-year post-graduate courses leading to a degree or diploma; in addition, 84 were given for other types of experience and 337 for study tours.
During the year, 50 fellows from the following countries or territories outside South-East Asia visited the Region: Afghanistan, Botswana, Egypt, Ghana, Iran, Iraq, Kenya, Republic of Korea, Malaysia, Nigeria, Papua New Guinea, Singapore, Sudan, Swaziland, Turkey, United States of America, Yemen and Zanzibar.
The table on page 61 shows the fellowships awarded by subject of study and country of origin of the fellow, from 1 May 1975 to 30 April 1976; Graph No. 2 and the table on page 60 show the number of awards in each calendar year over a five-year period.
Tables 1 to 4 in Annex 6 give, in respect of each country of the Region, information on: (I) the distribution of awards by source of funds and type of fellowship; (2) the 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 fellows.
Following the establishment of a working group at Headquarters to review the whole fellowships programme and identify the inter-relationship between fellowships and other components of WHO'S assistance, a sub- committee was constituted in the Regional Office to examine all aspects of WHO fellowships. Information collected from former fellows is expected to assist in making a realistic assessment of what has been achieved and how the fellowships have benefited specific and allied projects and programmes. This will also help in determtning the future policy for the award of fellowships according to the needs of the countries for trained health manpower.
7.9 The Regional Office Library
During the year, the Library received 1473 books, pamphlets, WHO publications, reports, etc., and 7409 issues of current periodicals. In a11,4178 consultations (3644 by WHO staff and 534 by others) were made of material in the Library; 2682 publications were issued to Regional Office and field staff and photocopies amounting to 8362 pages were supplied. Reference material was provided in connexion with various seminars and meetings held within and outside the Regional Office.
In order to ascertain the ability of health libraries to provide literature to their clients, a survey of health libraries of all types - medicine/dentistry/phamcy/nursing/public health, etc. - was initiated. An earlier survey, restricted to medical school libraries only - was carried out in 1968-1969 and resulted, among other measures, in the institution of the scheme of "student loan libraries".
During the year, six student loan libraries were provided to medical schools in India, Sri Lanka and Mongolia, as mentioned in Section 7.1. SEA/RC29/2 Page 63
The Library continued to provide governments in the Region with reference and bibliographical services, photocopies of references from periodicals not available within the countries and MEDLARS/MEDLINE services, together with photocopies of some of the key references.
A "Study on the use of health literature published in the countries of South-East Asia" was carried out during the year, which revealed that only 10% of the literature published in biomedical sciences was covered in the Irides: Medicus.on which is based the MEDLARSIMEDLINE system. The possibilities of developing an "Index to Medical Periodicals in the Countries of South-East Asia" are being explored.
A large number of back volumes of periodicals was given to some of the local libraries on the understanding that the periodicals would be available on loan whenever required.
AssiaLance was provided to the Regional Centre for Documentation on Human Reproduction, Family Planning and Population Dynamics in the collection of material, preparation of general and special bibliographies and dissemination of relevant information within the countries of the Region.
8. BIOMEDICAL RESEARCH
In accordance with the decisions of the World Health Assembly and the Executive Board, greater responsibility for the promotion and development of biomedical research has been entrusted to the Regional Offices. At the twenty-eighth session of the Regional Committee, the technical discussions were on the topic of "The Organization of Research in Disciplines of Regional Priority, with Special Reference to Methods for Expanding the Coverage and Improving the Quality of Health Services in the Comunity" .
The major objectives of the regional research programme would be to strengthen national research capabilities; promote and co-ordinate research on regional priority problems related to social and economic development not adequately covered by national and other efforts, and promote research designed to facilitate the rapid application of existing and emerging scientific knowledge.
A Regional Advisory Committee on Medical Research, consisting of 11 members, has been established with effect from 1 January 1976. This committee, which held its first meeting from 5 to 9 January, has laid the basis for the promotion and development of research in the Region.
The priority areas for regional research identified by the Couunittee cover communicable diseases (malaria, leprosy, tuberculosis, filariasis , dengue haemorrhagic fever, diarrhoea1 diseases including cholera, and schistosomiasis), nutrition, control of human fertility, environmental health, delivery of health services,and other specific studies such as chronic liver diseases, including primary liver cancer. SEAfRC29 /2 Page 64
To facilitate close collaboration with the technical units in the Regional Office and Headquarters and also with research bodies in Member countries and to promote and co-ordinate research in the Region, a Research Unit and a Research Development Committee have been established.
The Research Unit is currently following up the recomendations made at the first meeting of the Regional Advisory Committee on Medical Research, which deal with up-dating of the information base, gathering information on research activities being conducted in the Region and on institutes with potential research capability, and making preparations for the second meeting of the Advisory Codttee, scheduled for the end of August 1976.
Research currently being conducted in South-East Asia is mainly through the support of WHO Headquarters, with the emphasis on research in human reproduction; research projects in the fields of leprosy, tuberculosis, anaemia and nutrition are also being supported. A limited number of research activities are sponsored and supported by the Regional Office but are mostly incorporated as parts of on-going projects. Advisory services to research at the national level have also been given. Additional resources for increasing research in the Region are being sought.
9. TECHNICAL INFORMATION AND REFERENCE SERVICES
"Should the WHO publication series and periodicals continue as they are, i.e., in form and content?" "Do they reach all those to whom they will be of use - in other words, are they easily accessible to all the potential readers? If not, what should be done to remedy this situation?" "How should the internal reporting system be streamlined?" These were questions raised in some important Headquarters documents during the year which received special attention. The Regional Office, in the light of its experience and knowledge of conditions in this part of the world, made a thorough study of the documents concerned and commented upon them in detail. Possibilities of WHO Representatives and regional offices helping to draw up more useful and practical free mailing lists for the distribution of WHO publications/documents and of increasing the efficiency of the sales and distribution system were among the points stressed. The desirability of resuming the regional publications programme in this region was recognized.
A record number - 254 - of assignment reports, final reports and reports on meetings and seminars was issued during the year under review. Some of them were brought out under special printed cover, as it was considered that they merited wide distribution. Such reports included: (a) "Health Manpower Planning - the Case of Indonesia"; (b) "Report of the Inter-country Course on National Planning for Nursing"; (c) "A Manual of Health Programming Technology"; (d) "Paediatric Education in Rural Health" (report on the WHO/UNICEF Course for Senior Teachers of Child Health); (e) "Better Health for Sri Lanka" (a report on the health manpmer study carried out in that country); (f) a publication entitled SEA/RC29/2 Page 65
"The Bangalore Pump"; (g) the report on the "Seminar on Solid Wastes Management"; (h) the report on a "Survey on Nursing and Midwifery Education and Personnel in the South-East Asia Region", and (i) the "Report of a Special Working Group on Prevention of Visual Impairment and Blindness".
The report and minutes of the twenty-eighth session of the Regional Committee and the report on the technical discussions on the I,organization of research in disciplines of regional priority, with special reference to methods for expanding the coverage and improving the quality of health services in the community" were, as usual, edited and issued under special printed cover. The "Handbook of Resolutions and Decisions of the WHO Regional Committee for South-East Asia" was brought up to date and printed.
In addition to the material mentioned above, wide distribution was given to a number of documents received from WHO Headquarters and other sources, e.g., the Bulletin of the Pan American Health Orgmzization and reprints of articles on various diseases.
Documentation and reference services continued to be provided during meetings organized by WHO: lists of documents were compiled and requests for documents dealt with.
The year under review saw a further increase in the sales. The total sales during 1975 amounted to $36 400*, an increase of $4700 (14.8%) over the figure ($31 700) for the previous year. The increase was all round, viz., 10.2% in subscriptions, 17.4% in retail sales and 56.5% in sales over the counter. The sales for the first six months of 1976 amounted to nearly $35 000 - almost as much as the figure for the whole of 1975.
WHO participated in the Second World Book Fair, which took place in New Delhi in January. A WHO stand was put up and publicity material, including a specially designed folder giving information on WHO publications and their availability through the Regional Office, was distributed to the several thousands of people who visited the stand. An advertisement was inserted in the Directory issued by the Fair authorities. WHO publications were also displayed at a number of meetings.
*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 subscriptions) 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/RC29/2 Page 66
Lists of new publications were brought out periodically as supplements to the WHO Catalogue and were widely distributed. Several groups of medical students, particularly nurses and health educators, who visited World Health House, as well as participants in WHO-sponsored meetings, were briefed on the availability of WHO publications at concessional rates.
On the basis of a consultant's findings that ex-WHO fellows often failed to maintain their contacts with the Organization through its publications and were in many cases not aware of their easy availability, an arrangement for supplying them with the necessary information by means of personal letters was worked out and implemented; such letters are now being issued as a routine in respect of all fellows on their return from their studies. PART I1
ORGANIZATIONAL AND
ADMINISTRATIVE HATTERS SEA/RC29/2 Page 67
1. THE REGIONAL COMKITPEE
The twenty-eighth session of the Regional Cornittee for South-East Asia was held in the Regional Office from 25 to 30 August 1975. Representatives were present from all Member countries of the Region. In addition, the session was attended by representatives of the United Nations Development Programe, the Food and Agriculture Organization of the United Nations, the International Labour Organisation, and eleven non-governmental organizations in official relations with WHO.
The session was opened by the retiring Chairman, Dr Sulianti Saroso of Indonesia. India's Minister of Health and Family Planning, Dr Karan Singh, inaugurated the session, and an address was given by the Regional Director, who also read out a message from WHO'S Director-General.
The Regional Committee elected Dr Mostakul Hoque of Bangladesh as Chairman and Dr N.D. Joshi of Nepal as Vice-chairman.
Introducing his Annual Report, the Regional Director referred to the widening gap between the developing and the developed countries, which had also affected the health sector. The efforts so far made to improve the health of the people had not yielded the desired results and there was therefore a need for new approaches to tackle the problems being encountered.
Within WHO itself, a process of introspection was taking place, and the emphasis was being shifted from many small projects to fewer comprehensive programmes - a new approach which was being adopted by some countries in the Region. Country health programming exercises, essentially a national undertaking in which WHO collaborates, had enabled countries to assess their problems and plan their own solutions within available resources.
It was pointed out that the implementation of the smallpox eradication campaign was an excellent example of international co-operation, and the Charter for Health Development would be another example of such collaboration.
There were numerous other serious problems facing the Region, such as malnutrition, poor water supply and sanitation, blindness, dengue haemorrhagic fever, malaria and several other communicable and non- communicable diseases, which deserved attention.
In its discussion on the Annual Report, the Committee considered a paper on a multipurpose workers' scheme, and the general feeling was that such a scheme would improve the coverage of the rural population. The importance of this subject was stressed, the main points emerging during the discussion being the need for planning the programme,training and education,supervision and guidance of field workers, and evaluation. The Committee adopted a resolution requesting the Regional Director, among other things, to collect and disseminate information on the training programmes in different countries, and to develop guidelines for evaluation. SEA/RC29/2 Page 68
The discussion on family health concentrated on the need to achieve self- sufficiency in the production of various contraceptives in those countries with large programmes. The integration of nutrition with the basic health services and the need to develop programmes for combating malnutrition and deficiency states were considered as requiring priority attention. There was also an urgent need to develop programnes for providing nutritional supplements to the most vulnerable segments of the population. Other subjects discussed included health education, dental health and mental health.
On the subject of malaria, which was taken up as a separate agenda item, the Committee expressed grave concern over the recrudescence of the disease in some countries of the Region and felt the need for prompt and drastic measures in order not to waste the money and efforts that had been put into the programme over the last two or three decades. Shortage of DDT and its increased price, development of resistance by vectors and inadequate supply of anti-malarials were seen as the main difficulties. In a resolution on the subject, the Committee requested the Regional Director to continue his efforts to assist governments in increasing the production of anti-malarials and insecticides and in training personnel for long-term anti-malarial activities, as well as to stimulate and support studies on the operational aspect of control methods. A consultative meeting to evolve a suitable strategy for anti-malaria operations in the Region was also recommended.
As for the other communicable diseases, the Committee noted the remarkable progress made during the year in the smallpox eradication campaign, particularly the achievement of reaching zero incidence in India. The Committee discussed in depth other diseases such as leprosy, tuberculosis and dengue haemorrhagic fever, which were causing concern in most of the countries. In regard to 1eprosy.it emphasized the urgent need for co- ordinated and concerted efforts on the part of governments, international voluntary organizations and bilateral agencies to come to grips with the problem within a short time. The Committee also agreed that WHO should organize an inter-country meeting on leprosy towards the end of 1975 to discuss all aspects of the subject. In regard to dengue haemorrhagic fever, which was considered to be one of the major killing diseases of children under ten years of age, the Committee felt that a systematic approach should be adopted towards prevention, diagnosis, treatment and control, involving the establishment or strengthening of surveillance with a view to co-ordination within the Region and eventually with the Western Pacific Region.
Recognizing the role that health laboratory services played in the control of communicable diseases, epidemiological surveillance and biomedical research, several representatives requested an expansion of the programme.
The magnitude of the problem of visual impairment and blindness was discussed at length, and suggestions were made for mitigating the rate of social dependence and economic loss to the community. The Committee requested WHO to mobilize technical assistance and other resources to countries, and called upon governments to adopt national policies and programmes in this field. A resolution outlining action for WHO and for governments was adopted. SEAIRC29 12 Page 69
The Regional Comnittee, in stressing the importance of improving the environment as a means of promoting the health of the people, emphasized that health ministries should take a more active part in ensuring a healthy environment in new settlements through closer co-ordination with other ministries.
In regard to education and training, the problems of getting doctors and nurses to work among rural communities were discussed at length, and the need for revising the curricula of medical schools in order to prepare them to meet the real needs of the communities was stressed. It was also suggested that WHO might undertake an experiment in which nurses would be trained in a community setting rather than in the hospital.
The Regional Committee considered a draft of a Charter for Health Development in South-East Asia prepared by the Regional Office and approved the principles contained in the draft. It welcomed the trend of events which had led to the generation of interest and further development of biomedical research, and felt that research in the Region should be purposeful and based on carefully selected priority areas. Welcoming the proposed establishment of a Regional Advisory Committee on Medical Research, delegates suggested that the Committee should have a balanced representation in regard to both geographical areas and disciplines.
Technical discussions were held on "Organization of research in disciplines of regional priority, with special reference to methods for expanding the coverage and improving the quality of health services in the community". After the subject had been extensively reviewed by the technical discussions group, it was agreed that general guidelines for the Region and norms for individual countries should be established for orientation in the planning for health services. "Development of national nutrition programme9 with special reference to the vulnerable sectors of the population" was chosen as the subject for the technical discussions to be held during the twenty- ninth session.
In regard to administrative matters, the Regional Committee noted with satisfaction the greatly improved performance in the recruitment of long-term staff. A Sub-committee on the Programne Budget was set up to examine revisions to the progralnne budget for 1976-1977; its report was later approved.
In all, twelve resolutions were adopted by the Regional Committee.
The Cormittee agreed to hold its twenty-ninth session in September 1976 in Srinagar, India, and its thirtieth session in 1977 in Thailand.
2. REGIONAL PROGRAMHE PLANNING AND DII(ECTI0N
The Regional Director's Advisory C~mmittee~consistingof WHO Representatives and senior technical and administrative staff in the Regional Office, has continued to advise the Regional Director on policy matters relating to the planning and direction of the regional programne at project, country and regional levels, as well as on questions relating to the organizational structure and delegation of authority throughout the Region. SEAIRC2912 Page 70
The development of work on planning, administration, management, monitoring, evaluation and information systems as well as on country health programming has continued satisfactorily.
3. ADMINISTRATION
3.1 General
The Director-General visited New Delhi in August 1975 to attend the celebrations organized by the Government of India to mark the attainment of "zero" level of smallpox in India. He received, on behalf of WHO, the gift presented by the Government in appreciation of the Organization's collaboration in eradicating smallpox from India.
During the period 16 February to 2 March, the Director-General visited Burma, Thailand and Sri Lanka at the invitation of the governments of these countries. The Regional Director accompanied the Director-General on these visits.
The Regional Director, together with the Deputy Director-General from Headquarters and the WHO Regional Directors for Africa, the Eastern Mediterranean and Europe, visited the People's Republic of China from 17 to 25 Novenher 1975 at the invitation of the Government of that country.
In pursuance of the discussions at the twenty-eighth session of the Regional Committee, the Regional Director convened a meeting of the Working Group on Allocation of Resources, on 31 October and 1 November. The meeting was attended by representatives from Burma, India, Nepal and Thailand. The Indonesian member of the working group was unable to attend.
3.2 Organizational Structure
The structure of the Regional Office as on 30 June 1976 is shown in Annex 1.
Following the discussions at the twenty-eighth session of the Regional Committee and in view of the problems encountered by countries in the Region as a result of the spread of dengue, dengue haemorrhagic fever, Japanese B. encephalitis, Bancroftian filariasis and continued threats of the reappearance of plague (in the known foci of the Region), a separate unit entitled "Vector Biology and Control" has been established in the Regional Office. In pursuance of a resolution of the Twenty-ninth World Health Assembly, (WHA29.48), a special committee has been appointed by the Regional Director with a view to streamlining the structure of the Regional Office to effect economies in expenditure and at the same time increase efficiency.
3.3 Personnel 3.3.1 Staffing Operational restrictions resulting frm the liquidity crisis of the UNDP have led to an increase in the workload as regards recruitment and transfer of staff assigned to UNDP-financed projects. SEA/RC29/2 Page 71
The distribution of professional staff in the Region by nationality on 30 June 1976 is given in Annex 2. A column showing the worldwide distribution of WHO staff by nationality has been included.
The following table showa the number of posts in the professional category in the Region and the nlrmber actually filled as on 30 June 1976:
rD m . I. I. B m u g 3 m m .rl a m u M U C rn d U U o c rl a, ma u B 3 3 $85' 7, 3 ; 'F)a, 4 0 u m U 0 B 3 'U Organizational Y 3 M oV) wo m c rl X SZe c 2 rl w 3 dud .rl location @u rl 3- .cal U w a, uu a, a 33u .rlc M UC 0 1 m CWL mu U3 MV)B 5.2 mrm 08~o u 0 e alu .dQN dU U U a al W 3r& M 0 3-u .rl e c a, mra V) %a=? urh U uc)r UBm u3 al ur-4 mu0 m V) muu m m V)OIW 0 BP 0 00 03U 0 B . w3m &~aPI &O haw &r Regional Office 20 1 19 19 - -
Field programmes 244 22 222 19 4 24 4
Total 264 23 241 213 24 4
Twenty-three posts were inactivated because funds were not available from UNDP (7 field programme posts); because staff completing assignments earlier in the year are not to be replaced (11 field programe posts), and because recruitment has been kept in abeyance (1 post in the Regional Office and 4 posts under field programmes).
During 1975, 386 consultants (including 196 for the smallpox eradication programme) were employed in field programnes for periods ranging from two weeks to eleven months.
From 1 January to 30 June 1976, 88 consultants were employed.
During 1975, 23 professional and 9 general service staff, and until the end of June 1976, 24 professional and 5 general service staff separated from WHO service.
Three general service staff completed 20 years of service with the Organization and nine general service staff completed 25 years. SEA/RC~~/2 Page 72
3.3.2 Briefing
As in the past, efforts were made to assist new consultants and long-term staff in their new functions by sending them, in advance of their departure from their respective places of residence, a booklet containing briefing on all administrative matters, in addition to briefing on the technical aspects of their assignment.
To strengthen the offices of WHO Representatives in Nepal, Sri Lanka and Thailand, administrative officers were appointed. This augmentation ensures that these WRs, like their colleagues in Bangladesh and Indonesia, can be relieved of administrative work and can thus concentrate more on programme, technical and supervisory matters. A medically qualified national of Burma was appointed as Assistant WHO Representative in the office of the WHO Representative to Burma
The booklets on living conditions for all countries of the Region were updated during FebruarylMarch 1976.
During the period under review, 39 long-term staff members and 255 consultants were briefed and 37 long-term staff members and 343 consultants were debriefed.
3.3.3 Staff Training
One Regional Office staff member, one WHO Representative and one field staff member attended the training programe for WRs and senior public health managers held at WHO Headquarters during September-November 1975. During 1976 the Director-General approved refresher training for four professional staff (two assigned to field programmes, one assigned to the Regional Office and one WHO Representative).
Seven administrative officers (including the three assigned to the WRs' offices in Nepal, Sri Lanka and Thailand) and nine senior general service staff members attended a four-day 'Management Appreciation Course" organized in the Regional Office in November 1975. The course was designed to improve the managerial and administrative effectiveness of the staff concerned and was conducted by the All India Management Association.
3.3.4 Employment Conditions
Salaries of general service staff in Bangladesh, Indonesia and Sri Lanka were revised.
The.heads of the various agencies of the United Nations system in New Delhi continued their regular meetings to discuss matters of mutual interest, which included a review of various employment questions affecting both professional and general service staff in India. A regular dialogue continued in staff/managemeat meetings on matters of mutual interest. Graph 3 - Obligations Incurred on Field Activities in the South-East Asia Region US$ (mi 11 ions ) (1971-1975) Source: Of:. iiec. 200, 208, 214, 022 and 230 12 Regular budget UNDP funds UNFPA UHEO Others
1971 Total Field Obligations 9.0 US$(millions) SEA/RC29 12 Page 73
3.4 Finance, Budget and Accounts
The total obligations incurred on field activities in the last five years under the regular budget and total cash disbursements under UNDP, UNFPA* and other sources of funds were as shown in graph No.3.
The liquidity crisis in UNDP referred to earlier has led to special operational restrictions and additional reporting requirements, which have caused a significant increase in workload and administrative overheads.
4. PROCUREMENT OF SUPPLIES AND EQUIPMENT
During the period under review,procurement action was taken for project supplies and equipment valued at $2 478 873.-. These consisted mainly of laboratory equipment and chemicals, hospital and surgical supplies, drugs, vaccines, biologicals, audio-visual and teaching equipment, vehicles, printing material for smallpox eradication programmes and a limited amount of office equipment and stationery. In addition, medical books and periodicals costing $141 478 were ordered.
To combat the increasing incidence of malaria in India, 12 million tablets of chloroquine were procured and airfreighted and 14 million tablets of primaquine were procured and shipped.
There was a somewhat declining trend in the procurement of supplies during the period of this report as compared to the previous year, which was due to the following:
- financial crisis experienced in the UNDP-assisted programmes from the beginning of this year
- a slight decrease in the supplies and equipment for smallpox programmes due to the achievement of "zero" incidence of smallpox in India and Bangladesh.
Supplies provided by WHO to a number of research institutions in India receiving WHO research grants were cleared from the customs and sent to the institutions concerned.
Emergency supplies
To meet an urgent request from the Government of Nepal for cholera control, 2000 doses of TAB vaccine were airfreighted from India (Kasauli and Bombay), and three metric tons of bleaching powder were sent by road from Calcutta. These items were supplied on a reimbursable basis.
In response to an urgent request from the Government of Bangladesh for supplies for flood relief, the Regional Office iwediately procured and
*According to the revised procedure applicable to UNFPA projects, unliquidated obligations have been added to cash disbursements in 1974 and 1975. SEA/RC29/2 Page 74
airfreighted 400 ampoules (10 ml. each) of snake antivenom serum. Arrangements are being made for the procurement and despatch of 20 metric tons of bleaching powder and 10 litres of rehydration fluid.
Non-emergency purchases on a reimbursable basis
These were as follows:
For Bangladesh : Yellow fever vaccine, ACD blood packs, Kahn antigen, VDRL, antigen, anti-tetanus and anti-diphtheria sera
For Nepal : DPT, tetanus and anti-rabies vaccine and equipment for the production of anti-rabies vaccine.
The Revolving Fund
During the period under review, six requests for teaching and laboratory equipment and medical literature (amounting to $175 000) were received and ten requests totalling $186 238 were processed (including six received before 1 July 1975). Two requests were pending for completion of the necessary formalities.
5. COLLABORATION WITH OTHER AGENCIES
The increasing demand for resources for the health and related sectors as well as the need for concerted efforts for technical co-operation have made collaboration with various agencies an important issue. Extra-budgetary resources have increased over the past years in consequence of WHO'S efforts to improve collaboration. Excluding the special contribution for smallpox eradication, funds for 33.9% of the total expenditures incurred in this region in the 1975 fiscal year emanated from such sources.
It should, however, be recognized that collaboration has gone far beyond the projects executed by WHO and expressed in financial terms. WHO continued to carry out its constitutional role as the technical and co- ordinating agency in regard to multilateral and bilateral efforts in the field of health. Measures have been initiated at the country level to improve co-ordination of resources through sound planning based on long- term multi-sectoral as well as intra-sectoral programmes. Thus, the WHO Representatives are maintaining closer liaison with the representatives of various agencies and also with the planning bodies in addition, of course, to ministries of health.
5.1 United Nations
The United Nations Emergency Operations Fund has continued to provide for urgent remedial measures in Bangladesh. Recently it approved $50 000 for anti-malaria drugs in Burma.
5.1.1 United Nations Devebpment Progrme (UNDP)
With better monitoring, implementation and management, the programme delivery during 1975 increased to 7355, and in financial term to SEA/RC29/2 Page 75
$2.4 million. It is expected that.despite the liquidity crisis,programmes to the tune of $2.7 million will have been implemented by the end of 1976.
The financial stringency in UNDP has had an adverse effect on WHO'S programme. This is due to the following reasons: (a) as WHO'S projects financed by UNDP are part of the Organization's total programne formulated on the basis of priorities selected by Member States, the reduction in the UNDP budget has affected the implementation of some priority areas and funds from the Regular budget had to be diverted in some cases to maintain the basic and minimal activities which had originally been planned under UNDP funding; consequently, the Regular programne as planned originally had to be adjusted; (b) the activities of all UNDP-assisted projects have been considerably curtailed or staggered, and (c) while funds authorized by UNDP for expenditure in 1976 amount to $2.7 million, an amount of $2.4 million has already been carried foward from the 1975 legal obligations for activities initiated in 1975 but to be implemented in 1976. Thus, the excess funds over the past year's legal obligations are insufficient to finance new activities planned in 1976.
As for programmes in individual countries, in Bangladesh it is expected that four new projects and another now being implemented as preparatory assistance will start full activities soon, though with reduced expenditures for 19 76.
In Burma, two projects planned to start in 1976 have been postponed, and it is not known when these will be implemented.
In India, a large-scale project for water supply in Madras began operating in January, and another on "Pollution Investigation and Control in Maharashtra" is expected to start in the second half of 1976. The project document for a large-scale project on rural water supply is being finalized in consultation with the Government, UNDP, IBRD and UNICEF. The UNDP programmes in Indonesia, Mongolia and Thailand have also been affected. In Indonesia, UNDP is unable to finance the post of sanitary engineer under project IN0 SHS 006 and that of electro-medical engineer (INO RAD 002) beyond April and May 1976 respectively. Consequently, one of these posts will be abolished but the other is being continued up,to November 1976 under the Regular budget. In Thailand, where a UNDP-funded community water supply project was scheduled to start in January 1976, WHO had to finance the implementation under its Regular budget because of non-availability of UNDP funds.
As for the situation in Mongolia, it was understood in March that four long-term posts were to be discontinued after July 1976 and also that three on-going fellowships were to be transferred to the regular budget. A proposal to finance two of these posts during the second half of 1976 and the whole of 1977 under the Regular budget is under consideration. The switch-over of funds in respect of the above activities will require a minimum of $305 100 from the Regular budget, as detailed below: 1976 -1977 Indonesia $ KT00 - Mongolia 71 000 96 000 Thailand 83 000 - SEA/RC29/2 Page 76
Collaboration with UNDP continued to be close and cordial; a representative of UNDP took part in the Regional Director's meeting with WHO Representatives which was held in the Regional Office in November.
5.1.2 ihzited Nations Children's Fund (UNICEF)
Collaboration with UNICEF has been very close both at the country and regional levels. During the year, WHO Representatives have maintained close liaison with UNICEF country representatives to ensure co-ordination of the prograrmnes. At the regional level, UNICEF officials participated in the Regional Director's annual meeting with WHO Representatives for joint discussion of programmes as well as programne formulation. Similarly, WHO was represented at the UNICEF Regional Staff Meetings held in New Delhi and Bangkok. During these meetings cornon progranme areas such as primary health care, nutrition and environmental health were discussed. The document on "Alternative Approaches" is being used as a basis for programme co-ordination. It has been agreed that a plan of action is necessary for implementing the various joint programs, particularly the primary health care programme, which has been emphasized during the year. The question of voluntary health workers is also receiving emphasis in view of the growing significance of cornunity development.
5.1.3 ihited Nations Fund for Population Activities (UIYFPAl
In the course of decentralization, the Regional Office has now the responsibility of collaborating directly with UNFPA co-ordinators at the country level as well as with UNFF'A headquarters in respect of country programmes. This policy has facilitated the process of communication.
During the year under review the trend has been to integrate various aspects of the population programme with socio-economic development, extending far beyond the health sector. ESCAP has also shown keen interest in the formulation of family planning programaes.
In Bangladesh, three existing projects have been revised, and it is hoped that the projects will be approved in the near future. Further, a new project on mobile sterilization teams has been developed.
A project in Nepal is still under formulation, and funds have been approved for three fellowships.
In Burma, where there is keen interest in maternal and child health activities, in order to strengthen national efforts and to help develop a national maternal and child health programme, funds have been allotted for fellowships and a study tour during 1976-1977.
All existing projects in Sri Lanka have been revised so as to continue the activities through the end of 1977. Further, Regional Office staff are collaborating with the national authorities and the UNFPA co-ordinator in formulating programmes for the next cycle, i.e., 1978-1981.
The UNDP's liquidity crisis has adversely affected UNFPA programmes in Thailand,since a part of UNFPA inputs were supposed to be financed under SEA/RC29 /2 Page 77
UNDP's programme based on its indicative planning figures (IPF). Discussions are continuing in this regard.
The four inter-country projects in the Region operated through UNPPA funds have been reformulated to ensure that their activities provide adequate technical advice to strengthen national efforts as well as to support the implementation and management of country projects.
5.1.4 Economic and Socia2 Comission for Asia and the Pacific (ESCAP)
The WHO Liaison Officer has continued to co-ordinate activities with ESCAP. Recent trends in the United Nations have indicated that ESCAP is being considered as a focal point to identify development problems of the countries of the Region as well as with responsibility for implementing certain projects. As part of co-ordination with ESCAP, the Regional Office seeks the Commission's opinion on the various inter-country projects that are being formulated for UNDP finance for the coming IPF cycle, that is, 1978-1981. In addition, the WHO Liaison Officer participates in some aspects of ESCAP's work such as nutrition, human environment and population. The Regional Office has participated in various meetings organized by ESCAP, particularly the Inter-Agency Meeting on Social Development, and the First Committee on National Resources and Population.
5.1.5 WorZd Food Progrme (WFPI
The Regional Office continued to collaborate with the World Food Programme for assistance to various countries in the Region. It took part in the WFP missions to India, Sri Lanka and Nepal. The WHO maternal and child health officer attached to a project in Bangladesh represented the Organization in a joint WHO/WFP appraisal mission to Nepal in January 1976 and the Regional Adviser on Nutrition was a member of an Inter-Agency Identification and Formulation Mission which visited India in February/ March 1976. A WHO field staff member in Colombo took part in an Evaluation Mission to Sri Lanka for the project "Rural Water Programme in Drought Stricken Areas".
Close co-operation and cordial relationships were maintained with the WFP advisers stationed in some of the countries in the Region.
5.1.6 Internationaz Atomic keqg Agency (IAEA)
Collaboration continued with the International Atomic Energy Agency. It is expected that a number of institutions in this region will participate in the eighteenth IAEA/WO Postal Dose Inter-comparison Studies of Clinical Radiation with Thermoluminescent Dosimetry. Briefing was given to an IAEA staff member who visited the Regional Office on his way to Sri Lanka to assist that country in the field of radiation protection.
5.1.7 United Nations Industrial Deve Zopnent Organization (VNIDOI
WHO was represented at the UNIDO meeting on Transfer of Technology in Pharmaceuticals, held in Lucknow and New Delhi in May. The discussions in the final sessions centred round the role that the pharmaceutical industry should play in fulfilling the health needs of the population. SEAIRC29 12 Page 78
The role that those developing countries with an advanced pharmaceutical industry could play in the transfer of technology to those countries in which such expertise is yet to be established, was forcefully put forward.
Discussions were initiated with UNIDO for assistance to India in the production of anti-malaria drugs; the proposal is under the Government's consideration.
5.2 Specialized Agencies
5.2.1 Food and Agriculture Organiaatia of the United Nations (FAOI
WHO was represented at a number of FAO-sponsored meetings held in the Region during the year.
The WHO health education specialist attached to one of the projects in Sri I.anka attended the FAO-sponsored Workshop on Population Education in the In-service Training Programme of Rural Development Agencies in Asia and the Far East, held in Sri Lanka from 19 to 28 November 1975.
A Regional Office staff member attended the FAO/UNIDO Meeting on Safety in Design and Operation of Ammonia Plants, which took place in New Delhi from 20 to 24 January 1976.
5.2.2 International Labour Organisation (IM)
Close collaboration was maintained with the International Labour Organisation in connexion with the UNDP-assisted project on "Development of the Central and Regional Occupational Health and Industrial Hygiene Laboratories in Indonesia", and in the field of occupational health in Sri Lanka.
The WHO Representative to Sri Lanka represented the Organization at the Eighth Asian Regional Conference of ILO held in Colombo from 30 September to 9 October 1975.
5.2.3 United Natim EducationaZ, Scientific and Cultural Organization (UNESCO)
WHO was represented at the Consultative Seminar on Out-of-School Educational Programmes in Population Education, convened by the UNESCO Regional Office for Education in Asia and held in Bangkok from 20 to 28 October 1975. The WHO staff member who attended the seminar also took the opportunity of his stay in Bangkok to visit and study important programmes of the UNESCO Regional Office and to hold discussions with a number of specialists in that office.
The WHO Liaison Officer to ESCAP attended the UNESCO Third Regional Consultation Meeting on the Asian Progrme of Educational Innovation for Development, also held in Bangkok from 19 to 24 January.
Two other meetings in which WHO was represented were the Technical Working Group on Alternative Structures and Methods in Teacher Education, called SEAIRC29 12 Page 79
by the Asian Centre of Educational Innovation for Development, UNESCO, and held in Kathmandu from 21 to 30 October 1975, and the Meeting of Experts on Regional Information Policy and Planning in South and Central Asia, which took place in New Delhi from 18 to 20 March.
5.2.4 IntemationaZ Bank for ~econstructionand DeveZopment (IBRDI
Relations between the World Bank and WHO continued to be close and cordial and consultations have been frequent on matters falling within spheres comnon to both Organizations, particularly water supply and environmental sanitation.
One of the staff members of the Bank visited the Regional Office in October to discuss WHO/IBRD co-operative programe activities in water supply and wastes disposal. The services of one of the sanitary engineers attached to an inter-country project were loaned to the Bank in connexion with the water supply, sewerage and drainage project in Calcutta, India. Discussions were held with the Bank on possible IBRD assistance to Thailand.
A team from the Bank visited Indonesia in January 1976 in connexion with population activities and to review the Bank's own experience as a result of its assistance to these activities in that country. Another team visited Sri Lanka in December to identify a possible water supply project for IDA participation. WHO took part in these missions.
5.3 Non-governmental Organizations in Official Relations with WHO
Regional Office staff continued to maintain close and cordial relations with the national organizations in the various countries of the Region affiliated to international non-governmental organizations. WHO was represented in a number of meetings sponsored by these bodies. The presence of representatives from non-governmental organizations in official relationship with WHO at the twenty-eighth session of the Regional Committee was utilized to hold informal discussions and exchange ideas with them, one of the important topics of discussion being the prevention of blindness.
5.4 Bilateral and Other Agencies
WHO'S co-ordination with US AID,which has improved considerably, is extremely significant, since US AID and WHO together provide nearly four-fifths of the funds available for the development of health, nutrition and population programmes.
US AID participated in the Regional Director's meeting with WHO Representatives, when the US AID representative emphasized that US AID support would be available for five major areas: (a) development of health delivery systems; (b) development of health planning; (c) family planning and population control; (d) nutrition, and (e) development of environmental sanitation, including the control of tropical diseases such as malaria. US AID has particularly assisted malaria, water supply and sanitation prograrmnes. In Nepal, such collaboration continues in respect of the malaria programme, which depends heavily on US AID for the purchase of insecticides. US AID is also assisting Indonesia in family planning and malaria. Close collaboration is expected in the training of nurses, sanitarians and personnel for immunization programmes. Further, US AID has co-operated in developing micro-planning at the country level in Thailand and Nepal. SEA/RC29/2 Page 80
The other inter-governmental, bilateral or voluntary agencies vith which WHO collaborated during the year included the Colombo Plan, the Danish International Development Agency (DANIDA) , the Norwegian Agency for International Development (NORAD), the Swedish International Development Authority (SIDA), the Danish "Save the Children" Fund and the Danish "Scouts Help" Organization. These organizations have collaborated in the fields of health planning and management, immunology, leprosy and smallpox.
6. PUBLIC INFORMATION
The year 1975 witnessed the disappearance of smallpox from its last strongholds in South-East Asia. Since, only a year earlier, the disease has claimed thousands of lives, the all-out drive spearheaded by WHO in India and Bangladesh created unprecedented interest. The Regional Office acted as a focal point for providing the mass media with information as well as suggestions and ideas for obtaining stories, film coverage, radio interviews and feature articles.
The eradication of smallpox and the campaign leading up to it received considerable coverage in the national and international mass media. This helped to create increased avareness and perhaps also contributed to the achievement of the goal of "zero" incidence of smallpox.
Press, Radio and TeZevision
Contacts with the national, regional and international press, radio and television networks continued to be close and productive.
A press conference was arranged for the Director-General during his visit to New Delhi to participate in the celebrations marking the attainment of 11 zero" smallpox status by India. This conference was attended by more than 50 representatives of the national and international press.
Another event which received wide publicity was the Consultative Meeting on the Prevention of Visual Impairment and Blindness, which was held in New Delhi in March,attended by eminent ophthalmologists and representatives of non-governmental organizations, including the President of the Inter- national Agency for the Prevention of Blindness. On the eve of this meeting, a press conference was arranged with the President of the International Agency for the Prevention of Blindness, who also appeared on Indian television in its half-hour "Perspective" programe and was interviewed for the External Services of All India Radio. A panel discussion was arranged vith the national participants for Delhi Television
Because of its alarming increase in South-East Asia, malaria has been making headlines in almost all of the newspapers in the Region, and the Consultative Meeting on Malaria, organized in Nw Delhi in April, was widely covered and many inquiries were received. One of the Assistant Directors-General of WHO, who attended this meeting, was interviewed by SEA/RC29/2 Page 81
the Indian national news agency, Samachar; the record of this interview was widely distributed. The opening of the meeting itself received front- page treatment, several leading newspapers also publishing photographs. AS a follow-up, Reuters , the Los AngeZes Times, the Patriot/Link group, the Hindustan Times, the Indian Express and the Morning Echo were given individual interviews and provided with information. Radio networks which carried programmes on malaria were the American Broadcasting Company, the Voice of America and United Nations Radio.
In addition to the above-mentioned meetings, several radio and television broadcasts were arranged with WHO staff as well as national participants in WHO-organized conferences in New Delhi. Prominent among these was che Regional Director's World Health Day message on the External Services of All India Radio which was, as usual, translated into several regional languages. The Regional Director also broadcast on Delhi Television and was interviewed by the Voice of America. In connexion with WHO'S smallpox eradication activities, the Director-General appeared in a 15-minute interview on Indian Television,and All India Radio recorded a question- answer session with him.
Fi lns
A Regional Office film, "Smallpox - Last-Ditch Struggle in Bangladesh", was completed. The film was extensively used by the smallpox field staff in Bangladesh and India, and was also shown in New York and Geneva.
Another film project on which work was going on related to the training of health workers engaged in the smallpox surveillance activities. Work on this film, which is entitled "Smallpox : India Remains Alert", was almost complete and the first prints were expected soon.
At the suggestion of the Royal Commonwealth Society for the Blind, preliminary details were being worked out for the production of a film on the prevention of nutritional blindness. The Society has offered support for this film project, which will depict the activities of the Nutritional Rehabilitation Centre and Bio-chemical Unit of the Government Erskine Hospital in Madurai, South India.
Films produced by WHO Headquarters continue to be in demand, and a number of them were sold in the Region.
Co-operation with Headquarters
As in the past, material and photographs on health activities in the Region were supplied to Headquarters for publication in periodicals such as WORLD HEALTH and the WHO ChronicZe. Articles appearing in WORLD HEALTH included two on blindness prevention in Burma and in India and one on road accidents in India.
World Health Day
The theme for World Health Day 1976, "Foresight Prevents Blindness", had special relevance to conditions in South-East Asia, where a majority of the SEAfRC29 12 Page 82 world's blind live. The fact that most of this blindness could be prevented or cured created widespread interest in the problem. In connexion with the observance of the day, 7000 English copies of the set of articles prepared by Headquarters were reproduced and distributed; in addition, a Hindi translation was arranged and 1500 sets were distributed. The set was also translated into the national languages of Burma and Indonesia. Thousands of posters and photo charts were distributed.
Three countries - Bangladesh, India and Indonesia - brought out special postage stamps in various denominations depicting the theme of the Day.
Reports received from countries indicated that national leaders, health officials, non-governmental and social welfare organizations, medical practitioners and the general public participated in the observance of the Day. More than 500 press clippings were received from the Indian press alone showing the extent of public interest.
Personal contacts with the general public helped create increased awareness about health problems and WHO'S efforts to collaborate with governments in their solution. Several groups of visitors to World Health House were given talks and shown films explaining the work of WHO.
There was a continuous flow of written requests for information on WHO as well as health matters in general, and these were complied with, as in the past. MAHLER IN SOUTH-EAST ASIA
In Burma. Or Mahlerand Or Gunaratne (flanking WHO Representative. Or Kim. Township medical officer. Or U Kyaw Hla. and Dr U Win Naing and Dr U Sein Win, Deputy Team Leaders of the Health Demonstration Centre) visit the Hfego Township Hospital.
In Sri lanka. Or Mahler greets the Prime Minister, Mrs Bandaranaike.
In ThaBand. Dr Sem Pring Puong Kao. Chairman of the National Haalfh Sub-committee (left) Or Prakorp Tuschinda. Under-Secretary of State for Health (centre) and Or Amorn Nondasuta. Deputy Under-Secretary (right), together with Or Gunaratne. listen attentively to Dr Mahler's address. Students and teachers make enqu,r,=a ,he WHO stand at the Second World Book Fair. New Delhi. January 1976, which was attended by 200 000 visitors.
in a WHO-assisted course for
..,..hvolvement in internation., .L.,V.C,C; : Or Captain Shankarlal. Red Cross Secretary. lectures on the theme of World Health Day. "Foresight prevents blindness", at Churu. Rajasthan. India. PART Ill
ACTIVITIES UNDERTAKEN BY GOVERNMENTS
WITH THE HELP OF WHO SEA/RC29/2 Page 83
PROJECT LIST
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 the first column (under "Project Number, Source of Funds, Co-operating Agencies") "R" means the Regular budget; "UNDP" the United Nations Development 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 parenthesis. In the second column, under the title of the project, the starting and, where relevant, finishing dates are shown within brackets. The projects are listed in accordance with the programme classification.
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 fellowships which do not form part of assistance to a larger project; other fellowships are shown under the projects concerned. SEA/RC29/2 Page 85
1. BANGLADESH
Project Number Source of Funds Co-operating Agencies Title
BAN SHS 001 Organization of Health Services, Planning and Hospital R Administration (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, especially to rural areas.
Assistance provided by WHO during the year. A public health administrator, a medical officer and a secretarial assistant.
Probable duration of assistance. Some years.
Work done during the year. A medical officer (statistician) joined the project in November 1975 and has been advising on the establishment of a division of vital and health statistics in the Ministry of Health and Family Planning. He is also assisting with the setting up of a peripheral administrative network for the collection of vital and health statistical data and in the development of a suitable health information system in the country.
A public health administrator was assigned in May 1976 to advise the Government on the establishment of a sound organization for health planning and to assist with training. Emphasis is being laid on the organization and development of integrated health and family planning services in Bangladesh at all levels to ensure maximum population coverage with improved quality care based on realistic and rational health planning.
BAN SHS 002 Development of Health Services and Training of Auxiliaries* R (Oct. 1972 - )
Aim of the project. To develop further and strengthen integrated health programmes for rural areas (thana health centre, etc.), by planning, implementing and evaluating training and re-orientation programmes for professional staff and auxiliary health and allied workers.
Assistance provided by WHO during the year. (a) A medical officer and an auxiliary health training officer; (b) supplies and equipment.
Probable duration of assistance. A number of years.
Work done during the year. Various categories of auxiliary health personnel have been trained under this project to man sub-centres. Training has so far been given to sanitary inspectors, health inspectors, laboratory technicians, hospital record technicians, dental technicians, family health visitors and family health workers. In-service refresher training courses have been organized for microscopists. Efforts are being made to arrange training and re-training programmes for family welfare
*Previous title: Development of Health Services, Education in Public Health and Training of Medical Assistants SEA/RC29/2 Page 86
workers and to improve the functional role of supervisors. It is hoped to develop rural health services further by organizing training programmes with the help of comprehensive health teams including health educators, sanitarians, nurses and public health nutritionists. The WHO medical officer and the WHO auxiliary training officer continued to assist the Government in these activities.
BAN SHS 005 Health Laboratory Services R (~uly1975; Sept. 1975; Dec. 1975 - April 1976; - )
Aim of the project. To organize a network of public health laboratories throughout the country at district and sub-divisional levels attached to the existing hospitals for both clinical as well as public health, including sanitary laboratory work; also to strengthen further the Institute of Public Health to function as a central laboratory and produce and control the following vaccines: smallpox, TAB and beta-propiolactone inactivated rabies and DPT.
Assistance provided by WHO during the year. (a) A consultant; (b) a nine-month fellowship for study in Sri Lanka and two six-month fellowships for study in India.
Work done during the year. A consultant was assigned to the project from December 1975 to April 1976. During his assignment, a draft long-term plan was evolved for a comprehensive laboratory service under a unified administrative system with the Institute of Public Health as a central laboratory, in addition to four regional laboratories, district hospital laboratories and a network of thana laboratories. Steps were taken to improve the quality of vaccines against rabies, cholera and typhoid, and plans were drawn up for the manufacture of diphtheria and tetanus vaccines. The strengthening of quality control is an integral part of this plan. A system was evolved for the distribution of stains and reagents to thana laboratories.
The training of technicians will be geared to the demands for services required from the laboratories by the different health programmes.
The attainment of these objectives is made difficult because of certain constraints, of which the more important are (a) lack of a unified administrative agency for the laboratories; (b) manpower training is not sufficiently practical and geared to the demands of priority health programes; (c) lack of a career structure, and (d) absence of a system to service peripheral laboratories in regard to materials, technical guidance, supervision and leadership.
A microbiologist is under recruitment for this project.
BAN MCH 001 Development of Family and Child Health Services* R (Jan. 1973; Apr. - Aug. 1973; Oct. 1973 - )
Aim of the protect. To develop maternal and child health services in a phased manner, with special emphasis on the retraining of health personnel in maternal and child care and the training of specialist manpower for maternal and child health work, and to establish a referral system for maternal and child care in support of rural health services.
Assistance provided by WHO during the year. A nine-month fellowship for studies in the United Kingdom, Tanzania, Kenya and India.
Probable duration of assistance. Several years.
Work done during the year. A senior paediatric educator is being assigned to support the second phase of assistance to undergraduate paediatric education and training. This consultant will assist with the teaching programe in paedfatrics in a selected medical college. *Previous title: Family Health SEAlRC2912 Page 87
A senior teacher of child health was awarded a training fellmship to attend the UNICEF/WHO Course for Senior Teachers of Child Health, which started in March 1976.
The activities of this project were closely co-ordinated with those of BAN MCH 003.
BAN MCH 002 Training of Health Personnel in Family Planning UNFP A (March 1975 - )
Aim of the project. To develop and implement a training programe for a new category of multipurpose health worker, tentatively called the family welfare visitor, who will work in rural areas.
Assistance provided by WHO during the year. (a) A nurse-midwife educator; (b) supplies and equipment.
Probable duration of assistance. Until 1979.
Work done during the year. The retraining of lady health visitors and lady family planning visitors as family welfare visitors has been completed. The first group of 168 family welfare visitors completed their education in September 1975 and 161 have been posted. lbenty-eight trainers prepared at the post-basic training school under project BAN HMD 001 are actively engaged in the training of the second group of family welfare visitors. A workshop was organized for principals of the training centres used for the family welfare visitors,and a revision of the curriculum to make it more oriented towards maternal and child health and to give greater emphasis to field practice is under consideration.
Workshops for the trainers of village level workers, family welfare assistants (male) and family planningassistants(female), have been held; the training of the workers has just started.
Aim of the project. To develop the clinical programme in family health in a phased manner with special emphasis on family planning based on maternal and child health.
Assistance provided by WNO during the year. A maternal and child health officer.
Probable duration of assistance. Some years.
Work done during the year. The medical officer in family health continued to provide support to the national authorities in the planning and implementation of the family health programme.
The achievement of milestones was delayed on account of a series of governmental changes which took place during the period under review.
With assistance from Regional Office and field staff, the project document was revised in order to rephase the activities.
The work under this project was closely co-ordinated with those of BAN MCH 001 and other UNFPA-supported projects in Bangladesh. SEA/RC29/2 Page 88
BAN HED 001 Public Health Education R (Nov. 1972 - Feb. 1973; July 1973; Dec. 1973 - Jan. 1974; May 1974; April 1975; June 1975; - )
Aim of the project. To strengthen the Department of Social and Preventive Medicine in the Medical College, Dacca, and start a DPH course at the Institute of Public Health.
Assistance provided bv WHO during the vear. 'Itro twelve-month fellowships for study in India.
BAN HED 002 Health Education R (Jan.-March 1974; - )
Aim of the project. To develop health education, including services, manpower training, studies, methods, materials and media and other components of the programme such as school health and family life education.
Assistance provided by WHO during the vear. Supplies and equipment.
Probable duration of assistance. Until 1978.
BAN HM) 001 Nursing Advisory Services and Training R (Aug. 1972 - )
Aim of the project. To develop the nursing component of national health care delivery services and the programmes in nursing and midwifery essential to the preparation of the necessary nursing personnel.
Assistance provided by WHO during the year. (a) A senior nurse educator and a public health nurse educator and temporary assistance from nurse educators assigned under ICP HMD 001; (b) a ten-month fellwship for study in India: (c) supplies. . and equipment.
Probable duration of assistance. Until 1980.
Work done during the year. Assistance to the post-basic training centre continued. Though not all activities were completed as planned, the centre has made good progress. It has been difficult to admit the scheduled 40 students per year because of the lack of hostel and teaching facilities. Those students who are admitted to the two-year programe continue to do practice teaching at the basic schools of nursing in the country and thus help to strengthen nursing education in these schools. All graduates of the post-basic training centre have been posted and most of them promoted.
Notable progress was made toward getting the training centre recognized by the Government as a permanent autonomous institution. Budgetary provision has been made and the principal has been allowed to advertise for and select students for admission. Also, 13 new posts have been sanctioned. The Bangladesh Nursing Council has reviewed the programe - a preliminary step to the granting of degree status.
Additional accomplishments have been (1) completion of a plan for a new public health nursing programe, (2) preparation of a prospectus for the school, (3) improvement of the students' record system, and (4) recruitment of a local librarian for six months to bring the library into a usable state.
So far 30 trainers of family welfare visitors have been prepared at the college, and 28 of them are actively engaged in this training in centres throughout Bangladesh. SEA/RC29/2 Page 89
Two nurse educators from the inter-country project ICP HMD 001 taught short courses in Bangladesh - one on ward administration and one on surgical patient care.
The senior nurse educator continued to work with the Superintendent of Nursing Services in the Ministry.
In March, a team from the Regional Office visited Dacca on a follow-up evaluation of this project as part of the project formulation and reporting experiment for information systems development.
BAN ESD 001 Strengthening of Epidemiological Services RIUNDP (Aug. 1972; Feb. 1973; July 1973 - Dec. 1974; Aug. 1975; Jan. 1976; - )
Aim of the project. To improve and strengthen the surveillance and control of communicable diseases in the integrated health services.
Assistance provided by WHO during the year. (a) A consultant; (b) a two-week fellowship for study in India; (c) supplies and equipment.
Probable duration of assistance. A number of years.
Work done during the year. A WHO consultant visited Bangladesh from 2 to 11 August 1975 to assist in the development of the epidemiological surveillance programme in the country, with special reference to the assessment of the problem of dengue haemorrhagic fever. On his recommendation, anti-mosquito activities were continued in order to control the density of A. aegypti as a measure against dengue haemorrhagic fever.
A plan of action for the surveillance and control of communicable diseases was concluded.
A WHO epidemiologist is under recruitment for this project.
BAN ESD 002 Epidemiology and Disease Control UNDP (Jan. 1975 - )
Aim of the project. To review, plan and prepare a pragrame for organizing an epidemiological service in the country; to organize the Institute of Epidemiology and Vector Control Research, which will train technical personnel and give consultations on technical matters, and improve che organization of surveillance and control of co-nicable diseases in integrated health services.
Assistance provided by WHO during the year. (a) An epidemiologist and a consultant; (b) supplies and equipment.
Probable duration of assistance. A number of years.
Work done during the year. A WHO consultant-virologist assisted the project from October 1975 to April 1976 in the reorganization of the virological work at the Institute of Epidemiology and Vector Control; the training programme and serological studies also received assistance.
The WHO epidemiologist who had been assisting the prolect since January 1974 completed his assignment in January 1976. At the Institute of Epidemiology and Vector Control, which officially started functioning in January 1975, virological laboratory facilities were developed for the diagnosis of enteroviruses (poliomyelitis) and infectious hepatitis. Animal houses have been developed to support the epidemiological investigation of communicable diseases, and a plan for the epidemiological survey of dengue haemorrhagic fever has been drawn up. SEAlRC29 12 Page 90
A laboratory for serological studies on arboviruses has been organized and a plan for the epidemiological survey of parasitic diseases has been drawn up. Thus, the necessary foundation has been laid for the further development of the Institute.
The project's activities were reviewed with the UNDP Resident Representative, Bangladesh, during his visit to the Regional Office in March. The revised project document is being finalized.
A joint UNDP/WHO mission visited Bangladesh from 15 to 28 July 1975 to discuss this as well as other UNDPIWHO-assisted projects in the country.
BAN MPD 001 Malaria Eradication R (Nov. 1972; July 1973; Sept. 1973 - Jan. 1974; March 1974; Feb.-March 1975; Dec. 1975; - ) Aim of the project. To eradicate malaria from the entire country and to prevent the re-establishment of endemicity.
Assistance provided by WHO durinp. the year. A four-month fellowship for studies in India, Sri Lanka and Thailand.
Probable duration of assistance. Some years.
Work done during the vear. According to the mid-year estimates for 1976, out of a total population of 73.9 million in Bangladesh, 34.7 mlllion are in the pre- maintenance phase, 30.1 million under discovery and treatment of cases, including the consolidation phase, and 9.1 million under extensive mosquito control measures, including the attack phase. A small population - about 17 000 - is covered by drug prophylaxis and drug administration alone. A long-tern malariologist is under recruitment and is expected to be in position by July 1976. It is proposed to provide a team consisting of a public health administrator, a malariologistl epidemiologist, an entomologist and a sanitary engineer towards the end of 1976 to carry out an independent assessment of the malaria situation in the country.
At the national level, there were indications of changed thinking about the approach to eradication, and a possible switch to control strategy is envisaged following the Government's decision to carry out anti-malaria activities through the general health services.
During 1975, training in microscopy was given to 42 new microscopists at the Malaria Eradication Training Centre, Dacca, &nd 126 microscopists in five groups attended an eight-week orientation training course on laboratory techniques at the Paramedical Institute, Dacca. Refresher courses were organized for family welfare woikers and various supervisory pereonnel at district and thana levels. Three officers of the programme are undergoing the one-year DPH course at the Institute of Post-Graduate Medicine, Dacca.
Epidemiological information for 1975 shows that 31 346 slides were found positive for malaria in the examination of 2 921 927 blood smears, giving a slide positivity rate of 1.07% (as compared to 16 846 positives detected out of 1 853 790 examinations resulting in a slide positivity rate of 0.91% during 1974). A marked improvement - 57.6% in slide examinations - over the 1974 leve wss noticed, but the increase in the slide positivity rate indicated a further de Ferioration in the epidemiological situation. The increase in examinations (88.1%) was only from consolidation and maintenance areas; in attack are- the examinations actually fell by 10.7% from the 1974 level. The increase in detected cases in 1975 over the previous year in consolidation and maintenance areas was of the order 382% and that in attack areas was 62%. Considered in this context, there was a serious slip in areas in consolidation and maintenance. P. fakiparum infectiono fell by 7% as a proportion of total positives while in absolute numbers they registered a 67% increase in 1975 over 1974. SEAlRC2912 Page 91
Studies on chlaroquinesensitivity extended to Chittagong Hill Tracts have confirmed the presence of resistant strains of P. faZcipamun at RI and RII levels, with the population at risk being 1.61 million.
Persistent transmission in the eastern parts of the country continues to be a problem, and is believed to be related technically to the presence of A. b. baZabacensis with its outdoor resting and biting habits, and operationally to poor human response, unfavourable socio-economic factors and difficult topographical features.
BAN SME 001 Smallpox Eradication R (March 1972 - )
Aim of the project. To achieve total eradication of smallpox in the country by 1977.
Assistance provided by WHO during the year. (a) Five medical officers, an administrative officer and 117 consultants; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1977.
Work done during the year. The number of cases of smallpox recorded during the year up to 30 June 1976 was 819; the last known case in Bangladesh occurred on 16 October 1975 in Barisal District. Since then three intensive house-to-house searches, supervised by senior staff, have failed to reveal any further cases. During the year, seven house-to-house searches have been conducted. An assessment shows that over 95% of the villages have been searched. Knowledge of the reward of Takas 500 reaches an average of 90"L of all households, the lowest district figure in the countrj being 76%. Pre-search and review meetings, attended by smallpox epidemiologists, have been held at the national, district and thana levels. Sixty specially trained surveillance teams have continued to operate throughout the country. Special attention has been paid to market and school searches.
A search of the Chittagong Nil1 Tracts District was undertaken in February, led by three epidemiologists. Reporting at all levels has been strengthened, and training of epidemiologists and surveillance teams has been organized in Dacca and Camilla.
A new operational guide for smallpox eradication was prepared
Senior staff participated in the inter-country workshop on smallpox surveillance in Kathmandu in January 1976.
WHO assisted the project with personnel, vehicles, motor-cycles, bicycles and boats, as well as petrol, subsistence allowance and payment of reward for the detection of cases.
BAN MBD 003 Mvcobacterial Disease Control R (Jan. 1975 - )
Aim of the project. To develop, organize, implement and assess the surveillance and control of mycobacterial diseases.
Assistance provided by WHO during the year. (a) A leprologist, a medical officer
and a technical officer (laboratom. operations): . .. (b)~ ~ a six-month fellowship for studies in India and Burma; (c) supplies and equipment.
Probable duration of assistance. Until 1983.
Work done during the year. A detailed scheme for the strengthening of the health organization at the district, sub-divisional and thana levels for the control of mycobacterial diseases was prepared. The Government has included this scheme in the National Annual Development Plan and allocated a sum of Tk. 400 000 for the year 1975-1976. SEAIRC29 12 Page 92
A review of the logistics of distribution of BCG vaccine in the country showed that 1.91 million BCG vaccinations had been performed during 1975. This, hnrever, did not provide comprehensive coverage to any geographically delimited area. The BCG vaccination programme is therefore being reorganized, and a comprehensive campaign to vaccinate children under 15 years of age has been started in three urban areas and four rural sub-divisions, to be extended to the entire country in a phased manner.
The leprosy mobile units and clinics treated 22 326 cases during the year. In addition, a leprosy survey is being undertaken in one thana of Dacca District where the prevalence of the disease is estimated to be relatively high. Arrangements for the treatment of the detected cases have been made at the rural dispensaries in the thana.
A programme for tuberculosis/leprosy passive case-finding and case-management has been started in all the thana health centres and rural health centres of the country. The medical officer of the thana health centre will undertake this work, and field personnel such as family welfare workers will advise symptomatic cases encountered by then during home visits, to get themselves examined at the thana health centres and to take the required treatment. The laboratories of the thana health centres are being made fully functional for the microscopic examination of mycobacteria.
The National Tuberculosis Clinic at Shyamoli, Dacca, and the Leprosy Clinic at Mohakhali, Dacca, have been made central teaching institutions for imparting training under this project. Forty-three medical officers, 39 laboratory technicians and 19 BCG technicians haw been given re-orientation training on mycohacterial disease control. Nursing tutors and lady health visitor trainees from the maternal and child health training centres also received training in tuberculosis/leprosy control at these institutions. Concurrent assessment and evaluation of the activities is being built into the progrme. At present, this is limited to the laboratory equipment. The project received equipment and supplies from both WHO and UNICEF. The UNICEF supplies included BCG vaccine, anti-tuberculosis drugs, refrigerators, sterilizers and equipment for vaccination and laboratory work. Several voluntary agencies also participated in the programme. The WHO medical officer (tuberculosis) took up his duties in May 1976, raising the strength of the team to three, the other two being the leprologist and the technical officer (laboratory operations).
BAN VDT 001 Venereal Diseases and Treponematoses Control R (0ct.-Nov. 1972; Feh.-May 1974; Feb. 1975; - )
Aim of the project. To re-organize the programme.
Assistance provided by WHO during the year. Supplies and equipment
BAN SQP 001 Pharmaceutical and Biological Quality Control R (Aug. 1972 - Feb. 1973; Aug.-Sept. 1973; Jan.-April 1974; March 1975 - Jan.1976; - )
Aim of the project. To strengthen drug quality control laboratories at central and zonal level end to train technical 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 1982.
Work done during the year. A consultant was assigned for a period of eleven months to assist in the maintenance of drug-producing machines to facilitate increase in SEAlRC2912 Page 93
production, to advise on the organization and upgrading of the Central Workshop for the repair and maintenance of drug-producing machines and electro-medical equipment, and for providing in-service training; he also assisted in the repair and maintenance of electro-medical equipment at the zonal level and helped in organizing a national seminar-cum-workshop for 16 participants. He assessed the existing situation at the Pharmaceutical Laboratory and the Instrument Repair Workshop of the Central Medical Stores and repaired and recommissioned a number of pieces of equipment. Also, a plan for the expansion of the Pharmaceutical Laboratory and the Instrument Repair Workshop was prepared. He made several recornendations on various aspects of training, on the repair and maintenance of electro-medical equipment and for strengthening and improving pharmaceutical production. His report has been forwarded to the Government.
BAN ISB 001 Production of Rehydration Fluid R (July 1972; Jan.-Sept. 1973; Dec. 1974 - March 1975; July-Aug. 1975; - )
Aim of the project. To develop the resources for the production of intravenous electrolyte solutions at the Institute of Public Health, Dacca, so as to enable the country to become self-sufficient in its day-to-day requirements and self-dependent in meeting emergency situations such as cholera and others.
Assistance provided by WHO during the year. A five-and-a-quarter-month fellowship for studies in Switzerland, United Kingdom and the Federal Republic of Germany, and a one-month fellowship for study in Switzerland.
BAN BSM 001 Connnuni ty Water Supply and Sanitation R (Dec. 1972 - UNICEF Aim of the project. To plan, organize and administer a national environmental health progranane 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 and a sanitarian; (b) supplies and equipment.
Probable duration of assistance. Until 1980.
Work done during the year. The activities of the project, including in-service training, continued in accordance with the work-time schedule. A national survey and evaluation conducted during the year revealed that the majority of wells were well maintained and were being used considerably throughout the villages.
Reorientation training to staff at various levels in the Village Sanitation Division continued to make good progress. Progress was also made in setting up selling centres where concrete squatting slabs and casing for sanitary latrines were being sold on cash payment with nominal subsidy from the Government.
The WHO sanitary engineer, together with the WHO sanitarian, continued to give technical guidance and assistance in providing water supply and sanitation facilities throughout the country, including the setting up of pilot projects for improved maintenance, drawing up of curriculum for school sanitation, etc. They also actively took part in the production of a documentary film on "Community Health" by the Department of Public Health Engineering.
UNICEF continued to provide substantial assistance to the project. SEA/Rc29/2 Page 94
BAN HldP 001 Occuvational Bealth R (0ct.-Nov. 1973; April 1975; April 1976; - ) Aim of the project. To control health hazards in industry.
Assistance provided by WHO during the year. A nine-month fellowship for study in Singapore.
Probable duration of assistance. Until 1983.
BAN HMD 099 Fellowships R
Post-~raduate studies in bone pathology. A twelve-month fellowship for study in the United States of America. SEA/RC29/2 Page 95
Project Number Source of Funds Co-operating Agencies Title
BHU SHS 001 Development of Health Services UNDP (Jan. 1975 - ) UNICEF
Aim of the project. To establish basic health units, provide integrated curative and preventive health services with special emphasis on maternal and child health and the control of tuberculosis, train health manpower for the basic health units, ensure quality control of drinking water, and improve the nutritional state of the population.
Assistance provided by WHO during the year. (a) A public health administrator, a public health nurse educator and a consultant; (b) supplies and equipment.
Probable duration of assistance. Until 1978.
Work done during the year. Assistance continued to be given in the development of basic health services. The project was strengthened with the assignment of a WHO public health administrator, who took up his duties as the team leader in November 1975. The general framework of the Health Training School was drawn up and curricula, training methods and objectives for the different categories of workers such as health assistants, basic health workers and auxiliary nurse midwives, were drawn up in order to start the training formally. The WHO public health nurse educator started the training of auxiliary nurse midwives in March 1976, and six out of the 12 trainees completed the first year of training. The training of health assistants and basic health workers continued to receive assistance. The number of dispensaries in the country, which was 46 at the time of inception of the project, rose to 61; nine of these were converted into basic health units. Assistance was given in establishing a model field practice basic health unit. The recommendations of the project staff on, among other things, the setting up of a National Drug Review Committee to define the drugs to be used by basic health unit staff and on the direction to be given to clinical therapeutic teaching were accepted by the Government. Advice was given on setting up zonal public health laboratories. The WHO public health nurse educator provided general advice on the development of nursing services, especially on encouraging the recruitment of potential Bhutanese professional nurses and the need for a nursing service structure and career pattern. Assistance was provided in the preparation of a draft project document covering the period 1978-1982 for submission to the UNDP.
During August-October 1975, a consultant in the field of nutrition assisted the Government in conducting a SUNey to determine the nutritional profile of children and mothers, the incidence of goitre, organization of health education in nutrition, and integration of nutritional activities in school health and the basic health services. His report has been sent to the Government. SEAlRC2912 Page 97
3. BURMA
Proiect Number Source of Funds Co-operating A~encies Title
BUR SHS 001 Rehabilitation of the Handicapped R (0ct.-Nav. 1969; July 1970; July 1971; 0ct.-Nov. 1971; May 1972; Sept. 1972 - Feb. 1974; May 1974; July 1974; March-April 1975; March 1976 - )
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 consultant; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1976.
Work done during the year. A consultant in occupational therapy was assigned in March 1976 for a period of six months to assist with the training and service aspects of occupational therapy services.
BUR SHS 002 Planning and Strengthening of Health Services R (May-Aug. 1969; Jan.-March 1970; Nov. 1970; May 1972; UNICEF Oct. 1972; Oct. 1973 - March 1978; Aug.-Nov. 1974; Aug.-Sept. 1975; Jan. 1976 - )
Aim of the project. To plan and 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) A consultant; (b) two six-month fellowships for studies in Czechoslovakia, Switzerland (WHO Headquarters) and India, two three-month fellowships for studies in Hong Kong and Singapore, and a three- month fellowship for study in the United Kingdom; (c) supplies and equipment.
Probable duration of assistance. Until the end of 1976.
Work done during the year. A consultant in systems analysis was provided early in January to assist in the country health programming exercise being undertaken by the Government. He gave assistance in the programing phase and in writing the programme proposals, which included outlining the procedures, analytical and computational activities, preparation of formats and scheduling and managing the process of programming and project formulation. Once the programmes evolved have been approved, project formulation is expected to begin. Apart from providing direct assistance in the various project formulation efforts, the consultant was also expected to assist in the organization of a workshop for the orientation of the officers concerned in project formulation efforts.
BUR SHS 003 Maintenance and Repair Workshop for Health Equipment R (Sept. 1971 - Feb. 1975; Nov. 1975; June 1976 - ) UNICEF
Aim of the project. To establish workshops and train staff in the repair and maintenance of equipment used in health institutions. SEA/RC29/2 Page 98
Assistance provided by WHO during the year. (a) A consultant; (b) two twelve-month fellawships for study in the United Kingdom; (c) supplies and equipment.
Work done during the year. A consultant (electro-medical engineer) took up a four- month assignment in June to assist, among other things, in the further development of training of technicians and the phased establishment of workshops for the repair and maintenance of electro-medical equipment.
BUR SHS 004 Hospital Services Management R (Feb,-May 1975; - )
Aim of the project. To promote hospital administration and management, including the planning and development of facilities for the diagnosis, treatment, care and rehabilitation of the sick.
Assistance provided by WHO during the year. Supplies and equipment.
BUR NCH 001 Maternal and Child Health R (June-Aug. 1969; Aug. 1970; 0ct.-Oec. 1970; Oct. 1971; Jan. 1972; March 1972; Aug.1972; Oct.1972; Feb. 1973; Aug. 1973; May 1974; March-April 1975; - )
Aim of the proiect. 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. Supplies and equipment.
BUR MCH 003 Development of Family and Child Health R (June 1975; Aug. 1975; March 1976; - )
Aim of the prolect. To plan, implement and evaluate a family health programme with emphasis on maternal and child health and nutrition activities; to develop staff for the family health programme.
Assistance provided by WHO during the vear. (a) Three three-month fellowehips - one for study in the United Kingdom, one for studies in the United Kingdom and Czechoslovakia and one for studies in the German Democratic Re~ublicand the United Kingdom; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1976.
Work done during the year. Action was completed for the provision of a long-term maternal and child health officer to assist in the development of the new family health programe, which will be based on strategies identified during the country health programming exercise.
The activities under project BUP. NUT 001 were merged with this project during the period under review. This project works in close co-ordination with BUR HW 005, "Education and Training of Health Manpower".
BUR NUT 001 Nutrition Services R (May 1972; Oct. 1972; May-June 1974; Nov. 1974; June 1975; Oct. 1975 - Jan. 1976; - )
Aim of the proiect. To strengthen nutrition activities of the health services by assisting the nutrition unit of the Directorate General of Health in developing models and in its program of in-service orientation courses for medical personnel. SEA/RC29 /2 Page 99
Assistance provided by WHO during the year. (a) A consultant; (b) a six-week fellowship for study in the United Kingdom.
Probable duration of assistance. Until the end of 1976.
Work done during the year. A consultant was assigned in October 1975 for a period of three months to assist in a local training course for township medical and health officers, to develop growth charts for maternal and child health work, to establish new rehabilitation centres and to help evaluate the pilot village nutrition promotion centres.
The consultant took part in the fourth two-week training course organized by the nutrition project, at which he presented two technical papers. In collaboration with the staff of the nutrition project, he assisted in an operational research study, as a result of which nutrition intervention programmes were established in Rangoon and Mandalay Divisions. A growth chart for children was devised for adoption. He also made recommendations for the improvement of the laboratory of the project and for raising its status to that of a reference laboratory for the whole of the country.
The report of the consultant has been forwarded to the Government.
BUR HED 001 Health Education R (Nov. 1966; May 1968; Aug. 1971; Nov. 1971 - Jan. 1972; June-AUK.- 1972; Oct. 1973 - Jan. 1974:. Aua.- 1974 - Jan. 1975; Sept.-Oct. 1975; - )
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; to develop health education manpower and educational materials required for health education services and training programmes.
Assistance provided by WHO during the year. (a) Two three-month fellowships for study in India and an eighteen-month fellowship for study in the United Kingdom; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1976.
BUR HMD 001 Nursing Advisorr Services R (March 1959 - April 1966; June 1969; Oct. 1970 - Jan. 1971; May 1971 - )
Aim of the project. To assist in the development of nursing and midwifery education and services.
Assistance provided bv WHO during the year. (a) A consultant; (b) a twelve-month fellowship for study in India; (c) supplies and equipment.
Probable duration of assistance. Until the end of 1976.
Work done during the year. A nurse consultant was assigned to the project from October 1975 to January 1976 to assist with a short course in neonatal nursing. The course was held in Mandalay from 10 November to 20 December for 20 senior staff nurses from hospitals in Burma. The course covered the comprehensive care of the mature healthy newborn as well as the low-birth weight infant, with particular emphasis on the nursing responsibilities. SEA/RC29/2 Page 100
BUR HMD 003 Institute of Medicine I and School of Preventive UNDP and Tropical Medicine, Rangoon (Feb.1955 - Feb. 1959: Feb. 1961: Sent. 1963: Aue. 1966 , - - Jan.1967; Dec. 1967;-July 1968 hiy 1973; Feb.-June 1975; March 1976; - )
Aim of the Project. To assist the Institute of Medicine I in improving undergraduate teaching and to promote research in post-graduate studies; 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 seven-month fellowship for study in the United Kingdom; (b) supplies and equipment.
BUR HMD 005 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 auxiliary health personnel, and to 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) A project manager, a professor of maternal and child health, an epidemiologist, a nurse educator, three consultants, a secretarial assistant and a clerk-typist; (b) five fellowships - two for six months, one for twelve months, one for two months and one for six weeks - for study in the United Kingdom, and a five-month fellowship £or studies in Malaysia, Singapore, Australia and Hong Kong; (c) supplies and equipment.
Work done during the year. During the period under review three consultants were assigned to this project. Two visiting professors - one in immunohaematology and the other in bacteriology - were assigned during September-December 1975. A visiting professor in imunofluorescence was in position from December 1975 to March 1976. The visiting professor in maternal and child health who had been assisting the project since April 1975, left in November. The reports containing the reconmendations of these consultants were sent to the Government.
Arrangements were completed for the assignment of two visiting professors - in clinical biochemistry and radiology - in July and October 1976, respectively, for two months each. Action was in hand for the provision of a visiting professor in operational research in medical education, as well as to provide assistance in the fields of cytogenetics, human genetics and forensic medicine.
The nurse educator has been very active with group educational activities. These included two six-week courses for lady health visitors and midwives in public health nursing, a two-week workshop for ward sisters in ward teaching and administration, and two two-week courses for midwives and lady health visitors on child growth and development; she also gave assistance with a twoveek course for medical superintendents and matrons and in the planning and implementation of a one-year diploma course for general nursing tutors which began in January 1976.
BUR ESD 001 Strengthening of Health Services (Epidemiology~ UNDP (Feb. :'May 1968; Jan. 1969 - )
Aim of the project. To establish epidemiological units in all the administrative divisions by converting the existing disease-control teams into epidemiological units; to organize epidemiological surveillance of diseases of public health importance in addition to thoae subject to the International Health Regulations; to initiate the planning and implementation of a national immunization programme with the aim of covering the eligible child population with vaccinations against smallpox, tuberculosis, diphtheria, tetanus, pertussis and poliomyelitis, through the basic health services.
Assistance provided by WHO during the year. (a) A consultant; (b) a six-month fell0wShip for studies in Yugoslavia and the United Kingdom; (c) supplies and SEA/RC29/2 Page 101
Probable duration of assistance. Until 1977.
Work done during the year. A WHO consultant assisted the project during August 1975 in organizing and cmducting a course on teaching methods for instructors of laboratory technicians. He also reviewed the training of laboratory technicians in Burma and suggested possible improvements in the methods and syllabi in use in order to make a physical assessment of the facilities and courses.
BUR ESD 002 Prevention, Control and Surveillance of Communicable R Diseases (Feb.- April 1975; Aug.-Nov. 1975; Jan. 1976; - )
Aim of the project. To prevent, control and undertake measures for the surveillance of communicable diseases.
Assistance provided by WHO during the year. (a) Temporary assistance from Regional Office and Headquarters staff; (b) a nine-month fellowship for study in the United Kingdom, two three-month fellowships for studies in the USSR and Iran, five two-week fellowships for studies in Thailand, Indonesia. Singapore and Malaysia, a three- month fellowship for studies in the United Kingdom and Denmark, and an eleven-week fellowship for studies in India, Philippines and Bangladesh; (c) supplies and equipment.
Work done during the year. One of the Regional Advisers on Communicable Diseases visited Bum during Auguat-September 1975 to discuss with the national health authorities the problem of the epidemic of dengue haemorrhagic fever and to suggest possible control measures.
A medical officer from the Virus Diseases Unit at WHO Headquarters visited Burma during Novemher-December to assist in the programme of poliomyelitis vaccination and to review the expanded programme of imunization.
A group of Burmese physicians visited Thailand and Indonesia for two weeks to observe and discuss problems related to dengue haemorrhagic fever.
BUR MPD 001 Malaria Control R (May 1954 - )
Aim of the project. To control malaria in certain areas, with the ultimate goal of malaria eradication from the entire country and to prevent the re-establishment of endemicity.
Assistance provided by WHO during the year. (a) a six-month fellowship for studies in Czechoslovakia, Switzerland (WHO Headquarters) and India, and a four-week fellowship for study in Japan; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1976.
Work done during the year. At the end of June 1976, out of the country's total population of 30.5 million, of which 28.4 million was in malarious areas, 5.0 million was reported to be in areas covered by vigilance activities, including passive case- detection, treatment and remedial measures by the integrated health services, 9.4 million in areas under discovery of cases, including active case-detection, treatment and focal spraying, 6.4 million under mosquito control measures with residual spraying of DDT combined with case-detection, and 7.6 million by drug administration and prophylaxis.
Case-detection activities during 1975 revealed 11 871 malaria positive caaes from a total of 279 910 blood examinations, resulting in a slide positivity rate of 4.2% (compared with 9246 positive cases out of the examination of 285 375 blood smears and with a slide positivity rate of 3.2% during 1974). The 31% increase in the slide SEA/RC29/2 Page 102
positivity rate indicates further deepening of the parasite reservoir in the population; 6069 (51.1%) of the positives were from areas under mosquito control operations, 4752 (40.0%) from areas under active discovery with treatment of cases and 1050 (8.9%) from areas under vigilance. P. fatcipmm infections accounted for 64.5% of the total cases detected as compared with 75.2% during 1974 and a peak (during recent years) of 80.7% during 1973. Further studies undertaken in 1975 of P. faZcipanrm-resistance to chloroquine have confirmed this phenomenon in Thambyuzayat and Myitkyinia areas.
BUR MPD 002 Filariaais Control R (Dec. 1969 Jan. 1970; Julv 1970 Dec. 1972: AUP. 1973: - - , - ' 0ct.-Dec. 1973; Aug. 1974;-0ct.-NOV. 1974; Feb. 1975; Oct. 1975; - ) Aim of the project. To apply filariasis control methods.
Assistance provided bv WHO during the year. A twenty-four wnth fellowship for study in the United Kingdom.
BUR BAC 001 Plaaue Control R (Dec. 1966; June 1970; Sept. 1970; Nov. 1970; Dec. 1971 - March 1972; Feb. 1973; Hay 1974; Aug. 1974)
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.
Assistance provided by WHO during the year. Supplies and equipment.
BUR MBD 001 Leprosy Control R (April. . 1960 - 1 UNICEF
Aim of the project. To intensify the leprosy control programe, to extend it to cover all the endemic areas, and to train personnel.
Assistance provided by WHO during the year. (a) A consultant; (b) two seven-month fellowships for studies in Czechoslovakia, Switzerland (WHO Headquarters) and India; (c) supplies and equipment.
Probable duration of assistance. Until the end of 1976.
Work done during the year. A consultant assisted the project for two months during December 1975 - February 1976 in reviewing and studying the epidemiological picture of leprosy in Burma, and also helped with the conduct of a training programee for leprosy workers. His recommendations were sent to the Government.
Leprosy control in Buwa ia progreasinR satisfactorily and ita integration into the general health services has been under way. This project ia being merged with BUR MBD 003, "Mycobacterial Diseases".
BUR MBD 002 Tuberculosis Control UNDP (Jan. 1964 - ) Aim of the project. To develop community-oriented tuberculosis control servicea.
Assistance provided by WHO during the year. (a) A consultant; (b) two two-and-a- half-week fellowships for studies in the Republic of Korea and India; (c) supplies and equipment. SEA/RC29/2 Page 103
Probable duration of assistance. Until 1978.
Work done during the year. The activities of the project, viz., BCG vaccination, case-finding and treatment, training of medical officers, nurses and health auxiliaries, continued ac the Union Tuberculosis Institute, Rangoon, and the Tuberculosis Centre, Mandalay.
A consultant visited Burma during February-April 1976 and assisted the Government in training the newly established Tuberculosis Assessment Team for the comprehensive assessment of the national tuberculosis programme and to initiate operational research for chemotherapy studies. His report was under study.
BUR MBD 003 Mycobacterial Diseases R (Jan. 1976 - )
Aim of the project. To strengthen the laprosy and tuberculosis control programmes integrated into the general health services.
Assistance provided by WHO during the year. (a) A leprologist and a statistician; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1976.
Work done during the year. This project supports the follow up of the WHO Headquarters-assisted project, "Leprosy/BCG Trial" (IR 0190) in Mandalay, Burma, and is the amalgamation of two projects, "Tuberculosis Control" (BUR MBD 002) and "Leprosy Control" (BUR MBD 001).
In February 1976, when the Director-General and the Regional Director visited Burma, detailed discussions were held with the national health authorities regarding the future of the Headquarters project on leprosy/BCG trial since assistance to the project has since been terminated. The Government, which attaches high priority to the conduct of research on rifampicin, required assistance in the scientific designing and drafting of a protocol for the research proposal, which was provided.
The regular WHO medical officer attached to the project continued to assist the project until the end of 1975 and his assignment was extended for three months to continue the work. The statistician continued to provide assistance.
BUR VIR 001 Trachoma Control R (March 1966:. Se~t.. 1966: May 1967: Nov. 1967: Feb. 1970: UNICEF ~ug.1970; July 1971; ~une-1972;.~ug.1973;.~ov. 1973;' Nov. 1974 - Jan. 1975)
Aim of the project. To continue the trachoma control programme.
Assistance provided by WHO during the year. Supplies and equipment.
BUR CAN 001 Cancer Control R (Nov. 1975; - )
Aim of the project. To train cytopathologists and cytotechnicians, to establish a training centre for the early detection, diagnosis and management of cancer in Rangoon, and to undertake epidemiological investigation and registration of cancer in Butma.
Assistance provided by WHO during the year. A twelve-month fellowship for studies in the United Kingdom and India. SEAIRC29 12 Page 104
BUR DNH 001 Dental Health Services R (Aug.-Oct. 1971; Feb. 1972; Sept. 1974; Jan. 1975; July 1975; Dec. 1975 - )
Aim of the project. To strengthen and expand training facilities for dental auxiliary personnel; plan the gradual expansion of existing and new dental health services,and establish and ensure gradual implementation of progrannoes to provide preventive and curative dental services.
Assistance provided by WHO during the year. (a) A dental tutor; (b) a three-month fellowship for studies in Denmark, Sweden and New Zealand; (c) supplies and equipment.
Probable duration of assistance. Until the end of 1976.
Work done during the year. A WHO dental health tutor joined the project in the last week of December 1975. He acquainted himself with the state of the Dental Nurse School and reviewed the physical and manpower facilities available at the School. He studied the curriculum and emphasized the need for developing a field training area on the outskirts of Rangoon. It was recornended that transport, equipment and medicaments used for preventive purposes in the field training area should be provided.
The dental tutor prepared two working papers for discussion with the authorities: (1) The development of curriculum, and (2) Examples on formulation of educational objectives.
BUR MNH 001 Mental Health Training and Services R (March 1973; July 1973; Oct. 1973; Dec. 1973 - Feb. 1974; Sept.-Oct. 1974; Jan. 1975; July 1975; - )
Aim of the project. To train psychiatrists and health workers in mental health, including the prevention and control of drug abuse; to undertake epidemiological investigations of the problem of drug dependence, and to strengthen facilities for psychiatric services, including rehabilitation.
Assistance provided by WHO durin~the year. (a) A six-month fellowship for study in the United Kingdom; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1976.
BUR RAO 001 Radiation Health R (June 1970: Jan. 1971: Dec. 1971: June-Se~t. 1972: Mav 1973:
Aim of the project. To strengthen the radiation protection services in Rangoon and Mandalay; eetabliah facilities for the training of personnel for radiological services, including physics, and strengthen services in radiation, radiotherapy and nuclear medicine.
Assistance provided by WHO during the year. (a) ltro tvelve-month fellowships for study in the United Kingdom; (b) supplies and equipment.
BUR SQP 001 Quality Control of Biological and Pharmaceutical Products R (July 1973; Sept.-Nov. 1973; July 1975; - )
Aim of the project. To advise on legislation and procedures to control the quality of biological and pharmaceutical preparations.
Assistance provided by WHO during the year. (a) A twelve-month fellowship for study in India; (b) supplies and equipment. SEAIRC29 12 Page 105
BUR SQP 002 Development of Production and Quality Control of R Biological and Pharmaceutical Products (April 1975; - )
Aim of the project. To enact legislation and evolve procedures to control the quality of biological and pharmaceutical preparations, to modernize methods for the production and assay of bacterial and viral vaccines and anti-sera preparations as well as to develop new vaccines.
Assistance provided by WHO during the year. Supplies and equipment.
Probable duration of assistance. A number of years.
Work done during the year. A team of three consultants from Australia is likely to visit Burma in August to assist in the formulation of a project proposal on the development of production and quality control of biological and pharmaceutical products. This proposal will be made available through the national authorities for mobilizing international assistance.
Problems in the production of DPT vaccine at the Burma Phamaceutical Industry (BPI) continue to persist, as the pertussis component does not yet meet the requirements for potency; meanwhile,soluble D, T and combinations of D and T are produced, but the absorbed preventions are in short supply because of shortage of A1(OHI3, which is not available locally.
The programme of work in the Division for Biological Products at the BPI is likely to improve as the Ministry of Health, after defining its policy with regard to the Expanded Imunization Programne, will be in a position to identify its imnediate and long-term requirements of vaccines and place firm orders well in advance. The Division, however, needs a major overhauling of its laboratories before it can undertake this task with the scientific and technical resources that are available and vhich have been built up with WHO assistance over the years. It is with this in view that the Government has been urged to seek material assistance from bilateral sources, and for this purpose the three-man mission mentioned above is expected to visit Rangoon shortly.
BUR ISB 001 Burma Pharmaceutical Industry (Production of Biologicals) R (Feb. 1964; July 1964; Aug. 1968; Feb. 1969; July 1969; UNICEF Feb. 1970:. Seot.1970. - March 1971:. Mav. 1971: Nov.1971: 0ct.-Nov. 1972; 0ct.-Dec. 1973; Aug. 1974; - )
Aim of the project. To assist the Biological Division of the Burma Pharmaceutical Industry, Rangoon, in modernizing methods of production and assaying of bacterial and viral vaccines and anti-sera preparations,as well as in developing new vaccineg.
Assistance provided by WHO during the year. Supplies and equipment.
BUR LAB 001 Strengthening of Laboratory Services R (May-June 1967; April 1968; June 1968; Aug.-Ocr. 1968; UNICEF 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) Tvo six-month fellowships - one for studies in Singapore and India and one for study in the United Kingdom - and a two- week fellowship for study in India; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1976. SEA/RC29/2 Page 106
BUR DHS 001 Vital and Health Statistics R (Dec. 1955 - June 1961; Jan. 1962 - Dec. 1967; April-June 1968; Aug. 1972; Dec. 1973 - March 1974; July 1974; Nov. 1974; May 1975; July 1975; - )
Aim of the protect. 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) A two-month fellowship for study in New Zealand and a nine-month fellowship for study in the United Kingdom; (b) supplies and equipment.
BUR DHS 002 Department of Medical Research R (Jan. 1972; Nov. 1972 - Feb. 1973; May 1974; Oct. 1974 - Jan. 1975; May-Aug. 1975; Peb. 1976; - )
Aim of the project. To strengthen the units of the Department of Medical Research.
Assistance provided by WHO during the year. (a) A consultant; (b) a twelve-month fellowship for studies in Singapore, United Kingdom and Switzerland; (c) supplies and equipment.
Probable duration of assistance. Until the end of 1976.
Wort done during the year. A consultant was assigned during July-Augwt 1975 to review the progress of the study on the physical fitness, growth and development and working capacity of the population and to advise on matters related to growth and nutrition.
The consultant studied the situation of the project, including field teams, pilot testing and project manuals, and the activities undertaken by the project pertaining to data processing and analysis, modifications of testing procedures and testing of anaerobic capacity. Diacwsions were held with the staff of the Department of Medical Research, the Department of Physiology, Institute of Medicine I and advice was given on topics related to research in habitual activity, working capacity and fitness at various ages. He also advised on limiting the scope of the project, phasing the activities and conducting the investigations according to a time schedule.
The report of the consultant was forwarded to the Government.
BUR DHS 003 Development of Health Information Services R (Dec. 1975 - Feb. 1976; - )
Aim of the project. To build co-ordinated health information services.
Assistance provided by WHO during the year. (a) A consultant; (b) a fourteen-month fellowship for study in Australia.
Work done during the year. A consultant assigned during December 1975-February 1976 assisted the Government in the preparation of a document on the national health profile in connexion with country health programming. He also took part in pilot investigations conducted by an operations research group to determine the resources used and output activities achieved in a sample of health establishments. He attended several meetings held in connexion with the country health programming exercise.
The consultant also studied the needs in relation to the development of a national health information system with special relevance to the central level of the health administration. He made some specific recommendations in this regard which, as well as his report, were forwarded to the Government. SEA/RC29/2 Page 107
BUR HWP 001 Occupational Health R (Jan.-April 1975; June 1975; Aug. 1975; Feb. 1976; - )
Aim of the project. To strengthen occupational health services, revise legislation and train personnel.
Assistance provided by WHO during the year. (a) Two fellowships - one for ten months and one for fifteen months - for study in the United Kingdom, and a six-month fellarship for studies in Australia and Singapore; (b) supplies and equipment. SEA/RC29/2 Page 109
4. DEEMCRATIC PEOPLE'S REPUBLIC OF KOBEA
Protect Number Source of Funds Co-operating Title
KRD SHS 001 Strengthening of Medical Care Services R (Jan. 1976; - )
Aim of the project. To strengthen, in general, health services and, in particular, specialized medical care in county hospitals, as well as train health personnel in the planning and administration of hospital services and various medical specialties.
Assistance provided by WHO during the year. Five two-month fellowships for studies in the USSR, Czechoslovakia and the German Democratic Republic.
KRD CAN 001 Cancer Control R (Feb. 1975; Feb. 1976; - )
Aim of the project. To (i) establish a system of registration, (ii) strengthen and train services for early detection, diagnosis and treatment, (iii) strengthen comprehensive cancer prevention and control measures, and (iv) promote epidemiological investigations and stimulate biomedical research in cancer.
Assistance provided by WHO during, the year. (a) Eight three-month fellowships for studies in the USSR and the German Democratic Republic; (b) supplies and equipment.
Probable duration of assistance. Some years.
Work done during the year. Seven senior physicians, surgeons and radiotherapists were awarded WHO fellowships to visit several oncological centres in Europe to observe the latest developments in cancer control activities. Supplies and equipment were provided for the Ontological Institute to strengthen facilities for cancer treatment and research.
KRD CVD 001 Cardiovascular Diseases R (Feb. 1975; Feb. 1976; - )
Aim of the project. To strengthen services for the management of cardiovascular diseases; to organize pilot projects for the prevention and control of rheumatic fever, hypertension, ischaemic heart disease and congenital heart disease; to establish standardized procedures for the laboratory diagnosis of heart disease; to train personnel in cardiology and cardiac surgery, and promote epidemiological investigations and research in cardiovascular diseases.
Assistance provided by WHO during the year. (a) Five two-month fellowships for study in the German Democratic Republic; (b) supplies and equipment.
Probable duration of assistance. Some years.
Work done during the year. A team of experts was awarded WHO fellowships to visit cardiovascular institutes in Europe for observing the latest trends in the management acd control of cardiovascular diseases. SEA/RC29/2 Page 111
5. INDIA
Project Number Source of Funds Co-operating Agencies Title
IND SHS 005 National Institute of Health Administration and R Education (NIHAE) (Se~t.. . 1965 - Mav 1967: March 1968: Dec. 1968 - Jan.1971: Nov. 1971; Jan. 1973 - )
Aim of the project. To assist in the conduct of studies in district health administration as well as in the promotion and planning of comprehensive health care services at the district level; to formulate research and teaching programmes pertaining to health administration, and to undertake teaching programmes, studies and research in the field of hospital administration.
Assistance provided by WHO during the year. A public health officer.
Probable duration of assistance. Until 1977.
Work done during the year. Assistance was provided in the conduct of an orientation training course-cureworkshop for State-level officers held at the Institute for 25 participants. The report on the WHO-assisted Research Project in District Health Administration (Rohtak) was finalized. Another research project entitled, "The Study of Multi-purpose Health Workers Strategy", developed jointly by the National Institute of Health Administration and Education, WHO and UNICEF, was approved and its implementation started in the States of Uttar Pradesh, Andhra Pradesh and Maharashtra. The organizational efforts made, and problems in the operation of the Multi-purpose Health Workers Scheme in the State of Uttar Pradesh, were assessed and a preliminary report on the training activities and the ancillary question of health and family planning training centres was prepared. Assistance was given in the conduct of meetings of representatives of Central Training Institutes and States to review the implementation of the Multi-purpose Health Workers Scheme.
IND SHS 006 Nursing in Clinical Specialties* R
IND SHS 006.4 Nursing in Clinical Specialties, Karnataka R (Jan. 1973 - )
Aim of the project. To improve clinical practice in selected specialties.
Assistance provided by WHO durin~the year. (a) A psychiatric nurse educator; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1977.
Work done during the year. The revised eleven-month course for the Diploma in Psychiatric Nursing comenced on 1 January 1976 with an enrolment of 26 students Eighteen out of 23 students of the 1975 class completed the old course and were awarded diplomas.
*The project started in January 1972 and is expected to continue for a number of years. During the period under review, a twelve-month fellowship was awarded for study in Australia. SEAIRC29 12 Page 112
The sixth in-service course for nurses and attendants started in February under the direction of the national counterpart.
A questionnaire distributed to all basic schools of nursing in India revealed an acute shortage of psychiatric nurse tutors and pointed up the need for guidelines on teaching mental health concepts and psychiatric nursing in the basic curriculum.
A workshop for nursing superintendents and a short course for nurse tutors and supervisors are planned for the latter part of 1976.
IND SHS 006.5 Nursing in Clinical Specialties, Maharashtra R (Jan.-March 1973; Nov.-Dec. 1973; May 1975 - )
Aim of the project. To improve clinical practice in selected specialties.
Assistance provided by WHO during the year. A consultant.
Probable duration of assistance. Until the end of 1977.
Work done during the year. A consultant assigned to KEM Hospital, Bombay, from May to September 1975 assisted initially in paediatric nursing care. An in-service education programme was conducted for nursing sisters and staff nurses. A guide was prepared on nursing care for acutely ill children on the respirator. The WHO nurse educator and national staff prepared a syllabus for a three-month course in paediatric nursing to serve as a basis for continuing education.
IND SHS 006.6 Nursing in Clinical Specialties, Pondicherry R (Jan. 1974 - )
Aim of the project. To improve clinical practice in selected specialties.
Assistance provided by WHO during the year. A maternal and child health nurse educator and a consultant.
Probable duration of assistance. Until the end of 1977.
Work done duriny: the year. The third refresher course in paediatric nursing was conducted from October 1975 to 31 January 1976. The fourth course commenced in May 1976 and the fifth is to be held later in the year. Improvements made in ward administration and nursing procedures have produced notable results in the quality of patient care and reduction of cross-infection in paediatric wards and the premature nursery. Further impetus was given to the development of an educational programme for mothers.
The "Guide for Care of the Low Birth-weight Infant" continues to be in demand and a revised edition is in preparation.
A consultant in orthopaedic nursing conducted two courses for nurses from orthopaedic wards of JIPMER hospital. Work is in progress on a "Guide to the Care of Orthopaedic Patients in Developing Countries". The same consultant is expected to take up a six- month assignment in September 1976 to work on this publication and to conduct courses in Pondicherry and Lucknw.
IND SHS 007 Development of Community Health Nursing Services R (April 1975 - )
Aim of the project. To strengthen the provision of and development of patterns of public health nursing services in selected States in India. SEAlRC29 12 Page 113
Assistance provided by WHO during the year. (a) Two public health nurse educators; (b) a six-month fellowship for studies in the Philippines and Malaysia; (c) supplies and equipment.
Probable duration of assistance. Until the end of 1977.
Work done during the year. The two areas selected for the operation of activities under this project are the States of Maharashtra and West Bengal.
Maharashtra
The WHO public health nurse assigned to Maharashtra from April 1975 made extensive visits covering all levels of health services in the State along with national counterparts. A plan of action with major milestones was drafted, with five districts of Aurangabad Division selected as the initial base of operations. One primary health centre was designated as a demonstration area in which the multi- purpose worker programe has been implemented.
A preliminary analysis of staffing patterns and logistics has been useful in pinpointing major needs and problems. Progress was made in delineating the requirements of a sub-centre, including lists of equipment and supplies.
The development of in-service training for auxiliary nurse-midwives and public health nurses is a major feature of the project.
West BengaZ
The WHO public health nurse assigned to West Bengal took up her duties in February 1976 and undertook field visits to several health centres in order to study the organization of services and select a base of operations. Consultations were held with nurses and officials of other health agencies, the College of Nursing and other training institutions. A plan of action with milestones was drafted and the first phase is gradually heing implemented. Initial delays resulted from lack of transport, but a vehicle has now been provided. Selection of a national counterpart is awaited.
IND MCH 001 Strengthening of Departments of Paediatrics, Obstetrics and R Preventive and Social Medicine in Indian Medical Colleges UNICEF (Aug. 1958 - )
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) A consultant; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1977.
Work done durin~the year. The title of this project is being changed to "Strengthening of Maternal and Child Health Services" and a new plan of operation developed to reflect the new emphasis which nw focuses on the development and pre-testing of curricula for teaching maternal and child health as a unified subject at undergraduate level in medical schools. At the same time, a handbook on maternal and child health is being written as a companion volume to the curriculum.
The remodelled paediatric curriculum developed under this project in previous years is now being implemented in two selected medical colleges and is being propagated within the country by means of intra-country fellowships given to visiting professors of paediatrics from other teaching centres. SEA/RC29/2 Page 114
The Ad Boo Committee on Maternal and Child Health Education met in March 1976 for the preparation and pre-testing of the maternal and child health curriculum, which will continue through the coming twelve months and will be evaluated in 1977.
IND MCH 002 Integration of Maternal and Child Health Services, UNFPA including Family Planning, into the General Health Services (May 1971 - )
Aim of the project. To integrate family health services through strengthening in-service training, service, delivery and operational research.
Assistance provided bv WHO during the year. Supplies and equipment.
IND HRP 001 Strengthening of the Teaching of Human Reproduction, UNFPA Family Planning and Population Dynamics in Medical Colleges ?~a~-~ept.1971; Dec. 1971; April 1973 - ) Aim of the project. To strengthen the service, teaching and research functions of the departments involved in the teaching of human reproduction, family planning and population dynamics in medical colleges.
Assistance provided by WHO during the year. Supplies and equipment.
Probable duration of assistance. Until the end of 1976.
IND NUT 001 Applied Nutrition Programne R (Oct. 1964 - ) UNICEF (FAD)
Aim of the project. To improve the health component of the Applied Nutrition Programme assisted by FA0 and UNICEF.
Assistance provided by WHO during the year. (a) Three three-month fellowships - one for studies in Malaysia, Philippines, Japan and Thailend, and two for studies in Thailand and the Philippines; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1977.
IND NUT 003 Nutrition Training R (Dec. 1970; May 1971; July-Sept. 1973; Jan.-Feb. 1974; Sept. 1974; Dec. 1974 - Jan. 1975; - )
Aim of the protect. To support nutrition courses conducted at the National Institute of Nutrition, Hyderabad; to train the teaching staff of the National Ipstitute of Nutrition, Hyderabad, in particular, and other institutions in general.
Assistance provided by WHO during the year. (a) Two guest lecturers; (b) supplies and equipment .
Probable duration of assistance. Until the end of 1977.
Work done during the year. Two guest lecturers assisted the National Institute of Nutrition, Hyderabad, for a period of two weeks each in January 1976. The lecturers, who assisted vlth the certificate and degree courses being conducted at the Institute, made recommendations for further improvement. SEA/RC29/2 Page 115
IND RED 001 Training in Health Education R (Sept. 1968; June 1969; April 1970; July 1970; Nov. 1970; April-Hav 1971; Aug. 1971; Nov.-Dec. 1971; Dec. 1972 - arch 19j3; Dec. 1973 - March 1974; Hay-June 1974; Aug. 1974; Oct. 1974; Feb. 1975; April 1976; - )
Aim of the project. To establish and develop three post-graduate health education training centres with rural and urban field practice areaa.
Assistance provided by WHO during the year. A twelve-week fellowship for studies in Thailand, Yugoslavia and the United Kingdom.
Probable duration of assistance. Until the end of 1977.
IND HED 002 Central Health Education Bureau R (Hav 1969; March 1971; June 1973; Jan. 1974; oct. 1974 - Feb. 1975; Sept.1975; - )
Aim of the proiecc. To assist the Central Health Education Bureau in strengthening various aspects of its work.
Assistance provided by WHO during the year. lko six-week fellowships for studies in the United Kingdom, Switzerland and Thailand.
IND HED 003 Health Education: Assistance to States UNDP (Oct. 1971 - Jan. 1972; July 1972; Aug.-Nov. 1972; Jan. 1973; March 1973; July 1973; Aug. 1974 - )
Aim of the project. To establish and develop Srate Health Education Bureaux; to integrate and co-ordinate health education activities of the general health services further with those of the family planning programme at different levels of the health administration, and to develop health education in primary and secondary schools and teachers colleges.
Assistance provided by WHO during the vear. Two health education specialists and two consultants.
Probable duration of assistance. Until the end of 1977.
Work done during the year. Assistance has been given to the Central Health Education Bureau in strengthening its services as well as to the Health Education Bureaux in the States and Union Territories to meet the health education needs of their respective areas. In this connexion, the development of field study and demonstration projects in many of the States, health education programmes in hospitals, and the initial efforts to develop health education teaching programes in medical schools and nursing schools,are significant.
During the year, two consultants were assigned - one each to the State Health Education Bureaux of Orissa and Jammu and Kashmir. They helped the respective State bureaux to review the health education services in the State and to expand or strengthen them. The work of these consultants is being followed.up by one of the long-term health education specialists assigned to the Central Health Education Bureau.
The other long-term health education specialist assisted the Central Health Education Bureau largely in the area of school health education. This year health education had been made a compulsory subject for grades IX and X by the Central Board of Secondary Education, and the Central Health Education Bureau was entrusted with the responsibility of preparing a suitable textbook for the purpose. The health education specialist assisted the Bureau in this task as well as in the preparation of other learning resource material. In addition, a teachers' guide is being planned for completion next year. SEA/RC29/2 Page 116
IND HMD 001 Medical Education R (Dec. 1958 - Sept. 1961; Nov.-Dec. 1965; Aug. 1966 - )
Aim of the project. To assist medical colleges in developing a curriculum based on educational objectives and in improving student evaluation; to assist with research methods and to train national staff in various medical and public health fields.
Assistance provided by WHO during the year. An eleven-month fellowship for studies in the Philippines and the United States of America, an eleven-month fellowship for studies in the Philippines. Thailand and Malavsia. a two-week fellows hi^ for studies in the United States'bf ~mericaand the unite2 ~i&dom, a four-month feilowship for study in the United States of America and a six-month fellowship for study in the United Kingdom.
Probable duration of assistance. Until the end of 1977.
IND HMD 002 Post-basic Nursing Education: Assistance to States*
IND HMD 002.1 Post-basic Nursing Education, Uttar Pradesh K (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 nurse educator.
Probable duration of assistance. Until the end of 1977.
Work done during the year. The WHO nurse educator assigned to the College of Nursing, Kanpur University, left in December 1975.
Assistance to this College started in April 1972, with the first graduates receiving their degrees in May 1975. Although faced with innumerable obstacles in the beginning, the College has been established on a sound academic basis in affiliation with Kanpur University under the Faculty of Medicine. Administrative and financial control is exercised by the Ministry of Health and Family Planning, but the College is an autonomous institution with its own budget, building and a Board of Nursing Studies.
Although national staff have now assumed full responsibility for the teaching programme and administration of the College, a short-term consultant will be assigned from September 1976 to assist in the further development of the medical- surgical component of the curriculum.
IND HMD 002.4 Post-basic Nursing Education, Karnataka R (July 1973 - Jan. 1974; Jan. 1975 - )
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) A nurse educator; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1977.
*This project started in January 1962 and is expected to continue until the end of 1977. During the period under review, a ten-month fellowship was awarded for study in the United States of America. SEA/RC29/2 Page 117
Work done during the year. Assistance was given on a comprehensive basis for the continuous development of the College of Nursing, Bangalore. This included curricula revisions, a staff development programme for faculty, student health, welfare and recreational programmes, improvements in the library and acquisition of teachinp aids and equipment.
The re-structured,post-basic degree curriculum was approved and the first class of students admitted in January 1976.
In May 1976, the College hosted a workshop for nurse tutors from colleges of South India, in collaboration with the WHO nurse educator from the Rajkumari Amrit Kaur College of Nursing, New Delhi.
IND HMD 002.7 Post-basic Nursing Education, New Delhi R (Nov. 1969 - )
Aim of the project. To expand post-basic nursing education, with initial emphasis on past-basic degree programmes usually offering professional specialization in teachingsadministration, public health or one oE the clinical specialties.
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. This project is the first of its kind in the Region and it differs from other post-basic nursing education projects in that its focus is on continuing education for nurses on a country-wide basis. Based at the Rajkumari Amrit Kaur College of Nursing in New Delhi, the programme has been developed in close collaboration with the Nursing Adviser in the Directorate General of Health Services, Ministry of Health and Family Planning.
From November 1975 through March 1976, a total of 12 courses was held, involving 185 participants representing 12 hospitals and 3 educational/research institutions. In May 1976 the first workshop to be held outside Delhi under this project was hosted by Karnataka State at the College of Nursing, Bangalore.
Topics selected far the courses were determined from a survey of nurses to identify their learning needs, and have covered a wide range of subjects, including teaching methods, administration, family planning, psychiatric nursing and other clinical subjects. Evaluation is a built-in feature of each course, utilizing a variety of methods, including informal voluntary feed-back from participants. There is growing evidence of the programme influencing action for improvement of the quality of nursing services.
The enthusiasm and hard work of the national counterpart and other faculty members has been a major contributory factor to the success of the project. The national counterpart attended the WHO inter-country workshop on Educational Technology held in Sri Lanka in March 1976 under project ICP HMD 001.
The project has received international attention, with the WHO nurse educator being invited to present a paper at a National Conference on Continuing Nursing Education to be held in the United States of America in October 1976.
IND HMD 005 Physical Therapy School, Baroda R (May 1968; March 1969; April 1972; July 1972 - )
Aim of the project. To train physiotherapists to degree standard, "Bachelor of Science (Physiotherapy)", at the Physical Therapy School in S.S.G. Hospital, Baroda, over a three-year period. SEA/KC29/2 Page 118
Assistance provided bv WHO during the year. (a) A physiotherapy tutor; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1976.
Work done during the year. The annual examinations for first, second and third-year physiotherapy students were completed.
Suggestions were made for improving the results of the examinations. The physiotherapy tutor completed her 21gyear assignment with the project at the end of December 1975. Throughout this period she assisted in the training and teaching programme of physiotherapists. The assignment report of the tutor was reviewed in the Regional Office and submitted to the Government.
IND HMD 006 Training Program for Medical Officers and Trainers R of Basic Health Workers l an. 1974 - )
Aim of the project. To strengthen the rural health services by training health staff, particularly doctors and trainers of basic health workers, auxiliary nurse- midwives, health assistants (F.P.) and other monovalent health workers to be converted into multi-purpose health workers.
Assistance provided by WHO during the year. A public health officer and a public health nurse.
Probable duration of assistance. Until 1979
Work done during the year. The WHO public health officer visited the USSR from 14 June to 9 July 1975 as WHO Director of the Travelling Seminar on the Training and Utilization of Medical Assistants, which was attended by 17 participants representing six WHO Regions. The project staff served as a resource group for the Orientation Training-cum-Workshop for State-level officers held at the National Institute of Health Administration and Education, New Delhi, from 21 to 26 July 1975 and attended by 25 participants from various States. Assistance was provided in drawing up an agenda for the Annual Conference of Directors of Central Training Institutes and Administrators.
The WHO public health officer delivered lectures to the participants in the course for district-level medical officers from Punjab, Gujarat and Himachal Pradesh, held at the Rural Health Training Centre, Najafgarh, in October, and to those in the course for trainers of health and family planning training centres from Bihar, held at the Central Health Education Bureau, New Delhi,in October/November. His other activities included participation in a lecture discussion on "curriculum development" during the All-India Workshop for Nursing Officers of State Health Directorates, held in New Delhi from 1 to 6 December, and in the National Hospital Convention, which took place in Bombay from 14 to 17 December. In addition, he assisted in the conduct of the Inter-country Seminar on Medical Assistants held in the Regional Office in February 1976. The WHO senior public health nurse presented a paper on "the Role of Nursing/Midwifery Personnel in Immunization" at the second Regional Seminar on Epidemiological Surveillance of Communicable Diseases (Immunization Programmes), held in the Regional Office in Noveder.
Financial assistance was given to the Government for the printing of manuals for health workers, their supervisors and medical officers of primary health centres, and for their pre-testing. Also, a grant was given to cover the stipends of trainees and for the holding of the Annual Conference of Directors of Central Training Institutes and Administrators.
Work on editing the Work Manual for the Health Worker (Male) was completed and the manuscript was given to the printer at the end of March; progress has also been SEA/RC29/2 Page 119
made with the drafting of the Work Manual for the Health Worker (Female). The lists of drugs to be included in the kits carried by health workers and health assistants and the drugs to be made available at the sub-centres were compiled and were awaiting government approval. In accordance with the Government's policy, selected druga used in the traditional systems of medicine will also be included.
The project staff were actively involved in the organization of the meeting of Directors of Central Training Institutes and State-level administrators, held under the Multi-purpose Health Workers Scheme, which took place in March.
The plan of operation of the project was signed in February 1976 by both the Governwnt of India and WHO.
IND HMD 007 Research in Nursing R (June 1975; June 1976 - )
Aim of the protect. TO assist colleges of nursing and institutions in the design and conduct of operational/action studies in the broad areas of nursing education and clinical nursing practice, including community health nursing, and to conduct workshopslseminars on nursing methods for the faculties of various colleges of nursing and senior nurses working in clinical areas of community health centres.
Assistance provided by WHO during the year. (a) A nurse researcher; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1977.
Work done during the vear. The WHO nurse researcher assumed her duties in June 1976 at the Rajkumari Amrit Kaur College of Nursing, New Delhi, the base of operations.
IND HMD 008 Seminars and Workshops on Medical Education R (Dec. 1965 - May 1966; Jan. 1967 - )
Aim of the project. To strengthen medical teaching further.
Assistance provided by WHO durinE the year. Two consultants.
Probable duration of assistance. Until the end of 1976.
Work done during the year. A national seminar on epilepsy for teachers of medical colleges in India, organized by the Regional Office in collaboration with the Indian Academy of Medical Sciences, was held in Bangalore from 19 to 23 July 1975. The seminar, which reviewed various aspects of epilepsy, including the sociological and cormunity aspects with special reference to the social customs prevailing in the country, was attended by 26 participants. Two consultants and one of the Regional Advisers on Health Manpower Development, together with four national advisers, assisted in the conduct of the seminar. The report on the seminar has been issued.
At the request of the Government of India, it was decided to hold, in November 1976,a national seminar on paediatric surgery at the All-India Institute of Medical Sciences, New Delhi, in collaboration with the Indian Academy of Medical Sciences. The necessary arrangements were under way.
IND HMD 009 Training of Medical Educators UNDP (May 1968; July 1968; Sept. 1968; Nov. 1971; Dec. 1971; Sept. 1972; Jan. 1973; May 1973; Dec. 1975; - )
Aim of the project. To provide further training to national medical educators.
Assistance provided by WHO during the year. A six-and-a-half-month fellowship for studies in the United Kingdom, United States oE America and Japan. SEA/RC29/2 Page 120
IND HMD 010 Strengthening of the Teaching of Human Reproduction, UNFPA Population Dynamics and Family Planning in Nursing and Midwifery Education (March 1972 - Jan. 1973; March 1973 - Jan. 1974; June 1974 - Feh. 1975; - )
Aim of the proiect. To improve the maternal and child health and family planning components of auxiliary nurse-midwife training and to strengthen the domiciliary midwifery 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. Supplies and equipment.
IND ESD 001 National Institute of Communicable Diseases R (Feb. 1972; Sept.-Dec. 1972; - )
Aim of the project. To assist the National Institute of Comunicable Diseases in the conduct of the Inter-regional Training Course in the Epidemiology and Control of Communicable Diseases, held partly in Prague and partly in Delhi; to assist the Institute in strengthening its faculty in order to improve further the field training of epidemiologists.
Assistance provided by WHO during the year. Grant.
Probable duration of assistance. Until the end of 1983.
Work done during the year. A grant-in-aid of $2000 is being provided to the Institute for the period November 1975 - October 1976. A memorandum of agreement between WHO and the Government of India was concluded in February 1976.
The Delhi part of the Eleventh WHO Inter-regional Training Course in the Epidemiology and Control of Communicable Diseases (Prague-Delhi) was organized at the Institute from 8 December 1975 to 20 February 1976, attended by eight participants - five from Burma and three from India. One of the Reeional Advisers on Communicable Diseases supervised the completion of questionnaires by the participants.
IND ESD 002 Strengthening of Health Services (Epidemiology) UNDP (March 1963 - )
Aim of the project. 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 Communicable Diseases (NICD) , Delhi.
Assistance provided by WHO during the year. A six-month fellowship for studies in Czechoslovakia, Switzerland (WHO Headquarters) and India, and a ten-month fellowship for studies in Czechoslovakia, Switzerland (WHO Headquarters), India, Burma,Thailand and Sri Lanka.
Probable duration of assistance. Until the end of 1976.
IND MPD 001 Malaria Eradication R (Aug. 1958 - )
Aim of the project. Effective control of malaria to protect areas of economic and health priority,prevention of mortality, and eventual eradication from the entire country.
Assistance provided by WHO during the year. (a) Supplies and equipment; (b) subsidy. SEAIRCBI2 Page 121
Probable duration of assistance. Some years.
Work done during the year. According to the programme phasing, based on the mid- year population estimates for 1976, a population of 355 million is living in maintenance areas, 90 million in consolidation areas and 144 million in attack areas, out of a total 589 million at malaria risk; a population of 30 million lives in malaria-free areas.
The revised figures on the incidence of malaria for the years 1972, 1973 and 1974, made available by the NMEP Directorate, are interesting: the number of cases detected during these years were, respectively, 1 430 025, 1 934 485 and 3 172 866, sharing an increasing discrepancy ranging from 5 to 27 per cent between the revised and provisional figures through these years. The slide positivity rate of 9.59% resulting from the detection of 3 944 349 (provisional) positive cases during 1975 out of 41.14 million blood examinations has been found to have registered an increase of 37.4% over the rate during 1974 and 110.3% over that during 1973. The provisional rate of annual parasite incidence for 1975 (6.7811000) shows an increase of 21.3% over that for 1974 (5.5911000). These increases are expected to register a further upward rise when the final figure on malaria incidence for 1975, which is expected to be nearly five million, is available. The total (provisional) incidence in 1975 increased by 24.3% over that in 1974, the respective increases in the attack, consolidation and maintenance phase areas being 12.2%. 19.0% and 56.7%. The P. falcipamun and mixed infections during 1975 accounted for 12.9% of the total incidence.
During January 1976, 81 362 malaria positives were recorded as compared to 63 287 during the corresponding month in 1974, showing an increase of 28.6%.
The 28 towns under the urban malaria scheme recorded, during 1975, a total of 203 801 malaria positives as against 109 718 recorded during 1974, registering an increase of 85.8%. In view of the deteriorating malaria situation, assistance for the procurement of anti-malaria drugs was provided from savings resulting from the sucrender of fellowships totalling nearly $132 000.
IND MPD 002 Filaria Control R (July 1975; - )
Aim of the project. To train senior medical and paramedical staff in methods of controlling filariasis .
Assistance provided by WHO during the year. Supplies and equipment.
IND SME 001 Smallpox Eradication R (Oct. 1967 - )
Aim of the project. To achieve total eradication of smallpox in the country by 1977.
Assistance provided by WHO during the year. (a) Ten medical officers, an operations officer, two administrative officers and 79 consultants; (b) supplies and equipment.
Probable duration of assistance. Until 1977.
Work done during the year. No smallpox cases were recorded in India this year. At least three regular house-by-house searches were carried out in all States of India, and in the previously endemic States, the number of searches reached as many as eight. Special searches were conducted in the major municipalities and in remote and border areas. First searches of Sikkim, Andaman and Nicobar and Lakshwadeep islands were conducted.
In between house-by-house searches, secondary surveillance, especially market and school searches, was developed. Pre-search and review meetings were held at regional, State, district, municipal and primary health centre levels, as many as possible being attended by epidemiologists.
Three all-India review meetings were held in the Regional Office. In all searches, an assessment of the search and of the effect of publicity of the reward for reporting cases was made.
Senior project staff took part in the inter-country workshop on smallpox surveillance held in Kathmandu.
Weekly reporting of smallpox and monthly reporting of fever rash cases was strengthened at all levels.
A new operational guide was prepared and distributed to all primary health centres, districts and municipalities. Training in all aspects of smallpox eradication was given at all levels, including surveillance team. Intensive investigations were carried out in respect of suspicious cases and deaths from chickenpox.
IND BAC 001 Production of Diphtheria, Pertussis and Tetanus R Vaccine, Kasauli UNICEF (Jan.-March 1961; Sept. 1961; March 1965; Dec. 1966; Aug. 1967; 0ct.-Nov. 1968; May-June 1970; Sept.1970; Nov.-Dec. 1970; April-May 1976; - )
Aim of the project. To fallow up on the WHO-assisted capacity developed at the Central Research Institute, Kasauli, for the production of DPT vaccine and its individual components.
Assistance provided by WHO during the year. Two consultants.
Work done during the year. International assistance to the Central Research Institute, Kasauli, was reactivated at the request of the Government to enable this laboratory to step up its installed capacity from its present level of 6.5 million to 20 million doses of DPT vaccine initially by 1978-1979 and 40 million doses by the end of 1981, subject to further assistance from UNICEF.
To this effect UNICEF is procuring heavy equipment of the semi-industrial type from the Netherlands as recommended by WHO; this equipment is scheduled to be installed in the remodelled premises of the Institute by mid-1977.
According to the action plan that has been elaborated, the Government is taking steps to put up a new building for containers, to complete the remodelling of the TP and DTP laboratories, to step up the capacity of the main services and connect these to the new blocks. WHO provided the technical and engineering experience of two consultants for about ten days in April-May 1976 to finalize "in site" plans and drawings of the semi-industrial vaccine plant at Kasauli.
Two fellows - one from the Haffkine Institute, Bombay (which also has plans to expand its production of DPT) and the other from Kasauli - proceeded to the Netherlands for training in vaccine technology.
IND MBD 001 Leprosy Control (National Pro~ramne) 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. SEA/RC29/2 Page 123
Assistance provided by WHO during the year. Two seven-month fellowships - one for studies in Czechoslovakia, Switzerland (WHO Headquarters), India, Burma, Thailand and Malaysia, and one for studies in Burma, Thailand, Indonesia, Philippines and Hong Kong.
Probable duration of assistance. Until the end of 1983.
Work done during the year. The Government has decided to launch an intensified programme for the control of leprosy. In this connexion, the Chief of the Leprosy Unit from WHO Headquarters visited New Delhi from 10 to 21 November 1975 and held discussions with officials of the Government of India as well as Regional Office staff concerning plans for future assistance to the programme.
IND MBD 002 Tuberculosis Chemotherapy Centre, Madras UNDP (Dec. 1955 - )
Aim of the protect. 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.
Probable duration of assistance. Until the end of 1976.
Work done during the year. The Centre continued clinical studies on various regimens of streptomycin and isoniazid and imparted training in tuberculosis control to medical and paramedical personnel. Several reports concerning the studies under- taken at the Centre were prepared for publication in Tubercle (see also IND MBD 004).
IND MBD 003 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 assessing the program.
Assistance provided by WHO during the year. A three-month fellowship for studies in the United Kingdom, Denmark, Norway, Czechoslovakia, USSR, Burma and Thailand.
Probable duration of assistance. Until the end of 1976.
Work done during the year. The tuberculosis control activities in the country, including bacteriological, radiological and sputum examinations, continued as planned.
A medical officer from the Tuberculosis Unit at WHO Headquarters visited the Tuberculosis Prevention Trial, Madras, during September-November 1975 and again in January-February 1976.
IND MBD 004 Tuberculosis Research Centre, Madras R (Jan. 1975; March 1975; - )
Aim of the project. To carry out research on tuberculosis.
Assistance provided by WHO during the year. (a) A consultant; (b) supplies and equipment. SEA/RC29/2 Page 124
Probable duration of assistance. Until the end of 1976.
Work done during the year. A WHO consultant assigned to the Centre from 7 to 30 January 1976 reviewed the progress of current studies, considered future studies and assessed the developments in the compound of the Centre in so far as they relate to its future working. He also studied the present publications policy of the Centre and suggested ways and means of improving it further.
A donation of rifampicin and streptomycin to the Centre by the British Medical Research Council was being arranged,
IND VIR 001 Virological Techniques R (Sept. 1968; Nov. 1969; Aug. 1971; act.-Nov. 1972; July-Aug. 1973; Oct. 1973; March 1974; Aug.-Oct. 1974; Feb.-March 1975; March 1976; - )
Aim of the proiect. To develop the laboratory capacity for the diagnosis and surveillance of virus diseases; to establish competence in the production and testing of live poliomyelitis vaccine and its neurovirulence testing at the National Institute of Comunicable Diseases, Delhi.
Assistance provided by WHO during the year. (a) A six-month fellowship for study in the United Kingdom; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1983.
IND WH 001 Training in Veterinary Public Health R (Aug. 1969; March 1970; May-July 1971; Oct. 1972; March 1973; June 1973; Sept. 1973: Feb. 1974: July 1974: Sept.-Oct. 1974: July-Aug. 1975; - )
Aim of the project. To develop further a post-graduate (Master's degree) course in veterinary public health at the All-India Institute of Hygiene and Public Health, Calcutta, and the Indian Veterinary Research Institute, Izatnagar.
Assistance provided by WHO during the year. (a) A consultant; (b) a twelve-month fellowship for studies in Belgium and the Netherlands; (c) supplies and equipment.
Probable duration of assistance. Until the end of 1977.
Work done during the year. A WHO consultant (food hygienist) assisted the All-India Institute of Hygiene and Public Health, Calcutta, from 15 July to 14 August 1975 in the field of food hygiene, i.e., in the development of a food hygiene laboratory at the Institute for the training of veterinary public health students and also for the determination of microbiological standards and investigation of food-borne diseases, particularly those of animal origin. He also visited the Indian Veterinary Research Institute, Izatnagar, for two days.
Efforts were under way to assign another consultant during the last quarter of 1976 to review the training and research activities of the Department of Veterinary Public Health at the All-India Institute of Hygiene and Public Health, Calcutta.
IND CAN 001 Cancer Control Pilot Project, Tamil Nadu R (July 1968 - )
Aim of the project. To start and develop a pilot project for the early diagnosis and control of oropharyngeal and cervical cancer and to establish a training centre in Kancheepuram (Tamil Nadu) .
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. SEA/RC29/2 Page 125
Probable duration of assistance. Until the end of 1977.
Work done during the year. The construction of a 250-bed cancer hospital was progressing satisfactorily. The Arignar Anna Memorial Cancer Institute continued its health education, screening (for early detection) and diagnostic activities for oropharyngeal and cervical cancer. Action was taken for the supply of radiotherapy equipment to the hospital.
A consultant assigned for a period of one month in May-June 1976 advised on the organization of the training of cytopathologists and exfoliative cytological services for early detection of cancer.
IND CAN 002 Establishment of Cancer Centres in States R (March-May 1976; - )
Aim of the project. To organize regional cancer control programmes, through the strengthening of training, service and epidemiological investigations, and to co-ordinate training and epidemiological research in the regional cancer centres.
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. A consultant assigned under this project visited cancer institutes proposed to be developed as regional cancer centres. He assessed the existing facilities at the Tata Memorial Centre, Bombay, and other institutions involved in cancer control activities in Ahmedabad, Bangalore, Trivandrum. Madras, Kancheepuram, Hyderabad, Calcutta, Kanpur and Delhi. Based on his evaluation of the existing training, service and research facilities, he discussed with national authorities future plans of development and made recommendations on the constitution of a national committee on cancer, organization of ontological services as an integral part of the proposed three-tier medical care system, training of personnel in oncology, and cancer research.
IND DNH 001 Improvement of Dental Education UNDP (July-Dec. 1966; Sept. 1967 - )
Aim of the project. To improve and strengthen dental education
Assistance provided by WHO during the year. (a) 'ho consultants and a temporary adviser; (b) cost of attendance of participants.
Work done during the year. A national Seminar on Public Health Dentistry was held in Lucknaw from 17 to 22 November 1975 with 28 participants from 14 dental institutions in India. WHO provided two consultants for a period of two months each to assist in the planning, conduct and evaluation of the Seminar. A temporary adviser to the Regional Director also assisted the Seminar, for which funds were provided to meet the travel and subsistence allawances of the participants.
The Seminar reviewed the existing facilities for services, training and research in public health dentistry, discussed the public health aspects of periodontal diseases, developed curricula for the teaching of colmnunity dental health and formulated recomnendations on the teaching of public health dentistry in dental colleges and the organization of services within the existing health services. SEA/RC29/2 Page 126
IND MNH 001 Fellowships R
Mental Health. A three-month fellowship for studies in the United States of America and Canada.
IND MNH 002 Mental Health R (June 1975; March 1976; - )
Aim of the project. To assist the National Institute of Mental Health and Neurosciences, Bangalore, in the planning and delivery of socio-culturally relevant training programmes for psychiatric educators and clinical specialists in psychiatric medicine, nursing and allied fields and in the development of ambulatory field training centres.
Assistance provided by WHO during the year. (a) A consultant; (b) a three-month fellowship for studies in the United Kingdom, Denmark and France.
Probable duration of assistance. Until 1983.
Work done during the year. A consultant has been in position since 1 March 1976. She will assist in developing post-basic degree and diploma courses, in the administration and the conduct of these courses, as well as the organization and development of practice areas for medical educators and clinical specialists in psychiatry.
IND MNH 003 Mental Health (Drug Addiction) R (Dec. 1975; - )
Aim of the project. To give training in epidemiology, prevention, treatment and rehabilitation of drug abuse.
Assistance provided by WHO during the year. A six-month fellowship for studies in Switzerland (WHO Headquarters), United Kingdom, Denmark, Netherlands, Poland, Iran, Thailand and Hong Kong.
Probable duration of assistance. Until 1977.
IND CVD 002 Prevention and Control of Cardiovascular Diseases R (Feb. 1976; - )
Aim of the protect. To develop cardiac resuscitation and rehabilitation services integrated into the existing health services, and train health and allied workers in the management of cardiac emergencies and in the organization of health education for the prevention and control of cardiovascular diseases.
Assistance provided by WHO during the year. A four-month fellowship for study in the United Kingdom.
Probable duration of assistance. Until the end of 1983.
IND RAD 001 Training of Radiographers R (March 1967 - )
Aim of the project. 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. Two six-month fellowships for study in the United Kingdom. SEA/RC29/2 Page 127
IND RAD 002 Radiation Medicine Centre, Bombay R (Jan.-Feb. 1963; March 1967 - )
Aim of the proiect. To organize the training of nuclear medicine specialists, strengthen services and research and also radio-pharmaceutical production activities of the Radiation Medicine Centre, Bombay.
Assistance provided by WHO during the year. (a) Two consultants; (b) a nine-month fellowship for study in the United States of America and a two-month fellovship for studies in Switzerland, Belgium, Spain and the United Kingdom; (c) supplies and equipment.
Probable duration of assistance. Until 1983.
Work done during the year. ?Wo consultants were assigned to the Radiation Medicine Centre during the year under review to assist in the training, service and research programmes. The first consultant, assigned for a period of two months during October-December 1975, advised on computer programming in nuclear medicine, evaluated the progress of training, services and research, helped with the training programmes and advised on the development of modem techniques in nuclear medicine. The second consultant, assigned for a similar duration in January-February 1976, advised on the development of modern techniques as related to thyroid diseases, discussed current and proposed research programmes with menbers of research groups and assisted in reviewing and planning the expanded training, research and service functions to be developed in the new premises which would provide three to four times the present area.
IND RAD 004 Advanced Course in Radiological Physics R (Dec. 1975 - March 1976; - )
Aim of the proiect. To conduct the M.Sc. course in radiological physics at the Division of Radiological Protection, Bhabha Atomic Research Centre, Bombay,and develop radiological protection services.
Assistance provided by WHO during the year. (a) A consultant; (b) two fellmships - one for twelve months and one for nine months - for study in the United Kingdom; (c) supplies and equipment.
Probable duration of assistance. Until 1977.
Work done during the year. A consultant assisted in the conduct of the course in radiological physics and research at the Division of Radiological Protection, Bhabha Atomic Research Centre, Trombay. He advised on: the implementation of the proposed advanced course in radiological physics; selection, practical orientation in training and employment opportunities for the graduates; regionalization of personnel monitoring thermoluminescent dosimetry services, efficient supervision of radiological units and establishment of better collaboration between the Division of Radiation Protection and Departments of Radiology. This centre was designated as a WHO Collaborating Centre for Secondary Standard Radiation Dosimetry, in collaboration with the International Atomic Energy Agency.
IND SQP 001 Drug Laboratory Techniques and Biological Standardization R (June 1967; 0ct.-Dec.1967; Aug.1968; July-Aug.1969; Nov.1969 - Jan.1970: . Se~t.1970. - Feb.1971: Dec.1971: 0ct.-Dec.1972: Feb. 1973; Aug.1973; Jan.1974; Sept.4ec.1974; April 1975; July-Sept.1975; - )
Aim of the project. To develop services concerned with the quality control of pharmaceutical and biological preparations, and to train staff.
Assistance provided by WHO during the year. (a) A three-month fellwship for studies in the United Kingdom, Denmark and the United States of America, a six-month fellowship SEA/RC29 /2 Page 128
for study in the United Kingdom, and two five-and-a-half-month fellowships for studies in the United Kingdom, Netherlands and Yugoslavia; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1977.
IND ISB 001 Production of Freeze-dried Smallpox Vaccine R (Sept.-Oct. 1964; June 1965 - March 1966; Feb. 1967 - UNICEF Jan. 1970; Aug.-Sept. 1972; July-Aug. 1973; April 1974; Aug. 1974; Nov. 1974; - )
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; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1976.
Work done durinp. the vear. The shelf freeze-driers at the freeze-dried smallpox vaccine producing laboratories at Patwadangar (2 units) Hyderabad (3 units) and Madras (3 units) were checked and overhauled with parts supplied by UNICEF and WHO. On the recormnendation of the consultant engineer who undertook this work during September-October 1975, replacement parts were aleo supplied as spares, and new sets of instruments for vacuum and tentperature measurement have also been provided. With the reconditioning of these units, which are over ten years old, the laboratories will be able to provide further useful service for the lyophilization of other vaccines in addition to smallpox vaccine. The engineers in all three centres were trained on the job under the supervision of the consultant engineer from the manufacturer. There is a need for adequate national follow-up arrangements in regard to servicing and spare parts.
IND ISB 002 Freeze-dried BCG Vaccine Production R (May-June 1968; June-Sept. 1970; Dec. 1973 - Feb. 1974; UNICEF Dec. 1974 - Jan. 1975; - )
Aim of the project. To produce freeze-dried BCG vaccine of atandard quality.
Assistance provided by WHO during the year. A consultant.
Probable duration of assistance. Until 1983.
Work done during the vear. A consultant assigned during December 1975-February 1976 reviewed the situation at the BCG Laboratory in Madras and at the National Institute of Coormunicable Diseases. Delhi, where a laboratory is coming up for the independent testing of BCG vaccine. Many improvements have been achieved: the rate of contamination has dropped substantially; the manufacture of fluid vaccine was discontinued and the total production, amounting to 30 million doses in 1975, is now lyophilized as the laboratory has acquired another new plant for the freeze-drying of the vaccine. The import of plass anpoules has been stopped, locally manufactured ones being used instead; the changeover was facilitated as the manual sealing was discontinued in favour of automatic batch sealing of ampoules using machines which have been recommended by WHO and procured by UNICEF. As the production target for 1980 amounts to 60 million doses, two more such machines are being procured by UNICEF. Guinea-pigs are in short supply, as the new animal house under construction is not yet ready. As a result, biological tests (safety and tuberculin testing) on the vaccine are lagging behind and are done at random and not on each and every batch. Quality control at the National Institute of Communicable Diseases is progressing well, but further expertise needs to be developed. WHO and UNICEF provide continuous support to the central laboratory at the National Institute of Comunicable Diseases. SEAlRC2912 Page 129
IND LAB 001 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 microbiologist, a technical officer and four consultants: (b) a three-month fellowship for study in the United Kingdom; (c) supplies and equipment.
Work done during the year. At the request of the Government a consolidated plan of operation was drafted to cover all WHO-assisted projects under the laboratory programme in India. The draft is under the Government's consideration.
During the period under review, the State Public Health Laboratory, Poona, provided a wide range of important services concerning surveillance and isolations from specimens. The laboratory's epidemiological team gave assistance in the investigation of an outbreak of typhoid fever in Sangli District, caused by large-scale contamination of water.
The laboratory provided reference assistance to the district laboratory in the isolation of pathogens, and strains of salmonella, shigella and cholera were referred to the National Reference Laboratories in New Delhi, Lucknow and Calcutta for typing, phage typing and verification. The laboratory has joined the national scheme sponsored by the Institute of Venereology, Madras, for proficiency in the MRL test.
Training was another important activity. Three tutors have been selected - one each in haematology, biochemistry and microbiology - to take part in the teaching of students of the B.Sc. course for laboratory technicians which is to start next year at the B.J. Medical College. A twelve-hour seminar was conducted by the WHO technical officer to introduce all three tutors to their role in teaching and training. Also, a six-week course was organized for upgrading five malaria microscopists from Poonil as multi-purpose laboratory technicians. The experimental manual prepared by WHO Headquarters on basic laboratory techniques was tested during these courses and suggestions were made for further improving the manual.
The WHO project staff visited the civil hospital laboratories in the following places where the laboratory procedures have been streamlined: Satara, Sangli, Kolhapur, Bhir, Osmanabad, Amravati and Akala. The laboratories at Satara and Kalhapur have started work on cholera bacteriology. The laboratories at district hospitals and primary health centres continued to be surveyed by the project staff.
Depending on the availability of funds, the State Government intends to upgrade 136 rural hospitals in Maharashtra by March 1979. Each of these hospitals will have a laboratory component. In Delhi, the three National Reference Laboratories held a three-week joint course on "Microbiological methods in Streptococcus infections" and "Microbiological methods in Staphy2ococcus and Pseudomonas in hospital sepsis control". Two WHO consultants and the Directors of the three laboratories (at Lady Hardinge and Maulana Azad Medical Colleges and the All-India Institute of Medical Sciences) helped with the course, which was attended by 16 bacteriologists from medical colleges and State laboratories. The course was followed up by other equally important activities. The two WHO consultants visited different hospital centres at New Delhi, Madras, Vellore, Bombay, Poona, Aurangabad, Chandigarh, Rohtak and Lucknow. With the assistance of the Indian Council of Medical Research, another course on Streptococcus infections was held in Vellore for 16 participants from the southern States. The methods used in the course were compiled and are being reproduced for distribution. The manual on Streptomccus microbiology was revised and distributed to all laboratories interested in Streptococcus. In April, a one-week course was held for 16 bacteriologists from laboratories collaborating in the Sa~moneZZa SEA/RC29/2 Page 130
surveillance programme in India, on "Production and Standardization of Sa~monetta typing antisera". The reference laboratories from the Central Research Institute, Kasauli, Lucknow, and Lady Hardinge Medical College were represented at this meeting.
Though the work of the team in Maharashtra has progressed according to plan, some of the milestones were not reached, and there was delay in reaching others. This is due partly to some of the following: (i) shortage of qualified manpower to supervise laboratory work; (ii) lack of training; (iii) shortage of laboratory space; (iv) insufficient coverage and services for the maintenance and repair of equipment, and (v) absence of a scheme for the regular supply of essential requirements to the laboratories.
IND BSM 001 Groundwater Training Course R (Feb.-May 1970; July 1970; June 1971; Dec. 1973; Feb. 1974; July 1974; Nov. 1974 - Feb. 1975; Nov. 1975; - )
Aim of the project. To train staff in the development and utilization of ground- water for community water supplies.
Assistance provided by WHO during the year. Three three-month fellowships for studies in the United Kingdom, Yugoslavia and Greece.
IND BSM 002 Villa~eWater 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 where water is scarce; to train professional and drilling staff.
Assistance provided by WHO during the year. (a) Two consultants; (b) five two- and-a-half-month fellowships for studies in Australia, Philippines and Thailand, three three-month fellowships for studies in Yugoslavia, United Kingdom and the USSR, three three-month fellowships for studies in the United Kingdom and the Netherlands, three three-month fellowships for studies in the United Kingdom, Switzerland and the Federal Republic of Germany, and nine three-week fellowships for study in India; (c) supplies and equipment.
Probable duration of assistance. Until the end of 1977.
Work done during the year. The WHO sanitary engineer under the inter-country project ICP BSM 001, "Community Water Supply and Sanitation", and stationed in the UNICEF Regional Office in New Delhi, continued to provide technical advice and guidance to the village water supply program in India.
A consultant information scientist was provided from November 1975 for a period of six weeks. He assisted the Central Public Health and Environmental Engineering Organization, Ministry of Works and Housing, and the Maharashtra State Government in developing a pilot field project to test the WHO Information Systems Guide on Planning and Evaluation of Community Water Supply and Waste Water Disposal Programmes.
A consultant hydrogeologist was recruited against the provision of hydrogeologist under this project and took up his six-month assignment early in February 1976. He visited Jammu, Chandigarh and the States of Maharashtra, Tamil Nadu, Andhra Pradesh and Karnataka and had discussions with officials of groundwater boards on hydrogeological aspects of rural water supply.
Efforts were made to recruit a master driller for this project.
Close collaboration was maintained with UNICEF. SEA/RC29/2 Page 131
IND BSM 003 Solid Wastes Disposal R (Feb.-March 1973; June-Aug. 1974; Nov.-Dec. 1974; Sept.-Dec. 1975; - )
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 durinp. the year. A consultant.
Probable duration of assistance. Until the end of 1977.
Work done during the year. A WHO consultant, recruited for three months early in September 1975, advised the Government on problems of solid wastes. He visited various centres, namely, Madras, Bangalore, Hyderabad, Delhi, Lucknow, Kanpur and Calcutta, and reviewed plans for the development of composting plants. He also asslsted the Government in conducting a Workshop on Solid Wastes Management at Ahmedabad, Gujarat, from 28 to 30 October 1975.
It is ~lannedto provide consultant services for further assistance in this field
IND BSM 004 Rural Water Suppl~ UNDP (Aug.-Nov. 1975; - )
Aim of the proiect. To develop a national programme of rural community water supply.
Assistance provided by WHO during the year. A consultant.
Work done during the year. A WHO consultant was provided for three months during August-November 1975 to review the existing situation of rural water supply, identify needs with respect to problem areas and prepare a full project document. The document prepared by the consultant for the Government to request UNDP assistance for the rural water supply programme in India has been sent to the Government.
IND CEP 001 Prevention and Control of Water Pollution R (kt.-Nov. 1969: Aoril 1971: 0ct.-Dec. 1971: Julv 1972: ~ec.1972 - ~et;. i973; ~ul;1973; ~ec.1973; arch 1974; Aug. 1974; Oct.1974 - Feb.1975; May-Dec.1975; March 1976; - )
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 temporary adviser and a consultant; (b) three eleven-week fellowships for studies in the Netherlands, United Kingdom, Iraq and Kuwait, a two-day fellowship for study in the USSR, three ten-week fellowships for studies in the United Kingdom, Netherlands and Switzerland, and six three-month fellowships - three for studies in the United Kingdom, Netherlands and the Federal Republic of Germany and three for studies in the United Kingdom, Netherlands and Switzerland; (c) supplies and equipment.
Probable duration of assistance. Until the end of 1977.
Work done during the year. A WHO temporary adviser in water pollution control was assigned to the project from May 1975 for a total period of three months to assist various Stares in India in setting up water pollution control boards and laboratories. His recommendations have been submitted to the Government.
Another WHO consultant was asaianed to the project from mid-November 1975 for a period of one month to advise the Central Public Health Environmental hgineering Organization and the Delhi authorities on problems connected with the prevention and control of water pollution. His report has been sent to the Government. SEA/RC29/2 Page 132
IND CEP 002 Control of Air Pollution R (Feb.-March 1971; March 1973; Dec. 1973 - March 1974; Sept.-0ct.1974; Dec.1974; 0ct.-Nov.1975; Feb.1976; - )
Aim of the project. To study the problems of air pollution connected with industrial development and to promote a control programme.
Assistance provided by WHO during the year. (a) A consultant; (b) eight three-month
fellowshios - two for studies in the United Kinedom" and the Netherlands.. three-- for ~~ studies in the United Kingdom, Netherlands, Turkey and Greece, and three for studies in the United Kingdom, Sweden, Federal Republic of Germany, Netherlands and Poland.
Probable duration of assistance. Until the end of 1977. -.Work done during the year. A WHO consultant was assigned to the National Environmental Engineering Research Institute, Nagpur, in October 1975, to assist the Institute in reviewing its programme of research in the field of air pollution control. His recommendations have been sent to the Government.
IND CEP 003 Medical Toxicology Unit R (0ct.-Dec.1972; Dec.1973 - April 1974; July 1975;
Aim of the project. To undertake studies on the effect of air pollutants and organochlorine pesticides in man.
Assistance provided by WHO during theyear. (a) A consultant; (b) two six-month fellowships for study in the United Kingdom; (c) supplies and equipment; (d) grant.
Probable duration of assistance. Until the end of 1977.
Work done during the year. A WHO consultant was assigned to the Medical Toxicology Unit, Lucknar, for two months (October-December) to review the laboratory procedures, advise on research projects and assist in the training of national staff. The report of the consultant is being processed for submission to the Government.
IND HWP 001 Occupational Health R (April-Sept.1964; Aug.1970; Nov.1970 - Jan.1971; July 1972; Aug.1973; Dec.1973; March 1975; Dec.1975; - )
Aim of the project. To conduct courses in occupational health related to specific hazards found in industries, and to undertake studies on specific hazards.
Assistance provided by WHO during the year. (a) A six-month fellowship for studies in Sweden and the United Kingdom; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1977.
IND PIP 001 Water Supply and Sewera~e,Madras UNDP (Jan. 1976 - )
Aim of the project. To prepare a master plan, covering all aspects of water supply, drainage and sewerage, for the Madras Metropolitan Area.
Assistance provided by WHO during the year. (a) A project manager, an administrative assistant, a clerk-stenographer and a driver; (b) supplies and equipment.
Probable duration of assistance. Until 1978. SEAIRC2912 Page 133
Work done during the year. A project manager for the project was appointed in January 1976 and the other staff joined in February and April. The briefing on the site of representatives of the consulting firms short-listed for sub-contracts was held in Madras from 2 to 7 May. It is expected that the work at site will start in September 1976.
IND SES 001 National Environmental Engineering Research R Institute (NEERI) , Nagpur (Feb. 1961 - )
Aim of the project. To develop the Institute as a major research and training centre for environmental sanitation problems; to ca-ordinate research programmes.
Assistance provided by WHO during the year. A consultant.
Probable duration of assistance. Until 1980.
Work done during the year. A consultant was assigned to the National Environmental Engineering Research Institute (NEERI), Nagpur, for a period of one month in October-November 1975 to advise the Institute on water treatment research. The recommendations af the consultant have been sent to the Government.
IND SES 003 Public Health Engineering Education UNDP (0ct.-Dec. 1967; March-April 1968; Nov. 1968; Nav. 1972; July 1973; Oct. 1973; Aug. 1974; June 1975; - )
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 by WHO during the year. Three three-month fellowships for study in the United Kingdom.
IND DHS 002 Strengthening of Health Statistics1 Services R (July-Oct.1970; July 1972; July 1973; Oct. 1973 - Feb.1974; July 1975; Sept.-Nov.1975: - )
Aim of the project. To develop a health statistics system; to review and improve hospital statistics and medical records; to plan curricula for the training of medical records personnel; and to organize and conduct training programmes for statistical staff.
Assistance provided by WHO during the year. (a) A consultant; (b) a three-month fellowship for study in the United Kingdom, two six-month fellowships - one for studies in the United Kingdom and India and one for study in the United Kingdom - a twelve-month fellowship for study in the United Kingdom, and a five-and-a-half- month fellowship for study in the United States of America; (c) supplies and equipment.
Work done during the year. During September-November 1975, a consultant assisted in the development of a health information system for the planning, monitoring and evaluation of health service activities. During his visits to several Indian States and in discussions with the authorities concerned, he reviewed three existing information sub-systems, viz., the collection and compilation of vital statistics; the development of data bases within primary health centres and their use in providing information to higher echelons, and the development of hospital record management. Several useful recommendations covering these fields were formulated and sent to the Government for consideration. SEA/RC29/2 Page 134
Financial assistance was provided to the project to enable the Government to use to a greater extent the capacity available within the country for the training of medical record officers and technicians. Also during the year, an electronic calculator was provided for the use of the project.
Efforts were made to recruit a suitable consultant for three months to meet the Government's request for assistance in developing hospital statistics with special reference to hospital morbidity and to evaluate the present state of medical record departments under the project. SEA/RC29/2 Page 135
6. INDONESIA
Project Number Source of Funds Co-operating Agencies -Title
IN0 SHS 001 Strengthening of National Health Services R (Feb.-March 1969; May 1969 - ) UNICEF
Aim of the project. To plan, programme, monitor and evaluate health services; to establish a research and development programme concerning health care delivery; to co-ordinate and integrate health services and improve their effectiveness and efficiency; to standardize and intensify training activities for health staff, and to promote reviews of public health practices and organization intended to lead to the optimal delivery of health care.
Assistance provided by WHO during the year. (a) Two public health administrators, a nurse educator, a management officer, three systems analysts, a health economist, an educational specialist, two consultants and assistance from a Headquarters staff member; a secretarial assistant and a clerk; (b) two twelve-month fellowship$ - one for study in the Philippines and one for study in the United Kingdom - an eighteen-month fellowship for study in the United States of America, a three- month fellowship for studies in the Philippines and Malaysia, and three two-month fellowships - one for study in India, one for studies in the United Kingdom, India and the Philippines, and one for study in the United Kingdom; (c) supplies and equipment.
Probable duration of assistance. Until 1979.
Work done during the year. Assistance continued to be given to the health centre programing exercise. Three aspects of this programming, viz., (i) situational analysis, (ii) defining the problems, and (iii) determining the manpower needs and requirements, were finalized. With assistance from the project staff, a three-week seminar on the methodology of planning and health centre programming and another on health centre programming and primary health care for defining the guidelines, were organized. A design for a health centre service was prepared. In addition, a tentative project proposal for primary health care in Indonesia was developed, and training was given to a nucleus of Indonesian consultants/instructors to prepare them in the use of behavioural science technology in training and education. As a part of the National Leprosy Programme, a pilot survey of leprosy in South Sulawesi was completed, and plans were made for a similar survey in the island of Bali. An innovative project entitled ''Village Health Promoters", introducing voluntary health insurance, was initiated in three villages. Assistance was given in the conduct of two ten-week courses in operational researchlsystems analysis at the Health Sefvices Development Institute.
The project staff were actively involved in the conduct of the Annual National Health Conference, which took place in Jakarta from 14 to 17 January and was attended by provincial health officials and representatives from the Ministry of Health. As a follow-up of this conference, which discussed the present policies concerned with community health services, including the framework of primary health care, improvements in health centre programming in relation to manpower and financial resources were brought about.
Assistance was given in the conduct of a number of surveys, e.g., (i) a study of career development patterns, income structure and attitudes of government doctors, (it) the protocol for a study on drug utilization in health centres and regency hospitals, (iii) a study on the planning and budgeting process for health, and (iv) a study on community-oriented family planning. SEA/RC29/2 Page 136
An experimental edition of the Child Care Manual entitled, "The Child in the Health Centre - Book I - A Manual for Health Workers",was produced in English as a part of the maternal and child health "package" and was implemented on a trlal basis. Assistance continued to be given to the development of other components of the maternal and child health "package". The preparation of another manual entitled, "Care Manual"+for use by the primary health nurse and less qualified workers such as village health workers in family health,was begun. A course in research methodology was organized. Guidelines were prepared for the annual health planning and evaluation in the provinces and for the formulation of the third five-year development plan.
During the period under review, two meetings of the Joint GRIO/Indonesia Co-ordination Committee were held with the participation of a staff member each from the Regional Office and WHO Headquarters. The meetings reviewed the progress of this project in particular as well aa other WHO-assisted projects in general and provided guidelines for effective implementation of WHO assistance in future.
IN0 SHS 006 Strengthening of Health Services, Irian Jaya DNDP (March 1975 - April 1976)
Aim of the protect. To promote the health of the population through the development of integrated health services at all levels as part of the socio-economic development of the Province, with particular emphasis on the development of s more effective and efficient administration of health eervices in the Province.
Assistance provided by WHO during the year. (a) A sanitary engineer; (b) a five- month fellcuship for study in the United States of America.
Work done. The WHO sanitary engineer-cum-team leader who has been working with the project since April 1975 continued to provide technical advice and guidance on matters pertaining to environmental health.
During the period under review, he made field visits to Biak, Sorong and Lamena. and submitted a report. In addition, together with the WHO sanitarian on project IN0 BSM 001, he helped the national authorities in the preparation and conduct of a workshop on environmental sanitation held in Jayapura for ten days in September.
The project was terminated on 30 April 1976 on account of reduction in the UNDP budget for Indonesia; this resulted in the re-assignment of the WHO sanitary engineer to another WHO-assisted project in Indonesia.
IN0 HCH 001 School Health R (Jan. 1974; Dec. 1974 - March 1975; Dec. 1975; - )
Aim of the project. To develop school health services.
Assistance provided by WHO during the year. (a) A consultant; (b) an eleven-month fellowship for studies in Egypt and the United Kingdom; (c) supplies and equipment.
Work done during the year. During December 1975-March 1976, a consultant assisted in co-ordinacing a national workshop on school health and took part in discussions on the future development of school health services. He also attended two regional workshops on school health and an inter-country seminar on drug abuse held in Jakarta. His report was submitted to the Government. One of the Regional Advisers on Maternal and Child Health discussed with the Government the future plan of action for this project. SEA/RC29/2 Page 137
IN0 NUT 003 Nutrition Training R (May 1975; - )
Aim of the project. To develop effective control programmes and strengthen and expand the nutrition aspects of health services and train staff.
Assistance provided by WHO during the year. A ten-month fellowship for study in India.
Probable duration of assistance. Until the end of 1980.
IN0 NED 003 Development of Health Education in Family Health UNFPA (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) A health education specialist and a consultant; (b) a tweuty-four-month fellowship for study in the United States of America, a nine-month fellowship for studies in the United States of America, Egypt, Iran, India, Sri Lanka and Thailand, and a aix-month fellowship for study in the United Kingdom.
Probable duration of assistance. Until 1977.
Work done during the year. The impact of the Organization's assistance to health education in Indonesia is seen in the present state of health education services,the availability of an adequate cadre of health education specialists, the graduation of the first group of health educators trained in the new MPX Programe in Health Education at the University of Indonesia, and the increasing integration of health education in health programmes. The former Health Education Bureau was raised to the status of a Directorate within the Directorate General of Community Health Services, thus making it accessible to all community health services for the development of their educational components.
Of the nearly forty health education specialists who have obtained post-graduate qualification in health education abroad under the US AID/WHO Kealth Education Specialist Manpower Development Project, all but two have now returned to the country. Some of these persons are helping to strengthen the health education services at the central level and others have been assi~ned- to the School of Public Health, the National Family Planning Co-ordination Board, the Directorate of Education. the Centre for Education and Trainine of the Ministrv of Health. and to some of the provincial health departments. :he development bf health education units within each provincial health department will make their services uniformly available on a country-wide basis, with, of course, the guidance and assistance of the central Directorate of Health Education.
Most of the activities listed above are relatively new. Therefore, objectives have to be determined, working procedures established, and the necessary guidelines formulated in each case. To assist in these activities further, a long-term health education specialist has been assigned to the Directorate of Health Education. In addition, a short-term consultant was provided to assist in health education research.
IN0 HMD 001 Medical Education R (May 1964 - )
Aim of the profect. To develop the teaching programmes of the medical faculties in keeping with national needs and the progress of the educational sciences. SEA/RC29/ 2 Page 138
Assistance provided by WHO during the year. (a) Two medical educators; (b) five fellowships - one for seventeen months, tw for twelve months, one for eight months and one for six months - for study in Thailand; (c) supplies and equipment.
Probable duration of assistance. A number of years.
Work done during the year. Since 1975 two long-term staff members have been provided in the field of medical education - one to the Consortium of Medical Sciences and the other to Airlangga University, Surabaya.
A large number of fellowships have been provided,mostly for the training of teachers in basic medical sciences.
Assistance is no longer given for the strengthening of individual departments in medical schools but is instead being provided for the planning and development of programmes initiated at the central level.
IN0 HMD 002 Nursing Education and Services* R (June 1967; Aug. 1967; Jan.-Dec. 1969; April 1970 - )
Aim of the project. To reorganize the total nursing system of the country within the context of national health plans in order that equitable distribution and utilization of adequately trained nursing manpower may be effected.
Assistance provided by WHO during the year. (a) Two nurse educators and a consultant; (h) supplies and equipment.
Probable duration of assistance. Until 1980.
Work done during the year. This project, formerly known as "Nursing and Midwifery Education", assumed a new importance with the signing of a revised plan of operation, broadening its scope and placing it at the heart of the Government's overall scheme for the development of health services.
In 1975, a nurse scientist from WHO Headquarters assisted the national authorities in the preparation of a draft plan for the systematic development of nursing in Indonesia, comprising Phase I, the Primary Health Nurse (PKK) programme, and Phase 11, the University Nursing Education programme.
The WHO nurse educators assisted the Ministry of Health's "task force" with the first draft of a plan for the develoment of nursing services and education. Efforts were directed toward launching the PKK programme, including the preparation of curriculum guides, plans for teacher training, conversion of existing training programmes to the new system, and plans for building new schools. A major milestone was achieved early in 1976 with the opening of ten schools for PKK training. The primary health nurse is designated as the worker who will provide basic health services in rural communities.
Team members of this project and their national colleagues work in close collaboration with the staff of project IN0 SHS 001.
IN0 HMD 003 Post-graduate Education in Public Health R (Jan.-Feb. 1972: Julv-Aue. 1972: March 1973: Julv 1973: -~eb.1974; ~ul;19fi; D~C.1974 - March 1975; --)
Aim of the project. To develop further the teaching and training programmes conducted by the School of Public Health, University of Indonesia.
*Previous title: Nursing and Midwifery Education SI?A/RC29/2 Page 139
Assistance provided by WHO during the year. (a) One consultant; (b) a twelve-month fellowship for study in the United Kingdom, a six-week fellowship for study in the Netherlands, and ten ten-month fellowships for study in Indonesia; (c) supplies and equipment.
Probable duration of assistance. A number of years.
Work done during the year. A consultant was provided in 1975 under this project. The post of a medical educator has been held in abeyance and it is hoped that this staff member will be provided in 1978. Short-term consultants have been assisting in the fields of public health administration and programmes of public health.
Fellowships have been provided for the teaching staff of the Faculty of Public Health to visit institutions outside Indonesia. Further,national fellowships have been provided for post-graduate training in public health at the School of Public Health, Jakarta.
IN0 HMD 007 Stren~theninpof the Teaching of Human Reproduction, Family UNFPA Planning and Population Dynamics in Medical Schools (Jan. 1971 - March 1974; Oct. 1975; -
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 twelve-month fellowship for study in the United States of America.
IN0 ESD 002 National Institute of Medical Research R (June 1972; Aug. 1972; Nov. 1972; Jan. 1973; July-Oct. 1973; Dec. 1973; Feb. 1974 - )
Aim of the project. To assist in the design, organization and analysis of biomedical studies.
Assistance provided by WHO during the year. (a) An ecologist, a statistician and a consultant; (b) supplies and equipment.
Probable duration of assistance. Some years.
Work done during the year. The title of the project was changed to "Research in Communicable Disease Ecology" and its plan of operation was signed by the Government and WHO. Its objective is to carry out ecological studies relating to communicable diseases in general and parasitic infections regarded as public health hazards in particular, with priaricies on ancyclostomiasis, taeniasis, cysticercosis, filariasis and schistosomiasis.
Planning and initiation of the agro-engineering aspect of schistosomiasis control in the pilot area in Lindu Valley, Central Sulawesi, was undertaken with assistance from a WHO consultant engineer. Earlier, the WHO ecologist took part in a number of meecings and discussions with national staff and prepared a paper on "Control of Schistornu Japonicwn infection in Lundu Valley".
A national course on research methodology and development was organized and studies on plague, soil-transmitted helminthic infecti~n~filariasisand cysticercosis are progressing.
A WHO statistician was assigned to the project towards the end of January 1976. SEAlRC2912 Page 140
IN0 ESD 003 Strengthening of Eoidemiological Surveillance R (June 1975 - )
Aim of the prolect. To strengthen further epidemiological surveillance in the country at both central and intermediate levels, and to train staff.
Assistance provided by WHO during the year. (a) A temporary adviser, four consultants and assistance from a Headquarters staff member; (b) a two-and-a-half-week fellowship for studies in the Republic of Korea and India; (c) supplies and equipment.
Probable duration of assistance. Some years.
Work done during the year. In the beginning of the year under review a WHO consultant reviewed and discussed arbovirus studies undertaken by the National Institute of Health Research and Development, with special reference to dengue haemorrhagic fever, and also studied the control activities. This work was followed up by another consultant who visited hospitals admitting and treating cases of dengue haemorrhagic fever,and assessed the progress in the introduction of new methods of diagnosis and treatment of cases of dengue shock syndrome as well as lethality from the disease.
A scientist/entomolngist from WHO Headquarters assisted in an assessment of priorities and requirements for an entomological organization and the development of entomological services. A consultant was also assigned to assist with the development of the newly established Entomology Section. Another consultant (epidemiologist) advised on the management of the epidemiological surveillance programme and evaluation of the recording and reporting system of communicable diseases; a further consultant advised the yaws control programme.
A consultant in epidemiology is under recruitment.
IN0 MPD 001 Malaria Eradication R (May 1955 - )
Aim of the project. To control malaria in the entire country and eventually eradicate it, with special emphasis on Java and Bali and on the socio-economic areas of the other islands,as an integrated activity.
Assistance provided by WHO during the year. (a) Three malariologists, two entomologists and a translator/typist; (b) a sixteen-month fellowship for study in Iran; (c) supplies and equipment.
Probable duration of assistance. A number of years.
Work done during the year. At the end of the period under review, the malaria control programme covered a population of 82.9 million in Java and Bali under extensive mosquito control measures, and a population of 45.8 million in the other islands which had not been covered by any specific anti-malaria measures except insecticide spraying in areas selected on the basis of socio-economic priorities covering a very small population. A population of 4.4 million in Jakarta was considered malaria-free.
The delay in the delivery of supplies ordered under the US AID loan agreement is likely to result in further delays in the implementation of the "expanded control programme". The Indonesia-Malaysia-Singapore Border meeting on malaria was held in February as planned; the importance of mutual consultations, the need for anti-malaria operations in border areas, legislation and inter-regional training in malaria were emphasized during the discussions.
The first spray cycle of 1976 in Java and Bali, although started in January, could not progress satisfactorily owing to late delivery of DDT, which is likely to affect the epidemiological situation adversely, as A. aconitus peak densities occur during the March-May period followed by a peak incidence of malaria in June-July. During 1975 a total of 1.66 million houses was sprayed, consuming 1029 tons of DDT. SEA/RC29/2 Page 141
A study on the resistance of P. falcipamun to chloroquine/amodiaquine carried out in South Sulawesi on 22 subjects revealed no evidence of resistance; in all cases asexual parasites disappeared on the third day and were absent thereafter for a two-week period of observation.
The importance of training continued to be stressed during the year, particular attention being paid to the training of microscopists. Reorientation courses for medical officers and refresher courses for other staff were organized in the provinces and at the Communicable-disease Training Centre, Ciloto, West Java, in addition to various courses for microscopists.
Cases-detection data for 1975 from Java and Bali reveal that the examination of 8 382 909 blood smears resulted in 125 146 malaria positive cases, giving a slide positivity rate of 1.492 against 229 693 positives from 7 519 108 examinations with a slide positivity rate of 3.05% during 1974; 42 806 positives (provisional) were found in other islands from 140 751 examinations, resulting in a slide positivity rate of 30.4%.
Special village studies, carried out jointly with the Vector and Rodent Control Research Unit, on the impact of one round of spraying with malathion zgm/m2 and with fenitrothion Zg/m2 are under way in Semarang Regency, an area in Central Java where A. aconitus is resistant to DDT.
IN0 MPD 002 Malaria Control, Irian Jaya FUNDWI (Jan. 1970 - )
Aim of the project. To control malaria in Irian Jaya.
Assistance provided by WHO during the year. A four-month fellowship for studies in India, Malaysia and Thailand, and two two-month fellowships for study in India.
IN0 MBD 001 Tuberculosis Control R (Julv 1961 - ) UNICEF
Aim of the project. To integrate BCG vaccination without prior tuberculin testing into the work of the maternal and child health clinics and regency polyclinics; to train staff engaged in case-finding by microscopic examination of sputum, and to provide ambulatory treatment.
Assistance provided by WHO during the year. Three three-month fellowships - one for studies in Singapore, Malaysia and Sri Lanka, one for studies in India, Singapore and Malaysia, and one for studies in Malaysia, Philippines and India.
IN0 MBD 002 Leprosy Control R (July-Sept. 1955; Sept. 1956 - Dec. 1967; Feb.-May 1969; Feb. 1970; April 1974 - )
Aim of the project. To organize a training-cum-demonstration area in leprosy control.
Assistance provided by WHO during the year. A leprologist.
Probable duration of assistance. Some years.
Work done during the year. Training of various categories of health workers involved in leprosy control activities continued. Random surveys were conducted in South Sulawesi.
Representatives of the Danish "Save the Children" Organization visited the country and had discussions with the national authorities on the integration of the SEAIRC29 /2 Page 142
activities of organizations such as the National Leprosy Training Centre in Ujung Pandang and a leprosarium in South Sulswesi supported by a private body, into the national leprosy campaign.
The Danish "Save the Children" Organization approved an additional budget to extend the office building and carry out essential supplementary operations at the National Leprosy Training Centre.
IN0 DNH 001 Dental Health R (Jan.-April 1968; July 1969; Aug.1970 - Feb.1971; Aug.1971 - UNDP Jan. 1972; Nov.1972 - April 1973; May-Oct. 1973; 0ct.-Nov. 1974; April 1975; March-April 1976; - )
Aim of the project. To plan further dental activities and strengthen dental health services within the framework of health services, and to promote research in dental health.
Assistance provided by WHO during the year. A consultant.
Work done during the year. A consultant assigned during March-April reviewed the progress related to PELITA I1 as regards dental health and evaluated the implementation of the dental health plan for PELITA I1 with special emphasis on educational changes in dental schools and training of dental auxiliaries, progress in applied dental research projects and changes made in the delivery of dental care through health centres and school dental services.
He recommended that the duration of the dental course should not exceed five years, including community work; that the departmentalized clinics in the dental schools should be replaced by an integrated clinic for total patient care; that the teaching of social, basic and clinical sciences must be integrated and related to the responsibilities of the dentist, and that the present emphasis on technology should be reduced in favour of early community and patient contact in the education of dental health personnel. He outlined various steps for dental research geared to some of the current problems in dental public health.
IN0 MNH 001 Mental Health R (Aug. 1974; Nov. 1974; Dec. 1975; Feb. 1976; - )
Aim of the project. To train medical, nursing and allied health personnel for community-oriented mental health services within the framework of comprehensive health services, to strengthen psychiatric services, including rehabilitation, and undertake epidemiological investigations of mental illness.
Assistance provided by WHO during the year. A three-month fellowship for study in the United Kingdom and a twelve-month fellowship for study in Australia.
Probable duration of assistance. A number of years.
IN0 RAD 001 Radiation Health R (June 1972; - )
Aim of the project. To develop a national radiological health protection service; to establish a national medical physics service and strengthen training services and research in radiological sciences in medical faculties and related health institutions.
Assistance provided by WHO during the year. Supplies and equipment. SEAlRC2912 Page 143
IN0 RAD 002 Training of X-ray and Electro-medical Technicians UNDP (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 a specialist in electro-medical techniques; (b) two twelve-month fellowships - one for study in the United Kingdom and one for studies in the Federal Republic of Germany, Netherlands and the United Kingdom.
Work done during the year. The WHO tutor in radiography assigned to the Academy of Radiography in Jakarta completed her term and left in April. During her assignment she gave a practical orientation to the training of radiographers, assisted in the preparation of the curriculum and trained the national counterparts. Tutors trained under the WHO fellowship programme returned to the Academy and were oriented towards giving an intensive practical training in clinical radiology training. Preliminary steps were taken for organizing a second Academy in Surabaya.
A specialist in electro-medical engineering was assigned in November 1975 and has been assisting the Academy in the training of technicians in the repair and maintenance of electro-medical equipment in Jakarta. The reorganization of the workshop received his attention. Attempts were made to explore the availability of bilateral assistance to this project.
IN0 SQP 001 Quality Control of Food and Drugs R (Dec. 1973 - March 1974: Oct. 1974: Jan. 1975: arch-~a~ 1975; July 1975; Feh. 1976; - )
Aim of the project. To draft legislation to cover the quality control of food and drugs; to improve the central quality control laboratory, and to train personnel.
Assistance provided by WHO during the year. (a) Two five-and-three-quarter-month fellowships for studies in Thailand and India and a four-month fellowship for study in the United Kingdom; (b) supplies and equipment.
IN0 LAB 001 Laboratory Services R (June 1967; June-Aug. 1968; June 1969; June 1970 - ) UNICEF
Aim of the project. To strengthen health laboratory services.
Assistance provided by WHO during the year. (a) A technical officer and a clerk- typist; (b) a twelve-month fellowship for studies in the United Kingdom and India; (c) supplies and equipment.
Work done during the year. During the year under review the following activities were completed: project milestones for the year 1976 were formulated; the first issue of a technical bulletin for provincial laboratories was issued; contacts with UNICEF were re-established and supplies are now under procurement to 17 kabupaten laboratories; two courses for technicians from kabupaten laboratories were held - one in Palembang, Sumatra, and the other in Makassar, Sulawesi. In order to give training to technicians in provincial centres, arrangements are being made to test the experimental manual devised by WO Headquarters in two schools for technicians; on a survey visit to three provincial and six kabupaten laboratories, the inspectors of the provincial health services in Jambi, Bengkulu and South Sumatra provinces were urged to extend, operate and maintain a scheme which should provide regular support (material and technical) by the provincial laboratories to laboratories in kabupatens and health centres in their respective provinces as the technical staff in these peripheral laboratories are under-utilized for lack of reagents and chemicals. Follow-up visits were paid to the laboratories in Banjarmasin, Palu and ,SEA/RC29/2 Page 144
Ujung Pandang with a view to developing their work and making their utilization more effective. The laboratory section of the health centre manual was completed and the manual is now being printed.
Two milestones for 1976 were completed - one in time and the other ahead of time; progress has been made in other milestones.
Among the constraints noticed in the six kabupaten laboratories visited was shortage of materials - IKES should establish a policy as to how these materials could be provided regularly from the provincial laboratories; the question of providing a subsidy to kabupatens in case these cannot afford the cost of the materials should also be considered. Inaccessibility as well as lack of supervision and control are among the other constraints that prevent the laboratories from being more effective.
IN0 LAB 002 Vaccine and Sera Production UNDP (Dec. 1968; Jan. 1969; March 1970; 0ct.-Dec. 1970; Nov. 1971; UNICEF Feb. 1973; Sept.-Oct. 1973; Nov.-Dec. 1974; March-April 1975; - )
Aim of the proiect. To improve methods of producing bacterial and viral vaccines, anti-toxins and toxoids; also to develop capability for the quality control of vaccines and sera.
Assistance provided by WHO durin~the year. Supplies and equipment.
IN0 BSM 001 National Community Water Supply and Sanitation R (March 1969: June 1969 - ) UNICEF
Aim of the project. To plan community water supply and sanitation facilities in rural and urban areas and to train personnel.
Assistance provided by WHO durin~the year. Two sanitary engineers and a sanitarian.
Probable duration of assistance. Until 1980.
Work done during the year. A second WHO sanitary engineer was added to the project to help with the planning and implementation of the urban water supply and sanitation programme.
The project continued to make good progress. Under the INPRES (1974-1975) mral water supply programme, 73% of the piped water supply systems were completed and the rest were under construction. All the pipes and fittings provided by UNICEF were received in the project areas and provinces. This programme also included 33 artesian wells, 163 rain-water collection, 81 spring protection and 10 127 handpump systems. The construction of 40 intakes of piped water supply systems was also completed under the INPRES (1975-1976) programme.
In September 1975, the WHO sanitarian took part in a programme of practical field training in environmental hygiene and sanitation which was attended by 25 chiefs of sanitation sections in Irian Jaya.
Dutch assistance for rural water supply in West Java was approved with a grant of NF 1 million and a loan of about NF 10 million by the Dutch Government for material and equipment; the Government has allocated Rupiah 20 million for the purpose. Negotiations continued between the Government and the Federal Republic of Germany for financial assistance for rural water supply in Central Java.
The WHO sanitary engineer-cum-team leader and the WHO sanitarian attended a UNICEF1 WHO Meeting on Alternative Approaches to Delivery of Health Services held in Puncak in November. They assisted in the organization and conduct of a national workshop on rural community water supply held in Bandung in March-April 1976 and presented a paper. SEAlRC29 /2 Page 145
The progress of the project was reviewed from time to time through visits to Indonesia by one of the WHO Regional Advisers on Environmental Health, who found that the work was being carried out in accordance with the planned programme.
IN0 PIP 002 Jakarta Sewerage and Sanitation Project UNDP (June 1974; Aug. 1974 - )
Aim of the project. To prepare a plan for the development of sewerage and sanitation facilities in Jakarta and to train personnel.
Assistance provided by WHO during the year. A project manager.
Probable duration of assistance. Until 1977.
Work done during the year. The project continued to make progress under the technical advice and guidance of the WHO project manager and the consulting services of the sub-contractor.
During the period under review, the main activities related to the completion of water sampling and analysis of domestic wastes, a study on water pollution, including sampling of water of various rivers, canals and the Jakarta Bay, and the preparation of draft reports on the Immediate Programme, Design Criteria and Socio-economic Study,which were examined by the WHO Review and Guidance Mission in July 1975. These documents were revised for re-submission to the Regional Office for comments, which were despatched to the sub-contractor for final printing. The work on the preparation of other draft reports continued, although there had been some delay in the finalization of some of the reports. The sub-contractor has, however, been trying to make up the time lost in the revision of initial drafts.
The project was visited by IBRD engineers, who discussed the master planning concepts and the Immediate Program.
One of the Regional Advisers on Environmental Health reviewed the progress of the project during visits to Indonesia in September 1975 and in January and May 1976 and provided necessary technical guidance on some of the draft reports of the sub- contractor.
IN0 PIP 003 Rural Water Supply Project, East Java Province UNDP (Feb. 1975 - )
Aim of the project. To develop and implement a planned rural water supply program-e for East Java Province.
Assistance provided by WHO during the year. (a) A project manager, a sanitary engineer and two consultants; (b) supplies and equipment.
Probable duration of assistance. Until 1977.
Work done during the year. In addition to the WHO project manager, who has been in position since March 1975, a WHO sanitary engineer was assigned to the project in September 1975. A WHO consultant-hydrogeologist completed a four-month assignment in August 1975 and submitted a report, which was later revised to reflect the needs of the project. A draft report was also presented by a WHO consultant-economist on completion of his three-month assignment in March 1976.
During the period under review, the main activities related to the carrying out of water supply surveys in eleven regencies of East Java, the collection and evaluation of data, the preparation of a short master plan report for the regency of Mojokerto, the presentation of cost estimates for the feasibility studies of eleven major water supply systems and also for the typical rain-water collection systems, the completion of a report for a water usage study of an existing piped water supply system on the island of Madura, etc. SEA/RC~~/~ Page 146
The progress of the project was reviewed in July 1975 jointly by a staff member from WHO Headquarters and one of the sanitary engineers assigned to an inter- country project. and, in September, by one of the Regional AdvLatrs on Environmental Health.
In January 1976, the activities were assessed by a Tripartite Review Mission comprising representatives from the Government, UNDP and WHO. The review and finalization of the project document by the Mlssion was deferred since the commencement of the full-scale project this year was uncertain on account of the current UNDP financial crisis.
IN0 SES 001 Training in Sanitary En~ineering 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 Technology, Bandung, and other institutions.
Assistance provided by WHO durinz the year. (a) A sanitary engineer; (b) a twenty- four-month fellowship for study in the United States of America, a four-month fellowship for study in Thailand, and an eleven-month fellowship for study in the Netherlands; (c) supplies and equipment.
Probable duration of assistance. Until the end of 1977.
Work done during the year. The teaching and training programmes in sanitary engineering at the Institute of Technology, Bandung, and other related institutions continued as planned. The WHO professor of sanitary engineering assisted in the establishment of a new three-year programme in Bachelor of Sanitary Engineering, and of a one-year non-degree graduate programe.
Apart from devoting considerable time to the environmental health manpower study in Indonesia and to the final preparation of the health centre manual, particularly the section dealing with hygiene and sanitation, the WHO professor was involved in the IBRD/WHO sector study on water supply and sanitation in Indonesia.
In January 1976, the WHO professor was re-assigned to the inter-country project on community water supply and sanitation. Consequently, the Institute will be assisted in the development of courses in environmental health by a team of faculty members from the University of Oklahoma, USA, through a contractual agreement. These arrangements were finalized with the concurrence of the Government and the agreement was signed in May 1976 by the University.
Discussions were held on the preparation of a UNDP project proposal to help the Government, as a follow-up of WHO assistance, in developing the Institute - the only one of its kind in the country - as a training institution in sanitary engineering.
Satisfactory progress was recorded in the training of teaching staff of the Department of Sanitary Engineering through WHO fellovships. Most of the supplies and equipment ordered by WHO were received.
The activities of the project were reviewed by one of the Regional Advisers on Environmntal Health during a visit to Indonesia in September 1975. SEA/RC29/2 Page 167
7. MALDIVES
Project Number Source of ~unds Co-operating Agencies Title
MAV SHS 001 Public Health Administration R (Oct. 1959 - )
Aim of the project. To develop comprehensive health services, promote manpower development and strengthen medical care services, with particular emphasis on the control of endemic diseases of social and economic importance.
Assistance provided by WHO during the year. (a) A laboratory technician, a sanitarian and five consultants; (b) a twenty-four-month fellowship for study in Sri Lanka and two six-month fellowships for study in India; (c) supplies and equipment.
Probable duration of assistance. A number of years.
Work done durin~the year. The training of 13 community health workers comprising the first and second groups was completed. The training of the third group is under way and is expected to be completed shortly.
Surveys for malaria, filariasis, tuberculosis and leprosy were conducted. Till March 1976, 303 patients had been reported to be under treatment for tuberculosis. The total number of leprosy patients stood at 1119,including 145 lepromatous cases, at the end of March 1976.
During the period under review, a number of consultants - in the fields of surgery, anaesthesia, paediatrics, pathology, ENT and skin diseases - were assigned to the Maldives.
A team consisting of a surgeon and an anaesthetist was assigned to the country twice during the year. During these visits the consultants performed about 180 operations of selective surgery. The team also conducted a short intensive reorientation programme on "General Principles and Practices of Surgery and Anaesthesia", at the Government Hospital, Male. A third visit by this team is envisaged in October 1976. A visit of a representative from Walkrite Ltd., was arranged along with the provision of appliances for polio victim. The skin specialist held clinics for the patients suffering from skin diseases. The study revealed that the disease pattern was a mixed presentation of some usual tropical dermatoses and some others rather uncommonly seen elsewhere.
The programme of BCG, smallpox and DPT immunizations was carried out as planned.
As of December 1975, the nuber of health centres in the atolls totalled 16
MAV HMD 001 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 medical officer, a public health nurse and a consultant; (b) a thirty-six-month fellowship for study in India; (c) supplies and equipment. SEAJRC29I2 Page 148
Work done during the year. So far two groups of auxiliary health personnel (community health workers) have been trained and the third group is undergoing training. In addition, training is being given to nurse-aides.
A public health officer was assigned to the project in March. In addition to organizing training programmes for auxiliary health personnel with the assistance of the public health nurse educator, he is co-ordinating the activities of all WHO-assisted projects in the Maldives.
MAV HMD 002 Pellowshi~s UNDP
Medical Education. A forty-eight-month fellowship for study in India.
MAV MPD 001 Malaria Control R (Jan. 1972 - )
Aim of the project. To control malaria in the entire country, leading to its eventual eradication.
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. The entire population of the Maldives, totalling 135 thousand at the end of the period under review, has already received protection at least once through DDT spraying along with five-day mass drug administration.
Focal spraying activities during the second half of 1975 covered a total of 36 islands, including 13 uninhabited islands, in Haa-Alif, Haa-Daalu,Shaviyani, Noonu, Baa and Raa atolls. A total of 8472 persons in 2444 houses and structures was given protection with spraying and mass-drug administration; 1580 kg of 75% DDT was consumed in extending 100% insecticidal coverage.
During 1975, a total of 61 908 blood smears was examined, of which 1105 were found positive for malaria - 1087 for P. rrivaz, 15 for P. faZcipanon, including one mixed infection (all from one focus) and three P. matapias. The slide positivity rate was 1.78% as compared to 0.36% during 1974.
MAV MBD 001 Leprosy and Tuberculosis Control R (Oct. 1975 - ) Special Account
Aim of the project. To control the spread of tuberculosis and leprosy by means of reducing sources of infection and increasing immunity among persons susceptible to these diseases.
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. With the object of running leprosy control activities more effectively, plans are under way to promote the joint development of the leprosy and tuberculosis control programee in the Maldives. This programme is to be assisted financially by the Danish "Scouts Help" Organization. SEAfRC29 12 Page 149
One of the Regional Advisers on Communicable Diseases visited the Maldives and had discussions with the national health authorities and WHO project staff; he also visited field areas. A consultant leprologist was assigned to organize a team and conduct a survey of leprosy and tuberculosis in the country and prepare a programme to cover all leprosy and tuberculosis cases in the country; his report is being processed. The survey team also performed other activities, including BCG vaccinations and immunization against DPT and smallpox; medical care was also provided during the survey period.
A representative of the Danish "Scouts Helpu Organization also visited Male and had discussions with project staff as well as the national authorities. Discussions were also held in the Regional Office concerning financial support for the project.
Action is under way to assign a medical officer on a regular basis.
MAV BSM 001 Water Supply and Sanitation R (April 1971; Aug. 1973; March-June 1974; Aug. 1974 - ) UNICEF
Aim of the project. To develop water supply and sanitation systems in Male and other atolls; to train personnel.
Assistance provided by WHO during the year. (a) A sanitary engineer; (b) supplies and equipment.
Probable duration of assistance. Until 1981
Work done during the year. During the period under review, the WHO sanitary engineer assigned to this project continued to provide technical advice and guidance to the Maldives Water and Sanitation Authority on the development of a water supply and sanitation programme in the country. The programme of chlorination of wells continued.
The contractual agreements between the Government and the contracting firm, as well as between the Government and WHO, for the consrruction of the marine drive sewer project were signed in December 1975; construction work is in progress.
MAV PIP 001 Water Supply and Sewerage for Male UNDP (March-May 1974; Dec. 1974; July 1975; - )
Aim of the project. To develop a water supply and excreta disposal system for Male.
Assistance provided by WHO during the year. A thirty-six-month fellowship for study in India. SEAlRC29 12 Page 151
8. MONGOLIA
Project Number Source of Funds Co-operating Agencies -Title
MOG SHS 003 Rehabilitation Services R (June-Julv 1973: Julv 1974: Oct. 1974 - Feb. 1975:
Aim of the project. To develop medical rehabilitation services and train necessary personnel.
Assistance provided by WHO during the year. (a) Three consultants; (b) three six- month fellowships - two for study in the USSR and one for studies in the USSR and Poland; (c) supplies and equipment.
Probable duration of assistance. Until 1977.
Work done during the year. A team of three consultants,in physical medicine, orthotics and prosthetics and physiotherapy,advised on the training of health and allied personnel in rehabilitation and on the organization of comprehensive rehabilitation services in Mongolia. The report containing their recommendations is under review.
MOG SHS 004 Strengthening of Emergency Health Services R (Nov.-Dec. 1974; May-June 1975; Aug. 1975; Jan.-April 1976; - )
Aim of the project. To develop, plan and manage emergency health care services, and provide continuing education on new trends in emergency care.
Assistance provided by WHO during the year. (a) Three consultants; (b) two three- month fellowships for study in the USSR and a six-month fellowship for studies in the USSR and Bulgaria.
Probable duration of assistance. Until 1980.
Work done during the year. A consultant in toxicology was assigned to Mongolia for six weeks during January-February to make an epidemiological survey of the causes of poisoning and to suggest preventive measures, to assess the exisLing services for the treatment of patients of poisoning and to make recomendatFons for their improvement within the framework of the emergency care services. The consultant also trained national staff and gave advice to research workers in the field. The report containing his recommendations has been sent to the Government.
A team of two public health administrators was assigned for two weeks during February-March to evaluate the state of the emergency care services in Mongolia and the implementation of the recommendations made by an earlier consultant. They also assessed the information system and proposed measures for its improvement, advised on research and took part in national courses on health management. Their report has also been sent to the Government.
MOG SHS 005 Management of Health Services R (Jan.-March 1975; Aug.-Nov. 1975; Jan.-Feb. 1976; April 1976; - )
Aim of the project. To develop integrated health services and train health personnel in all aspects of community health services; to develop a health information system and train health statistical personnel; to develop health services management and operational research. SEA/RC29/2 Page 152
Assistance provided by WHO during the year. (a) Twelve fellowships - five for five months for study in the USSR, two for ten months for study in the USSR, two far Four months for studies in the USSR and Poland, a nine-month fellowship for study in the USSR, a seven-month fellowship for study in the USSR, and a six-mbnth fellohship for studies in the USSR and the German Democratic Republic; (b) supplies and equipment.
Probable duration of assistance. Several years.
MOG MCH 001 Maternal and Child Health Services R (June-Sept. 1965; Nov. 1966; July 1967 - Dec. 1974; Aug. 1975)
The project has been merged with MOG MCH 002. During the period under review, two seven-month fellowships were awarded for study in the USSR.
MOG MCH 002 Maternal and Child Health R (Julv 1975 - ) UNICEF
Aim of the project. To improve maternal and child care further, including nutrition, with emphasis on the development of specialized services for the care of mothers and children.
Assistance provided by WHO during the year. (a) A medical officer and a consultant and temporary assistance from a Headquarters staff member; (b) five five-month fellowshi~s- two for studv in the USSR. two for studies in the USSR and Bulaaria. and one for studies in the USSR and Poland; (c) supplies and equipment.
Probable duration of assistance. Several years.
Work done during the year. The plan of operation for the project was completed and signed by the Government, WHO and UNICEF. UNICEF's assistance to this project will continue up to the middle of 1976.
The long-term medical officer in maternal and child health completed his assignment in February.
A consultant in obstetrics and gynaecology assigned to this project during October 1975 - January 1976 made an assessment of the current programme of undergraduate and post-graduate education and training in obstetrics and gynaecology for health professionals. In addition, he demonstrated new methods of educational technology in obstetrics and gynaecology as well as new surgical techniques. A staff member from WHO Headquarters visited Mongolia in September 1975 to advise on the improvement of obstetric and gynaecology services within the general health services.
The activities of this project are closely co-ordinated with those of project MOG HMD 003.
MOG RED 001 Health Education R (Nov. 1970 - March 1971; Sept. 1971 - Jan. 1972; Sept. 1972; Feb.-May 1973; Aug. 1973; June 1974; Oct. 1974; Sept. 1975; - )
Aim of the project. To develop and implement a health education programme.
Assistance provided by WHO during the year. A three-month fellowship for study in the USSR.
Probable duration of assistance. Until the end of 1977. SEAlRC2912 Page 153
MOG HMD 001 Nursing Services and Education R (Dec. 1966; June 1968 - Dec. 1975) 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) five two- month fellowships - two for study in Poland, two for studies in Poland and Yugoslavia, and one for study in the USSR.
Work done. Following a survey of the needs for nursing and other middle-grade health manparer carried out in 1966, a WHO nurse educator was assigned in June 1968, and she undertook a further detailed survey of nursing needs, which formed the basis for the plan of action. The project continued in operation until December 1975, except for the year 1972 when the nurse educator was on study leave.
The major objectives were to develop a basic school of nursing, to strengthen training programmes for auxiliary nursing personnel, and to improve nursing services in hospitals, polyclinics, health centres and domiciliary services.
In 1970, a two-year basic nursing prograrmne was started, for which the admission requirement was ten years of general education. By December 1975, when the project ended, four schools of nursing had been established, with a new building in Darhan completed in 1975. The largest school, in Ulan Bator, has an enrolment of 555. In 1975, there was a total of 396 graduates from the four schools. Graduates are assigned to aimaks throughout the country, based on a master plan according to needs and taking into consideration the interests of the nurses.
Refresher courses for auxiliary nurses were conducted on a continuing basis at different locations, covering the fields of medical, surgical and paediatric nursing. Short courses were organized for tutors on methods of teaching, educational psychology, and the use of teaching aids. In-service education programmes were started in hospitals, with graduates of the basic programme serving as teachers. From 1974, a course on nursing procedures for second-year medical students was found to be very useful and is to be continued.
With the rapid expansion of basic and auxiliary nurse training, the need for tutors became acute. In 1974, a nine-month post-basic tutors' course was given. A post- basic course in nursing administration started in September 1975.
Thirteen short-term fellowships and 11 long-term (36 months) fellowships were provided for the training of doctors, feldshers and nurses under this project. This helped considerably in strengthening the teaching staff for the training programmes.
An important feature of the project has been its contribution to national planning for nursing education and services, including participation in:
- preparation of a five-year development plan involving total planning for nursing (1970) ;
- drawing up of an organizational chart for a nursing unit at the Ministq of Health level;
- preparation of a job description for the Chief Nurse, and
- preparation of five-year plans for post-basic nursing education and for middle-level health workers.
The aims of this project will be carried forward and expanded under a new project, MOG HMD 004, "Training of Health Manpower". SEA/RC29/2 Page 154
MOG HMD 003 Assistance to the State Medical Institute, Ulan Bator R (April-May 1970; Sept. 1970; Dec. 1970 - Jan. 1971; May 1971; UNDP July 1971; Dec. 1971; Aug.-Nov. 1972; Jan. 1973 - )
Aim of the protect. To develop further and improve the medical education system by improving admission procedures, by revising the curricula, teaching and evaluation practices, and by developing a corps of teachers competent in different branches of medicine and able to apply modern teaching technology.
Assistance provided by WHO during the year. (a) Two medical educators, seven consultants and a secretarial assistant; (b) six fellowahips - one for twelve months for studies in the USSR and the German Democratic Republic, one for twelve months for studies in the USSR and the United Kingdom, one for ten months for studies in the USSR and Hungary, one for six months for study in the USSR, one for ten months for studies in the USSR and Yugoslavia, and one for eight months for study in the USSR; (c) supplies and equipment.
Probable duration of assistance. Until 1978.
Work done during the year. The project activlties continued during the year and assistance in various disciplines was provided through consultants. Large quantities of supplies and equipment were also provided.
MOG HMD 001 Training of Health Manparer R (Jan. 1976 - ) Aim of the project. To organize teaching and training programmes for health personnel to carer to national needs; to improve the education and training of paramedical personnel and associated professions, including revision of curricula and procedures. to be able to apply modern teaching technology.
Assistance provided by WHO durinp the year. (a) A nurse educator; (b) supplies and equipment.
Probable duration of assistance. until the end of 1985.
Work done durinn the year. This project started on 1 January 1976 as a follow up of projects HOG HMD 001, "Nursing Services and Education", and MOG DNH 001, "Dental Health Services".
The plan of operation was signed by the Government and WHO, translated into Mongolian and distributed to all key persons concerned with the development of the project.
Major emphasis is on the training of all categories of middle-level health workers and planned development of post-basic training and continuing education programes. A post-basic training centre is to be established in Ulan Bator. Short courses in educational technology will be organized for teachers.
The nurse educator continues to provide assistance to the schools of nursing, seminars for tutors, and in the preparation of refresher courses for auxiliary nurses.
This project will develop in close co-ordination with projects MOG HMD 003, "Assistance to the State Medical Institute", and MOG SHS 005, "Management of Health Services".
MOG ESD 001 Epidemiolo~icalServices and Surveillance R (Jan. 1972; Aug.-Nov. 1973; July 1974; Sept.-Nov. 1974; July-Sept.1975; Jan.-April 1976; - 1 Aim of the project. To develop further epidemiological surveillance of diseases representing major public health problems, and to strengthen further health laboratory services in the country. SEA/RC29/2 Page 155
Assistance provided by WHO during the year. (a) Four consultants and assistance from two Headquarters staff members; (b) three fellowships - two for thirteen weeks and one for twelve weeks - for study in Czechoslovakia; (c) supplies and equipment.
Probable duration of assistance. Some years.
Work done during the year. Meningococcal meningitis continued to pose a major public health problem in the country. During July/August 1975, two WHO consultants and a medical officer from the Bacterial Diseases Unit at WHO Headquarters were assigned to the project. One of the consultants assessed the prevalence of serotypes of N. meningitidis and their drug-resistance patterns in the aimaks in order to select the proper vaccine and antibacterial drugs for disease control. The other consultant surveyed bacterial air pollution in yurtas and in apartments with a view to devising air hygiene measures, in particular in areas with a prevalence of the serogroup of N. meningitidis where vaccine could not be used. The medical officer from WHO Headquarters co-ordinated the activities of the two consultants and assessed the reactions and innnune response to the new A+C combined vaccine in small groups of young adults in Ulan Bator for possible use in disease control.
A donation of 45 000 doses of groups A, C and AH vaccine (11 000 each) was received from Institut Merieux, France, for use in the controlled field trial against cerebrospinal meningitis. Also, the supply of other media and reagents for this purpose was arranged. Three WHO consultants were assigned early in 1976 to assist in the formulation, in collaboration with the Government, of a long-term programme for the control of cerebrospinal meningitis through the health services. One of them visited Mongolia in JanuarylFebruary 1976 to evaluate the type-specific meningococcal vaccines ,and the second consultant was assigned in MarchiApril 1976 to follow up and complete the study of bacterial air pollution in various premises and its relationship to cerebrospinal meningitis. The third consultant made a follow-up visit in March/April 1976 to assess the prevalence of serotypes of N. meningitidis and their drug resistance patterns in the aimaks.
A medical officer from the Innnunology Unit at WHO Headquarters visited the project during April-May 1976 to establish laboratory facilities for the diagnosis of virus diseases and to train physicians and laboratory personnel in this field.
A consultant is under recruitment to provide assistance in preparing mid-term and long-term prognoses of the most important infectious diseases in Mongolia. Another consultant, also under recruitment, will assist in the epidemiological investigations of infectious hepatitis, recornend practical measures for strengthening the epidemiological services and survey of infectious hepatitis, and assist in training national staff and in improving the public information system concerning hepatitis. Arrangements are also under way for the Chief of the Veterinaty Public Health Unit at WHO Headquarters to visit Mongolia to give advice on zoonoses control.
MCG MBD 001 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. Supplies and equipment.
MDG VPH 001 Brucella Vaccine Production UNDP (May-July 1970; June-Aug. 1972; Feb. 1973; Sept. 1973 - )
Aim of the project. To produce freeze-dried Bmcel.ta vaccine and establish laboratory facilities for its testing. SEA/RC29/2 Page 156
Assistance provided by WHO during the year. (a) A microbiologist, a scientist (epizootiologist), a consultant and a secretarial assistant; (b) supplies and equipment.
Work done during the year. Among the important activities carried out during the year were the following:
Two million doses of freeze-dried Rev.1 vaccine were issued to meet the requirements of the on-going vaccination progranme for this season; the State Control Laboratory was further strengthened by the appointment of a national expert in biological standards; in addition to the other tests, batches of vaccine are naw tested for their protective effect experimentally on guinea pigs; also, six batches were referred to the WHO/FAO Brucellosis Reference Centre for independent testing in Moscow and the United Kingdom; the rate of rejection on account of poor potency has been greatly reduced; late vaccination of small ruminants in Dalanjargalant and Sant Somons (about 60 000 animals) was undertaken in October 1975 on the request of the Academy of Sciences as a special study.
Post-vaccination control testing in two aimaks and in the above two somons, which were vaccinated in 1975, has provided good evidence that the vaccine produced locally is antigenically effective. Thus, out of 700 samples of serum from vaccinated ruminants which were tested, antibodies to a second degree were demonstrated in 81% of the animals. Controlled field vaccination trials were under way in Burenkhangai, Orkhon and Dalanjargalant somons with a view to determining a small dose of vaccine that would be equally effective as the present full dose. In Salinga Aimak, out of 275 abortive foetuses which were referred to the aimak laboratory for bacteriological testing, BruceZZa Bio-type-3 was isolated 33 times and SaZmoneZta abortus ovi8 was isolated from six foetuses; a field control survey of mass lambing and abortion ocurrences along with the control of their reporting were undertaken in the two aimaks vaccinated last year; an early report suggests a significant drop in abortion amng vaccinated ruminants.
The project was involved in some educational activities, of which an important one was the six-day seminar on laboratory surveillance of brucellosis in men and animals. The seminar was held at the Central Veterinary Laboratory (CVL) and at Songino Biofabrika for 12 bacteriologists from the CVL, the aimak veterinary laboratories and the Central Biological Laboratory; discussions were held on the bacteriology and immunology of brucella control in men and animals and the participants were also offered practical exercises. In addition to the Seminar, the project organized five short training courses of two days' duration each for a number of participants from Ulan Bator and two aimak centres.
The project also extended assistance to areas outside its purview where its technical know-how was sought. The team offered technical advice on improving the milk processing technology in the Government dairy plant in Ulan Bator.
ming to the difficult financial situation in UNDP, many important activities planned for 1976-1977 had to be curtailed or cancelled. The post of administrative assistant was abolished in favour of technical assistance to be provided by a consultant in laboratory surveillance. Owing to lack of funds to provide a consultant, defects in the only lyophilizer which is available for processing the vaccine could not be attended to.
The bacteriological surveillance of abortus in areas that have been covered by the vaccination programme is rendered difficult because of inadequate transport facilities. This seriously restricts the effective coverage that aimak veterinary laboratories can provide in their respective areas.
In general, the project is expected to meet most of the milestones and in implementing additional milestones that had not been planned earlier. Steps are being taken to minimize the damage that might result from early withdrawal of UNDP assistance, and the possibility of procuring assistance from sources other than UNDP is being explored. SEAlRC29 I2 Page 157
MOG OCD 001 Control of Non-Communicable Diseases R (Feb.-March 1975; May-Aug. 1975; April 1976 - )
Aim of the project. To identify health problems due to non-communicable diseases, undertake epidemiological investigations and health education for prevention and contro1,and train health and allied personnel for early detection, diagnosis, and treatment services, including biomedical research.
Assistance provided by WHO during the year. (a) Two consultants; (b) four fellowships - two for five months and two for four months - for study in the USSR, and a five-month fellowship for studies in the USSR and the German Democratic Republic; (c) supplies and equipment.
Work done during the year. A consultant was assigned for ten weeks during May-July 1975 to advise on the siting and organization of in-patients and specialized services, the rehabilitation of long-stay patients, diagnostic facilities and training of doctors and nurses in psychiatry. The consultant's recommendations were forwarded to the Government.
Another consultant took up a three-month assignment in May 1976 to advise on the training of physicians in the use of the latest drugs in the management of chronic non-communicable diseases such as cancer and cardiovascular diseases.
MOG DNH 001 Dental Health Services R (May-June 1970; Feb.-July 1972; Dec. 1972 - May 1973; Aug.-Oct. 1973; May 1974; Sept. 1974; Nov. 1974; June 1975; - )
Aim of the project. 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. Two six-month fellowships for study in the USSR.
MOG RAD 001 Strengthening of Radiological Services and Maintenance R of Electro-medical Equipment (Nov. 1968 - Feb. 1969; April 1971 - Dec. 1974; Feb. 1975; Sepc. 1975; - )
Aim of the project. To train technicians in the repair and maintenance of electro- medical equipment; to strengthen repair and maintenance services for hospital equipment through the organization of a central and a series of satellite workshops; to promote radiation protection practices in health institutions.
Assistance provided by WHO during the year. (a) Two four-month fellowships for studies in the USSR and Czechoslovakia; (b) supplies and equipment.
Work done during the year. A consultant is under recruitment to advise on the organization of radiation protection services.
MOG SQP 001 Quality Control of Drugs R (Feb. 1971; Sept.-Oct. 1971; June-Aug. 1973; Oct. 1973; June-Sept. 1974; Nov. 1975; April-June 1976; - )
Aim of the project. To develop further the manufacture of pharmaceutical products and to upgrade services associated with their quality control; to train staff.
Assistance provided by WHO during the year. (a) A consultant; (b) two three-month fellowships for studies in the USSR and Hungary; (c) supplies and equipment. SEA/RC29/2 Page 158
Work done during the year. Technical assistance was provided to the State Drug Control Laboratory in organizing a section for the biological control of medicines. Working under difficult conditions,the consultant provided for this purpose devised an immediate plan for correcting the situation and for making a beginning with minimum activities in biological control. To this effect two counterparts were appointed - a pharmacist trained in biological quality control and a veterinarian. A modest supply of small laboratory animals was procured and kept at the State Drug Control Laboratorymhere the testing of drugs is undertaken. The purpose of biological tests, the use of animals for this purpose and the reading of results, were all explafned to the counterparts. Notes describing the different tests used in biological testing procedures, such as the pyrogenicity test for injectables, the safety and toxicity test in guinea pigs and selected drug testing in rats were provided, the counterparts were trained and protocols were given to them. Steps are being taken to consolidate the temporary arrangements and also to develop further the activities undertaken by the project initially. In this connexion, the consultant has recomended that: (1) small laboratory animals such as rabbits, guinea pigs and rats should be regularly supplied, preferably from Songino, where expert veterinary supervision is available for breeding and stocking purposes (Songino is the ideal place where such development can take place); (2) counterparts need to be trained further in their respective areas with regard to biological control, and (3) assistance should be sought for the provision of essential equipment to enable the laboratory to perform basic tests.
MOG LAB 001 Public Health Laboratory Services UNDP (May-Aug. 1964; Dec. 1964; Aug. 1965; Oct. 1966 - Sept. 1968; UNICEF Jan. 1969; May 1969; Sept.-Oct. 1969; Feb. 1970 - May 1973; Feb. 1974 - )
Aim of the project. To strengthen health laboratory services and to train personnel in medical laboratory technology.
Assistance provided by WHO during the year. A clinical pathologist and two consultants. -Probable duration of assistance. Until the end of 1976. Work done during the year. The clinical pathologist who has been assisting the project since April 1974 completed his assignment in July 1975. During the period under review, two consultants have provided additional support to the project - a consultant in clinical chemistry and another to review the training. The reports of the clinical pathologist and the consultants were sent to the Government. The following milestones have been completed; a two-month course in bacteriology for laboratory technicians; planning and co-ordination of the laboratory aspects of the activities of project HMD 003 with those of this project; evaluation of the project by the Laboratory Council, and a manual of clinical pathology for Mongolian staff.
As a pathologist was provided under bilateral assistance, it was felt that the provision for another pathologist under this project should be utilized to recruit two other consultants - one in gama globulin and the other in SaLmoneZZa bacteriology (the latter could not take up his assignment on account of the UNDP financial situation).
During his three-month assignment the consultant in gamma globulin transferred the improved technology of placental serum fractionation using alcohol for the separation and purification of albumin and globulin. Counterparts were trained, the laboratory lay-out was reorganized by reinforcing asepsis, and the quality of the globulin was greatly improved, as control testing, including electrophoresis, N2 estimation and albumin detection are done on all lots of the final product. Detailed protocols of the procedure involved in precipitation and purification were given to the national counterparts and a flow-chart describing the step-by-step procedures in the preparation of gamma globulin was annexed to the consultant's report and copies distributed to all concerned. Alternative plans were provided in case the Government decided to step up the production of gamma globulin. SEAlRC2912 Page 159
MOG LAB 002 Rehydration Therapy (Production and Control) R (June-July 1973; 0ct.-Nov. 1973; Sept. 1974 - April 1976)
Aim of the project. To produce rehydration fluids and train paediatricians in the practice of oral and parenteral rehydration therapy.
Assistance provided by WHO during the year. (a) Two scientists and a consultant; (b) supplies and equipment.
Work done. The WHO team - the production manager and the scientist for quality control - completed its assignment in March. While the final report is being processed, some of the important reco-ndations made by the team were sent to the Government. After long delays in construction and the delivery of supplies ordered from Czechoslovakia, the intravenous fluid plant procured from Chirana with assistance from UNICEF has been installed and commissioned for production; because of the limitation in the supply of power and steam, however, the plant will operate at only 40% of its installed capacity, which is rated at 75 000 cts annually; the national staff has been appropriately trained to run the service competently; two chemists have been trained in physical and chemical control. Bacteriological control is done by the Institute of Hygiene, Epidemiology and Microbiology. Protocols for the production of the different intravenous solutions, instruction notes, laboratory procedures, and standards for control were provided to the national staff in the laboratory.
Two centres - one in the Children's Hospital, Ulan Bator, and the other in the Middle Aimak - were established. UNICEF provided a set of equipment for resuscitation and intravenous therapy. The centres will be used as emergency rooms for the treatment of out-patient infants suffering from severe dehydration, with or without toxicosis caused by gastroenteritis, fevers and pneumonia. The centre in Ulan Bator is well equipped for the simultaneous treatment of six infants at a time. Because of the concentration of resources and the availability of clinical material, the centre is also used for training nurses and medical officers.
The project needs to be adequately followed up. To this effect power should be stepped up and the steam line extended to the precincts of Pharma Works; steps should be taken to order in time the supply of expendables - chemicals and glassware - in sufficient quantities so that production is not impeded; better and more adequate facilities for the storage of the intravenous fluid and chemicals are also needed.
The activities will be followed up under project MOG MCH 002, "Maternal and Child Health" .
MOG DHS 001 Health Statistics R (Aug.-Sept. 1967; Sept. 1968; Jan.-Sept. 1969; Jan. 1970; April-July 1971; April-July 1972; Sept. 1972; Feb.-April 1973; Aug.-Dec. 1973; July 1974; - )
Aim of the project. To develop health statistical services and to train personnel.
Assistance provided by WHO during the year. Supplies and equipment.
MOG SES 001 Strengthening of Health Services (Public Health Inspection) R (April 1974; July-Nov. 1974; March 1975; Sept. 1975; - )
Aim of the project. To evaluate the sanitary control services and develop them further; to improve the training of personnel for the State sanitary inspection services; to strengthen the public health chemical laboratories.
Assistance provided by WHO during the year. (a) Two four-month fellowships for study in the USSR; (b) supplies and equipment. Probable duration of assistance. Until 1980. SWL/RC29/2 Page 161
9. NEPAL
Agencies Title
NEP SHS 001 Development of Health Services R (Sept.-Nov. 1968; Jan. 1970 - )
Aim of the project. To strengthen the development of an integrated health service in conformity with the development plans of the Government; 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) A public health administrator, an epidemiologist, a public health nurse, a medical records officer, an electro-medical engineer, a sanitarian, two consultants and a secretarial assistant; (b) a nine- and-a-half-month fellowship for studies in the United Kingdom, India and Thailand, a sixteen-month fellowship for study in Iran, and two one-month fellowships for study in India; (c) supplies and equipment.
Probable duration of assistance. A number of years.
Work done during the year. The training of auxiliary health workers, auxiliary nurses, midwives and staff nurses was continued. A national Workshop on Health Planning for Senior Health Personnel was held in Kathmandu in the first week of March. The aim of this activity was to stimulate the active interest and involvement of health workers at all executive levels. Another national course on "Managerial Aspects of Integrated Community Health" was held in June 1976. Assistance was provided in preparations for the training of ayurvedic personnel in order to extend their role within the basic health services. Various steps were taken for the development of integrated basic health services in the districts.
The exercise of project formulation for basic health services continued till the end of November 1975 and again in February 1976 with the help and full participatiar of staff members of the project and the operations research specialist from the Regional Office.
BCG and smallpox vaccinations were completed in six districts; further BCG vaccinations were being carried out in many other areas.
A preliminary geographical and state of health survey was carried out in Kaski District with a view to developing a suitable health care delivery system to provide basic health care to the population.
The services of a teacher in anaesthesiology were provided to the Institute cf Medicine, Tribhuvan University, Kathmandu. Another consultant advised on the development and strengthening of the National Health Planning Unit in the Ministry of Health.
NEP SHS 002 Medical Stores Management R (Nov. 1972 - ) UNICEF
Aim of the project. To develop and expand medical stores and supply services.
Assistance provided by WHO during the year. A medical stores management officer SEA/RC29/2 Page 162
Work done during the year. Several steps were taken to bring about improvements in the supply and distribution systems in medical stores. The record card system was introduced in a number of places such as the Kathmandu Stores, Biratnagar Hospital store, Birganj Hospital store and the store at the Bara District health office. This procedure is expected to be extended further to other health centres. It is planned to establish some model medical stores in the country to serve as centres for the in-service training of medical storekeepers and personnel in charge of hospital pharmacies.
NEP HED 001 Health Education R (May-Aug.1967; Sept.1968; Nov.1968 - Feb.1969; Sept.1969; UNICEF April-May 1970; July 1970; Dec.1970 - Jan.1971; May 1971; July-Sept. 1971; July-Aug.1972; Dec.1972; June 1974 - June 1975; Jan.-June 1976; - )
Aim of the project. To develop health education services at both central and other levels of the health administration to support health education activities as an integral part of health programmes; to develop school health education in primary and secondary schools and teachers' colleges.
Assistance provided by WHO during the year. (a) A consultant; (b) a four-week fellowship for study in India.
Probable duration of assistance. Until 1983.
Work done during the year. WHO assistance to health education programmes continued during the year with the assignment of a consultant from January to June 1976. He helped the Government to implement the recommendations made by the previous long- term consultant as well as the health education project formulated with his assistance. When all or the majority of these recommendations are implemented, it is expected that the health education services will be able to meet the needs of the country's health programmes.
In addition, the consultant assisted the Institute of Education in the development of the Diploma and the Master's programme specializing in health education. Assistance was also provided to the Ministry of Education in developing the curricula for primary and secondary schools, and to the Institute of Medicine of Tribhuvan University with the health education components of its various courses. Further, the consultant assisted with the integration of health education in health services. Fellowships were provided for training national health educators abroad.
A long-term health education specialist is to be assigned in 1977 to assist with the further development of health education.
NEP HMD 001 Training of Health Manpower R (June 1975 - )
Aim of the project. To train health manpower needed for the comprehensive health care system.
Assistance provided by WHO durinp, the year. (a) A nurse-midwife educator and two consultants; (b) a twenty-four-month fellowship for study in India; (c) supplies and equipment.
Probable duration of assistance. A number of years.
Work done during the year. A radiography tutor took up a six-month assignment early in July 1975 to advise the Dean of the Institute of Medicine of Tribhuvan University on the training of radiographers taking the certificate course in radiography, as well as to assist in the organization of the course and its curriculum content, the SEA/RC29/2 Page 163
practical experiences necessary for the students,and student evaluation. The consultant also advised on the proper utilization of the radiology departments of various hospitals in Nepal for the teaching and service aspects of radiology.
A consultant in medical education, assigned during July-September, advised the Dean of the Institute of Medicine on the development of a curriculum for doctors designed to meet the needs of Nepal. His recommendations were sent to the Government.
A nurse midwife educator was assigned in October 1975. She has been advising on the revision of the midwifery portion of the basic nursing curriculum and on the future development of post-basic courses for nurses in clinical teaching and the teaching of midwifery.
It is proposed to assign a consultant in radiography in July 1976. At the request of the Institute of Medicine, Kathmandu, a change in the programme was made in order to provide two consultants for three months - one in curriculum development and the other in community medicine - later in 1976. Action was also initiated for the assignment of a consultant in the field of clinical sciences.
NEP HMD 002 Fellowships R
Nursing. A twelve-month fellowship for study in India.
NEP MPD 001 Malaria Eradication R (June 1954 - )
Aim of the project. To eradicate malaria.
Assistance provided by WHO during the year. (a) Two malariologists, a sanitarian, a transport assistant and a secretarial assistant; (b) a two-week fellowship for study in Malaysia and eight fellowships - seven for six weeks and one for twelve months - for study in India; (c) supplies and equipment.
Probable duration of assistance. A number of years.
Work done during the year. According to mid-1976 estimates, a population of 7.3 million out of a total of 12.7 million lives in areas at malaria risk; of this, 6.6 million persons are covered by the malaria eradication programme, with 2.2 million under the attack phase and 4.4 million under consolidation, including 1.5 million in six districts under integrated health services. A population of 0.1 million is under control operations through the availability of anti-malaria drugs, whereas 0.6 million are not covered by any anti-malaria operations.
The eighth Indo-Nepal Border Anti-Malaria Co-ordination Conference was held in Kathmandu in January 1976. A situation analysis by a joint national/WHO/US AID team was undertaken at the beginning of 1976 to evaluate the epidemiological situation, to identify the bottlenecks hindering the execution of the activities on schedule and ways to resolve them, to recommend suitable activities for the Eastern Hills, and to highlight any measures likely to improve considerably the overall efficiency of the programme. The report of the team is under consideration.
During 1975, a total of 11 856 malaria positive cases was detected from 1 438 483 blood examinations, giving a slide positivity rate of 0.8% (as against 14 647 positives detected from 1656 329 blood examinations with a slide positivity rate of 0.88% in the previous year). Of these, 914 including 62 P. fazciparum (1140, including 80 P. faZ&pam during 1974) came from the six integrated districts, 2931, including 841 Pf (3388, including 1085 Pf in 1974) from consolidation and case-detection areas, and 8011, including 2049Pf (LO 119, including 1755Pf in 1974) from attack areas and those reverted from the attack phase. A reduction in the number of positive cases to some extent was obser~din all areas, but it SEA/RC29/2 Page 164
occurred mainly in areas under attack. The P. faZcipam proportion continued to rise from 14.6% in 1973 to 19.9% in 1974 and to 24.9% in 1975, largely on account of importation. There was, however, a reduction of 35.8% in indigenous cases in areas in the case-detection, consolidation and integration phases. The annual blood examination rate in the integrated districts fell from 10.9% in 1974 to 5.0% in 1975, whereas it improved slightly, from 14.9% to 15.5%. in consolidation and case-detection areas. The annual parasite incidence registered a fall (from 4.59/1000 in 1974 to 2.811000 in 1975) in attack areas but a slight increase (1.1711000 to 1.2311000) in the consolidation and case-detection areas; in the integrated areas the reduction from 0.77/1000 in 1974 to 0.6011000 in 1975 loses credibility when studied in the context of the increase in the slide positivity rate from 0.57% to 1.09% during the same period, specially when the annual blood examination rate is observed to have been reduced to less than half in these areas. The annual parasite incidence in some of the districts under the integrated health services has been observed to be higher than in many areas in consolidation.
In view of the changing epidemiological situation, the entomological activities have mostly been confined to the terai areas on the Indo-Nepal border.
NEP SME 001 Smallpox Eradication R (Feb. 1962 - Dec. 1963; Aug. 1966 - ) UNICEF
Aim of the project. To eradicate smallpox.
Assistance provided by WHO during the year. (a) A public health officer and an operations officer; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1977.
Work done during the year. No smallpox cases were recorded in Nepal during the year.
Continuing searches for possible cases were conducted throughout the year; reports of suspicious cases were thoroughly investigated.
Two teams were created and started work in February, carrying out programme assessments as well as surveillance. Tibetan refugee camps were searched for pock-marked children.
A new operational guide was introduced. The project staff organized the inter- country workshop on surveillance held in Kathmandu in January. During the year, the public health officer assisted with the country health progralming exercise.
NEP MBD 001 Leprosy Control R (March 1967; Dec. 1968; Sept. 1969; July 1970; May 1971; Oct. 1972 - Jan. 1973; May 1974 - )
Aim of the project. To develop and expand a leprosy control programme and train staff.
Assistance provided by WHO during the year. (a) A leprosy control officer and a consultant; (b) two three-month fellwships for study in India.
Probable duration of assistance. Some years
work done during the year. A revised draft of the curricula relating to the diagnosis, treatment and clinical management of leprosy patients was prepared and submitted to the national health authorities for incorporation in the new course of paramedical workers of the national leprosy control programme. Training activities were further strengthened. SEA/RC29 /Z Page 165
The leprosy control officer attached to the project visited Burma for three weeks during March 1976 for in-service training.
A consultant took up a three-month assignment in June 1976 to assist in reviewing the leprosy control project and in conducting a national course on leprosy control.
NEP MBD 002 Tuberculosis Control R (March 1965 - Sept. 1970; April-May 1971; Feb. 1972; UNICEF June-Aug. 1972; Dec. 1972; Oct. 1973 - )
Aim of the project. To develop a tuberculosis control programme as part of the basic health services, and to train personnel.
Assistance provided by WHO during the year. (a) A medical officer; (b) six three- month fellowships far study in India; (c) supplies and equipment.
Probable duration of assistance. Some years.
Work done durina the year. The WHO medical officer and his national counterpart took part in the project formulation exercise; the draft report of the project formulation for tuberculosis control in Nepal was submitted to the Government. Mass radiography was conducted in Kathmandu and anti-tuberculosis drugs were supplied for the treatment of cases. The programme of BCG vaccination continued satisfactorily, and simultaneous BCG and smallpox vaccination by vaccinators of the smallpox programme was also carried out.
NEP VPH 001 Prevention of Rabies R (Nov. 1972 - Feb. 1973; Jan. 1974; - )
Aim of the project. To prevent rabies.
Assistance provided by WHO during the year. Supplies and equipment.
NEP LAB 001 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 technical officer; (b) a twelve- month fellowship for study in the United Kingdom and three fellowships - two for six months and one for two weeks - for study in India; (c) supplies and equipment.
Work done during the year. A project formulation exercise was carried nut for the medium and long-term planning of a national laboratory service with the aim of correcting the present imbalance in the distribution of laboratories in the different regions and increasing the number of district laboratories from the present 18 to 49 by the year 1980. In support of the basic health services, laboratory work in the surveillance of malaria, tuberculosis and leprosy as well as in family planing will be undertaken by these laboratories in at least eleven districts by the year 1980, when full integration would have been achieved.
The following milestones have been completed with some delay in the scheduled targets: assessment of facilities and work in the district laboratories at Bara, Kaski, Parsa, Rsuthat, Siraha and Saptari and review of zonal and district laboratories at Birganj, Jaliswar and Butwal.
Assistance was given in the installation of the equipment procured by UNICEF in the East-Central Region. Delays were reported in the following milestones: development of quality control schemes in the zonal laboratories in Biratnagar, Pokhara and SEA/RC29/2 Page 166
Nepalganj, installation and codssioning of UNICEF equipment in the Western Region; completion of the draft copy of the laboratory manua1,and extension of the quality control scheme to other functioning regional laboratories.
Some non-scheduled activities have also been completed, including a survey of the status of laboratories and arrears in malaria work in six district areas and the training of eleven microscopists from district laboratories in the examination of sputum for tuberculosis, skin smears for leprosy and blood films for malaria. Comments of the Regional Office and the technical officer on the layout of the new health laboratory for the Central Region, to be sited in Teku, Kathmandu, were given; this laboratory will function as the reference laboratory for communicable diseases for the whole of Nepal. Comments were also made on the training of students at the central health laboratories. The laboratory will have the following departments: food and water bacteriology, enteric bacteriology, general bacteriology, tuberculosis virology and cervical cytology. The construction of the building is scheduled to start during the current financial year.
The project is experiencing difficulties with regard to field activities. Lack of transport continues to affect the supervision of the district laboratories adversely. Also, owing to lack of trained personnel, laboratory technicians may not he available for work in the district laboratories in the integrated districts. One way of overcoming this difficulty may be to provide microscopists with further training so as to enable them to perform a range of simple laboratory procedures.
NEP BSM 001 Community Water Supply and Sanitation R (Jan. 1971 - ) UNICEF
Aim of the project. To plan, organize and implement a long-term comprehensive national programme of colmnunity water supply and waste disposal.
Assistance provided by WHO during the year. (a) Two sanitary en~ineers;(b) a ten- month fellowship for study in India, a twelve-month fellowship for study in the Netherlands. and three two-month fellowships for studies in India, Thailand and Malaysia; (c) supplies and equipment.
Probable duration of assistance. Until 1980.
Work done during the year. The WHO sanitary engineers of the project continued to carry out their functions as planned. One of them assisted the Department of Water Supply and Sewerage in the planning, survey, design and construction of water supply schemes undertaken by the Department.
The most significant activity during the period under review was the conduct of a project formulation exercise far the development of water supply and excreta disposal within the framework of the Government's policies and objectives as set out in the country's Fifth Five-Year Plan.
Construction of rural water supply schemes continued to make substantial progress, and this is attributable to increased availability of materials, adequate transportation facilities and technical manpower. A loan agreement to finance rural development projects in Nuwakot and Rasuwa districts covering 100 community water supply schemes was signed between the Government and IBRD.
Ten United States Peace Corps volunteers, who arrived in August 1975, completed a three-month training progranrme, which was drawn up by the WHO sanitary engineers. A group of 46 trainee overseers completed the first year of a three-year training course at the Engineering Institute, Lalitpur, and were assigned to various district panchayats to spend the second year in practical training. One of the national counterparts proceeded to the USA to follow the training course organized by the World Bank. SEA/RC~~/~ Page 167
UNICEF continued to provide substantial assistance to the project, which also received adequate support and necessary facilities from the government agencies concerned.
NEP PIP 001 Development of Water Supply and Sewerage in UNDP Greater Kathmandu and Bhaktapur (July 1969; Nov. 1970 - Oct. 1973; Aug. 1971; Jan. 1976)
The activities were completed in October 1973. During the period under review, a five-and-a-half-month fellowship was awarded for studies in Australia, Malaysia and Singapore. SEA/RC29/2 Page 169
10. SRI LANKA
SRL SHS 001 Medical Rehabilitation R (Nov. 1968 - Feb. 1969; Feb.-June 1970; Jan.-March 1972; March 1973; July-Sept. 1973; Sept. 1974; Nov. 1974; April 1975; Sept.-Dec. 1975; Feb. 1976; - )
Aim of the project. To strengthen community-oriented medical rehabilitation services and to train staff.
Assistance provided by WHO during the year. (a) A consultant; (b) a six-month fellowship for study in Canada; (c) supplies and equipment.
Probable duration of assistance. Until 1979.
Work done during the year. The development of community-oriented rehabilitation services with adequate referral services was assisted by a consultant provided during September-December 1975. In addition to reviewing the progress made since an earlier assignment to the project, the consultant assisted further in the development of a comprehensive rehabilitation centre at Ragama Hospital and in the planning and organization of medical rehabilitation services, the establishment of rehabilitation centres in other hospitals and in the training of staff in this field. His report has been sent to the Government. Extension of rehabilitation services to the periphery and utilization of local talent and indigenous material for providing aid were noteworthy developments in Sri Lanka during the year.
SRL SHS 002 Port Health Services R (Sept. 1969; Sept. 1970; Aug. 1972; March 1973; Aug. 1973; 0ct.-Dec. 1973; July 1974; Sept. 1974; Aug. 1975; - )
Aim oE the project. To strengthen port health services.
Assistance provided by WHO during the year. (a) An eleven-month fellowship for studies in the United Kingdom, Yemen and India; (b) supplies and equipment.
Probable duration of'assistance. Until the end of 1979.
SRL SHS 003 National Health Planning R (June-Aug. 1970; Sept.-Dec. 1971; June 1972 - Dec. 1973; March 1974; July 1974; Nov. 1974 - March 1975; July-Aug. 1975; Oct. 1975; March 1976; - )
Aim of the project. To establish and strengthen a health planning unit in the Ministry of Health and to train Staff.
Assistance provided by WHO during the year. (a) A consultant and temporary assistance from Regional Office staff; (b) three fellwships - one for twelve months for study in the United Kingdom, one for two weeks for studies in Burma and Nepal, and one for eleven months for study in Australia; (c) supplies and equipment.
Probable duration of assistance. Some years. SEA/RC29/2 Page 170
Work done during the year. In addition to the assignment of a consultant and assistance from Regional Office staff, financial aid was provided in the conduct of two national orientation courses for administrators from provincial/base/district hospitals. The aim of the courses was to promote efficient management of hospitals by apprising the participants of the latest developments in the field of organization and management as applied to hospitals. The report of the consultant has been sent to the Government.
SRL SHS 004 Strengthening of Electro-medical Division R (June-Sept . 1972; Feb .-March 1973; March 1974; Aug. 1974; Oct. 1974 - )
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.
Assistance provided by WHO during the year. (a) A consultant; (b) three nine-month fellowships for studies in the Netherlands and the United Kingdom, an eight-month fellowship for study in the United Kingdom, and a three-month fellowship for studies in the United Kingdom and the United States of America; (c) supplies and equipment.
Probable duration of assistance. Until 1980.
Work done during the year. The short-term assignment of the electro-medical engineer provided to this project was converted into a long-term one, This staff member continued to attend to calls for repairs, maintenance and installation of health equipment utilized in the health services within Colombo and outside.
Theory courses in electricity, introduction to electronics, semi-conductors and basic circuits were conducted for technicians and artisans.
The electro-medical engineer has suggested early procurement of some measuring equipment and tools required for the installation, maintenance and repair of sophisticated equipment.
SRL SHS 005 Training of ~naestliesiologists R (Aug. 1972; Aug. 1973; March 1974 - )
Aim of the project. To establish a national training centre in anaesthesiology.
Assistance provided by WHO durin~the year. Supplies and equipment.
Probable duration of assistance. Until 1979.
Work done during the year. A consultant is being provided to evaluate the training programme for the development of anaesthesiology and the courses conducted in this field.
SRL MCH 001 Family Health UNFPA (Nov.-Dec. 1971; Feb.-June 1972; Aug. 1972 - ) UNICEF
Aim of the proiect. To promote family health as an integral part of the general health services.
Assistance provided by WHO during the year. (a) A medical officer, a demographer and a nurse educator; (b) nine one-month fellowships for studies in India and Thailand, sixteen fellowships - one for ten days and fifteen for two weeks - for study in Singapore, fifteen fellowships - six for one week and nine for two weeks - for study in India, twelve fellowships - one for twelve months and eleven for one month - for study in the United Kingdom, and two Eour-week fellowships for studies in Thailand and Indonesia. SEAlRC2912 Page 171
Probable duration of assistance. Until the end of 1977.
Work done during the year. Evaluation of this project by an external review team in November 1975 recorded satisfactory achievement of the objectives. The population growth, formerly 2.1% (1972), has fallen to 1.9% (1975). Despite a 100% implementation of the project, the provision of family planning facilities in the country still lags behind the rising demand however. This demand is mainly hospital-based and for sterilizing procedures. The future intention is to plan for a stronger field-based spacing programme. The major in-service training (14 000 health personnel) and fellowship (254 regional tours) components of this project will be completed in 1976, whereafter emphasis will be laid on incorporating regular on-the-job training into the service routines of all personnel of the health team. "Intensive implementation district" demonstrations will also become fully operational during 1976 and 1977. A fresh plan for the 1978-1981 period is being developed in 1976.
SRL NUT 001 Public Health Nutrition R (Dec. 1969 - Jan. 1970; Dec. 1971 - Jan. 1972; Sept. 1972; Nov. 1973 - Jan. 1974: June-Oct. 1974: Dec. 1975 - Jan. 1976; - )
Aim of the project. To strengthen the public health nutrition programmes and to train national staff in nutrition.
Assistance provided by WHO during the year. (a) A consultant; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1979.
Work done during the year. A consultant (nutritionist) was assigned to Sri Lanka for two months from mid-December 1975. He reviewed, among other things, the nutrition activities, training courses in nutrition, collaboration among bilateral and international agencies, integration of nutrition activities into the basic health services, and the delivery of nutrition services through paediatric departments and maternity wards. He recommended the establishment of a nutrition training and education unit in the Ministry of Health, the development of a national food and nutrition policy and a system for nutritional surveillance.
Steps were taken to provide another consultant to evaluate the public health nutrition programme in close collaboration with the Nutrition Unit of the Medical Research Institute and to recommend measures for strengthening training in public health nutrition.
SRL HED 001 Health Education R (Nov. 1966 - Feb. 1967; Feb.-May 1969; Sept. 1969; June 1970; Oec. 1970; Jan. 1971; March 1971; July-Sept. 1971; July 1972 - )
Aim of the project. 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 health education specialist; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1983.
Work done during the year. WHO'S assistance to the reorganization and expansion of health education services in Sri Lanka was nearing completion at the end of the year under review. Not only has the Health Education Bureau in the Department of SEA/RC29/2 Page 172
Health Services been placed under an Aasistant Director of Health Services (Health Education) but also several sub-units created within the Bureau with responsibility for school health education, hospital health education, health education field services, field study and demnstration, training, dental health, evaluation and research and audio-visual aids and mass cmunication media. To man some of these units, five health education specialists (medical) have returned from post-graduate training abroad under the UNFPA-supported project SRL HED 002. Thus, for the first time, the health education services are in a position to expand their activities to meet the educational needs of national health programmes.
In addition, the health education units in the offices of Superintendents of Health Services as well as in some specialized disease-control programmes were strengthened with additional staff. For this purpose 15 university graduates were recruited as health educators and were given training locally. Opportunities for specialized training in health education in universities abroad will be given to them later.
School health education also received considerable impetus during the year. A workshop attended by teachers from selected rural schools as well as health and health education personnel was held in order to develop realistic curricula in the context of the country's health problems. This was followed by another ten-day workshop for physical-cum-health instructors of teacher training colleges. The WHO long-term health education specialist continued to assist in all these activities.
SRL HED 002 Health Education in hrnily Health UNFPA (July-Oct. 1971; March-June 1972; Nov.-Dec. 1972; June 1973 - ) (UNESCO)
Aim of the project. To promote family health through health education; to support family health education activities with audio-visual and mass communication media; to train health professionals for health education responsibilities in the field of family health; to undertake research to provide directions for health education activities and to evaluate the effectiveness of such activities.
Assistance provided by WHO during the year. (a) Assistance from the health education specialist assigned under SRL HED 001; (b) three four-month fellowships for studies in India, Thailand, Malaysia and Indonesia; (c) supplies and equipment.
Probable duration of assistance. Until 1977.
Work done during the year. The activities of this project have helped to strengthen health education services in Sri Lanka which are, in consequence, in a better position to undertake educational activities in support of family health. Particularly significant are the recruitment and training of fifteen health educators, the post- graduate training of four medical officers as health education specialists and the in-service training of 21 health administrators and hospital administrators who occupy key positions relevant to health education. In addition, guidelines were developed to help health workers throughout the country to integrate health education in health service programmes with special emphasis on family health.
A mid-term review revealed that the project had contributed to health education in Sri Lanka and that the efforts should now be concentrated on the periphery. Accordingly, particular attention is being given to activities in the field.
T'ne activities of this project were co-ordinated with those of SRL tiED 001 and assisted by the long-term health education specialist assigned to that project. SEAIRC29 12 Page 173
SRL HMD 001 Medical Education R (June-Aug.1959; Nov.1963 - April 1964; Oct.1964 - Dec.1965; Sent.1966: Nov.1967: Se~t.1968- Aun.1969: Jan.-March 1970: Ma; 1970;~~ug.19701 l4a;ch 1971; t& 1971; 0ct.-Dec.1971; Feb.-April 1972; Aug.1972 - March 1973; May 1973; Jan.-Feb. 1974; June-Dec.1974; Hay-Nov.1975; March-April 1976; - )
Aim of the project. To develop undergraduate and post-graduate teaching programaes further 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) five fellowships - three for twelve months and two for three months - for study in the United Kingdom, two fellowships - one for three months and one for two months - for study in the United States of America, a three-month fellowship for study in India, a six-month fellowship for studies in the United Kingdom and the United States of America, and a three-month fellowship for studies in India, Thailand, France and the United Kingdom; (c) supplies and equipment.
Probable duration of assistance. Until 1979.
Work done during the year. During the year under review, assistance was provided through two consultants in studying and developing progrannnea on medical education. One of them assisted in the development of educational technology at Peradeniya and also took part in the Seminar on Educational Technology - Instructional Methods, as a faculty member. The other consultant studied the problem of social paediatrics in Colombo and Peradeniya and has given recommendations for implementing the programme. The reports of the consultants have been fowarded to the Government.
SRL HHD 002 Nursinp, Advisory Services R (July 1960 - Feb .1966; Aug.-0ct .1966; Sept.-Dec.1967; Dec.1969; Feb.1970: Mav 1970: Julv 1970: Sent.1970: Feb.-June 1971:
Aim of the project. To develop nursing and midwifely education and services.
Assistance provided by WHO during the year. (a) A consultant; (b) three fellowships - one for seven-and-a-half months and two for twelve months - for study in India.
Probable duration of assistance. Until 1979.
Work done during the year. A consultant in surgical nursing was assigned to the project in September 1975 for ten weeks to assist with a short course on the Nursing Care of Surgical Patients. The course was held in Colombo from 13 October to 14 November 1975 for 23 nurses from government hospitals and schools of nursing in Sri Lanka. Her recommendations were later sent to the Government.
One of the Regional Nursing Advisers visited the project in February 1976.
SRL HMD 005 Health Manpower Study UNFPA (Feb.-April 1971; 0ct.-Nov. 1971; April 1972 - Dec. 1973; Sept. 1974)
The activities concluded in December 1973. During the period under review, supplies and equipment were provided. SEA/RC29 12 Page 174
SRL HMD 006 Strengthening of Nursinx/Midwife~y Education UNFPA (Feb. 1972; July 1973 - )
Aim of the proiect. To strengthen the nursingJmidwifery 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,olidwifery and child care; to produce nursing and midwifery texts and other reference material in the local languages.
Assistance provided by WHO during the year. (a) A nurse educator and two consultants; (b) ten twelve-week fellowships for studies in India, Thailand, Singapore and Indonesia, a twenty-four-month fellnrshi~for studv in India. a three-month fellowshio for studies in 1ndia and Thailand, and a'three-week fellwrship for study in hail and;' (c) supplies and equipment.
Probable duration of assistance. Until the end of 1976.
Work done during the year. A UNFPA project review was held in October 1975 and a reprogrammed budget was submitted. The nurse educator's post was extended only up to end-June 1976, though the activities of the project will continue until December 19 76.
Work on renovation of the schools of nursing has progressed slowly. The preparation of study guides for nurses, especially translation into the national languages, made progress, and the guides are under print. A tool for evaluating student nurses' knowledge of family health is being used in schools of nursing after field testing.
Between 26 January and 30 March 1976, a consultant organized three short courses for midwives, midwifery tutors and staff nurses on midwifery units with the aim of improving the teaching of midwifery and family health in Sri Lanka.
Another consultant joined the project in May. She will be teaching several short courses on tests and measurements between May and August 1976.
Two short courses in educational science were held for tutors in November and December 1975 at Peradeniya; tutors also received training in audio-visual aids and underwent orientation in educational technology.
SRL HMD 007 Teaching of Human Reproduction, Family Planning and IJNFPA Population Dynamics in Medical Schools (Aug.1974; Oct.1974; Dec.1974 - March 1975; July 1975 - )
Aim of the project. To strengthen the teaching of human reproduction, family planning and population dynamics in medical schools.
Assistance provided by WHO during the year. (a) Six consultants; (b) four fellowships - two for three months for study in the United Kingdom, one for three- and-a-half months for study in the United States of America, and one for three months for studies in Australia and the Philippines; (c) supplies and equipment.
Probable duration of assistance. Until 1977.
Work done during the year. During the year under review, six short-term consultants were provided in the disciplines of statistics, population dynamics, behavioural sciences, maternal and child health (2) and demography. These consultants assisted in strengthening the teaching of the above subjects at the Peradeniya and Colombo campuses. One of the consultants in maternal and child health assisted the Peradeniya campus and the other was assigned to Colombo. Both consultants also assisted in the National Seminar on the Teaching of Human Reproduction and Population Dynamics. The reports of the consultants were forwarded to the Government. SEAlRC2912 Page 175
SRL HMD 008 Post--graduate Teaching of Community Medicine R (Dec. 1975; March-April 1976; - )
Aim of the project. To initiate and strengthen a post-graduate course in community medicine.
Assistance provided by WHO during the year. Two fellowships - one for six months and one for three months - for study in the United Kingdom, and three three-month fellowships - one for study in Singapore, one for studies in India, Thailand and Singapore, and one for studies in India, Singapore and Malaysia.
Probable duration of assistance. Until 1979
Work done during the year. During the period under review, fellowships were provided for training in comunity medicine. A consultant in the field of epidemiology is being provided and fellowships will he awarded for the training of pas t-graduate teachers.
SRL HMD 009 Training in Public Health UNDP (Nov. 1974; Sept. 1975; - )
Assistance provided by WHO during the year. Seven one-month fellawships for a study tour of the People's Republic of China.
SRL ESD 002 Strengthening of Surveillance and Control of R Communicable Diseases (May 1975 - )
Aim of the project. To strengthen the surveillance and control of comunicable diseases.
Assistance provided by WHO during the year. (a) A statistician; (b) a twelve-month fellowship for studies in the United Kingdom, Denmark, Iran and India, and a four- week fellowship for study in India; (c) supplies and equipment.
Probable duration of assistance. Until the end of 1980.
SRL MPD 001 Malaria Control R (Aug. 1960 - )
Aim of the project. To control malaria, with the ultimate objective of eradicating the disease.
Assistance provided by WHO during the year. (a) A parasitologist, an entomologist, a technical officer and a secretarial assistant; (b) supplies and equipment.
Probable duration of assistance. Some years.
Work done during the year. At the end of the period under review, the Anti-Malaria Campaign continued to extend protection to a population of 5.3 million with extensive mosquito control measures and to a population of 5.1 million with passive case-detection, limited active case-detection, treatment of cases and focal spraying. A population of 3.6 million was living in the relatively malaria-free areas.
A very alarming feature of the malaria situation in the country was the continuing increase in the proportion of P. faleipanun infections, which, starting at a level of less than 1%during the epidemic years of the late sixties, reached nearly 16% during 1975. This increase, together with the widespread prevalence of resistance of A. mcZicifacies to DDT, necessitated the launching of a "crash programme" last SEA/RC29/2 Page 176
year, bringing the erstwhile "P. faZcipanvn areas" under four rounds of 2gmlm2 malathion spraying. Later, this had to be extended to the Health Division of Anuradhapura and the health area of Puttalam owing to high P. faZcipartun incidence. To ensure a high degree of operational efficiency, it was decided to start operations from one or two ends of each health area and extend them across the area in a synchronized manner. Subsequently, however. owing to practical difficulties this approach was given up and the earlier spraying pattern was reintroduced. Preliminaxy results of the application of malathion indicate a decrease in the P. fatcipanun incidence, but the reduction in the level of P.vivax is not yet of a comparable order. DDT, it seems, has extremely limited value for malaria control in Sri Lanka in the near future. Bio-environmental methods of control are being contemplated in suitable areas, and the use of Abate for larviciding is also planned.
Case-detection during 1975 revealed 400 777 malaria positive cases out of 1 492 008 blood slides examined, giving a slide positivity rate of 29.6%; 63 853 (15.92) of these were P. faZcipamrm and mixed infections. The situation worsened further during the year compared with 1974, when 315 448 positives with a slide positivity rate of 22.2% were recorded and P. faZuipamun infections accounted for 8.3% of the cases. The health areas worst affected by this species during 1975, in addition to the known P. faZcipam areas, were Puttalam and those in the Health Division of Anuradhapura - all in the northern dry belt.
SRL VPH 001 Veterinary Public Health Services (Zoonoses Control) R (March 1972; Oct. 1973 - Aug. 1974; Dec. 1974; - )
Aim of the project. To develop services for the control of rabies.
Assistance provided by WHO during the year. Supplies and equipment.
Probable duration of assistance. Until the end of 1979.
SW. VBC 001 Vector Control UNDP (Dec. 1972 - Jan. 1974; Jan. 1975 - )
Aim of the project. To control insect vectors oE communicable diseases of public health importance.
Assistance provided by WHO during the year. (a) An epidemiologist and an entomologist; (b) a twelve-month fellowship for study in the United Kingdom and a four-veek fellowship for study in the Federal Republic oE Germany; (c) supplies and equipment.
Probable duration of assistance. Until 1978.
Work done during the year. The WHO entomologist designed a form for obtaining information on the epidemiology of arbovirus diseases. The anti-filariasis campaign was working satisfactorily and aedes (Stegomyin) studies were conducted as planned. The long-term WHO medical officer (epidemiologist) took up his assignment in March.
One of the Regional Advisers on Comunicable Diseases visited Sri Lanka in February and reviewed the activities of the project with the WHO project staff and the national health authorities. It is expected that the anti-filariasis campaign will be expanded further to include other vector-borne diseases of health importance, arbovirus diseases, etc. SEA/RC29/2 Page 177
SRL DNH 001 Dental Health R (April 1970 - Aug.1972; May 1974; Sept. 1974; Nov. 1974 - May 1975; Oct. 1975; Dec. 1975; - )
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 twelve-month fellowship for study in the United Kingdom and a six-month fellowship for studies in Denmark and Sweden; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1979.
SRL MNH 001 Mental Health R (Nov. 1955 - Jan. 1956; Aug.1960; Nov.-Dec.1961; Jan.-May 1963; June-July 1966; March 1967; Sept.1969: Nov.1969: . Aue.1970:- 0ct.-~ec:1970;~eb.1971; ~ec.1972- arch 1973; July 19731 Nov.-Dec.1973; June 1974; Jan.-April 1975; Dec.1975 - March 1976; - )
Aim of the project. To give training in psychiatry to undergraduates and post- graduates in medicine; to nurses and other health personnel; to develop community- oriented mental health care services integrated within the existing public health delivery system; to introduce innovative approaches in mental health care, and to undertake epidemiological investigations of mental illness.
Assistance provided by WHO during the year. A consultant.
Probable duration of assistance. A number of years.
Work done during the year. A consultant was assigned for three months from December 1975 to assist in designing and conducting courses in psychopathology, psychotherapy and research methods in psychiatry at the Department of Psychiatry, Peradeniya Campus. The consultant also advised on the further development of post-graduate training in psychiatry. The report containing his recommendations has been forwarded to the Government.
SRL SQP 001 Quality Control of Biological and Pharmaceutical Products R (March 1966; Sept. 1966; Dec. 1967; Jan.-April 1971; April 1972: Nov. 1973 - Mav 1974: Aue.-Se~t. 1974:
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) A consultant; (b) supplies and equipment.
Probable duration of assistance. Until 1979.
Work done during the year. A consultant assigned during July-September 1975 studied the organization of existing pharmacy departments, the distribution system of pharmaceutical products in the national health services, quality control of drugs, and the training of personnel. Considerable progress was observed in regard to the establishment of a national quality control laboratory, training of personnel implementation of the policy of the National Formulary Committee and the rationali- zation of the import of medicines. The consultant advised on the accelerated development of the pharmaceutical industry, standardization of pharmacy education and training and co-ordination of all operations related to the surveillance and quality control of drugs. Ihe report containing his recommendations has been sent to the Government. SEAIRC2912 Page 178
SRL LAB 001 Strengthening of Laboratory Services R (Aug. 1966 - March 1969; Oct. 1969; Dec. 1969; May 1970; Aug.-Sept. 1970; Nov.1970; April 1971; July 1971; Oct.1971; Dec. 1971; Feb.1972; June 1972; Aug.1972; March 1973; Aug.4ept.1973; Dec.1973 - Feb.1974; May 1974; July 1974; Sept.1974; Nov.1974 - March 1975; June-Julv 1975:
Aim af the project. To develop further specialized diagnostic and reference functions in support of communicable-disease control and prevention, and to train staff.
Assistance provided by WHO during the year. (a) A consultant; (b) three fellowships - one for fifteen months, one for nine months and one for eleven weeks - for study in the United Kingdom, and a three-month fellowship for studies in the United Kingdom, Singapore and Malaysia; (c) supplies and equipment.
Probable duration of assistance. Until 1979.
Work done durin~the year. A consultant spent four weeks during August-September in strengthening the entero-virus laboratory work at Colombo South Hospital. Two entero-virus diseases are specially important in Sri Lanka: (i) poliomyelitis, which causes 400 paralytic cases every year despite an immunization programme that has been going on for the past twelve years, and (ii) echovirus (not yet typed), which caused an epidemic outbreak of conjunctivitis recently.
Virology work is done in four laboratories - two under the Ministry of Health, at the Medical Research Institute and at Colombo South Hospital; two other laboratories which have facilities but are not yet comnissioned in virology work are at the Medical College in Colombo and the Medical College in Peradeniya.
The laboratory at Colombo South in its present condition is barely able to provide virology services to implement a programme for the surveillance of poliomyelitis. The main constraints hampering the development of work on the epidemiological surveillance of poliomyelitis are: (i) the shortage of technical staff trained in virology; (ii) the involvement of the laboratory in many viral activities which further reduces the availability of the trained staff for more important viral problems, and (iii) shortage of equipment and laboratory materials.
The consultant drew up a programme of work for poliomyelitis surveillance of which the following are the highlights: the establishment and operation of a cold chain for the storage and distribution of polio vaccine; the testing of vaccines for antibody response on a paired specimen; because of the natural sero conversion, vaccination of infants of a lower age group between 6-12 months of age, and finally, ways and means of increasing the acceptance of the vaccine for three doses from its present lw level of 30% to 80% of the child population.
To enable the laboratory to be commissioned for polio surveillance, a number of recommendations were made, including the strengthening of the staff by the appointment of two additional technicians and the provision of laboratory equipment.
SRL LAB 002 Production of Improved Vaccines R (Dec, 1969; Feb. 1970; Jan. 1974; Dec. 1974 - Feb. 1975; UNICEF Aug.-Sept.1975; June 1976 - )
Aim of the project. To produce freeze-dried smallpox and other vaccines.
Assistance provided by WHO during the year. (a) Two consultants; (b) a twelve-month fellowship for study in the United Kingdom; (c) supplies and equipment.
Probable duration of assistance. Until the end of 1979. SW/RC29/2 Page 179
Work done during the year. The plan of operation of the project was signed by the Government, WHO and UNICEF on 21 October 1975. A consultant engineer from the manufacturers helped in installing a lyophilizer, and a WHO consultant commissioned the plant for production.
A suite of two rooms at the Medical Research Institute has been remodelled to accommodate a freeze-dried plant which has been supplied by UNICEF. The plant and the water-chilling unit provided by the Government have been installed according to the lay-out planned by the consultant. The plant was commissioned and both smallpox and 5% rabies vaccines (BPL inactivated brain emulsion) are now freeze- dried. The first three batches since the plant was commissioned for production have met the requirements with regard to potency and stability.
SRL BSM 001 Community Water Supply and Sanitation R (Oct. 1963 - Dec. 1975) UNICEF
Aim of the project. To develop programmes of community water supply, sewage disposal, storm-water drainage and general sanitation, and to train personnel.
Assistance provided by WHO during the year. (a) A sanitary engineer and a consultant; (b) two nine-month fellowships for study in the United States of America and a twelve-month fellowship for study in the Netherlands; (c) supplies and equipment.
Work done. The project commenced in February 1972 and came to an end on 31 December 1975. In addition to the assignment of a regular WHO sanitary engineer, consultant services were provided to assist in the development of a preventive maintenance system for water supplies and in the preparation of a community well programme. The National Water Supply and Drainage Board was responsible for its implementation.
The project consisted of two phases: (i) the development of rural community piped water supply schemes, and (ii) the preparation of a national plan for providing the entire population with access to safe water and sanitary excreta disposal.
Development of rural community piped water supply schemes: Originally, it was proposed to construct under this project 100 systems phased over a period of five years with supplies and equipment from UNICEF. As a result of inflation, however, the UNICEF grant of one million dollars for the purpose was found sufficient only for 55 systems. The development of these schemes was well advanced, although rather behind the schedule incorporated in the plan of operation. Nine schemes were commissioned, three others were completed, and work on the remaining was at different stages of construction. Assistance was provided in introducing a comprehensive management system for imported material and equipment as well as in developing methods for yearly and quarterly planning of work and for periodically reviewing the progress.
Preparation of national plan: The Government initially proposed drawing up a long-term national plan only for rural water supplies in the country, but later water supply to urban areas and estates and excreta disposal were also included in order to provide a comprehensive plan. Assistance was provided in the study of the needs for the entire country and in the collection of necessary data. The work on the preparation of the plan by the Government made good progress, and an interim plan was produced,designated as "the 1971 phase of the National Plan for the provision of access to safe water and sanitary excreta disposal for the entire population of Sri Lanka by the year 2001". The activities are being continued under project SRL BSM 002.
SRL BSM 002 Provision for Basic Sanitary Services R (Jan. 1976 - )
Aim of the project. To provide safe water supplies and excreta disposal in rural communities throughout the country. SEA/RC29/2 Page 180
Assistance provided by WHO during the year. (a) A sanitary engineer and a consultant; (b) a twelve-month fellowship for study in the United Kingdom.
Probable duration of assistance. Until 1981.
Work done during the year. This is a continuation of project SRL BSM 001, "Community Water Supply and Sanitationl',but covering a wider range of sub-programmes. During the period under review, the WHO sanitary engineer continued to provide aesistance to the National Water Supply and Drainage Board in the planning and implementation of the piped community water supply achemes in different parts of the country.
A consultant sanitary engineer was provided from mid-May 1976 for a period of two- and-a-half months to review the existing situation of rural water supply in the country and to prepare a project docment proposing UNDP assistance to this project.
SRL HW 001 Occuvational Health and Industrial Hygiene R (Aun. 1968: July 1969: Dec. 1969 - Feb. 1970: July 1972: .Tune 1973; ~u~:-Sept;1974; Aug. 1975; - )
Aim of the project. To control health hazards in industry.
Assistance provided by WHO during the year. (a) Ztro fellowships - one for six months and one for one month - for study in the United Kingdom; (b) supplies and equipment.
Probable duration of assistance. Some years.
SRL FSP 001 Food Hygiene R (May 1974; June 1975; Sept. 1975; Jan.-April 1976; -)
Aim of the project. To establish a national food control administration and train staff for various branches of food control.
Assistance provided by WHO during the year. (a) A consultant; (b) four three-month fellowshi~s- two for studv in Australia and two for studv in the United Kingdom- - and a six-month fellowship for study in the United Kingdom.
Probable duration of assistance. Until the end of 1980.
Work done during the year. During January-April 1976, a consultant was assigned to this project to assist the Government in (i) strengthening the food control unit of the Ministry of Health, (ii) revising the existing legislation on food control, and (iii) training staff in food inspection, food hygiene and analysis of food samples. The report containing his recommendations has been sent to the Government. SEAlRC2912 Page 181
11. THAILAND
Project Number Source of Funds Co-operating Agencies Title
TEA SHS 001 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.
Assistance provided by WHO during the year. (a) A twenty-four-month fellovship for study in the United States of America and two six-month fellowships for study in the United Kingdom; (b) supplies and equipment.
THA SHS 002 Health Planning and Management R (Oct. 1970 - )
Aim of the project. To assist in national health planning and in health administration, including the health information system and health management aspects, with 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 a management officer and temporary assistance from a Headquarters staff member; (b) a twelve-month fellowship for study in the United States of America, a three- week fellowship for study in Sri Lanka and two three-month fellowships - one for studies in Denmark and Sweden and one for study in the United Kingdom; (c) supplies and equipment.
Probable duration of assistance. Until 1981.
Work done during the year. Following the completion of project formulation, the National Five-Year Development Plan for the health sector was prepared and submitted to the National Social and Economic Development Board. Assistance is being given in the planning, management and development of a health information system encompassing three Divisions in the Ministry of Health, viz., Planning, Vital and Health Statistics and Epidemiology, with the aim of introducing &ern management methods. A staff member from WHO Headquarters (systems analyst) and a management officer from the Swedish International Development Authority also provided assistance.
THA SHS 006 Development of Provincial Health Care* R (Nov. 1974; Jan. 1976 - )
Aim of the project. To strengthen integrated rural health services.
Assistance provided by WHO during the year. A management officer.
Probable duration of assistance. A number of years.
Work done during the year. This project is a continuation of the project, "Strengthening of Health Services", to which WHO has given assistance in 1974 and 1975.
*Previous title: Strengthening of Rural Health Services SEAlRC2912 Page 182
A management officer(funded by SIDA) joined the project early in 1976 to assist with planning and monitoring so as to ensure that the project's objectives are achieved with the minimum use of resources. As in the past, a subsidy was approved for 1976 for evaluation, operational studies and the training of primary health care workers and relevant categories of health staff.
THA MCH 001 Bangkok Municipality Fadlv Planning Field Worker Project UNFTA (Nov. 1973 - Jan. 1974; July-Sept. 1974; Jan.-March 1975; UNICEF Oct. 1975; - )
Aim of the project. To improve and expand the family health services in the Bangkok- Thonburi Metropolis as an integral part of the general health care services provided at the health centres.
Assistance provided by WHO during the year. A twelve-month fellowship for study in the United Kingdom.
Probable duration of assistance. Until the end of 1976.
Work done during the year. The project continues to make progress with the exception of the long-term fellowships component, which has been delayed because of the failure of the candidates nominated by the Government to attain proficiency in English. New field workers were recruited and given training.
The first run of the computerized data system covering 1974 and part of 1975 was completed. The system appears satisfactory, and three persons have been trained in its operation at the Institute of Population and Social Research of Mahidol University.
The data collection phase of the continuation rate survey has been completed. Activities connected with the consumer satisfaction survey and the survey on the effectiveness of health personnel are proceeding.
A project revision was completed for reprogramming of the activities for the three- month period October-December 1976.
THA MCH 002 Accelerated Development of Maternal and Child Health UNFPA and Family Planning Services UNICEF (March 1974; - )
Aim of the project. To improve the maternal and child healthlfamily planning services of the hospitals and rural health centres in the four north-eastern provinces, for the better delivery of these services.
Probable duration of assistance. Until the end of 1976.
Work done during the year. The construction component of this project was completed during the period under review. The construction of the maternal and child health sub-centre at Amphur Pol, in Khon Kaen Province, was completed in November 1975, and at Amphur Swanapoom, in Roi-et Province, in December and the equipment is being installed in these two facilities.
Reports available regarding new family planning acceptors for the period January- August 1975 show 43 956 new acceptors, which is a slight (3.2 per cent) decrease in comparison with the same period in1974. There was a decrease in the number of IUD acceptors, an increase in pill acceptors, and a slight increase in sterilization acceptors.
The first computer print-out of statistics on maternal and child health services was completed, covering the year 1974. The data collected are based on the evaluation criteria as laid down in the project document. SEA/RC29/2 Page 183
A Tripartite Review of the project was held in September 1975.
The project document was revised to reprogramme the activities for the three-month period October-December 1976.
Ihe medical officers of the Regional Team on Family Health stationed in Bangkok completed his assignment at the end of May 1976, and a replacement is under recruitment .
The activities of this project are closely co-ordinated with those of other UNFPA- supported projects.
THA HRP 001 Expanded Sterilization Project UNFPA (March 1974; - )
Aim of the project. To make sterilization services more readily available within the family health services, as an integral part of the general health services.
Probable duration of assistance. Until the end of 1976.
Work done during the year. The project's achievements continue to exceed targets. From the start of the project up to August 1975, the number of sterilizations performed has totalled 196 294.
Again, from the figures available, 77.8 per cent of all female sterilizations were done in hospitals, while maternal and child health centres accounted for 9.2 per cent and first-class health centres for 13 per cent. Similar figures for male sterilizations showed hospitals performing 54.4 per cent, maternal and child health centres 3.2 per cent and first-class health centres 42.4 per cent.
The major problem has been the lack of funds for reimbursing the health institutions for the sterilizations performed. The UNFPA funds approved for 1976 will be sufficient only for payments for sterilizations done up to March 1975.
The project document was revised for reprogramning for the three-month period October-December 1976, which includes support to the mobile sterilization teams.
The activities of this project are closely co-ordinated with those of other UNFPA- supported projects in Thailand.
THA NUT 001 Institute of Nutrition and Food Science, Ramathibodi R (Nov. 1973; Jan.-Peb. 1974; Aug. 1974; Nov. 1974; Jan.-Feb. 1975; July 1975; - )
Aim of the protect. To improve the instruction and research at the National Institute of Food and Nutrition, to identify health priorities among nutritional problems and to develop remedial measures through the general health services.
Assistance provided by WHO during the year. A twenty-four-month fellowship for study in the United States of America.
THA HED 001 Development of Health Education R (Dec. 1966; Sept. 1969; Jan. 1971; June 1975 - )
Aim of the project. To develop health education services in support of health programmes in the regions and the provinces, health education manpower, audio-visual materials, behavioural science research and application of research findings to health education programmes. SEA/RC29/2 Page 184
Assistance provided by WHO durin~the year. (a) A consultant; (b) supplies and equipment.
Probable duration of assistance. Until the end of 1983.
Work done durinn the Year. A UEO consultant assisted the Government in reviewing the activities of the Eealth Education Division of the Ministry of Public Eealth and in determining whether these aervices were adequate to meet the health education needs of the various health progr-s. This work helped the Government to formulate the health education project in line with the country's long-term and short-term needs. The Regional Adviser on Eealth Education also assisted the Government in the formulation of the project and, later on, with the plan of action for implementing the various activities of the project.
The Organization was also concerned vith the development of health education specialist manpower required by an expanded health education service. For this purpose a consultant assigned unaer the project TW tMD 003 assisted in developing a curriculum for a new MPH Prograrrmp. in Eealth Education at the Faculty of Health, Mahidol University, Bangkok; this institution at present offers only a B.Sc. Programme in Health Education. It is expected that the new MPH Programre will help to develop health education manpower to meet the country's needs. WHO fellarships were awarded to key staff members to undertake post-graduate training in health education abroad.
THA HMD 002 Nursing Education and Services R (Jan. 1968 - Dec. 1975)
Aim of the project. To assist in studying nursing needs and resources, in strengthening nursing services and education, in developing university-level courses for nurses, and in organizing and conducting studies related to nursing services and education.
Assistance provided by WtiO during the year. (a) A nurse educator and a consultant; (b) two twenty-four-month fellowships for study in the United States of America and a fourteen-month fellowship for study in Israel.
Work done. This project began in 1968 as an e~pansionof the activities of project Thailand 0021, which had been in operation since 1954. The new project was national in scope and covered all areas of nursing. In it wen merged the nursing components of all existing WHO projects in the country and thue all nursing advisers and educators were transferred to the new project. Over the years there have been seven long-term consultants in the specialized fields of psychiatric nursing, public health nursing, nursing education and nursing administration, in addition to short-term consultants who carried out the following specific assignments: (1) the organization of sterile central supply services; (2) studies of the activities of nursing personnel, and (3) paediatric patient care.
The objectives of this project were to assist in (1) the development of more effective patterns of nursing administration and education at both national and local levels; (2) the preparation of nuroe leaders in administration, education and clinical specialties, and (3) the formulation of legislation supporting the establishment of standards for nursing practice and nursing education, licensing and registration of nursing personnel and the establishment of a nursing council or similar body for implementing the regulations.
The first two objectives have been met to a high degree. Though other agencies have also given assistance to Thailand in the field of nursing, WHO can still lay claim to having helped in the upgrading and development of nursing education along sound, modern educational lines. Specifically, in basic schools of nursing there have been (1) improved correlation of theory and practice. (ii),iqroved supervision and guidance of students, (iii) introduction of clinical conferences,and (iv) developmnt of psychiatric and public health nursing experience for students. SEA/RC29/2 Page 185
During this time the requirement for admission to schools of nursing was raised from 10 to 12 years of general education and the minimum standard curriculum was designed.
In 1967, a post-basic course in nursing education (B.Sc.) was begun at Chulalongkorn University with the admission of 25 students. This programme was one of the main foci of attention from 1968 onwards. The number of students has now doubled and a master's degree programme has been added.
Assistance was also given to nursing service administration, both hospital and public health, through nurse consultants and short in-service courses. Additional activities have included surveys of nursing, assistance with the publication of "Facts about Schools of Nursing", and help with the preparation of teaching materials in Thai. Supplies and equipment have also been provided.
Fellowships have played an important part in improving nursing in Thailand. All fellars have returned to the country following their education abroad and almost all of them continue to remain in Thailand. They hold top-level positions in nursing, e.g., Chief Nurse in the Ministry of Public Health, chief nurses of hospitals and public health agencies, principals of schools of nursing, deans of colleges of nursing, etc., and as such are a very great influence in formulating the policies and practices of nursing.
There has been little success in meeting the third objective, which relates to legislation.
The results achieved, particularly in nursing education, have been good. Thailand now has post-basic schools of nursing which, if it were not for the language problem (all courses are taught in Thai),could be used for the placement of fellows from other countries. The facilities available at these schools are already being used for observationlstudy tours for nurses. The nurses of Thailand have made good use of all the assistance given to them through this project.
THA HHD 003 Faculty of Public Health R (Dec.1968 - Jan.1969: 0ct.-Nov.1969; Jan.1970; Nov.1970; Oec.1971 - ~an.19721March-May 1972; ~an.1974; Oec.1974; Jan.1975; April 1975; June-Aug.1975; Dec.1975; March 1976; - )
Aim of the project. To assist the Faculty of Public Health, Mahidol University, in further developing its teaching and training programmes for better co-ordination and effective support of the health services in health planning and management.
Assistance provided by WHO during the year. (a) Two consultants; (b) two fellowships - one for eighteen months for studies in the United States of America and the United Kingdom and one for six months for study in the United States of America.
Probable duration of assistance. A number of years.
Work done during the year. A consultant in health education was assigned to the project during June-August 1975 to assist in planning and developing the curriculum for the MPH degree in health education. The recornendations of the consultant were forwarded to the Government.
Another consultant, provided for two weeks in March 1976, carried out an assessment of an WH curriculum for the international school of public health at the Faculty of Public Health, Bangkok. His assignment report was also submitted to the Government.
Post descriptions were finalized in respect of a public health nurse educator and a specialist in education to assist the Faculty of Public Health. It was expected that both the positions would be filled by July. SEAlRC2912 Page 186
THA HMD 004 Medical Education and Training R (May 1971 - )
Aim of the project. To develop further the teaching and training programmes of the existing four medical faculties at Chiengmai, Chulalongkorn and Mahidol Universities, including the Faculty of Post-graduate Studies of the latter, and to plan the Faculties of Medicine at Prince of Songkhla and Khon Kaen Universities.
Assistance provided by WHO during the year. Two fellowships - one for twelve months and one for three months - for atudy in the United Kingdom, a two-month fellowship for study in Australia and a two-month fellowship for study in the United States of America.
THA HMD 011 Health Manpower Development (Ministry of Public Health) R (Jan. 1976 - )
Aim of the proiect. To develop and implement the training programmes for health workers to prepare them for work in rural areas; to prepare teaching materials for primary health workers.
Assistance provided by WHO during the year. A nurse educator.
Probable duration of assistance. A number of years.
Work done during the year' This is a new project resulting from the country health programing and project formulation exercises in Thailand. It began in January 1976 with the reassignment of the WHO nurse educator from project THA HMD 002, which terminated in December 1975.
In the first six months, the following activities took place: the job descriptions for village health volunteers (VHV) and health communicators were written; a first group of six VHV's were taught at a first-class health centre in Korat Province, and work began on a manual for village-level workers. Committees are being set up to consider other aspects of the project such as curriculum revision.
Pending redefinition of the specific responsibilities of several related projects, i.e., SHS 006, HMD 003 and HMD 011, the plan of operation for this project has been drafted.
THA ESD 002 Strengthening of Epidemioloxical Surveillance R (Aug.-Sept. 1975; - )
Aim of the proiect. To develop further, organize and implement the control of communicable diseases by improving the surveillance services starting from the periphery.
Assistance provided by WHO during the year. A four-month fellowship for study in the USSR, a two-week fellowship for study in Noway, and a two-and-a-half-week fellowship for studies in the Republic of Korea and India.
THA MPD 001 Malaria Eradication R (Jan. 1962 - )
Aim of the project. To eradicate malaria.
Assistance provided by WHO during the year. (a) A malariologist, an entomologist, three sanitarians and an assistant; (b) a twenty-four-month fellowehip for study in the United Kingdom; (c) supplies and equipment.
Probable duration of assistance. A number of years. SEAIRC29 12 Page 187
Work done during the year. At the end of June 1976, a population of 32.4 million out of a total of 39.4 million at malaria risk was estimated to be in the consolidation phase. A population of 7.0 million continued to be in the attack phase, and 3.6 million people living in urban areas under municipal administration were considered free from malaria risk.
At the end of 1975, over a period of four years, anti-malaria activities had been integrated into the general health services in areas in consolidation with a population of 16 million where malaria transmission had reached a low level.
Surveillance activities for the first nine months of 1975 revealed a total of 197 963 malaria positive cases out of 2 675 093 blood examinations, giving a slide positivity rate of 7.4%; this does not compare favourably with the 1974 race of 6.6%. The nwnber of P. fatciparum, including mixed infections, was 129 465 during these months, constituting 65.4% of the total infections and indicating a downward trend in the ratio of P. falcipanun infections.
A post of epidemiologist was created effective from July 1976 in lieu of that of a sanitarian. Recruitment action is in hand.
THA DM1 001 Dental Health R (Jan. 1967: Nov. 1967 - April 1968; April 1969;. Aun.- 1969 - .luly 1970; Feb. 1971; ~piil1971; ~&ch1972; Aug.-Sept .l972 ; Feb.-March 1974; Sept.-Oct. 1974; April 1975; - )
Aim of the project. To improve dental services and to train dental health personnel.
Assistance provided by WHO during the year. Supplies and equipment.
Probable duration of assistance. Until 1977.
THA MNH 001 Mental Health R (June 1963: Dec. 1963 - Feb. 1964: Jan. 1965 - Dec. 1969; .NOV. 1974.- Feb. 1975; June 19751 Aug. 1975; Nov. 1975; - )
Aim of the project. To train undergraduates and post-graduates in psychiatry, to develop community-oriented mental health care services within the general medical delivery system, and undertake epidemiological investigations into mental illness.
Assistance provided by WHO during the year. (a) Three fellowships - one for twenty- four months for study in Canada, one for fourteen months for study in Australia, and one for twenty-seven months for study in the United Kingdom; (b) supplies and equipment.
Work done during the year. The Regional Adviser on Mental Health visited Thailand for three weelcs during May-June 1976 to assist in the planning of a new mental health project formulated following country health programming; to observe developments in mental health and make recommendations; to assist in implementing a collaborative research project with WHO Headquarters on the monitoring of mental health needs; and to review progress in the prevention and treatment of drug addiction.
THA RAD 003 School for Medical Physicists UNDP (Jan. 1971 - Jan. 1973; July-Aug. 1973; June 1974; Dec. 1974 - March 1975; May 1975: - )
Aim of the project. To teach and train medical physicists.
Assistance provided by WHO during the year. (a) A twelve-month fellowship for study in the United Kingdom; (b) supplies and equipment. Probable duration of assistance. Until the end of 1976. SEA/RC29/2 Page 188
TIM SQP 001 Quality Control of Pharmaceutical Preparations R (May 1970; Sept. 1970 - Sept. 1975; Nov. 1975; - )
Aim of the protect. 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) a twenty-four-month fellowship for study in the United States of America, a three- month fellowship for study in Australia, and a six-month fellowship for studies in the United Kingdom and the Netherlands; (c) supplies and equipment.
Work done during the year. The long-term staff member assigned under this project left in September 1975. During the earlier part of his assignment, he assisted with upgrading manufacturing standards through inspection and the training of inspectors. Later, with a shift in the emphasis, he contributed towards more effective laboratory work (devising procedures for drug analysis) ,testing products offered for sale, as well as organizing training courses in pharmaceutical analysis for Thai pharmacists working in the industry and for foreign pharmacists concerned with phamaceuticalanalysis. Instruments and other laboratory equipment were supplied for the regular training of pharmaceutical analysts, 25 of whom were trained in 1972. In 1975, 14 participants attended a course in biological testing. The automation of product registration records contributed towards efficient and planned sampling of pharmaceutical products.
The development of this project has been satisfactory. The establishment of pharmaceutical testing laboratories for the Northern, North-Eastern and Southern Regions equipped with all facilities for routine chemical and physical testing of pharmaceuticals requires attention.
THA LAB 001 Strengthening of Laboratory Services R (April-May 1968; March 1969; Sept. 1969; Dec. 1969; March 1970; UNICEF 0ct.-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.
Assistance provided by W0 during the year. (a) A microbiologist and two consultants; (b) a twenty-one-month fellowship for study in the Uoited Kingdom, an eighteen-month fellowship for study in Australia, and two one-month fellcwships - one for studies in the United Kingdom, Netherlands and Denmark and one for study in Japan; (c) supplies and equipment.
Work done during the year. Most of the milestones that had been planned were met, although some were behind schedule; others which had not been planned earlier were also implemented. Some of the more important activities carried out during the period under review were the folloving:
WHO counterpart mediuorplan activities for the project were drafted. With a grant from WHO, 15 clinical pathologists in charge of regional laboratories will be trained at Mahidol University instead of being sent abroad for training. The first course will start in 1977.
A two-year course for technicians - the only one of its kind in Thailand - was started at the Department of Medical Sciences, with an annual intake of ten students. The programe for in-service training was completed as planned. Over 35 technicians from regional laboratories have benefited from these short courses. It was possible to achieve integration of health and clinical laboratories in provincial hospitals. Manuals in haematology, bacteriology and parasitology were produced and distributed SEA/RC29/2 Page 189
to provincial laboratories. A two-week course on the maintenance of instruments and laboratory equipment was conducted for technicians from provincial laboratories, who also serviced and repaired defective equipment from their own laboratories while attending the course.
A consultant provided during the year advised on ERA tissue culture rabies vaccine, which is being developed on an experimental basis at the Virus Research Institute, Department of Medical Sciences. In order to test the proficiency of provincial laboratories in bacteriology, cultures are being forwarded by the Department of Medical Sciences, the results of their reports being followed up by the Public Health Laboratory and by on-the-spot visits wherever feasible. Similar control schemes are being planned for assessing inter-laboratory proficiency in chemistry and haematology.
THA BSM 001 Community Water Supply and Sanitation UNDP (Jan. 1969 - Nov. 1975) UNICEF
Aim of the project. To plan and implement a national environmental health programme and, more specifically, to provide technical advice and guidance in the expansion of the national community water supply and sanitation programmes.
Assistance provided by WHO during the year. (a) A sanitary engineer; (b) a two-month fellowship for studies in the Netherlands, India and Bangladesh; (c) supplies and equipment.
Work ddne. This project has concluded successfully. WHO assistance started in November 1967, when a consultant under the inter-country project on community water supply and sanitation surveyed the rural water supply situation in Thailand and assisted in the preparation of detailed plan8 and designs for the programme in this field. Pending the signature of the plan of operation and availability of UNDP funds, a WHO sanitary engineer was assigned in March 1968 under the same inter-country project to give technical advice on the planning and implementation of rural water supply schemes. This assistance continued until the end of 1975, with additional inputs from UNDP and UNICEF from 1969 onwards, from the latter in the form of materials and equipment.
In addition to the regular WHO sanitary engineer, consultant services were provided for assistance in various specific aspects of the programme, e.g., groundwater development, storm-water storage and drainage system, training of waterworks personnel in water supply engineering and allied subjects as well as in the operation and maintenance of water supply systems, and creation of a revolving fund for self-supporting cornunity water supplies. Fellowships were awarded for higher study abroad.
The project has not only achieved all its targets but surpassed many of them. In preliminary surveys, including identification of potential water sources and in the preparation of water supply systems, with materials and cost estimations as well as the construction bids with local contribution, it covered more villages than originally planned. Also, in organizing and conducting training courses for new operations, waterworks personnel, managerial staff and potable water supply project personnel it exceeded the set number. The project was expanded to cover villages having a population of less than 500; 151 water supply systems sewing 352 villages with a population of 502 188 were constructed. A pilot project for preventive maintenance of water supply systems was initiated in nine selected centres in the provinces of Khon Kaen and Kalasin. A pilot well-drilling project for jetting small-bore deepwells was commenced in collaboration with the Provincial Water Supply Division of the Public and Municipal Works Department. Assistance was also provided to that Division in carrying out a feasibility study on the Khon Kaen sewerage system.
As a continuation of this project, a new programme for community water supply with a wider scope was started in January 1976. SEA/RCZ9/2 Page 190
THA BSM 002 Community Water Supply R (Jan. 1976 - )
Aim of the project. To plan and implement the national environmental health programme, and, in particular, to promote the development of provision of safe water supplies to smaller communities by exploitation of groundwater sources or use of appropriate technology for water treatment.
Assistance provided by WHO during the year. A sanitary engineer and a hydrogeologist.
Probable duration of assistance. Until 1981.
Work done during the year. This is a continuation of project THA BSM 001, "Community Water Supply and Sanitation". Owing to the non-availability oE anticipated funds from UNDP, however, several changes of plan were necessitated during the period under review.
Two long-term staff, a sanitary engineer and a hydrogeologist, who joined the project in January and February 1976 respectively, provided assistance in planning and implementing the national environmental health program. Another !4HO sanitary engineer under the inter-country project ICP BSM 001, "Community Water Supply and Sanitation", stationed in Thailand, also gave assistance to the Rural Water Supply Division, Department of Health.
THA SES 001 Improvement of the Sanitary Engineering Department, R Chulalongkorn University, Bangkok UNDP (Nov. 1973 - Feb. 1974; May-Oct. 1974; Jan. 1975; May-June 1976; - )
Aim of the project. To strengthen the Department of Sanitary Engineering at Chulalongkorn University.
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. A consultant was assigned to this project for a period of one month during May-June 1976. He reviewed and evaluated the programe for the strengthening of the Sanitary Engineering Department of Chulalongkorn University. He also advised the Department on further co-ordination with various other organizations in the country, other countries in South-East Asia, aa well as with WHO, in order to continue the programme at the highest level of efficiency.
THA FSP 001 Food and Drug Control Administration R (Aug.-Oct. 1964; Feb.-April 1971; Oct. 1971; Aug. 1972; Jan.-Nov. 1974; Dec. 1974 - March 1975; Dec. 1975; - )
Aim of the project. To assist the Department of Medical Sciences, Ministry of Public Health, in establishing a national food and drug control administration and in training staff.
Assistance provided by WHO during the year. A seven-month fellowship for study in the United States of America.
Probable duration of assistance. A number of years. SEA/RC29/2 Page 191
THA DHS 001 Vital and Health Statistics R (Aug. 1957 - July 1959; Oct. 1959 - April 1960; Nov. 1968 - Jan. 1969; Feb.-Oct. 1971; Dec. 1971; Sept. 1972 - Feb.1975; July 1975)
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) Three fellmships - one for ten months for studies in the United Kingdom and New Zealand, one for twelve months for study in Australia, and one far two months for study in the United Kingdom; (b) supplies and equipment.
Thailand 0057 Faculty of Tropical Medicine R (Aug.4ept.1959; June-Aug.1961; June 1962; June-July 1963; Jan.-Dec.1964; Jan.1967; Aug.1967; July 1968; June-Dec.1969; May 1970; July-Sept. 1970; Dec. 1970; March-June 1971; Dec.1971; July 1972; Nov. 1972; Jan.-March 1973; July 1973; Jan.1974; March 1974; May 1975; - )
Aim of the project. To continue to strengthen the Faculty of Tropical Medicine of Mahidol University.
Assistance provided by WHO during the year. A twelve-month fellowship for study in the United States of America.
Thailand 0059 Epidemiology R (Oct. 1966; Dec. 1966 - Aug. 1967; July 1968; Aug. 1969; UNDP May-June 1970; June-Sept. 1971: Nov. 1971: Jan. 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 seven-week fellowship for study in the United States of America.
Thailand 0128 Training and Increased Mobility for Health Personnel UNFPA in the National Family Planning Programme UNICEF (March 1974; - )
Aim of the project. To meet the continuing need for training government health personnel, including doctors, nurses, auxiliary midwives, sanitarians, family planning clinic and field workers, for family health services, and to increase the coverage of the population receiving family health services from the health personnel.
Assistance provided by WHO during the year. Assistance from one of the medical officers provided under ICP MCH 011.
Work done during the year. Two courses were held for nurse supervisors, who came from 16 provinces. Some observers also took part.
Orientation training for 545 nurses and midwives and 347 sanitarians was completed in March 1976.
The project document was revised in order to reprogramme the activities during the period October-December 1976.
The activities are closely co-ordinated with those of other UNFPA-funded projects in Thailand. SEA/RC29/2 Page 193
12. INTER-COUNTRY
Project Number Source of Funds Co-operating Agencies Title
ICP SHS 001 United Nation's Asian Development Institute*, R Bangkok ESCAP (Jan. 1964 - ) UNICEF
Aim of the project. To assist the faculty of the Asian Development Institute with the health component of training courses and other allied activities of the Institute.
Assistance provided by WHO during the year. (a) A public health administrator and a technical officer (economist) ; (b) supplies and equipment.
Work done during the year. In addition to assisting the Asian Development Institute in its courses, the WHO public health administrator and the WHO technical officer helped with the joint WHOIADI Inter-regional Workshop for Trainers and Planners on Health Planning, held in Chiengmai, Thailand, during July-August 1975 and attended by representatives from 13 countries belonging to three WHO Regions. Assistance was also given in the conduct of an Expert Group Meeting on Health Project and Programme and of an interregional Seminar on Health Project Analysis, held at the Institute in October 1975.
The WHO technical officer (economist) undertook, on behalf of the Asian Development Institute, a short assignment to the Trust Territories of the Pacific Islands. During this consultantship he prepared an estimate of the cost of health care in the past and the future on the basis of past trends. He also made an analysis of health care financing and drew up recmendations concerning this financing.
The WHO staff was involved in the preparatory work for the joint WHO/ADI Regional Course on Comprehensive Health Planning and Development, scheduled to be held in the second half of 1976, and in the preparation of a pre-final version of the "Assessment of the Health Situation in a Least Developed Country - The Case of Nepal".
ICP SHS 002 Oraanization and Administration of Hospital and Medical R Care Services (Aup.-Oct. 1968: Dec. 1968: Feb. 1969: Julv 1970 - Jan. 1971: Sept.-~ec. 197i; Feb. 1972; ~a~-~ul~-l972-;Nov. 1972 - July 1973; Nov. 1973; June 1974 - )
Aim of the project. To assist in the development of regional health services, in the organization of systems of medical care, in hospital administration, including the planning and development of facilities for the diagnosis, treatment, care and rehabilitation of the sick; and in the development of uniform systems of record keeping and reporting, including support to referral service systems for hospitals and health centres; to assist in training staff at various levels of operation.
Assistance provided by WHO during the year. (a) A medical records officer, a consultant and two temporaq advisers; temporary assistance from Headquarters and Regional Office staff; (b) secretarial assistance; (c) cost of attendance of participants ; (d) supplies and equipment.
Probable duration of assistance. A number of years.
*previous title: Asian Institute for Economic Development and Planning, Bangkok. SEA/RC29/2 Page 194
Work done during the year. An inter-country seminar on Peripheral Medical Services was conducted in BangkokfChiengmai (Thailand) from 1 to 10 September 1975, attended by 20 participants from Bangladesh. India, Indonesia, Mongolia, Nepal, Sri Lanka and Thailand. The purpose of this seminar was to identify the problems and develop guidelines for the organization and administrative concepts of the practice and technique for the delivery of primary medical care in the rural areas. The seminar was assisted by the Regional Adviser on Medical Care, one of the Regional Nursing Advisers and the Co-ordinating Technical Officer of the Steering Committee on Primary Health Care from WHO Headquarters. In addition, there were two temporary advisers.
Another inter-country activity organized during the year was the Seminar on Application of Ways and Approaches Resulting from Earlier Studies to Achieve Increased Coverage by Health Care Delivery Programmes, which was held in the Regional Office from 3 to 9 February 1976. The purpose of this seminar, in which there were 16 participants from Bangladesh, the Democratic People's Republic of Korea, India, Indonesia, Nepal, Sri Lanka and Thailand, was to identify and recommend measures for achieving increased health service coverage, with particular emphasis on primary health care at the cornunity level and in relation to the priority health needs of the population. This activity was assisted by the Regional Adviser on Medical Care, the Scientist and Co-leader of Primary Health Care and Rural Development Programme Area from the Division of Strengthening of Health Services. WHO Headquarters, and two temporary advisers.
In Sri Lanka, the Second and Third National Orientation Courses for administrators from provincial/base/district hospitals were conducted, from 7 to 24 October 1975 and 22 March to 9 April 1976 respectively. A consultant (hospital administrator) assisted the second course and the Regional Adviser on Medical Care took part in the third course, both of which were held in Colombo.
Assistance was provided to Burma and Indonesia in the field of medical records and in the conduct of courses for medical record technicians by the assignment of the WHO medical records officer attached to this project.
ICP SHS 006 Health Research and Development R (June 1970 - )
Aim of the project. To provide support to the Prograwme Support and Co-ordination Unit (PSC) in the delivery of its main functions: country health programing (CHP), project formulation and management (PF&M) , medium-term programming (MTP) , programme budgeting (PB) , development of programme evaluation methodology (DPEV) , programme/ project information system (PPIS), and consultation services to countries on their request.
Assistance provided by WHO during the year. (a) A public health administrator, a project management officer, an operations research specialist, a social scientist, a consultant and a secretarial assistant: (b) supplies and equipment.
Probable duration of assistance. A number of years.
Work done during the year. The project assisted in conducting country health programming exercises, followed by project formulation, in Nepal and Burma, and in holding a management workshop in Thailand; formulation of WHO projects in Nepal and Thailand was also undertaken during the year. Preparation of a revised manual for country health programming workshops on the basis of past experience in the Region was also completed. The project staff participated in a workshop on health planning for senior health personnel organized by the Government of Nepal.
The preparation of the Sixth General Programme of Work was completed and work on developing a medium-term programme for the Region was undertaken and was in the final stages. SEA/RC29/2 Page 195
The project contributed to programme budgeting activities of the Regional Office. It was deeply involved in organizing the first meeting of the Regional Advisory Committee on Medical Research and assisted in preparing the necessary background papers. It also contributed to the functioning of the Committee for Research Promotion and Development in the Regional Office.
Work on development of the WHO information system continued in co-operation with WHO Headquarters, and the formulation of project and programme profiles was nearing completion.
Help was provided in developing guidelines for the evaluation of training programmes for multi-purpose health workers as a follow-up of a resolution adopted by the Regional Committee at its twenty-eighth session. Work also continued on developing a method far the evaluation of projects and of country and regional programmes. The second operational assessment and evaluation of project BAN HMD 001 was undertaken to demonstrate the feasibility and usefulness of in-depth evaluation and replanning of on-going projects.
The final report on the national health manpower study in Sri Lanka, "Better Health for Sri Lanka", was published. The project also assisted in conducting a regional seminar on health manpower planning held in Colombo.
The consultant/economist completed the preparation of a paper on the socio-economic basis of the Charter for Health Development. He also assisted in preparing background papers for the meeting of the Working Group on Allocation Resources,held in the Regional Office in October-November.
In addition, the team leader and other members of the team took part in a nder of inter-country seminars and consultative meetings as members of the WHO secretariat.
ICP SHS 009 Advisory Services R (March-July 1973; 0ct.-Dec. 1973; July-Aug. 1974; Jan.-March 1975; Sept.-Dec. 1975; - )
Aim of the project. To provide consultant services in various subjects upon specific requests of governments; also to provide support to activities currently financed under inter-regional projects and suitable for implementation in this region.
Assistance provided by WHO during the year. Three consultants.
Probable duration of assistance. Until 1980.
Work done during the year. A team of two consultants visited five countries in the Region - Bangladesh, Burma, India, Indonesia and Sri Lanka - in September-November to study the teaching of community medicine in medical schools and prepared separate reports for each country outlining measures for strengthening the teaching of conudunity medicine. The recammendations of the consultants have been sent to the governments concerned.
The Medical Officer in Public Health Ophthalmology from the WHO Regional Office for Europe was assigned as a short-term consultant to visit Indonesia, Sri Lanka and Thailand during October-December 1975. He assessed the magnitude of the problems of visual impairment and blindness, evaluated existing facilities for community- oriented eye health care services and discussed with national authorities the establishment of services and training in public health ophthalmology. His assignment reports were sent to the governments concerned. SFA/RC29/2 Page 196
ICP SHS 011 Medical Rehabilitation R (Feb. 1974 - )
Aim of the project. To study (i) the problems of rehabilitating the physically handicapped and (ii) facilities available; to advise on the integration of various components of rehabilitation services into a unified programme.
Assistance provided by WHO during the year. (a) A medical rehabilitation officer, a physiotherapist, a technical officer and a secretarial assistant; (b) cost of attendance of participants; (c) supplies and equipment.
Probable duration of assistance. Some years.
Work done during the year. The inter-country team based in Dr Kariyadi Hospital, Semarang, Indonesia, completed a community-oriented disability survey and helped in the development of preventive measures and rehabilitation services making use of indigenous talents and material resources. They assisted in the development of comprehensive rehabilitation referral services in the General Hospital, Semarang. In addition, their expertise was made available to the Rehabilitation Centre in Solo and to Fatmawati Hospital, Jakarta.
The team organized an inter-country course on the prevention of disability and rehabilitation of the disabled, which was held from 17 February to 8 March for participants consisting of orthopaedic surgeons, physical medicine experts, physiotherapists and physiotherapy nurses from Bangladesh, Burma, India, Indonesia, Sri Lanka and Thailand. The course, which was conducted by making uee of the facilities available in Semarang, Solo and Jakarta, demonstrated the method of community surveys for identifying the pattern of disability, organization of education, training and research in medical rehabilitation, and establishment'of comprehensive community-oriented services.as part of the existing health services. The team also conducted a national training course.
The team leader (orthopaedic specialist) completed his assignment in April.
ICY SHS 012 Srrengtltening of Health Services Admini~tration UNDP through Training in Plannin (March 1969: Julv-Se~t.-. 1966: !lev. 1969 - ~eb.1970: June 1970 - )
Aim of the project. To develop and strengthen health planning as an integral part of health services administration in the participating countries in order to meet more effectively and efficiently the health needs of the people within the framework of their social and economic development; to provide training in health planning methods and health systems management, including, where appropriate, practical field training; to develop a training capacity so as to provide national self-sufficiency in training as well as operations.
Assistance provided by WHO durin~:the year. (a) A public health administrator, a management officer and two consultants; (b) supplies and equipment.
Work done during the year. Two long-term staff members, viz., a public health administrator (team leader) and a management officer, joined the project in September 1975. They provided assistance in the planning, organization and conduct of a workshop on "Training Needs for Management in the Ministry of Health" held at Jakarta (Indonesia). They also helped with a course in health planning held at the National Institute of Health Administration and Education, New Delhi. The public health administrator assisted with the country health programming exercise in Burma.
The project staff, in collaboration with a consultant, assisted in the planning, organization and conduct of a three-month health planning course for aimak health officers in Mongolia and in the preparation of a report on the development of SEA/RC29/2 Page 197
need-based and effective training courses in health planning and health systems management. Assistance was also given in the planning and conduct of a two-day seminar on country health programming for senior Mongolian officials to familiarize them with the basic concepts, purpose and broad overview of techniques of country health programing.
An educational specialist was assigned under this project during December 1975 - February 1976 to assist the teaching and training institutions in the countries of the Region in developing need-based and effective training courses in health planning and health,systems management. His report is being processed for submission to the governments concerned.
ICP MM 002 Course for Senior Teachers in Child Health R (June-Oct. 1970; Dec. 1973; Sept.-Oct. 1974; Oct. 1975; UNICEF Feb.-March 1976; - )
Aim of the project. To provide advanced training for senior teachers in child health in developing countries with the object of improving education in child health in these countries.
Assistance provided by WHO during the year. (a) Two fellowships - one for nine
months for a~~ candidate-.--- ~ from Indonesia and one for einht- mnths for a candidate from Thailand - for studies in the United Kingdom, Tanzania, Kenya and India (WHO/UNICEF Course for Senior Teachers of Child Health); (b) cost of attendance of participants; (c) supplies and equipment.
Work done during the year. The second "Reunion" Meeting of Past Fellows of the UNICEFIWHO Course for Senior Teachers of Child Health was held from 15 to 18 'October 1975 in the Regional Office (see also Section 7.2 in Part I).
ICP MM 005 Seminar on School Health R (Feb. 1971; Sept.-Nov. 1974; Dec. 1975 - Feb. 1976; - )
Aim of the project. To enable school health officers, public health and maternal and child health planners to examine methods for the further improvement of school health services in the Region.
Assistance provided by WHO during the year. A consultant.
Work done during the year. During December 1975 - February 1976, a consultant was assigned under this project to visit Bangladesh, Burma, India, Sri Lanka and Thailand, which had sent participants to WHO-sponsored seminars on school health in the past, with a view to assessing the impact of these seminars on the development of the school health services in these countries. He also assessed the adequacy and efficiency of the school health services and studied ways of achieving further development of these services as part of the community health services, as well as possible areas for further WHO assistance.
The impact of the seminars on the school health officers was evident; their work has improved considerably, and all of them show enthusiasm and eagerness to develop school health programmes in their respective countries.
The report of the consultant has been issued.
ICP MCH 010 Education and Studies in Child Health R (Feb.-March 1974; Dec. 1974 - March 1975; - )
Aim of the project. To assist in further developing the education and service programmes, including special studies, in priority areas in the field of child health. SEA/RC29/2 Page 198
Assistance provided bv WHO during the year. A grant-in-aid.
Work done during the year. Preparations were under way for holding a Seminar on the Teaching and Practice of Neonatology with a view to drawing up guidelines in this field applicable to countries in the Region.
A follow-up inquiry regarding the recolm~endationsof the inter-country meeting on post-graduate paediatric education held in March 1975, is also under way.
A grant-in-aid was given to the Institute of Medicine I, Rangoon, Burma, for a study on the "Outcome of Pregnancy, Including Perinatal Morbidity and Mortality and Low Birth- weight Babies". The possibility of an institution in India undertaking a similar study is being explored.
ICP MCH 011 Regional Team on Family Health UNFP A (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, including the maternity-centred approach.
Assistance provided by WHO durinR the year. (a) Two medical officers, a statistician, two consultants, a temporary adviser and two secretarial assistants; (b) cost of attendance of participants; (c) supplies and equipment.
Probable duration of assistance. Some years.
Work done during the year. The team leader and the statistician were in position during the major part of the year. The team leader assisted in various activities of the family health projects in Bangladesh, India, Indonesia, Nepal and Sri Lanka. He was also associated with a WHO Headquarters group in connexion with the assessment of research and training centres in India. He attended (a) a Workshop on 'Recent Advances on Long-acting Systemic Agents for the Regulation of Fertility'; (b) a Symposium on 'Bucharest - A Year After', and (c) a workshop on the 'Strengthening of Integrated Teaching of Human Reproduction, Family Planning and Population Dynamics in Medical Colleges in India'.
The medical officer stationed in Thailand was actively involved in the family health programme in that country. He also acted as the UNFF'A Co-ordinator in Bangkok.
The statistician assisted with the statistical aspects of the family health programmes in the Region. He was involved in the proposed perinatal study in Burma, which was formulated under project ICP MCH 010. He attended a Seminar on Evaluation of Family Planning Programmes held in Manila from 2 to 8 October 1975.
A Seminar on "The Paediatrician and Family Health" under this projecr was held in the Regional Office from 24 to 29 November for 19 participants from Bangladesh, India, Indonesia, Nepal, Sri Lanka and Thailand. A consultant and a temporary adviser assisted in the conduct of this seminar. The team members assisted in the planning and preparation and formed part of the WHO secretariat.
A "Symposium on Field Operational Research in Delivery of Maternal and Child Health/ Family Planning Services" was held in June 1976 in Indonesia for 23 participants from six countries of the Region - Bangladesh, India, Indonesia, Nepal, Sri Lanka and Thailand. A consultant and two temporary advisers assisted with this activity.
A consultant under this project assisted with the Inter-Regional Training Programe in the Medical Termination of Pregnancy for Senior Obstetricians and Gynaecologiscs in India. SEA/RC29/2 Page 199
ICP NUT 001 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 provided by WHO durin~the year. Supplies and equipment.
ICP HED 003 Development of Health Education in Family UNPPA Health Pro~rammes (Aug.-Nov. 1971; Oct. 1972 - Jan. 1973; 0ct.-Dec. 1973; Feb.-May 1974; Dec. 1974 - )
Aim of the project. To assist in developing, implementing and evaluating the effectiveness of the health education component of family health programmes; in improving the quality and utilization of information, educational and teaching materials used for family health education; in providing continuing education to staff of training institutions and key health education personnel in different aspects of family health education and in developing capabilities in family health education.
Assistance provided by WHO during the year. (a) A health education specialist; (b) cost of attendance of participants; (c) supplies and equipment.
Probable duration of assistance. A number of years.
Work done during the year. An inter-country workshop on "Assessment of Mass C~municationsMedia in Family Health Education" was held in New Delhi from 22 to 31 October 1975 with 19 participants from six countries of the Region. Plans have been made for organizing a further three workshops under this project in 1976, and the health education specialist from this project was assigned as a consultant to an inter-country workshop on "Trends in Educational Technology" under project ICP HMD 001.
Visits were made to Nepal, Sri Lanka and South India to consult with key health educators and to evaluate field training for the Diploma in Health Education.
Educational materials and reports from a variety of other sources have been evaluated and over 100 items have been passed on to 30 national health educators and training institutions through a regular series of information packages. Bibliographies and special training materials have been prepared at the request of other WHO projects.
A series of case studies, written by health educators from India, Sri Lanka, Thailand and Nepal was collected and edited as part of a project organized by WHO Headquarters.
ICP HMD 001 Continuing Education for Nurses R (Jan. 1967 - ) UNICEF
Aim of the project. To stimulate and encourage Member countries to develop continuing education programmes for nurses and assistant nurse-midwives; to assist institutions and health centres in Member countries in the planning and organization of continuing education for nursinglmidwifery personnel on the basis of local needs and demands; to develop, compile and publish reference materials geared to the needs of nurses/midwives at the primary health care level, end to encourage and promote the collection, exchange and evaluation of information and studies in continuing education. SEA/RC29/2 Page 200
Assistance provided by WHO during the year. (a) Three nurse educators, four consultants and two secretarial assistants; (b) cost of attendance of participants; (c) supplies and equipment.
Probable duration of assistance. Until the end of 1977.
Work done during the year. The project staff assisted the nursing project in Bangladesh (BAN WD 001) in conducting three country-level courses. The second course on "Ward Administration to Improve Nursing Care of Patients" was held from 10 November to 6 December in the Wrses' Training Centre of Chittagong Medical College Hospital, attended by nineteen staff nurses and ward sisters. One of the project nurses also carried out a post-course evaluation of the first "Ward Administration" course held eight months prevlously. Evaluation of the second course was done by the nurse educator who conducted two courses in the "Management of the Surgical Patient". One course was held at Rajshahi Medical College Hospital from 26 April to 21 May and the other at Mymensingh Medical College Hospital from 7 June to 2 July. Twenty surgical staff nurses attended each course. The nursing advisory services project in Bangladesh hopes to have further assistance from this project in evaluating the surgical course; this information is used for upgrading the nursing curriculum and hospital services.
An inter-country course on "The Improvement of Hospital Nursing Services" was held in Jakarta from 10 to 28 November. The twenty-five participants consisted of medical superintendents, matrons and nursing auperintendents and came from six countries of the Region. One of the project's nurse educators served as the course director and was assisted by two short-term consultants (a medical administrator and a nurse administrator) and two temporary advisers. The team received assistance from project ICP HSM 001 in devising an evaluation too1,which will be used to assess the impact of the course on nursing administration. The evaluation forms have been sent to the participants and WHO personnel in the countries to record the progress participants have made in the application of new managerial skills in their jobs. The results of the evaluation will be annexed to the course and assignment reports of the consultants.
The inter-country course on "Trends in Educational Technology" was held in the Medical Education Unit, University of Sri Lanka, Peradeniya Campus, from 1 to 19 March for twenty-two principal and senior tutors and two medical instructors, who came from Bangladesh, India, Indonesia, Mongolia, Nepal, Sri Lanka and Thailand; a WHO medical officer also took part. The faculty included a project member as the course director, a consultant in educational technology, a consultant nurse educator and a national counterpart. A post-course evaluation is under way.
Plans were under way for courses on "Continuing Education for Nurses" to be conducted in Thailand for three months commencing in July and in Sri Lanka for three months beginning in September.
Preparations have begun for an inter-country course on "Community-based Nursing Education Programmes", to be held in the Regional Office in the latter part of 1977.
The "Survey on Nursing and Midwifery Education and Personnel in the South-East Asia Region of WHO" was published in April 1976 and distributed.
One of the nurse educators completed her assignment on 31 March 1976. Two nurse educators continued to be in position.
ICP HMD 002 Educatios and Training of Environmental Health Personnel R (Sept. 1970 - April 1971; 0ct.-Dec. 1972; Nov.-Dec. 1973; - )
Aim of the project. To assist in the training and utilization of engineers and other personnel in various aspects of environmental health.
Assistance provided by WO during the year. Supplies and equipment. SEA/RC29/2 Page 201
ICP HMD 003 Community Health Aspects of Medical Education R (March-April 1970; Oct. 1972; Nov.-Dec. 1974; Feb. 1976; - )
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) Two consultants and assistance from a Headquarters staff member; (b) cost of attendance of participants; (c) supplies and equipment.
Probable duration of assistance. Some years.
Work done during the year. A Seminar on Medical Assistants was held in the Regional Office from 16 to 21 February 1976, attended by twenty-four participants from eight countries of the Region. The seminar,which was assisted by two consultants and one staff member from WHO Headquarters, was organized to highlight the role of middle- level workers and their importance. The participants rec~mmended~thatthere was a need for utilization of medical assistants in the countries of the Region in the delivery of curative, preventive, promotive and rehabilitative health services as well as in the mnagerial and co-ordinative roles. They defined the medical assistant as an "extender of the doctor's services" irrespective of the presence or absence of a doctor. The report of the seminar has been issued.
ICP HMD 004 WHO-sponsored Training Centre for Nurses, R Wellington (New Zealand) (Jan. 1970 - Dec. 1975)
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. A nurse instructor.
Work done. In 1975, the last group of students completed the programme, at which time the project was terminated. Only four applications had been received for 1976 and it was not considered justifiable to continue the programme with so few candidates.
During the six years of the Centre's operation, a total of 62 candidates received training (28 from Thailand, 15 from Indonesia, 13 from Nepal, two from Sri Lanka, one from India, in addition to three from Afghanistan in 1970 when it was a Member of this region). The Centre provided excellent opportunities to nurses from Member countries who could not otherwise participate in post-basic nursing programmes.
ICP HMD 006 Educational Technology R (Sept. - Nov. 1975; - )
Aim of the project. To promote the establishent of educational technology centres in the countries of the Region for the local production of teaching materials for education and the training, initially, of medical teachers and later on of other levels of healch workers; to provide support to the teacher training centres in different countries of the Region, and to help in the conduct of courses for national personnel concerned with the production of educational mterials.
Assistance provided by WHO during the vear. (a) Three consultants and two temporary advisers; (b) cost of attendance of participahts.
Work done during the year. A seminar on Educational Technology - Instructional Methods, was held at the Medical Education Unit, Faculty of Medicine, Peradeniya, Sri Lanka, from 30 September to 11 October 1975. Altogether,23 participants from SEA/RC29/2 Page 202
six countries of the Region attended the seminar, which wae assisted by a consultant and a temporary adviser. In addition, a staff member each from the Regional Office and WHO Headquarters took part in this activity.
Following discussions with the Director-General of Health Services of Nepal during the twenty-eighth session of the Regional Cormittee in August 1975, a Seminar on Medical Education Suitable for Developing Countries was held in Kathmandu from 10 to 14 November. The seminar vas attended by 23 participants from six countries of the Region and was assisted by two consultants and a temporary adviser.
Preparations were under way for the assignment of a conaultant from October to December 1976 to three countries of the Region - Bangladesh, India and Nepal - to report on the development of facilities for teacher training and educational technology.
In view of the uncertain position in respect of project ICP HND 009 because of UNDP funding constraints, it was proposed to provide for certain components in this project to meet the requirements of project ICP HMD 009 with effect from 1977.
ICP HND 008 Medical Education in Human Reproduction, UNFPA Family Planning and Population Dynamics (March 1972 - )
Aim of the prolect. To assist in the planning, preparation, conduct and evaluation of short training courses for senior medical teachera 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) Three consultants and two temporary advisers; (b) cost of attendance of participants; (c) supplies and equijment.
Work done during the year. The Fourth Training Course in the Teaching of Human Reproduction, Family Planning and Population Dynamics in Medical Schools was organized at the Faculty of Medicine, Chulalongkorn University. Bangkok,from 6 to 17 October 1975. In a11,31 participants from the countries of the Region took part in the training course - 6 from Bangladesh, 3 from Burma, 6 from Indonesia, 1 from Nepal, 6 from Sri Lanka and 9 from Thailand. They consisted of five deans of medical schools and senior teachers from departments of paediatrics, obstetrics and gynaecology, preventive and social medicine, physiology, anatomy, epidemiology, pathology, internal medicine, biochemistry, psychiatry, pharmacology, surgery, cornunity medicine, and parasitology as well as a director of medical care.
The faculty consisted of three coneultants in the disciplines of obstetrics and gynaecology and human reproduction and two temporary advieers - one being the Acting Head of the Medical Education Unit and the other the Acting Head of the Department of Obstetrics and Gynaecology of the Faculty of Medicine, Chulalonglwrn University. In addition, eight guest lecturers were invited and addressed the participants on specific topics. One of the Regional Advisers on Health Manpower Development also took part in the course.
The course reviewed the progress of the ongoing programme on the teaching of human reproduction, family planning and population dynamics in the Region in relation to the existing guidelines,wbich were distributed to the participants. Evaluation of the existing educational activities in this field was made, and the participants also discussed methods for increasing the impact of such activities in the field of human reproduction, family planning and population dynamics. The report of the course has been distributed to all the medical schools in the Region as well as to the participants. SFA/RC29/2 Page 203
Preparations were under way for holding the fifth training course on the subject in the Regional Office in November-December 1976. A consultant will be visiting the institutions which have sent participants to the previous courses, in order to aaaess how far the participants have been able to introduce and strengthen the teaching of this subject in their institutions and how they have disseminated the knowledge acquired to other teachers and institutions.
ICP HMD 009" Medical Teachers' Training and Continuing Education UNDP (March 1969 - )
Aim of the protect. To increase the regional capacity to train teachers of health professionals in all aspects of medical pedagogy and to assist in introducing a method of continuing education of health personnel already in service.
Assistance provided by WHO during the year. (a) A project co-ordinator, eight consultants and two temporary advisers; (b) a twelve-month fellowship for a candidate from Sri Lanka for study in the United States of America; (c) cost of attendance of participants; (d) supplies and equipment.
Work done during the year. An inter-country course in Educational Science for Teachers of Health Professionals was held in Negombo, near Colombo, from 15 to 27 September for 22 participants - senior medical teachers, administrators and senior nursing personnel - from seven countries of the Region. The course was assisted by two consultants and two temporary advisers; the project co-ordinator and a project staff member from Mongolia also took part.
The project co-ordinator left in November on completion of his assignment, and the project has since been looked after by one of the Regional Advisers on Health Manpower Development.
Funds were made available for holding a national course in educational science for teachers of health professionals at the Jawaharlal Institute of Post-graduate Medical Education and Research, Pondicherry (India). In addition to two consultants, one of the Regional Advisers on Health Manpower Development assisted in the initial conduct of the course, which was held from 15 to 28 March 1976. There were 14 participants,including eight from the institute.
Two consultants were also provided to assisr. with a national course in educational science for teachers of health professionals, held in Dacca from 1 to 14 April: twenty-four participants from different medical institutions of Bangladesh attended the course. A similar course was held in Ulan Bator from 17 to 29 May, also asslsted by two consultants. Two similar courses are planned for July 1976 - one in Rangoon and one in Mandalay. Action was also taken to finalize the recruitment of a consultant for writing up the Agency Terminal Report of the project in July 1976.
ICP ESD 002 Regional Epidemiological Surveillance and Training R (Sept. 1966 - )
Aim of the project. To assist in strengthening epidemiological surveillance programes directed towards priority diseases, in introducing epidemiological surveillance activities into the functions of local health services, and in training staff.
Assistance provided by WHO during the year. (a) Assistance from three medical officers from Headquarters and Regional Office staff; (b) cost of attendance of participants.
*previous number: SE ICP HMD 007 SEAIRC2912 Page 204
Work done during the year. The Second Regional Seminar on Epidemiological Surveillance of Comunicable Diseases (Immunization Programmes) was held in the Regional Office from 19 to 26 November 1975. Fifteen participants from nine countries of the Region attended. The faculty for the Seminar included, in addition to Regional Office Staff, three staff members from WHO Headquarters. The seminar reviewed the situation of immunization programes in the Region, considered the objectives of and realistic targets for the expansion of the national immunization programmes, examined the constraints and discussed the planning, implementation and evaluation of immunization programmes.
ICP MPD 001 Assessment Team on Malaria Eradication R (May 1959 - Dec. 1961; Nov. 1963 - )
Aim of the pro.iect. To provide technical assistance in the fields related to a multi-disciplinary approach to the control of malaria and other parasitic diseases.
Assistance provided by WHO during the year. (a) A sanitary engineer; (b) supplies and equipment.
Probable duration of assistance. A number of years.
Work done during the year. Operational routines of attack against vector mosquitoes being limited, in this Region, to house-spraying, it is necessary to promote epidemiologically-supported measures of malaria control.
The public health engineer/scientist assigned to this project provided technical assistance, in view of a reorientation of the malaria control operations, to Burma, India, Nepal and Thailand. Priority was given to training and field demonstrations involving ecologically oriented interventions in the field of larviciding and bioenvironmental control.
ICP MPD 002 External Cross-Checking of Blood Films R (Sept. 1968 - Dec. 1975)
Aim of the project. To develop facilities in the countries of the Region for the independent cross-checking of blood films from malaria programmes.
Assistance provided by WHO during the year. (a) A laboratory specialist; (b) supplies and equipment.
Work done. This project was terminated at the end of 1975. On the pattern of the Regional Centre for External Cross-Checking of Blood Films wbich operated between 1963 and 1966 at the Central Research Institute, Kasauli, in India, and as suggested by the Regional Cdttee at its twentieth session in 1967, a full-time laboratory specialist was assigned in September 1968 to assist in the establishment of an independent cross-checking centre in Sri Lanka. In addition, he vas expected to render assistance to the Anti-Malaria Campaign in organizing the laboratory services. The Specialist was reassigned under the same project to Indonesia in February 1973.
In Sri Lanka, at the time of the departure of the laboratory specialist, 7 regional laboratories of the 12 planned under the 'decentralization of the laboratory services' scheme were functioning, staffed with 135 microscopists and 4 medical laboratory technicians in addition to 35 microscopists undergoing training. There were 314 microscopes available in different laboratories, with a microscope maintenance service. During this period, the average daily examination rate steadily improved and the backlog of examinations was reduced considerably. To carry out indirect supervision of the laboratory service, a cross-checking laboratory was established early in 1969 as dn alternative to effective and frequent on-the-spot supervision. The introduction of the wide-angle lense system enabled the cross-checking staff to SEAlRC2912 Page 205
increase the volume of examined blood without impairing the quality or rate of examination. During his assignment, the laboratory specialist assisted in various training courses - basic training to 93 microscopists, refresher training to 100 microscopists and training in malaria laboratory technology to 8 laboratory technicians. He also made short visits to Burma and Indonesia to assist with the laboratory aspects of the malaria programnes in those countries.
In Indonesia,the next location of this project, standard laboratory report form for use by all laboratories in Java and Bali were introduced, and the laboratory specialist visited municipal, regency and provLncial laboratories to advise on the methods to be followed in the new reporting system. The flow of informtion from the field and regency-level laboratories to the provincial headquarters needs to be improved further. A simplified form of reporting was devised for the other islands where the laboratory service is still to be developed.
Work at the headquarters reference laboratory improved with the provision of accommodation, with space for ten microscopists. After facing a shortage of staff for nearly two years, the laboratory seems now to be properly staffed and supervised. In addition to providing indirect supervision to the laboratories in the provinces by cross-checking their work, it assists in the examination of blood slides from various surveys conducted all over Indonesia.
The WHO laboratory specialist continued to make visits to the provinces in Java and Bali and other islands for assessing laboratory performance and for training the laboratory staff in malaria diagnostic techniques. During a visit to Irian Jaya, he took the opportunity to investigate the possible resistance of P. fakipznmr to the 4-sminoquinolines and to impart refresher training to microscopists from the province. Consolidated information on aspects related to training, indirect supervision and performance of the laboratory service in Indonesia during the entire period of the project's existence is awaited.
During 1975, the laboratory specialist was assigned for a period of two months to the rmlaria eradication programme in Nepal. In his report he suggested a complete re-organization of the laboratory supervisory system,both direct and indirect, and the provision of refresher training to all rmlaria laboratory technicians.
The laboratory specialist has now been assigned to project IN0 MPD 001.
ICP MPD 003 Seminar on Advanced Malaria Epidemiolo?,y R (April 1976)
Aim of the protect. To exchange information on the changing epidemiological patterns of malaria in the Region.
Assistance provided by WHO during the year. (a) Two consultants, three temporary advisers and assistance from Headquarters and Regional Off ice staff (b) cost of attendance of participants; (c) supplies and equipment.
Probable duration of assistance. Some years.
Work done. A "Consultative" Meeting on Malaria was held in the Regional Office from 21 to 24 April. There were 17 participants from the eight malarious countries of the Region, three staff members from WHO Headquarters, two consultants and three temporary advisers.
The Meeting reviewed the malaria situation in the Region, discussed the principles involved in an effective malaria control methodology, training needs and research objectives relevant to malaria in the Region. SEA/RC29/2 Page 206
Group discussions were organized for preparing 'Guidelines for developing national policies for anti-malaria activities and their implementation'. One group with a majority of public health administrators focused its discussion on planning, inter-sectoral co-operation at national level, financing, socio-economic aspects of malaria and its control priorities within the overall health plan and the organizational supporting structure. The other group, which consisted of a majority of malariologists with some health administrators, dealt with the technical aspects, applicable methods of attack,problems related to vectors and their resistance to insecticides and parasite resistance to drugs, possibilities for bio-environmental control of the vector, population movement, technical implementation and in-built evaluation procedures for anti-malaria activities.
Both groups gave special attention to the "Report of the Ad hoc Committee of the Executive Board" and its reccmendations, which included adequate funding, timely supplies, re-examination of the malaria situation for evolving suitable strategies, realistic planning, inter-disciplinary co-operation, community participation, cautious integratioe of anti-malaria activities into the general health services, a flexible approach to control methods,introduction of environmental management techniques, and thorough evaluation of operational and technical constraints.
In addition to several reccmendations, the meeting adopted two resolutions, one on "Research on Malaria" and the other on "Malaria Eradication and Control". The resolution on research called for greater allocation of funds for the promotion of research, while the other resolution urged the governments concerned to redouble their efforts to control malaria and called on international and bilateral sgmcies to increase substantially their technical, material and financial assistance to malaria programmes in the countries of the Region.
ICP SNE 001 Smallpox Eradication and Epidemiological R Advisory Team (Oct. 1962 - )
Aim of the project. To assist the countries of the Region in achieving total eradication of smallpox by 1977.
Assistance provided by WHO during the year. (a) Pour medical officers, three administrative officers, a secretarial assistant, a clerk-stenographer and a clerk-typist; (b) cost of attendance of participants; (c) supplies and equipment.
Probable duration of assistancg. Until the end of 1977.
Work done during the year. During the year, the staff of the team assisted the countries of the Region in maintaining smallpox surveillance at a high level.
They attended country and State meetings to prepare for and review country-wide searches. Participation of representatives from across borders in State/country meetings was arranged. In India, special searches were conducted by inter-country staff in Sikkim and the Andaman and Nicobar Islands. Two staff members were deputed to Bangladesh in December 1975 to strengthen the supervision of house-to-house searches.
Assistance was given in the preparation and production of a final operational guideline for smallpox eradication in countries which had been endemic until recently.
An inter-country workshop to finalize the strategy for the next two years was held in Kathmandu in January 1976. A ten-day visit to Burma to review the smallpox programme was conducted in April 1976.
Supplies and equipment were provided, and the printing and distribution of forms arranged. SEAIRC2912 Page 207
Arrangements for the independent testing of specimens and quality control of vaccines were continued.
Inter-country cross notifications were made and the results of investigations reported.
ICP MBD 002 Inter-Country Consultative meet in^ on Leprosy R (Dec. 1975)
Aim of the project. To review and analyse the magnitude of the leprosy problem in the countries of the Region, and to develop strategies for the control of the disease.
Assistance provided by WHO during the year. (a) A consultant, fifteen temporary advisers and assistance from Headquarters and Regional Office staff; (b) cost of attendance of participants; (c) supplies and equipment.
Work done. An inter-country Consultative Meeting on Leprosy was organized in the Regional Office from 18 to 20 December 1975. Fifteen participants (who served as WHO temporary advisers) - two each from Bangladesh, Burma, Indonesia, Sri Lanka and Thailand, one from Nepal and four from India - attended the meeting, in addition to observers from IBRD, DNICEF, ILEP, *us Suisse and the Leprosy Mission, India. Apart from the Chief of the Leprosy Unit from WHO Readquarters and Regional Office staff, a WW) consultant assisted with the preparation and conduct of the meeting.
The meeting reviewed the leprosy control programmes in Member countries. With the objective of bringing about a significant reduction in the quantum of infection in the community so that the disease was controlled at a level where it ceased to be a serious public health problem, the meeting emphasized the need for intensified case- finding activities in hyper-endemic areas and for effective treatment, as well as for undertaking collaborative field studies on treatment regimens in a number of suitable locations in the Region.
ICP CAN 001 Cancer Control and Prevention R (Oct. 1975 - ) Aim of the project. To promote regional and national collaboration for identifying the pattern of morbidity and mortality due to cancer; promote evolution of a national policy for cancer control; establish training and services and stimulate biomedical research,including epidemiological investigations.
Assistance provided by WHO during the year. (a) Temporary assistance from Headquarters and Regional Office staff; (b) cost of attendance of participants; (c) secretarial assistance.
Work done during the year. An inter-country Symposium on Chronic Liver Diseases, including Liver Cancer, in the countries of the South-East Asia Region was organized in New Delhi in October under the joint auspices of the Indian Council of Medical Research and WHO. Representatives from Bangladesh, Burma, India, Indonesia, Mongolia, Sri Lanka and Thailand attended the symposium, which discussed the incidence of chronic liver diseases, their etiology and the public health measures required for the prevention of infective hepatitis, mycotoxicosis and other toxins. Collaborative investigations of cirrhosis of the liver and liver cancer and the use of standardized protocols and procedures were also discussed. The Director of the Division of Non-communicable Diseases from WHO Headquarters and a representative of IARC assisted in the conduct of the symposium.
After the symposium, the Director of the Division of Non-connnunicable Diseases from WHO Headquarters, together with the Regional Adviser on Non-communicable Diseases, SEA/RC29/2 Page 208
visited the Tata Memorial Centre, Bombay,the Kidwai Manorial Cancer Institute, Bangalore, the Arignar Anna Memorial Cancer Institute, Kancheepuram, and the Indo-Danish Oral Cancer Research Project at the Dental College, Trivandrum, Kerala, to assess the cancer control activities in these institutions.
ICP CVD 001 Epidemiology. Control and Management R of Cardiwascular Diseases (Oct. 1973 - March 1974; Dec. 1975 - Jan. 1976; - ) Aim of the protect. To conduct group educational activities for the evaluation of the magnitude of cardiovascular diseases; to assess the current status and promote facilities for early detection, diagnosis, treatment and rehabilitation; to integrate training and specialized service facilities into the public health delivery system; and to co-ordinate epidemiological investigations on a regional basis.
Assistance provided by WHO during the year. (a) Two consultants, two temporary advisers, and assistance frcnn Headquarters and Regional Office staff; (b) cost of attendance of participants; (c) secretarial assistance.
Work done durin~the year. Three short-term consultants, including the Chief of the Cardiovascular Diseases Unit from WHO Headquarters and one temporary adviser to the Regional Director, assiated in the organization and conduct of an inter-country Seminar on Development of Cardiac Resuscitation and Rehabilitation Services, held in the Regional Office from 29 December 1975 to 3 January 1976. Tventy participants from Bangladesh, Burma, India, Indonesia, Sri Lanka and Thailand attended the seminar, hich reviewed available facilities for cardiac resuscitation and rehabilitation and prepared guidelines for the further development of these services, with emphasis on integration of registration, follow-up and evaluation within the existing public health delivery system. The participants also discussed ways and means of promoting regional collaboration in training and research and identified the major cardiovascular diseases requiring concerted public health measures for prevention, control and rehabilitation. The seminar urged the development of national programmes for promoting the cardiovascular health of the people, organization of basic cardiovascular and pulmonary resuscitation and rehabilitation services as an integral part of primary health care systems, establishment of referral centres with mobile services, and education and training of the community as well as health and allied personnel. These recommendations have been forwarded to governments.
ICP RAD 001 Radiation Protection R (Sept.-Dec. 1968; April 1969; Sept. 1969 - Jan. 1970; Nov.-Dec. 1971; Aug.-Sept. 1973; Dec. 1973 - March 1974; Oct. 1974 - March 1975; - )
Aim of the protect. To train personnel for radiation monitoring and surveillance, develop radiological health protection services, develop legislation against health hazards due to ionizing radiation and promote radiological sciences as applied to human health.
Assistance provided by WHO during the year. Supplies and equipment.
ICP PIM 001 Training in Imunology R (0ct.-Dec. 1969; Nov. 1970; Peb.-March 1972; Aug.-Sept. 1972; Nov.-Dec. 1975; - )
Aim of the project. To review the progress in immunology, particularly as related to communicable diseases, and to contribute towards increasing the competence of national immunologists. SEA/RC29/2 Page 209
Assistance provided by WHO during the vear. Cost of attendance of participants.
Probable duration of assistance. Some years.
Work done during the year. A joint DANIDAIWHO-supported course was organized in November-December 1975 at the WHO-ICMR Training-cum-Research Centre in Immunology, All-India Institute of Medical Sciences, New Delhi. Eleven teachers and investigators from the countries of the South-East Asia and Western Pacific Regions participated in the course, which devoted attention to humoral and cellular immunity with special reference to the immunology of reproduction and parasitic diseases.
ICP OCD 002 Prevention and Control of Visual Impairment and Blindness R (March 1976; - )
Aim of the project. To promote the establishment of regional and national training centres in public health ophthalmology in selected medical colleges in the countries of the Region; to establish pilot-cm-demonstration centres for training in community-oriented basic eye health care as an integral part of the existing public health delivery system and organize comprahansive ophthalmic referral services at the intermediate level.
Assistance provided by WHO during the year. (a) A consultant and a temporary adviser; (b) cost of attendance of participants; (c) secretarial assistance.
Work done during the year. A Consultative Meeting on the Prevention of Visual Impairment and Blindness was held in the Regional Office from 24 to 26 March. The special working group constituted for this meeting consisted of fifteen senior public health administrators and ophthalmologists from Bangladesh, Burma, India, Indonesia, Sri Lanka and Thailand. Representatives of the UNDP, UNICEF, UNESCO, ILO, the National Institute of Health, USA, as well as the President of the International Agency for the Prevention of Blindness and the Royal Commonwealth Society for the Blind took part in the meeting.
The group reviewed the magnitude of the problem of visual impairment; formulated strategies for providing basic ophthalmic services at the peripheral level and comprehensive ophthalmic referral services at the intermediate level; evaluated the existing facilities for comunity-oriented eye care services; recommended measures for the training of health and allied personnel in public health ophthalmology; considered measures for the mobilization of resources and suggested the establishment of machinery at national and regional levels for developing a co-ordinated programme of activities for the prevention of visual impairment and blindness.
A report of the proceedings and recommendations has been forwarded to governments in the Region.
The public health officer in ophthalmology from the WHO Regional Office for Europe assisted the meeting as a consultant for one month. A medical officer from the Virology Unit at WHO Headquarters also took part in the meeting.
ICP LAB 001 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. SEA/RC29/2 Page 210
Assistance provided by WHO during the year. A consultant.
Work done duriw the year. During November 1975 - February 1976 a consultant was assigned under this project to survey toxicology laboratories in India, Indonesia, Sri Lanka and Thailand with a view to identifying the areas in which the health laboratory services could be involved in the context of the comprehensive services which such laboratories provide to the comunity.
In most of the countries visited, the surveillance of toxicants and pollutants is an activity which involves several different ministries each having one or more laboratories to cater for the requirements of its respective programe. Apart from the ministry of health, the ministry of food and agriculture is involved in pesticide residues in food sources, the ministry of industry is concerned with the toxicity in the industrial environment, and the ministry of the interior deals with forensic toxicology and drug addiction control. It is obvious that under the present circumstances the ministry of health should restrict the work of the toxicology component of its laboratory programne to those areas which are serviced by it, namely, food and water toxicology for heavy metals, chemicals, additives and preservatives as well as pesticides in processed food and water products produced in the organized sectors of the community; narcotics toxicology with a view to supporting the medical services as part of its programme for drug abuse control, and industrial toxicology to safeguard workers in industries and to enforce minimum standards of hygiene. Clinical toxicology is no less important and also deserves adequate attention.
Certain constraints common to all the countries vieited which seriously hamper the utilization of the toxicology laboratory include the absence of legislation, making the practice of hygiene in the industrial sector difficult to enforce, and absence of acceptable standards for pollutants which makes it difficult to interpret or evaluate the significance of their concentration in food, air, water and soil.
The consultant has recommended that governments should adopt a front-line approach involving adequate legislation, formulation of standards and strengthening of the health laboratories to perform toxicology work. The report containing suggestions for solving these problems has been sent to the governments concerned.
ICP BSM 001 Community Water Supply and Sanitation R (April 1965 - )
Aim of the project. To assist in developing community water supplies and sanitation facilities and in planning and managing environmental health services.
Assistance provided by WHO during the year.' (a) Four sanitary engineers, a consultant and three secretarial assistants; (b) an eleven-month fellowship for a candidate from Indonesia for 8tudy:in the Netherlands.
Probable duration of assistance. Until the end of 1980.
Work done during the year. Supportive assistance to country programea continued. The Government of Burma was assisted in the preparation of propomale for a rural water supply programme for 2000 villages. One of the WHO sanitary engineers stationed in New Delhi was assigned to Chulalongkorn University, Bangkok, Thailand, for one month under project THA SES 001 to help in the further development of training programmes in sanitary engineering. The WHO sanitary engineer in BangLok continued his assistance to the Division of Provincial Water Supply of the Department of Public Works until the end of 1975. In January he was reassigned to the Rural Water Supply Division of the Ministry of Public Health to help with the development of the rural water supply programe.
The WHO sanitary engineer attached to the UNICEF Regional Office in New Delhi continued his assistance in the development of village water supply systems in India with material aid from UNICEF. SEA/RC29/2 Page 211
Work on the collection of.data for the preparation of country reports on urban water supply and sewerage as well as on rural sanitation proceeded as planned. A study on the engineering designs currently adopted in rural water supplies in Bangladesh, India, Sri Lanka and Thailand was undertaken by a consultant for the purpose of preparing a manual on standard design* for use in the Region.
The services of the senior sanitary engineer were lent for two weeks to IBRD in December to assist in their appraisal of the water supply and sewerage project for Greater Calcutta.
The post of sanitary engineer which had fallen vacant in February 1975 was filled in January 1976.
ICP CEP 002 Environmental Pollution Control R (Sept.-Nov. 1973; Sept.-Nov. 1974; April 1975; Nov. 1975; - )
Aim of the project. To assist the countries of the Region in the control and abatement of environmental pollution and hazards.
Assistance provided by WO during the year. Temporary assistance from a Headquarters staff member.
Probable duration of assistance. Until the end of 1980.
Work done during the year. Collection of data from the countries through questionnaires for an inventory of major polluting sources in the Region on a country-to-country basis continued. Consultant services from Headquarters were utilized for about one month in November to review the available data and to advise on the method for the preparation of the inventory. A consultant has been recruited to assist further in this activity and in the preparation of a WHO assistance programme in environmental pollution control, and he is expected to take up his assignment early in July.
ICP HLT 003 Regional Centre for Documentation on Human Reproduction, UNFPA Family Planning and Population Dynamics (Jan. 1971 - )
Aim of the protect. 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) Four consultants; (b) supplies and equipment.
Probable duration of assistance. A number of years.
Work done during the year. Short-term consultants recruited during the year assisted in the preparation of annotated bibliographies. Four issues covering the period February 1975 - April 1976 were published and work on the preparation of another was taken in hand. Special supplements covering' the following special topics were also issued: (1) Inrra-uterine Contraceptive Devices; (2) Reproductive Biology - female; (3) Sterilization - male and female, and (4) Abortions.
Work was also taken in hand for covering another special topic, "~emographic behavioural and social aspects of family planning". SEA/RC29/2 Page 212
In order to find out the views of the recipients regarding the usefulness of bibliographies, a qtrestionnaire waa sent to them.
A bio-registry of specialirrts in the field of human reproduction. family planning and population dynamics in the South-East Asia Region was prepared.
ICP HSM 001 Health Statistics Methodology R (Jan. 1972 - )
Aim of the project. To assist in the development of knowledge and skills necessary for the application of statistical methods to problems in the health field in the Region.
Assistance provided by WHO during the year. (a) A biostatistician; (b) supplies and equipment.
Work done during the year. The statistician attached to this project was involved in several important activities during the period. Among these were: developing methods to assess the impact of an inter-country course in nursing on the participants' day-to-day activities; preparation of guidelines on the methods of evaluating training programmes for multi-purpose health workers; preliminary analysis of data and preparation of questionnaires for follow-up data collection in connexion with an inter-coulltry course on "Improvement of Hospital Nursing Services"; participation in project formulation exercises on a national health information system in Nepal; preparing background material for a meeting of the Regional Committee's Working Group on Allocation of Resources; studies on the pattern of utilization of WHO funds among the various components of the Organization's assistance to countries, and participation in the advance preparations for the first meeting of the Regional Advisory Committee on Medical Research.
Programmes for computing data for reports on the Project Management Inforuation System (PMIS) were re-vritten and methods for predicting staff and fellowship requirements were developed. During the last quarter of the year the statistician was assigned to Indonesia for a period of two months to look after the duties of the statistician attached to the project, National Institute of Medical Research (IN0 ESD 002). during the latter's absence. SEAIRC2912 Page 213
13. INTER-REGIONAL (PROJECTS WITHIN THE REGION)
Project Number Source of Funds Co-operating Agencies -Title
Inter-regional 0033 Study Tour on Medical Termination of Pregnancy UNFPA (March 1975; May 1975; Aug. 1975; Dec. 1975 - Jan. 1976; April 1976; - )
Assistance provided by WHO during the year. Thirty-eight fellarships for candidates from India - five for six weeks and five for five weeks for studies in India, Sweden, Yugoslavia and the United Kingdom, four for six weeks and sixteen for five weeks for studies in India, Sweden, Yugoslavia and Singapore, and eight for three weeks for studies in India, United Kingdom, Yugoslavia and Singapore.
Inter-regional 0188 Liaison with the Economic and Social Commission R for Asia and the Pacific (July 1970 - )
Aim of the project. To carry out liaison functions with ESCAP.
Assistance provided by WHO during the year. A liaison officer, a secretary and a driver.
Work done during the year. The WHO Liaison Officer to ESCAP advised art the health aspects of jointly-assisted projects and continued to promote exchange of views and co-ordination of activities of mutual interest. He represented the Organization at a number of meetings called by ESCAP, as well as meetings of the Hekong Secretariat.
Inter-regional 1029 Research Team on Evaluation of Fertilitr UNFPA Control Methods (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 the methods of organizing clinical trials.
Assistance provided by WHO during the year. Two medical officers.
Work done during the year. In January 1976, this team became the new Human Reproduction Division of Chulalongkorn University's Institute of Health Research.
The WHO team leader of the project completed his assignment in Thailand at the end of May 1976.
IRP MBD 013 LeprosyIBCG 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. Some years. SEA/K29/2 Page 214
Work done during the year. Effective 1 January 1976, the Leprosy-BCG Trial, Bum (IR-0190) which had hitherto been an inter-regional activity, became a regional programme under the Mycobacterial Disease Control Project (BUR MBD 003).
The staff continued the re-examination of villages and newly arrived population, as well as registration of the newborn. A WHO consultant asaiated Burma during January-March 1976 in reviewing and studying the epidemiological picture of leprosy in the country and advised on improvements in control measures, reporting system, and clinical, pathological and epidemiological assessments.
Vector and Rodent Control Research Unit, Jakarta (April1966 - )
Aim of the project. To study (i) the ecology, biology and distribution of insect vectors of disease; (ii) the distribution, ecology and population dynamics of urban and comensal rodents, and (iii) techniques for the control of insect vectors and animal reservoirs of disease.
Assistance provided by WHO during the year. A medical officer, an entomologist/ scientist, an entomologist, a scientist and a secretarial assistant.
Probable duration of assistance. A number of years.
Work done during the year. The research activities of the project continued.
A WNO sanitarian was assigned to the sub-station of the VRCRU in Semarang.
The project leader was reassigned to WHO Headquarters, and another staff member from Headquarters was appointed aa project leader with effect from 15 September 1975.
IR VBC 043 Rodent Control Demonstration Study Unit, DANIDA Rangoon, Burma (0ct.-Nov. 1974; May 1975 - )
Aim of the project. To develop and demonstrate efficient and economical methods of controlling rodent populations under conditions obtaining in a large urban centre in South-East Asia and reduce and hold these rodent populations at a level where no threat to public health will exist.
Assistance provided by WHO during the year. A scientist.
Probable duration of assistance. Until 1980.
Work done during the year. An agreement between the Government and WHO on the establishment of a Rodent Control Demonstration Study Unit was concluded in July 1975. This unit will conduct research on all aspects of the ecology and control of important urban rodent populations.
A scientist from the Vector Biology Control Unit at WHO Headquarters vieited Burma in September 1975 to discuss the activities of this unit with the national authorities concerned and the project staff. SEA/RC29/2 Page 215
14. INTER-REGIONAL (PROJECTS OUTSIDE THE REGION WITH PARTICIPANTS FROM THE SOUTH-EAST ASIA REGION) (1 MAY 1975 - 30 APRIL 1976)
Number of -Title Participants
IRP HMD 046 Regional Acupuncture Training Course, China 7 (2 from Burma, (UNDP) (22 April - 22 July 1975) 2 from Nepal & 3 from Sri Lanka)
Inter-regional 0120 Twelfth Refresher Course in Anaesthesiology, 3 (1 from Indonesia & (WHP) Copenhagen (8-28 June 1975) 2 from Thailand)
IRP KMll 039 Travelling Seminar on the Training and Utiliza- 3 (1 from India & (UNDP) tion of Medical Assistants, USSR (18 June - 2 from Indonesia) 3 July 1975)
IRP BAD 021 Training Course in Radiation Protection, 4 (2 from Bangladesh, (WHO/DANIDA) Supervision and Inspection, Holte, Denmark 1 from Burma & (21 July - 16 August 1975) 1 from Indonesia)
IRP DNH 008 Course in Dental Public Health, Denmark 3 (1 from Burma, (WHO/DANIDA) (18 August - 4 October 1975) 1 from Indonesia 6 1 from Sri Lanka)
EURO/ICP/MBD/OZO Course on Production of Lyophilized BCG Vaccine, 1 from Indonesia (DANIDA) Denmark (1 August - 31 October 1975)
LRP HMD 017 Course in Modern Methods of Teaching Nursing, 2 from Bangladesh (WHOIDANIDA) Copenhagen (3 August - 13 September 1975)
IRP MCH 010 Advanced Course in Maternal and Child Health for 5 (1 from Bangladesh, (Funds-in-Trust) Maternal and Child Health Administrators, Warsaw 1 from India, (1 September - 24 October 1975) 1 from Indonesia, 1 from Nepal & 1 from Thailand)
IRP BAC 023 Travelling Seminar on Plague Control (Moscow, 5 (1 from Burma, (UNDP) S tavropol and Ashkhahad, USSR), (11-27 September 1 from India, 1975) 1 from Mongolia, 1 from Nepal & 1 from Thailand)
IRP CAN 025 Course in Cervical Cytology, Copenhagen 1 from Thailand (WHOIDANIDA) (22 September - 13 December 1975)
CWS/W2/133/15 Training Course on the Collection, Analysis and 3 (1 from India, IN~/73/016/A/01/14 Evaluation of Data on Comunity Water Supply 1 from Indonesia & (UNDP) and Wastes Disposal Services, Voorburg 1 from ihailand) (Netherlands), (6-17 October 1975)
1hT/73/017/A/01/14 Training Courses on Public Health Aspects of 3 (1 from Bangladesh, (UNDP) Pollutants of Inter-regional Significance, 1 from India 6 Sofia (Bulgaria), (9-21 November 1975) 1 from Thailand) (under SEAR0 budget) SEA/RC29/2 Page 216
Project No. and Number of Source of Funds -Title Participants IR HRP 035 (YH) WHO Course on Laboratory Management, Quality 3 (India - 3") (IiQ Special Control and Automation, Birmingham, United Account) Kingdom (1-5 March 1976)
IRP LAB 006 (VK) Inter-regional Courrre on Quality Control in 9 (1 from Bangladesh, (HQ Special Clinical Chemistry, Kuala Lwnpur (29 March - 1 from Burma, Account) 10 April 1976) 2 from India, 2 from Indonesia, 1 from Nepal, 1 from Sri Lanka 6 1 from Thailand)
Fifth Training Course on the Quality Control 5 (1 from Bangladesh, of Drugs with Particular Regard to Production 1 from Sri Lanka, Control, Copenhagen (19 April - 15 May 1976) 1 from Indonesia, 1 from Nepal 6 1 from Thailand)
ir Candidates from Thailand attended under arrangements made by Headquarters direct. ANNEXES ORGANIZATIONAL STRUCTURE (As at 30 jvne 1976)
( RECIOSAL DIRECTOR 1 I
P,PUBLIC INFORNATION
I ......
I WHO CHIEF, DIRECTOR, HEALTH SERVICES REPRESWTATIYES ADMMSTRATION 6 FINANCE ......
ASSISTAM DIRECTOR ASSISTANT DIRECTOR ASSISTANT DIRECTOR &SSISTANT DIRECTOR L...... !W) (SHS !DPC) !El+ b GO-ORD) I I 1 GROUP EDUCATIONAL PROGW SUPPORT FELLWSHI PS BLnGET 6 FINANCE ACTIVITIES CO-ORDINATION ' 6 CO-ORDINATION
...... >
8 ...... PERSONNLL 8 1 - ,8 ,8 REGIONAL ADVISERS - HEDICAL SUPPLIES Comrmnicable Di5eases maternal and Child Health Comnvnity ~ealthServices (Family Health) Enviromentel Health Non-co-uoicable Diseases ADMINISTRATIYE Nursing Health Education SERVICES '. '...... Health Laboratory Service3 Nutrition Health Statistics Organization of nedical Health Nanpouer Development Care Malaria Smallpox vector Biology and Control Mental Health
I >a* : , 3m3iYm * ; am-.m FIELD ...... , NO I PROGRAflNE "L1 - -, hi SEA/RCZY/Z Page 218 Annex 2
GEOGRAPHICAL DISTRIBUTION OF INTERNATIONU STAFF ASSIGNEII TO THE SOIITH-EAST ASIA REGION AS OF 30 JUNE 1976
I SOUTH-EAST ASIA REGION ' Country Mi0 (Global) Regional Field Staff including Total Total* Office WRs h Reg. Advisers
Australia - 5 5 31 Austria - 1 1 14 Hangladeah 1 2 3 7 Belgium - 1 1 37 Bolivia - 1 1 7 Brazil - 1 1 11 Bulgaria - 1 1 9 Burm 1 3 4 5 Canada - 6 6 63 Chile - 2 2 20 Colombia - 1 1 20 Cyprus - 1 1 4 Czechoslovakia - 3 3 13 Denmark - 3 3 27 Egypt - 3 3 40 Ethiopia - 1 1 3 Finland - 1 1 6 France 1 4 5 131 Germany, Federal Republic of 2 I 3 49 Ghana - 1 1 13 Greece - 1 1 12 Guatemala - 1 1 8 Haiti - 1 1 13 Hungary - I 1 8 Imiio 4 15 19 68 indoneeio 1 5 6 10 Ireland - 1 1 8 Italy - 2 2 42 Japan - 1 1 15 Liberia - 1 1 5 Malaysia - 1 1 6 Malta - 1 1 4 Mexico . 1 1 8 Nepal - 5 5 10 Netherlands 1 4 5 33 Nicaragua - 1 1 2 Nigeria - 1 1 12 Pakistan - 1 1 25 Philippines - 7 7 27 Poland - 3 3 18 Republic of Korea - 2 2 14 Republic of Viet-Nam . 1 1 6 Singapore - 1 1 3 Sri Lonka 2 10 12 20 Sudan - 1 1 15 Sweden 1 3 4 25 Thailand 1 4 5 5 Union of Soviet Socialist Republics - 11 11 49 United Kingdom 2 24 26 174 United Republic of Tanzania - 1 1 8 United States of America 1 30 31 226 Yemen - 1 1 2 Yugoslavia - 5 5 40 - Zambia -1 -1 1 - Other countries - 387 Grand Total 18 191 209 1819
*as of 31 March 1976 Not included: (1) Sraff on leave without pay (2) Staff assigned to IR CWO 002 (Liaison with ESCAP) SEA/RC29/2 Page 219 Annex 3
MEETINGS AND COURSES ORGANIZED BY WHO AND HELD IN THE SOUTH-EAST ASIA REGION (1 July 1975 - 30 June 1976)
-1975
1-3 July Workshop on Implementation of the Programe for New Delhi Medical Termination of Pregnancy at District Hospital and Block Levels (IR HMD 033)
19-23 July Seminar on Epilepsy (IND HMD 008) Bangalore (India)
July Course on Food Hygiene (SRL FSP 001) Colombo
4-22 August Course No. 1 on the Care of the Young Child Rangkok (THA HMD 002)
August Course on Strengthening of Laboratory Services Colombo (SRL LAB 001)
1-10 September Regional Seminar on Peripheral Medical Care Services Bangkok (ICP SHS 002)
1-19 September Course No.2 on the Care of the Young Child Bangkok (THA HMD 002)
2-6 September Third Workshop [or State Nutrition Officers New Delhi (IND NUT 001)
15-27 September Inter-country Course in Educational Science for Teachers Negombo of Health Professionals (ICP HMD 009) (Sri Lanka)
30 September - Regional Seminar on Educational Technology - Instructional Peradeniya 11 October Methods (ICP HMD 006)
6-17 October Inter-country Training Course on the Teaching of Human Bangkok Reproduction, Family Planning and Population Dynamics in Medical Schools (ICP HMD 008)
6 October - Course on Surgical Patient Care (SRL HMD 002) Colombo 7 November
7-24 October National Orientation Course No.2 for Administrators Colombo from Provincial/~ase/District Hospitals (SRI. SHS 003)
15-18 October Inter-regional Reunion Meeting of Past Fellows of the New Delhi uNICEF/WHO Course Eor Senior Teachers of Child Health (ICP MCH 002)
20-25 October Regional Seminar on Chronic Liver Diseases including New Delhi Liver Cancer (ICP CAN 001)
22-31 October Regional Workshop on Assessment of Mass Comnunication New Delhi Media in Family Health Education (ICP ED003)
27 October - Workshop on Health Management (IN0 SHS 001) South Sulawesi 15 November (Indonesia) SEA/KC29/2 Page 220 Annex 3
28-30 October Workshop on Solid Wastes Management (IND BSM 003) Ahmedabad (India)
October Workshop on Smallpox Eradication (NEP SME 001) Biratnagarl Pokhara/ Nepalganj (Nepal)
October Orientation Programme for Practising Nuraes in Colombo Occupational Health (SRL HWP 001)
October Course for Medical Records Technicians (BUR HID 005) Burma
3-29 November Ward Administration Course for Improvement of Patient Chi ttagong Care (Course No. 2) (BAN HMD 001) et an glade ah)
4-7 November Seminar on Industrial Toxicology (IND CEP 003) Lucknow (India)
10-14 November Regional Seminar on Medical Education Suitable for Pokhara Developing Countries (ICP HMD 006) (~epal)
10-28 November Short Inter-country Course on the Improvement of Hospital Jakarta Nursing Services (ICP HMD 001)
10 November - Inter-regional Course on Imunology (ICP IMM 001) New Delhi 5 December
10 November - Course on Neonatal Nursing Care (BUR HMD 001) Mandalay 19 December (Burma)
12-15 November Workshop on School Health Education (SRL HED 001) Colombo
17-22 November Seminar on Public Health Dentistry (IND DNH 001) Lucknow (India)
17-28 November Course on Occupational Health (IND HWP 001) Ahmedabad (India)
19-26 November Regional Seminar on Methods of Epidemiological New Delhi Surveillance (ICP ESD 002)
19-28 November Workshop on Teaching of Human Reproduction, Family Peradeniya Planning and Population Dynamics (SRL HMD 007) (Sri Lanka)
24-29 November Regional Seminar on Paediatriciana and Family Health New Delhi (ICP MCH 011)
November Workshop on Health Education in Family Health Colombo (SRL HED 002)
8-12 December Workshop on Management Training Needs (ICP SHS 012) Ciloto (Indonesia)
15 December - Course in National Health Planning (ICP SHS 012) New Delhi 13 January
Consultative Meeting on Leprosy (ICP MBD 002) New Delhi SEA/RC29/2 Page 221 Annex '5
29 December - Regional Seminar on the Development of Cardiac New Delhi 3 .January Resuscitation and Rehabilitation Services (ICP CVD 001)
30 December - Regional Workshop on Manpower Plannint: in Environmental Colombo 10 January and Public Health Services (ICP HMD 002)
-1976 5-10 January First Course on Laboratory Technicians Reorientation Dacca Training (BAN MBD 003)
12-24 January WIIO/JCMR Workshop on Mi crobialogical lnves tigations in New Dclhi Nosocamial and Streptococcsl Infections (IND LAB 001)
26-30 January Workshop on School Health (IN0 MCH 001) Jakarta
26-31 January Second Reorientation Course for Laboratory Technicians Dacca (RAN MRD 003)
26 January - Course Na.1 an Midwifery Education (SRI. HMD 006) Colombo 7 Febrrary
29 January - Regional Workshop on Smallpox Surveillance (Asian Sub- Kathmandu 1 February Ccntinent) (ICP St?E 001)
3-9 February Regional Seminar on Application of Ways and Approaches New Delhi resulting from earlier Studies to achieve Increased Coverage by Health Care Delivery Programmes (ICP SHS M)2)
6 February All-India Smallpox Pre-search Meeting (1ND SHE 001) New Delhi
16-21 February Regional Seminar on Medical Assistants (ICP HMD 003) New Delhi
16-28 February Course No. 2 on Midwifery Education (SRL HMD 006) Colombo
16 February - Course on Occupational Health (IND WP 001) Ahmedabad 1 March (India)
17 February - Inter-country Course on Preventive Rehabilitation in Semarang 8 March South-East Asia (ICP SHS 011) (Indonesia)
18-27 February Workshop on School Health Education (SRL HID 001) Colombo
1-19 March Inter-country Course on Trends in Educational Technology Peradeniya (ICP HMD 001) (Sri Lanka)
3-6 March Workshop on National Health Planning for Senior Health Nepal Personnel (NEP SHS 001)
8-19 March Course on Health Planning (ICP SHS 012) Ulan Bator
15-27 March Course in Educational Science for Teachers of Health Pondichcrry Professionals (ICP HND 009) (India)
Course No. 3 on Esdwifery Educdtion (SRL HND 006) Colombo SEA/RC29/2 Page 222 Annex 3
22-26 March Workshop on Research Methodology (ICP SHS 012) Ulan Bator
22-27 March Meeting of the Ad Hoc Cornittee on Training and Education New Delhi of Undergraduate Medical Students and Interns in MCH/FP (IND MCH 001)
22 March - Third National Orientation Course for Administrators from Sri Lanka 9 April Provincial/Base/Dis trict Hospitals (SRL SHS 003)
24-26 March Consultative Meeting on Prevention of Visual Impairment New Delhi and Blindness (ICP OCD 002)
1-14 April Course in Educational Science for Teachers of Health Dacca Professionals (ICP HMD 009)
5-12 April WHO/ICE!R Workshop on Diagnostic Reagents for Salmonella New Delhi and other Enteric Bacteria (IND LAB 001)
21-24 April Consultative Meeting an Malaria (ICP MPD 003) New Delhi
26 April - Course No. 1 on Surgical Patient Care (BAN HMD 001) Rajshahi 21 May (~angladesh)
3-5 May Inter-regional Task Force on the Intranasal Administration New Delhi of Hormonal Steroids
4-7 May Inter-regional Consultation on Post-graduats Teacher- New Delhi training Programs in Special Techniques for Fertility Management and Maternal Care
17-29 May Workshop for Teachers of Colleges of Nursing of South Bangalore India (IND HMD 002) (India)
17-29 May Course in Educational Science for Teachers of Health Ulan Bator Professionals (ICP HMD 009)
31 May - 11 June Inter-regional Workshop on Simulation Techniques Bangkok
31 May - 26 June Course No. 1 on Tests and Measurements (SRL HMD 006) Colombo
7 June - 2 July Course No. 2 on Surgical Patient Care (BAN HMD 001) Mymensingh (Bangladesh)
14-18 June Regional Symposium on Field Operational Research in Bandung Delivery of Maternal and Child Health/Family Planning (Indonesia) Services (ICP MCH 011)
21-25 June Workshop on Development of Self Learning Material for New Delhi Family Health Education (ICP HED 003)
Mid June - Mid Training Course in Leprosy Control Methodology Biratnagar September . (NEP MBD 001) (~epal)
June Course in National Health Planning (ICP SHS 012) Bangkok SEAlRC29 /2 Page 223 Annex 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 (1 July 1975 - 30 June 1976)
8-9 October UNICEF East Asia and Pakistan Regional Office: Meeting Dacca on Basic Child Care Services
14-20 October ESCAP: Second Session of the Cornnittee on Natural Bangkok Resources
10-15 Noveaber UNESCO: Sixth Regional Conference of National Commissions New Delhi of Asia and Oceania
12-20 November UNICEF: Meeting of UNICEF Country Representatives of New Delhi South-Central Asia Region
13-20 November UNICEF South Central Asia Regional Office: Regional New Delhi Staff Mee tin&
25-29 Novenber ESCAP: Meeting of Senior Officials for Review and Bangkok Appraisal of Development Progress
19-28 November FAO: Workshop on Population Education in the In-service Gannoruwa Training Programmes of Rural Development Agencies in (Sri Lanka) Asia and the Far East
12-16 December United Nations: Second World Congress on Water Resources New Delhi
20-23 January UNIDO-FAO: Inter-regional Meeting on the Design and New Delhi Operation of Ammnia Plants
18-20 March UNESCO: Meetin3 of Experts on Regional InEormation New Delhi Policy and Planning in South and Central Asia
20-26 April UNESCO: International Conference for the Education and New Delhi Trainin6 of Engineers and Technicians
22 April - UNIDO: Meeting on Transfer of Technology in the field New Delhi 4 May of Pharmaceuticals
7-11 June FAO: First Session of the Regional Animal Production Bangkok and Health Commission for Asia, the Far East and the South-West Pacific
29 June - ESCAP: First Session of the Comittee on Population Bangkok 5 July SEA/RC29/2 Page 224 Annex 5
CONFERENCES AND MEETINGS OF GOVERNMENTAL, NON-GOVERNMENTAL AND OTHER ORGANIZATIONS HELD IN SOUTH-EAST ASIA REGION AT WliICH WHO WAS REPRESENTED (1 July 1975 - 30 June 1976)
8-10 october Government of India: All-India Seminar on Rural Water Nainital Supply (India)
16-20 November Indian Society for Training and Development and the New Delhi International Federation of Training and Development Organizations: Fourth International Training and Development Conference
24-28 November SEAMEO: Seminar on Tropical Paediatric Problems Bangkok
25-28 November Government of India: National Seminar on Employment New Delhi of Children in India
14-17 December Catholic Hospital Association, Chris tian Medical Bombay Association and Voluntary Health Association of India: National Health Convention and Exhibition
12-14 February Indian Association for Comunicable Diseases: Fifth Jhansi National Conference on Communicable Diseases (India)
21 February Government of India: Second National Convention on New Delhi Environmental Engineerins
8 April National Society for the Prevention of Blindness: New Delhi Symposium on Prevention of Blindness
22-24 April Asian Development Bank: Meeting of the Board of Bangkok Governors
22 May International Council on Social Welfare, Regional Office Bombay for Asia and Western Pacific: Meeting of the Council SEA/RC29/2 Page 225 Annex 6
FELLOWSHIP TABLES
Table 1. Fellowships Awarded*. bv Source of Funds, Type of Fellowship and Countrv of Origin of the Fellow (1 May 1975 - 30 April 1976)
Grand Total 3 77 49 102 528 129 I 399
>'< Extensions are nor included.
.,..,,"The figures are broken down into two parts; for the periods from 1 May to 31 December 1975 and from 1 January to 30 April 1976. SEA/RC29/2 Page 226 Annex 6
Table 2. Fellowships Awarded by the WHO South-East Asia Region,by Subject of Study and Country of Orinin of the Fellow (1 Hay 1975 - 30 April 1976)
5 a a 9) 3 -ma A .I) .I) k 4 Croup 0 Subject 4 $2 No. a ,* ;izrl cl + Total ME%e "c sz 230 H ,"2r Z m;rj r4
1 Public Health Administration - 2 5 - 1525 1 14 4 48
2 Sanitation - - - 49 4-2 6 10 1 72
3 11- 2 1-4 - 14 4 2 7 4Maternal and Child Health and Family Planninq 13-26 3 -11 - 66 3 113 5 Comunicable Diseases and Laboratory Control
Cholera -1------1 Dengue fever and haemorrhagic diseases -5------5 Epidemiology -7- 3 - - - - - 2 12 Castro-enterology ------1 - - - 1 Hepatitis ------2 - - - 2 Immunology -1------1 Laboratory services 67- 2 1-5 6 9 3 39 Leprosy 2 - - 1 -1- 5 - - 9 Malaria 1 - - - 4-- 9 - - 14 Medical entomology ------11 2 Parasitology ------1 - 1 Plague -2------2 Port health -2------1 - 3 Tuberculosis -2- 1 51- 6 - 2 17 Vaccine production - - - - 1-- - . - 1 Venereal diseases -1------1 - 2 Veterinary public health - - - 1 ------1
6 Clinical Medicine
Anaesthesiology - - 5 ------5 Cancer -18 2 --- 1 1 - 13 Cardiovascular diseases - - - 2 --- - 11 4 Internal medicine ------1 - - - 1 Oto-rhino-laryngology - - - 1 - - 1 - - - 2 Radiology -2- 4 1-- - - - 7 Radiography - - 1 I-- - - - 2 Radiation protection 21- 1 1-1 - - - 6 Surgery -1- - - - 1 - - - 2 Toxicology - - - 2 - - - - - 1 3 Urology ------1 - - - 1 SEA/RC29/2 Page 227 Annex 6
Table 2 (continued)
5 a 4 a u 0 .A .A 10 s % Group w u m C Subject 4 u $2 4C 4 Total No. a C.dO clrl s .r( OW Mca 4 Ca-4u s
7 Basic Medical Sciences
Anatomy ------4 - 11 6 Biochemistry ------1 - - - 1 Medical education -1-1-- - - 4 - 6 Pathology 11------2 4 Physiology ------1 - 1 - 2 Pharmacology -1-- - - 1 - 1 - 3
8
Drug control administration - - - 4 3- - - - 1 8 Drug addiction -1------1 Dental health -1-1-- 2 - 2 - b Health education 2 3 10-- 11 3 1 21 Health statistics -2-51-4- - 2 14 Industrial health ------1 1 Mental health -1-33-3- - 1 11 Medical rehabilitation ------2 - 2 2 6 Nutrition - - - 4 2- - - 1 - 7 Occupational health 15------2 - 8 Pharmaceutical chemistry 1 - - 1 -- - - - 1 3 Physiotherapy ------1 - - - 1
TOTAL 18 55 18 127 46 4 55 35 136 34 528 SEA/RC29/2 Page 228 Annex 6
Table 3. Fellowship Programes in Other Regions Arranged by SEAR0 and Those in This Region Arranged by Other Regional Offices (1 May 1975 - 30 April 1976)
East ern Total No.of Region Western African European Mediter- fellowships of the Pacific Region Region ranean involved Americas Region Region
From the South-East 399 Asia Region to: 4 41 255 7 92
To the South-East 50 Asia Region from: 8 1 3 2 5 1.1 - SEA/RC29/2 Page 229 Annex 6
Table 4. Utilization of Former WHO Fellows by COuntry (Analysis of 275 reports received from 1 May 1975 to 30 April 1976)
Number of Fellows
Total
Utilization w % # W M w 8 .rl m # Y'L1 m .El PO w+ 222 LI m mew .*odd-> we M 4 0 P -PD* "4 P U e o. .A m Y 4 w
Utilization reports received 1 33 - 99 25 4 3 10 44 56 275 100
Employed suitably 1 32 - 69 25 3 2 10 44 56 242 88
Assumed greater responsibilities 1 19 - 56 17 2 2 8 33 46 184 67
Began new activities 1 21 - 55 17 - 2 6 25 42 169 61
Introduced new methods - 22 - 82 20 - 2 7 37 50 220 80
Established new services - 17 + 66 18 1 1 7 20 42 172 62
Imparted knowledge 1 20 ' 78 23 - - 7 32 46 207 75
Trained others 1 26 - 82 20 2 - 7 38 50 226 82
Engaged in research - 18 - 60 15 1 1 5 24 37 161 59
Maintained contact with others - 2-232-45725 9
International assignment - - - -12-132 9 3 SEA/RC29/2 Page 230 Annex 7
LIST OF TECHNICAL REPORTS ISSUED BY THE REGIONAL OFFICE (1 July 1975 - 30 June 1976)
Document Ti tlc Author
Addiction Producing Drugs
SEA/Ment. I26 Part II See SEA/Ment./Z6 Part 11 SEA/APD/3
Anaesthetics
SEA/Med.Educ. 1278 SEA/Anaesth/8 See SEA/Med.Educ./Z 78
Biomedical Research
SEA/RACMR/76.1 Report on the first meeting of the Regional Office Regional Advisory Committee on Medical Research, New Delhi, SE ICP RPD 001, 5-9 January 1976
Cancer
SEA/Cancer/24 Assignment report on oncological services Dr B.M. Aliev in Mongolia, MDG OCD 001, February - April 1975
SEAICancerl25 Report of an ICMR/WHO symposium on chronic Regional Office liver diaeases including liver cancer in countries of South-East Asia, New Delhi, SE ICP CAN 001, 20-24 October 1975
Cardiovascular Diseases
SEA/CVD/16 Report of a seminar on development of Regional Office cardiac resuscitation and rehabilitation services in South-East Asia,SE ICP CVD 001, 29 December 1975 - 3 January 1976 Cholera
SEA/Cholera/29 Final report on rehydration therapy - Mr V. Vesely and Corr .I production and control, NOG LAB 002, September 1974 - March 1975
~EA/Choleral30 Assignment report on intravenous electro- Dr (MIS) and Corr.1 lyte quality control of rehydration fluids, J. Sadvoska MOG LAB 002, October 1974 - March 1975 SEA/RC29/2 Page 231 Annex 7
I Document Title Author I Communicable Diseases I Assignment report on National Institute Dr Kasuke It0 of Dermatology, Thailand, THA HMD 005 16 December 1974 - 14 January 1975
Assignment report on strengthening of Dr L. Dobrzynski epidemiological services in Bangladesh, BAN ESD 001, 1 July 1973 - 30 June 1975
See SEA/Lep/56 I Assignment report on assistance and advice Prof. 0. Canizares on curriculum and activities of the National Institute of Dermatology,Bangkok, THA HMD 005, 16 December 1974 - 26 January 19 75
See SEA/Imun./8
Report of a mission on cerebrospinal Dr V. Burian meningitis and its control in the People's Republic of Mongolia, ME ESD 001, 20 July - 26 September 1975
Assignment report on evaluation of comuni-' Dr M. Chelsky cable-disease reporting and recording system in Indonesia, IN0 ESD 003, 23 September - 12 November 1975
Assignment report on an assessment of Dr Chan Kai Lok priorities and requirements for entomologi- cal organization for communicable-disease control, Indonesia (Annexed to document sEA/CD/60)
Assessment of priorities and requirements Dr N.G. Gratz for an entomologist for Cowunicable- Disease Control Directorate in Indonesia
Report on a visit on expanded immunization Dr F. Assaad programe in Burma, SE ICP ESD 002, November - December 1975 See SEA/1mun./9 I See SEA/Imun. 110 I
See SEA/Immun./ll SF&./ RC29 I2 Page 232 Annex 7
Document Title Author
SEA/CD/65 Assignment report on a sample survey on Prof. K.C. Kandhsri the prevalence of skin diseases in the Republic of Maldives, MAV SHS 001, 17 March - 30 April 1976 Dental Health
SEA/DH/3k Rev. 1 Assignment report on dental health in Dr J.V. Olson Thailand, THA DNH 001, 27 September - 18 October 1974
SEA/DH/35 Assignment report on dental health in Dr D.E. Barmes Indonesia, IN0 DNH 001, October - November Prof. N.D. Martin 19 74 Prof. P.D. Barnard
SEA/DH/36 Assignment report on dental health in Dr I.M. Fedyaev Mongolia, MOG DNH 001, April - June 1975 SEA/DH/37 Report on a seminar on management of Regional Office dental diseases on a public health basis, Lucknow (India), IND DNH 001, 17-22 November 1975
SEA/DH/38 and Report on a visit to selected dental Prof. Jens Waerhaug Corr . 1 schools on preventive and public health Dr Jukka Ainamo dentistry in India, IND DNH 001, November 19 75
and Corr. 1 Assignment report on dental health in Prof. P.D. Barnard SEAINutl56 Indonesia, IN0 DNH 001, 30 March - 25 April 1975
SEA/Drugs 118 Assignment report on quality control of Mr William Hewitt pharmaceutical and biological substances, Bangladesh, BAN SQP 001, 8 February - 10 April 1975 and 24 June - 18 July 1975
SEA/Drugs/l9 Assignment report on food and drug quality Mr P.S. Ramachandran control in Burma, BUR LAB 002, 14 March - 13 May 1975
~EA/Drugs/20Rev.1 Assignment report on quality control of Mr William Hewitt biological and pharmaceutical products, SRL SQP 001, 23 July - 2 September 1975 SEA/Drugs/Zl Final report on quality control of Mr William Hewitt pharmaceutical preparations in Thailand, THA SQP 001, 1970-1975
~EA/~rups/22 Assignment report on pharmaceutical and Mr R.C. Vaidya SEA/Educ. 117 biological quality control, Bangladesh, BAN SQP 001, March 1975 - January 1976 SEAlRC2912 Page 233 Annex 7
. Document Title Author
Education
SEA/CD/~~ See SEA/CD/~~ ~EAlEduc.116
~EA/Drugs/22 See SEA/~rugs/22 SEAIE~UC.117 Environmental Health
SEA/Env.San./l56 Assignment report on water-borne sanitary Mr Ruperto Casanueva facilities, BAN BSM 003, April 1975
SEA/Env.San./l57 Report on a short-term plan for the Mr A.K. Roy development of rural water supply in Burma, SE ICP BSM 001, 20 March - 8 April 1975
SEA/Env.San. I158 Report and working papers of a regional Regional Office seminar on solid wastes management, Bangkok, Thailand, SE ICP CEP 002, 29 October - 7 November 1974
SEAIEnv.San.1159 Assignment report on master plan for the Prof. C. Chayabongse and Corr. 1 conservation of the cultural heritage in the Kathmandu Valley, Nepal, NEP PIP 002 (UNDP ~~~/74/003/~113),May-July 1975
SEA/Env.San. 1160 Report of the WHO Review and Guidance Mr M.S. Suleiman and Corr. 1 Mission on Jakarta Sewerage and Sanitation Mr A.K. Roy Project, 30 June - 11 July 1975
SEA/Env.San./l61, Technical report on garbage disposal study Corr.1 and Add.1 in the City of Dacca, Bangladesh, BAN BSM 002 (UNDP ~GD/73/048) s~A/Env.San.1162 Assignment report on marine Outfalls in Dr Ing Fernando Josa Bombay and industrial waste disposal in Baroda, IND SES 001, 15 October - 14 December 1974 sEA/Env.San. I163 Assignment report on solid wastes Mr Frank Flintoff disposal - composting in the State of Karnataka (Supplementary to the report No. SEA1~nv.San.I138 dated 2 7 September 1974), IND BSM 003, 30 September - 15 October 1975 sEA/Env.~an.1164 Assignment report on solid wastes manage- Hr Frank Flintoff ment, City of Calcutta, IND BSM 003, December 1975 sEA/Env.San. I165 Assignment report on the financial evalua- Mr Frank Flintoff Rev. l tion of cwposting methods in India, IND BSM 003, November - December 1975 SEAlRC2912 Page 234 Annex 7
Document Title Author
SEAIEnv.San.1166 Report on a study on bacterial air Dr R. Skalova pollution in different premises and localities in Mongolia, MOG ESD 001, 15 July - 10 August 1975 SEA/Env.San. 1167 Report on a Government of IndiaIWHO work- Regional Office shop on solid wastes management,Ahmedabad, Gujarat, IND BSM 003, 28-30 October 1975
SEAIEnv.San.1168 Report on the Bangalore Pump,prepared for Regional Office the Government of India, IND BSN 002
SEA/Env.San. I169 Assignment report on water pollution Mr John Fineh control in India, IND CEP 001, 18 Novemba- 19 December 1975
SEA/EH/170 Assignment report on development of Mr Ronald Stamper information systems for community water supply/c~nitywaste disposal programmes in India, IND BSM 002, 16 November - 23 December 1975
~~4.1~~1171 Assignment report on hydrogeological Dr K.V. Raghava Rao conditions in Sri Lanka with special reference to camunity well prograrmne, SRL BSM 001, November 1975 - January 1976 SEAIEHl172 Assignment report on cormunity water Mr B.J. Kukielka supply and sanitation in Sri Lanka, SRL BSM 001, 1 February 1970 - 27 January 1976
Epidemiology
SEA/Cq/53 See SEAICDI~~ SEAIEpidl72
SEA/Epid/73 Assignment report on strengthening of Dr J. Cervenka health services (epidemiology) in India, IND ESD 002, 25 December 1974 - 1 April 19 75
SEAIEpidl74 Assignment report on strengthening of Dr F.A. Vorat epidemiological surveillance in Indonesia, IN0 ESD 003, 24 September - 19 October 1975
SEAIEpid175 Assignment report on strengthening of Dr P. Kunasol epidemiological surveillance in Bangladesh, BAN ESD 002, January 1974 - January 1976 SEA/Epid/76 Assignment report on training in arbovirus Dr Suchinda Udomsakdi surveillance in Bangladesh, BAN ESD 002 (UNDP ~G~/73/074), 14 October 1975 - 13 April 1976 SU/RC29/2 Page 235 Annex 7
Document Title Author
Filariasis
SEA/Mal/lO5 See SEA/Mal/lO5 SEA/Fi1/17
Health Education
SEA/HE/~~ Assignment report on health education in Mrs Varunee Surasiti Uttar Pradesh, India, IND HED 003 (UNDP IND/68/030), 31 December 1974 - 4 April 1975
SEA/HE/78 Assignment report on health education Dr (Mrs) Kamala (behavioural study) in Sri Lanka, Gopal Rao SRL HED 002, 28 February - 26 May 1975 SEA/HE/~~ Assignment report on "Division of Research Dr N. David Richards and Evaluation, Central Health Education Bureau, New Delhi", IND HED 002, October 1974 - February 1975
SEA/HE/80 Assignment report on State Health Dr Jafar S. Alhasani Education Bureau, Jammu & Kaahmir, IND HED 003, 3 May - 4 August 1975
SEAIHEIB~ Assignment report on curriculum and Prof. H.J. Weddle SEA/Med.Educ./263 training in health education, faculty of public health, University of Indonesia, IN0 HMD 003, 6 June - 5 August 1975 sEA/HE/~~ Assignment report on curriculum design for Dr Jerome Grossman MPH (Health Education) Course, Mahidol University, Bangkok, Faculty of Public Health, THA HMD 003, June - August 1975
SEA/HE/83 Assignment report on health education in Dr John T. Fodor Nepal, NEP HED 001, June 1974 - June 1975
SEA/HE/84 Assignment report on health education in Dr I.M. Wassef Orissa (India), IND HED 003 (UNDP IND/68/ 030), 1 September - 10 December 1975
SEA/HE/85 Report on an inter-country workshop on Regional Office assessment of mass cwonunication media in family health education, New Delhi (India), SE ICP HED 003, 22-31 October 1975
SEA/HE/86 Assignment report on development of health Dr Sunil Misra education in family health in Indonesia, IN0 HED 003, December 1975 - March 1976 SEA/RC29/2 Page 236 Annex 7
Document Title Author
Haemorrhagic Fever
SEA/Haem.Fever/l8 Assignment report on dengue haemorrhagic Dr S.B. Halstead Eever in Bangladesh, BAN ESD 001, 2-9 August 1975
SEA/Haem.Fever/l9 Assignment report on clinical aspects of Dr Suchitra dengue haemorrhagic fever in Indonesia, Nimannitya IN0 ESD 003, 15 July - 4 August 1975
SEA/Haem.Fever/20 Assignment report on dengue haemorrhagic Dr S.B. Halstead fever in Indonesia, IN0 ESD 003, 20 July - 2 August 1975
Health Laboratory Methods
SEAIHLM/lOL Assignment report on situation with regard Dr M.A. Sabourdy to the production oE laboratory animals, SE ICP LAB 002, 21-25 January 1975
SEA/HLM/105 Assignment report on health laboratory Dr V.G. Barinov services in Mongolia, MCG LAB 001, 30 March 1974 - 31 July 1975 SEAIHLM1106 Assignment report on strengthening of Dr Charles R. laboratory services in Sri Lanka, Anderson SRL LAB 001, 20 December 1974 - 30 March 1975
SEA/HLM/107 Assignment report on small laboratory Dr M.A. Sabourdy animals programme, India, SE ICP LAB 002, 5 January - 21 February 1975 SEA/HLM/lOB Assignment report on teaching of micro- Dr E.P. Pashkov biology in Mongolia, MOG HMD 003, 27 September 1974 - 28 January 1975
SEA/HIN/109 Assignment report on strengthening of Dr A.D. Evans laboratory services, Sri Lanka, SRL LAB 001, 28 August - 26 September 1975 SEAIHLMI110 Assignment report on improvement of health Dr C.L. Wisseman laboratory services in India, (India 0214), 10-25 September 1974
~EAlHU4/111 Assignment report on public health labora- Dr Iv Ivanov tory services in Mongolia, MOG LAB 001, 1 November 1974 - 30 April 1975 ~EAlHtM/112 Assignment report on strengthening of Dr M.K. Abelseth SEAlVaccine179 laboratory services in Thailand, THA LAB 001, July - August 19 75 . SEA/RC29/2 Page 237 Annex 7
Document Title Author
SEA/HLM/~~~ Assignment report on strengthening of Dr Clifford Riley laboratory services in Thailand, TEA LAB 001, 15 April - 25 June 1975 SEA/HLM/114 Assignment report on virology in Mongolia, Dr S.M. Dimitrova MOG LAB 001 (UNDP ~ON/68/005), 20 January 1974 - 19 September 1975
SEAIHJ.MI115 Report on a seminar-cum-workshop held in Regional Office Bombay (lndia), on care of the small laboratory animals, SE ICP LAB 002, 3-14 February 1975
SEA/HLM/116 Technical report on strengthening of Mr B.T. Suitters laboratory services in Burma, BUR ESD 001 (UNDP BUR/69/003), 28 August - 3 October 1975
SEA/HIMI117 Assignment report on health laboratory Dr Velu Kirov Velev services in Mongolia, MOG LAB 001 (UNDP MON/68/005), August - October 1975
SEA/HLM/118 Assignment report on small laboratory Dr G.J.R. Hovel1 animal care programme in Indonesia, SE ICP LAB 002, 6-22 January 1975
SEA/HLM/119 Assignment report on health laboratory Dr Dusan Djuric services in toxicology in Thailand, SE ICP LAB 001, 14 December 1975 - 5 January 1976 sEA/HL~l120 Assignment report on health laboratory Dr ksan Djuric services in toxicology in Sri Lanka, SE ICP LAB 001, 6-17 January 1976
SEA/HLM/121 Assignment report on maintenance and repair Prof. G.V. Sapre of laboratory equipment in Thailand, TEA LAB 001, 30 September - 5 December1975
SEA/HLM/122 Assignment report on health laboratory Dr Dusan Djuric services in toxicology in Indonesia, SE ICP LAB 001, 13 November - 13 December 19 75
SEA/Med'Educ' SEA/HLM1123 See SEA/Med.Educ. 1283
SEAIHIMI124 Manual of reference procedures in strepto- Dr G.S. Tawil coccal bacteriology and serology (Revised in 1976) SUlRC29 12 Page 238 Annex 7 . Document Titla Au tbor
SEA/HLW/125 Assignment report on health laboratory Dr Dusan Djuric services in toricology. Haharashera State (India), IND LAB 001. 26 January - 21 February 1976
SEAIHlM1126 Report on a visit to Thailand on streng- Dr G.S. Tavil thening of laboratory services in Thailand, TW UB001, 5-13 May 1976
Health Literature
SEA/HLTIl A report on the study on the use of health Hz S.C. Dhir and literature published in the countries of Ur S.K. Anand South-Eas t Asia
Imrmnologl!
SEA/Immun./8 Assigrrment report on expanded immunization Prof. A.B. Christie SEAICD156 progrlmrme for Indonesia, IN0 ESD 003, Hay- June 1975
Assignment report on national immunization Dr J. Keja w propme in Sri Lanka, SB ICP ESD 002, 15-24 March 1976
SEA/Immun./lO Assignment report on national immunization Dr J. Keja SEA/CD/63 programme in Nepal, SE ICP ESD 002, 25 March - 4 April 1976 SEAlImmun.111 Assignment report on national immunization Dr J. Keja SFA/CD/64 programme in Burma, SE ICP ESD 003, 16-28 February 1976 LepIosy
Assignment report on integration of Dr K.S. Seal vSEA/CD 5f1 and Corr.1 coumunicable-disease progrsmmes into the basic health services, Burma (with parti- cular reference to leprosy control), BUR HBD 001, December 1974 - February 1975
SEAl~ep157 Report on an inter-country consultative Dr K.S. Seal meeting on leprosy, New Delhi, India, SE ICP MBLl 002, 18-20 December 1975
SEAlLeplSB Assignment report on study of the epidwiio- Dr F. Noussitw logical picture of leprosy in Burma and the training of leprosy workers in epidemiology, BUR PIBD 001, 14 December 1975 - 15 February 1976 SEAIRC29/2 Page 239 Annex 7
Document Title Author
Malaria
SEA/Mal/lOS Assignment report on malaria and filaria- Dr B. Velimirovic SEA/Fil/l7 sis in Maldives, HAV BSM 001, 6 October - and Corr .l 16 November 1974
sEA/Mal/l06 Assignment report on malaria eradication Dr D.N. Popovic in Sri Lanka, SRL MPD 001, 22 May 1973 - 30 April 1975
SEA/Mal/l07 Assignment report on improvement of malaria Mr William Rooney laboratory services in Nepal, SE ICP MBD 002, 14 March - 10 May 1975
SEA/Mal/lOB Assignment report on assessment of malaria Dr J.H. Pull situation in Bangladesh, BAN MPD 001, Dr M.I. Boentarman 26 February - 21 March 1975
SEA/Mal/l09 Assignment report on malaria control Dr C.P. Nair programme in Burma, BUR MPD 001, 16 January - 15 July 1975
SEA/Mal/llO Assignment report on malaria eradication Mr J.L. Clarke in Sri Lanka, SRL MPD 001, 25 May 1972 - 15 March 1976
Maternal and Child Health
SEA/MCH/IOO Report on a conference on post-graduate Regional Office paediatric education, Bangkok, SE ICP MCH 010, 10-15 March 1975
SEA/MCH/~O~ Report of an & @ committee on post- Dr F.J.W. Miller SEAfMed.Educ.1249 graduate education in paediatrics,New Delhi Part I IND MCH 001, 20-25 January 1975
SEA/MCH/lOl Arrangements for curricula and courses of Dr F.J.W. Miller SEAlMed.Educ.IZ49 education and training in paediatrics Part I1 (child health) in India
SEA/McH/102 Assignment report on undergraduate paedia- Dr Priyano E. Soysa SEA/Med.~duc./250 tric education and paediatric services in the medical colleges in Bangladesh, BAN MCH 001, January-April 1975
SEA/MCH/103 Assignment report on implementation of Dr M.T. El-Garhy school health programmes in Indonesia, IN0 MCH 001, December 1974 - March 1975 SEA/MCH/104 Paediatric education in rural health - scientific papers presented at the reunion meeting of past fellows of the UNICEF/WHO course for senior teachers of child health, SE ICP MCH 002, 15-18 October 1975 SF,A/RC29/2 Page 240 Annex 7 r Document Title Author
SEA/MCH/~OS Assignment report on maternal and child Dr 2. Slunko health services in Mongolia, MOG MCH 001, October 1975 - January 1976
SEA1Med'Educ.1274 See SEA/Med.Educ. 12 74 SEA/MCH/106
SEAIMCHI107 Assignment report on school health services Dr Ibrahim Mourad in the South-East Asia Region, SE ICP MCH 005, December 1975 - February 1976
SEA/MCH/108 Assignment report on school health pro- Dr M.T. El-Garhy gramme in Indonesia, IN0 MCH 001, December 1975 - March 1976
SEA/MCH/109 Assignment report on maternal and child Dr M.C.J. Hunt health programme in the Republic of Maldives, MAV HMD 001, 12-30 November 1975
SEA/MCH/110 Report on a meeting of the & Dr F.J.W. Miller committee on training and education of undergraduate medical students and interns in maternal and child health, IND MCH 001, 22-27 March 1976
Maternal and Child Health and Family Planning
SEA/Med.Educ. I247 See SEA/Med.Educ./247 SEA/MCH/EP/~Z
SEA/MCH/FP/~~ Workshop on an implementation programme on Dr M.K. Krishna Menon medical termination of pregnancy at district hospital and block level, New Delhi, IR RP HHD 033, 1-3 July 1975
SEA/MCH/FP/~~ Report of a seminar on documentation in Regional Office the field of human reproduction, SE ICP HLT 003, 28 April - 2 May 1975
SEAIMCHIFP/~~ Report on a seminar on maternity-centred Dr A.K. Neumann approach to family planning in rural areas, Dr (Hrs) H. Dhillon Hyderabad, India, SE ICP HRP 001, Miss G. Krysan 9-13 December 1974
SEA/MCH/FP/46 Report on perinatal mortality and low Dr Helen M. Wallace birth-weight in South-East Asia, SE ICP MCH 010, 15 December 1974 - 15 March 1975
SEA/MCH/FP/~~ Proposal for a study of pregnancy and its Dr Helen M. Wallace and Corr. 1 outcome,including perinatal mortality and low birth-weight in South-East Asia, SE ICP HCH 010 SEAlRC29lZ Page 241 Annex 7
Document Title Author
SEAIMed.Educ' See SEA/Med.Educ. 1262 SEA/MCH/FP/48
sEA/McH/FP/~~ Report on a seminar on ~aediatriciansand Dr R.H. Jackson family health, New Delhi, SE ICP MCH 011, 24-29 November 1975
SEA1Med'Educ'1272 See SEA/Med.Educ. 1272 SWLIMCH/FP/SO
SEA1Med'Educ./287 See SEA/Med.Educ./287 sEA/McH/FP/~~
SEA/MCH/FP/52 Assignment report on medical termination Dr M.K. Krishna of pregnancy training centres in India, Menon SE ICP MCH 011, 29 December 1975 - 27 February 1976
SEA/Med'Educ' SEA/MCH/FP/53 See SEA/Med.Educ. 1289
Medical Education
SEAIMed.Educ.1245 Report on medical teachers' training course (held at the Faculty of Medicine, Chula- longkorn University, Bangkok, 25 November - 7 December 19741, South-East Asia Region
SEAIMed.Educ.1246 Report on a Workshop on conrmunity health Prof. S. Greenhill aspects of medical education, Peradeniya, Prof. Robert Steele Sri Lanka, SE ICP HMD 003, 9-14 December 1974
SEA/Med.Educ./247 Report on a training course on teaching of Dr O.P. Ghai SEA/MCHIFPI42 human reproduction, family planning and Dr P.R. Myerscough population dynamics, held in Denpasar,Bali (Indonesia), SE ICP HMD 008, 29 July - 9 August 1974
~~~/Med.~duc./248 Assignment report on medical education and Dr P.M. Newberne SEAINutl54 training, Thailand, THA HMD 004, 5 November - 2 December 1974 SEA/MCH/101 See SEA/MCH/~O~Part I SEA/Med.Educ. 1249 Part I
SEA/MCH/101 See SEA/MCH/~OI Part I1 SEA/Med.~duc.I249 Part I1
SEA/MCH/102 See SEA/MCH/102 SEA/Med.Educ. 1250 - SEAlRC2912 Page 242 Annex 7
Do cumen t Title Author I
SEA/Med.Educ./251 Assignment report on medical education in Dr J.S. Culeria Bangladesh, BAN HRP 001, 8 January - 21 April 1975
~~A/~ed.~duc./252Assignment report on social paediatric Dr B.M. Laurance programme of the University of Sri Lanka at the medical faculties of Colmbol Peradeniya, SRL HMD 001, July-Auaust 1975
SEA/Med.Educ.1253 Assignment report on medical education in Dr Prapont Piyaratn Indonesia, IN0 HMD 001, 11 May - 10 July 1975
SEA/Med.Educ./254 Report on a short refresher course on the Prof. R.C.B. Aitke SEA/Ment. 130 care of the mentally ill in the camnunity, Dr P.F. Kennedy held at Rangoon and Mandalay, Burma, Prof. J.S. Neki SE ICP HMD 007 (UNDP ~~~/73/028),10-28 Mrs P. Misra March 1975
SEA/Med.Educ./255 Assignment report on teaching and research Dr P.J.L. Cook in human genetics in Burma, BUR HMD 003, February-May 1975
SEA/Med.Educ./256 Report on a workshop on clinical research Regional Office methodology in Burma, BUR DHS 002, 2-13 June 1975
SEA/Med.Educ./257 Assignment report on medical education in Dr Joyce Leeson Sri Lanka, SRL HMD 007, 30 July - 27 September 1975
SEAIMed.Educ./258 Report on a seminar on epilepsy, held in Dr Earl Walker Bangalore (India), IND HW 008, 19-23 Dr Peter Jeavons July 1975
SF,A/Med.Educ./259 Assignment report on medical education at Dr B. Salafsky the University of North Sumatra, IN0 HMD 001, 21 October 1973 - 15 September 1975.
SEA/Med.Educ./260 Assignment report on training of health Dr G.B. Begbie manpower in Nepal, NEP HND 001, 29 June - 18 September 1975
sEA/Med.Educ./261 Assignment report on the role of statis- Dr Triloke Khosla SEA/VHS 1148 tics in the teaching of human reproduction, family planning and population dynamics in medical schools, SRL HMD 007, 15 July - 10 October 1975
s~~/~ed.kduc.1261 Educational level of mother and family Dr Triloke Khosla Add. 1 size (group demonstration material) SEA/RC29/2 Page 243 Annex 7
Document Title Author
SEA/Med.Educ./262 Report on a training course on teaching Dr K.J. Dennis SEA/MCH/FP/48 of human reproduction, family planning and Dr M. Finkelstein population dynamics in medical schools, Dr M.G. Kerr Bangkok, Thailand, SE ICP HMD 008, 6-17 October 1975
SEA/HE/~~ See SEA/HE/81 SEA/Med.Educ. 1263
SEAfMed.Educ.1264 Report on a seminar held in Pokhara, Dr Jagannatha Reddy Nepal, on medical education suitable for Prof. Nurul Islam the developing countries, SE ICP HMD 006, 10-14 November 1975
SEA/Med.Educ./265 Assignment report on endoscopic diagnos- Dr J.N. Savinkin tics in Mongolia, MOG HMD 003 (UNDP MON/ 72/004), 30 Septemher - 22 November 1975
sEAIMed.Educ. 1266 Assignment report on medical education Mr G. Entwistle and training, Prince of Songkhla University, Faculty of Medicine, Thailand, THA HMD 004, 20 January - 8 February 1975
SEA/Med.Educ./267 Assignment report on training in community Prof. M.A. Fernando medicine in medical schools in Bangladesh, Prof. S.A. Jha SE ICP SHS 009, 1 September - 29 November 1975
SEAj~ed.Educ.1268 Assignment report on training in community Prof. M.A. Fernando medicine in medical schools in Burma, Prof. S.A. Jha SE ICP SHS 009, 1 September - 29 November 1975
SEA/Med.Educ./269 Assignment report on training in community Prof. M.A. Fernando medicine in medical schools in India, Prof. S.A. Jha SE ICP SHS 009, 1 Septemher - 29 November 1975
SEA/Med.Educ./270 Assignment report on training in community Prof. M.A. Fernando medicine in medical schools in Indonesia, Prof. S.A. Jha SE ICP SHS 009, 1 September - 29 November 1975
SEA/Med.Educ./271 Assignment report on training in coramounity Prof. M.A. Fernando medicine in medical schools in Sri Lanka, Prof. S.A. Jha SE ICP SHS 009, 1 Septemher - 29 November 1975
SEA/Med.Educ./272 Assignment report on teaching of human Dr Nancy E. Waxler SEA/MCH/FP/SO reproduction, family planning and popula- tion dynamics in Sri Lanka, SRL HMD 007, 3 September 1975 - 6 January 1976 SEA/RC29/2 Page 244 Annex 7
Documm t Title Author
SEA/~ed.Educ.1273 Assignment report on medical education in Dr William L. Millard the University of Sri Lanka, Peradeniya, SRL HMD 001, 27 August - 18 October 1975 SEA/Med.Educ. I274 Assignment report on training and Dr J.N. Pohowalla S~AlMcH/106 education of health personnel in relation to maternal and child health care in Burma, BUR HMLl 005, 6 November 1973 - 5 October 1974; 6 November 1974 - 28 February 1975, and 28 April - 27 November 1975
~~A/~ed.Educ./275 Assignment report on curriculum in hos- Dr G.K. Palin pita1 administration, Faculty of Public Health, University of Indonesia, IN0 HMD 003, 1 November - 31 December 1975 SEA/Med.Educ.1276 Assignment report on assistance to the Prof. ~natoliA. Mongolian State Medical Institute, Konstantinov MCG HMD 003 (UNDP MON/72/004), January 1973 - July 1975 SEA/Med.Educ. 1277 Assignment report on training in diagnostic Miss M. Baily radiography in Nepal, NEP HMD 001, 7 July 1975 - 6 January 1976 SEA/Med.Educ./278 Assignment report on post-graduate train- Dr Erik Wain6 SEAIAnaesth.18 ing in anaesthesiology (Nepal),NEP SHS 001, Andersen 26 December 1975 - 15 February 1976 SEAIMed.Educ./279 Assignment report on teaching and research Dr V.V. Korolev in histology and embryology at the State Medical Institute, Mongolia, MCG HMD 003, (UNDP MONI 721004 ), November-December 1975
s~A/~ed.Educ./280 Assignment report on teaching of immuno- Dr Y. Hamashima fluorescent antibody techniques in Burma, BUR HMD 005, 4 December 1975 - 23 February 1976
SEA/Med.Educ./281 Assignment report on medical education and Prof. E.W. Shrigley microbiology in Burma, BUR HMD 005, 1 September - 9 December 1975 SEA/Med.Educ./282 Assignment report on teaching of pharma- Dr G.P. Chernychev SEA/Pharmacology/8 cology in Mongolia, MDG HMD 003 (UNDP MON/ 72/004), October 1975 - January 1976 ~EA/Med.Educ./283 Assignment report on education and train- Dr Shiela Worlledge sEA/HLM/123 ing of health manpower in Burma (huno- haematology), BUR HM) 005, 23 September - 23 December 1975 SEA/RC29/2 Page 245 Annex 7
Document Title Author
SEA/Med.Educ./28L Teaching of general and inorganic chemistry Dr A.V. Babkov at the Mongolian State Medical Institute, MOG HMD 003 (UNDP ~0~/72/004),October 1975 - January 1976
SEA/Med.Educ./285 Assignment report on assistance to the Dr E.A. Bogomazov State Medical Institute, Ulan Bator, MOG HMD 003 (UNDP ~0~/72/004),October 1975 - January 1976
SEA/Med.Educ./286 Assignment report on education in popula- Dr J.M. Last tion dynamics, epidemiology and family health in Sri Lanka, SRL HMD 007, 29 December 1975 - 26 February 1976
S~A/~ed.~duc./287 Assignment ceport on teaching family Dr O.P. Ghai SEA/MCH/FP/Sl planning in Sri Lanka, SRL HMD 007, 31 October 1975 - 30 January 1976
SEA/Med.Educ./288 Assignment report on assistance to the Dr G.N. Oleinik Mongolian State Medical Institute (Normal Physiology), MOG HhD 003, October 1975 - February 1976 SEA/Med.Educ./289 Assignment report on teaching of human . Dr Philip Myerscough SEA/MCH/FP/53 reproduction, family planning and popula- tion dynamics in medical schools in Sri Lanka, SRL HMD 007, 15 November 1975 - 18 March 1976
SEA/Med.Educ./ZgO Report on a visit to the Faculty of Public Dr E. Maurice Backett Health, Mahidol University, Bangkok, Thailand, THA HhD 003,
~EA/Med.Educ./291 Report on a course on educational science Dr Muangtong Khemmani for teachers of health professions, held Dr Bruce L. Hulbert at the Jawaharlal Institute of Post- graduate Medical Education and Research, Pondicherry, India, SE ICP HMD 009,
sEA/Med.Educ./292 UNDP technical report on medical teachers' Regional Office training course, South-East Asia Region, held in Negmbo, Colombo, Sri Lanka, SE ICP HMD 006 (UNDP RAS/73/028), 15-27 September 1975
~EA/Med.Educ./293 A report on a seminar on educational Regional Of £ice technology and instructional methods, Peradeniya, Sri Lanka, ICP HMD 006, 30 September - 11 October 1975 SEAlRC29/2 Page 246 Annex 7
------Documm t Title Au thor I I Report on a seminar on medical assistante, Regional Office New Delhi, SE ICP HHD 003, 16-21 February 1976
SEA/Med.Educ./294 The concept of the "Medical Assistant" in Prof. R.A. Smith Add. 1 the delivery of health services SEAIMed .Educ./294 Training of the "Medical Assistant" Dr Harieh Chandra Add.2 SEAIMed.Educ.1294 Evaluation of services delivered through Dr D.P. Upadhya Add. 3 "Medical Assistants" in some countries of the Region The Medical Assistant as a cmmunity workerI Dr J. Galea Mental Health I Report of a seminar on epidemiological Dr Patrick H. Huges investigation for prevention and control of drug dependence, Jakarta, SE ICP MNH 002, 7-12 October 1974
Report on seminar on education and train- Mrs Harper ing of personnel for mental health work Dr R. Shapiro in the community, Bangkok, Thailand, Dr J. Zusman SE ICP MNH 001, 28 November - 4 December 1
SEA1Med'Educ'1254SEAIMent.130 See sEA/~ed.Educ./254
SEAtMent. 131 Assignment report on psychiatric training Prof. V. Ivanov and services in Mongolia, MCG OCD 001, May-June 1975
Assignment report on development of train- Dr V.K. Varma ing programnes in psychopathology and psychotherapy, University of Sri Lanka, Peradeniya Campus, SRL MNH 001, 22 December 1975 - 3 March 1976
SEA/Ment./33 Field visit report on developments in Dr W.E.S. Kiernan mental health services in Indonesia, 12-25 April 1976
Nursing
Assignment report on development of health Miss Helen D. Ten services and training of auxiliaries in Brink Bangladesh, BAN SHS 002, 7 November 1972 - 30 April 1975 SEAlRC29 /2 Page 247 Annex 7
Document Title Author
SEA/Nurs/272 Report on a course on ortho~aedicnursing, Miss Mary Powell held in Rangoon, Burma, BUR HMD 001, 16 November 1974 - 30 April 1975
SEA/Nurs/2 73 An assessment of ~ost-basicnursing Miss Belga 0. education in India, IND HMD 002, January- Guerrieri December 1974 Mrs R.K. Sood
SEA/Nurs/274 Assignment report on post-basic nursing Miss H.K. Wilson education in Uttar Pradesh State (India), IND HMD 002, September 1972 - December 1975
SEA/Nurs/275 Assignment report on nursing services and Miss Irena and Corr.1 education in Mongolia, MOG HMD 001, 1966- Szarkowska 1975
SEA/Nurs/276 Assignment report on post-basic nursing Miss Belga 0. education in Bangalore, India, IND HMD 002, Guerrieri December 1974 - December 1975
SEA/Nurs/277 Rev.1 Assignment report on nursing education and Miss I. Bjarkroth services in Thailand, THA HMD 002, September 1972 - December 1975
SEA/Nurs/278 Survey on nursing and midwifery education Regional Office and personnel in the South-East Asia Region of WHO, ICP HMD 001
SEA/Nurs/2 79 Assignment report on short course on "The Dr I.D. Campbell improvement of hospital nursing services, Miss E.A. Edwards Jakarta", SE ICP HMD 001, 10-28 November 1975
Nutrition
SEA/Med.Educ. 1248 S~A/~ut/54 See SEA/~ed.~duc.1248
SEA/Nut/55 Nutrition education for health Brig. M.C. Sanyal SEA/DH/39 SEA/Nut/56 and Corr.1 See SEA/DH/39
SEAINutI57 Assignment report on physical fitness, Dr Oded Bar-Or working capacity, growth and development in Burma, BUR DHS 002, 26 July - 26 August 1975
~~A/~ut/58and Corr.1 Assignment report on development of health Dr C.C. Mahendra services (nutrition) in Bhutan, BHU SHS 00L (UNDP BHu/72/006), 20 August - 15 October 1975 SEAIRC29/2 Page 248 Annex 7
- Document Title Author - SEA/Nut/59 Assignment report on public health Dr R. Buzina nuttition in Sri L.nk.a, SRL NUT 001, 21 December 1975 - 1 February 1976 SEAINutl60 Assignment report on nutrition services Dr H.D. Weerasinghe in Burma, BUR NUT 001, October 1975 - January 1976
Occupational Health
SEA/Occ.Hlth/ll Assignment report on development of Dr Hugo F. Donoso central and regional occupational health and industrial hygiene laboratories, IN0 HWP 001
SEA/Occ.Hlth/lZ Assignment report on occupational health Dr T.F. PLcCarthy in Burma, BUR HWP 001, 18 January - 18 April 1975
O~hthalmology
SEAlOphthal16 Assignment report on public health ophthal- Dr B. Nizetic and Corr. 1 mology (prevention of blindness) in India, IND VLR 002, 14 April - 22 May 1975 SEA/Ophthal/7 Report on a visit to Thailand on public Dr B. Nizetic health ophthalmology, SE ICP SHS 009, 18 November - 4 December 1975 SEA/Ophthal/B Report on a visit to Indonesia on public Dr B. Nizetic health ophthalmology, SE ICP SHS 009, 5-15 November 1975
SEA/Ophthal/S Assignment report on public health Dr B. Nizetic ophthalmology (prevention of blindness) in Sri Lanka, SE ICP SHS 009, 28 October - 4 November 1975
SEA/Ophtha1/10 Report of a special working group on Regional Office prevention of visual impairment of blind- ness, SE ICP OCD 002, 24-26 March 1976
Or~anizationof Medical Care
SEA/OHC/15 Report on a seminar on organization of Dr R.F. Bridgman medical care in relation to general hospi- tals, Srinagar (India), SE ICP SHS 002, 14-23 October 1974
sEA/W/16 Report on an inter-country seminar on Dr P. Diesh peripheral medical care services, Bangkok Dr A.M. PLaglacas and Chiengmai, SE ICP SHS 002, Dr H. Duran 1-10 September 1975 SEA/RC29/? Page 249 Annex 7
Document Title Author
Pt~armacolop,y
SEA1Med'Educ.1282 See SEA/Med.Educ. 1282 SEA/Pharrnacology18
s~~/Plague/l3 Assignment report on plague control in Dr L. Klassovski Burma, BUR ESD 002, 25 February - 5 April 1975
s~~/Plague/lL Final report on the ecology of plague Dr Ronald W. Turner (mamals, fleas and man) in a tropical focus (Boyolali Regency, Central ~ava), IN0 BAC 001, 22 December 1971 - 31 January 1975
Public Health Administration
SEA/PHA/~~~ Health manpower planning - the case of Dr C. Montoya- Indonesia, IN0 SHS 001 Aguilar
SEA/PHA/~~~ Assignment report on development of food Mr F.R.E. Davies law enforcement, Indonesia, IN0 SQP 001, 1 April - 31 May 1975
sEA/PHA/146 Assignment report on long-term health Dr C. Sepulveda plans in Nepal, NEP SHS 001, 5-20 March 1975
sEA/PHA/147 Draft Charter for Health Development Regional Office
sEA/PHA/147 Add.1 Excerpts from the constitutions of Member governments of the South-East Asia Region of WHO. Supporting document No.1 - Draft Charter for Health Development sEA/PHA/147 Add.2 Excerpts from the statements made at the World Health Assemblies, Regional Camnittee sessions and on other important occasions, by the chief delegates, heads of State, ministers and other dignitaries- supporting document No.2, for the Draft Charter for Health Developmm t sEA/PHA/147 Add.3 Excerpts from National DevelopmentIHealth Plans of Member Governments of the South- East Asia Region of WHO - supporting document No.3, to the Draft Charter for Health Development SEAIRC29 12 Page 250 Annex 7
Document Title Author -
SEA/PHAI148 UNDP agency terminal report on national health planning and manpower studies, SE ICP SHS 012 (UNDP RAS/69/751)
SEA/PHA/149 Assignment report on "Better Health for Dr L.A. Simeonov Sri Lanka", SRL HMD 005
SEA/PHA/150 Assignment report on national health Prof. P.O. Woolley planning in Sri Lanka, SRL SHS 003, December 1974 - February 1975
SEA/PHA/151 Assignment report on food microbiology: Dr R.J. Gilbert strengthening of the microbiology unit and training of staff in Thailand, THA FSP 001, 8 January - 21 March 1975 SEAIPHAI152 Assignment report on food sanitation Dr F.R.E. Davies in Thailand, THA FSP 001, 29 December 1974 - 28 March 1975 SEAIPH.41153 Manual of Health Programming Technology, Dr C. Montoya Aguilar IN0 SHS 001
SEA/PHA/154 Rev.1 Assignment report on management of Dr C.G. Woods hospital services in Burma, BUR SHS 004, 13 February - 12 April 1975 SEA/PHA/155 Assignment report on health manpower Dr C. Montoya Aguilar planning and health centre programing in Indonesia, 16 April - 8 May 1975
SEAIPHA1156 Assignment report on strengthening of Dr Atm Prakash surgical services in Maldives, MAV SHS 001, Dr G.R. Gode 9 September - 4 October 1975
SEA/VHS/~~~ See SEAlVHS1147 SEA/PHA/~~~ and Corr.1 SEA/PHA/l58 Report on a course - second national Dr T.R. Anand orientation course for hospital administra- tors, Colombo, Sri Lanka, SRL SHS 003, 7-24 October 1975
SEA/PHA/159 Assignment report on strengthening of Dr J. Keja national health services in Indonesia, IN0 SHS 001, August 1970 - September 1975
SEA/PHA/160 Assignment report on health aspects of Dr William G. Baker socio-economic development: support to the United Nations Asian Development Institute, Bangkok, Thailand, ICP SHS 001, March 1970 - September 1975 - - SEA/RC29/2 Page 251 Annex 7
1 Document Title Author
SEA/PHA/~~~ Final report on Physiotherapy School, Miss S.P. Mann Baroda (~ndia), IND HMD 005, 21 July 1972- 31 December 1975
SEA/PHA/~~Z Report on the technical discussions, held Regional Office during the twenty-eighth session of the Regional Committee for South-East Asia,on the organization of research in disci- plines of regional priority, with special reference to methods for expanding the coverage and improving the quality of health services in the community, 25-30 August 1975
SEA/PHA/~~~ Assignment report on development of health Dr J. Biddulph manual, guides, etc. (Indonesia), IN0 SHS 001, 27 December 1975 - 26 January 1976
SEA/PHA/164 Assignment report on developing the Mr G.M. Luck systems approach in Indonesia, IN0 SHS 001, May 1973 - December 1975
SEA/PHA/165 Assignment report on training for health Dr Eigil M. Morch services in Indonesia, IN0 SHS 001, 27 October 1975 - 20 January 1976
SEA/PHA/~~~ Assignment report on food hygiene: Mr P.J. Aiyar revising food legislation, strengthening food control unit and training of staff, Sri Lanka, SRL ESP 001, 31 December 1975 - 30 March 1976
SEA/pHA/167 Assignment report on strengthening of Dr I.N. Jalkhovtceva emergency care services in Mongolia, Dr E.N. Shigan Mffi SHS 004, 24 February - 10 March 1976 sEA/PHA/168 Report on an inter-country seminar on Dr P. Diesh application of ways and approaches result- Dr S. Litsios ing from earlier studies to achieve Dr V.N. Rao increased coverage by health care delivery Dr P.R. Sondhi programmes, New Delhi, 3-9 February 1976
SEAlPHA1169 Assignment report on epidemiology and Dr 2. Myslak treatment of cases of poisoning, Mongolia, MOG SHS 004, January-February 1976
Radiation
SEA/Rad/ 79 Assignment report on strengthening of Dr H. Pibrovec radiologicaL service in Mongolia, MOG RAD 001, 1 March - 28 June 1975 ~EAlRC2912 Page 252 Annex 7
Document Title Author
SEA/Rad/BO Assignment report on school of medical Dr Hans Sveneson physics and radiation protection services in Thailand, THA RAD 003 (UNDP ~HA/70/033), 14 December 1974 - 16 March 1975
S~~/Rad/81 Assignment report on radiography and Dr Bruce E. Coleman and Corr.1 training of radiographers in Bangladesh, SE ICP RAD 001, 15 December 1974 - 5 March 1975
SEAIRadl82 Assignment report on radiation medicine Prof. R.E. Ellis in Burma, BUR RAD 001, 1 April - 6 May 1975
SEA1Med'Educ"277 See SEA/Med.Educ./277 SEAIRadl83
SEAIRadI84 UNDP agency terminal report on School of Medical Radiography, Thailand, THA RAD 002 (UNDP THA/b8/050)
SEAIRadl85 Assignment report on Radiation Medicine Sir Edward E. Pochin Centre, Bombay (~ndia)- review of the work and development, IND RAD 002, January-February 1976
SEA/Rad/86 Assignment report on Radiation Medicine Dr M.K. Loken Centre, Bombay (India), IND RAD 002, 19 October - 16 December 1975
sEA/Rad/87 Assignment report on advanced course in Dr S.L.I. Bacharach radiological physics in India, IND RAD 004, December 1975 - February 1976 Rehabilitation
SEAIRehabl22 Assignment report on medical rehabilita- Dr Andrew Seyfried tion in Sri Lanka, SRL SHS 001, 24 September - 30 December 1975 Smallpox
SEA/Smallpox/73 Report on a visit to Burma on s~llpox Dr Stanley 0. Foster eradication programe, SE ICP SHB 001, 4-14 April 1976
SEA/Smallpox/76 "Lessons learned from the Bangladesh Dr Stanley 0. Foster Smallpox Eradication Programe" SEA/RC29/2 Page 253 Annex 7
Document Title Author
Tuberculosis
SEA/TB/137 Assignment report on Tuberculosis Chemo- Dr Wallace Fox therapy Centre, Madras (India), IND MBD 004, 7-30 January 1976
Vaccine
SEA/Vaccine/72 Assignment report on biological standardi- Dr L. Higy-Mandic zation and production of DPT vaccine, Bangladesh, SE ICP ISB 002, 30 November - 14 December 1974
SEA/Vaccine/73 Assignment report on production and bio- Dr L. Higy-Mandic logical standardization of DPT vaccine in Sri Lanka, SE ICP ISB 002, 18-30 November 1974
SEA/Vaccine/74 Assignment report on biological standardi- Dr L. Higy-Mandic zation and production of DPT vaccine in Burma, SE ICP ISB 002, 14-25 January 1975
SEAIVaccinel75 Assignment report on biological standardi- Dr L. Higy-Mandic zation and production of DPT vaccine in Indonesia, SE ICP ISB 002, 28 October - 21 November 1974
SEAIVaccinel76 Assignment report on biological standardi- Dr L. Higy-Mandic zation and production of DPT vaccine in Thailand, SE ICP ISB 002, December 1974
SEAjVaccinel77 Assignment report on vaccine production, Dr N.A. Mikhailov MOG VPH 001, December 1974 - May 1975
SEA/Vaccine/78 Assignment report on production of Dr P. Atanasiu improved vaccines - rabies vaccine, SRL LAB 002, 30 August - 1 October 1975 SEAIHZMILLZ SEA/Vaccine/79 See SEA/HLM/112
SEA/Vaccine/80 Assignment report on brucella vaccine Dr G.O. Rasulov production in Mongolia, MOG VPH 001, June-September 1975
SEA/~accine/81 Assignment report on the condition of the Mr T. Clay Edwards freeze-dryers at the smallpox vaccine production unit, Dacca (Bangladesh) BAN SME 001, 22-28 October 1975
SEAIVaccinel82 Assignment report on condition of Edwards Mr T. Clay freeze-dryers in India, IND ISB 001, 23 September - 21 October 1975 SEA/RC29 / 2 Page 254 Annex 7 - Document Title Author
SEA/Vaccine/83 Assignment report on production and Dr T. Hashimoto control of freeze-dried BCG vaccine in India, IND ISB 002, 28 December 1975 - 6 February 1976
SEA/Vaccine/84 Assignment report on trial of meningo- Dr Bencic coccal vaccines in Mongolia, MEESD 001, 22 January - 22 February 1976 Veterinary Public Health
sEA/VPH/16 Assignment report on food hygiene labo- Dr C. Richard Dorn ratory and veterinary public health train- ing, All India Institute of Hygiene and Public Health, Calcutta, IND VPH 001, July-August 1975
Vital and Health Statistics
SEA/VHS/145 Assignment report on vital and health Miss Van C. Nguyen statistics in Thailand, THA DHS 001, 15 September 1973 - 28 February 1975
SEA/VHS/146 Assignment report on management of health Mr Stefan Marko services (data processing) in Mongolia, MOG SHS 005, 21 January - 22 March 1975 SEA/VHS/147 Assignment report on strengthening of Mr Ib Thorup SEA/PHA/157 national health services in Indonesia and Corr.1 (vital and health statistics).INO SHS 001, 10 May 1971 - 30 June 1975
SEA'Med'Educ'/261 See SEA/Med.Educ. 1261 SEAIVHS I148
SEAlVHS 1149 Assignment report on development of a Dr Richard Padley health information system in India, IND DHS 002, 7 September - 30 November 1975
SEA/VHS/lSO Assignment report on development of Dr Richard Padley health information systems, BUR DHS 003, December 1975 - February 1976 SEAlRC2912 page 255 Annex 8
BLJDCET PERFORMANCE
Table 1. Statement Showinp, the Im~lementationaf 1975 Prox-rames Under the Regular Budqet in the South-East Asia Region
(Express Percentage of Revised Obligations obligations Programe/Progrensne Sector Budget Incurred LO revised
1.1 organizational rneecings 1.1.3 Regional Comictee -18 000 19.44
2.1 Executive management 2.1.3 Office of the Regional Director -92 228 111.31
3.1 Strengthening of Health Services 2 741 720 84.08
3.2 Family Health 3.2.2 Maternal and Child iiealth 231 250 3.2.4 Nutrition 141 515 3.2.5 Health Education -207 220 -579 985 111.29
4.1 Health Manpower Development
5.1 Communicable Disease Prevention and Control 5.1.2 Epidwiological Surveillance of Comunicable Diseases 5.1.3 Malaria and Other Parasitic Diseases 5.1.4 Smallpox Eradication 5.1.5 Bacterial Diseases 5.1.6 Mycobacrerial Diseases 5.1.7 Virus Diseases 5.19 Veterinary Public Health
5.2 Nan-Comunicable Disease Prevention and Conrrol 5.2.1 Programme Planning and General Activities 5.2.2 Cancer 5.2.3 Cardiovascular Diseases 5.2.4 Other Chronic Nan-comunicable Diseases 5.2.5 Dental Health 5.2.6 Mental Healrh 5.2.7 Biomedical Aspects of Radietion
5.3 Prophylactic, Diagnostic and Therapeutic Substances 5.3.1 Programme Planning and General Activities 5.3.2 Specifications and quality Control of Pharmaceurical Preparations 5.3.3 International Standards for Biological Praducte 5.3.5 Health Laboratory Technology
6.1 Promtion of Environments1 Health 6.1.1 Programne Planning and General Activities 6.1.2 Provision of Basic Sanitary Measures 6.1.4 Control of Environmental Pollution and Hazards 6 Health of Warking Populations 6.1.6 Estebliahment and Strengthening of Environmental Health Services and Institutions 6.1.7 Food Standards Programe SEAIRCL912 Page 256 Annex 8
Table 1 (continued)
Percentage of Revised Obligations obligariona ProgrammeIPragrame Sector Budget Incurred to reviaed estimates
7.1 Health Sratistica 7.1 Pragrame Planning and General Activities 40 080 42 211 7.1.2 Health Statistical Hethodolagy 51 430 71 060 7.1.4 Development of Health Statierical Services -144 800 -120 264 -236 310 -233 535 98.83 7.2 Health 1.iterature Service. -27 391 98.92 7.3 WllO Publications 103.31 7.4 ileslth Irifams~ionof the L'ublic -84 220 -56 289 66.84 9.1 Regional Programme Planning and General Activities 89.97
9.2 Assistance to Country Programmes 657 441 109.27
9.3 Regional General Support Services 638 932 103.20
9.4 Regional Common Services 122.62
TOTAL 12 521 413 11 473 857 91.63 2.1.4 Directar-General's Development Programme 1 046 000 - GRAND TOTAL 12 521 413 12 519 857 99.99 *======s= C SEAlRC2912 Pege 257 Annex 8
Table 2. Statement Showing the Implewntation of 1976 Pro~ranaoesUnder the Re~ularBudget
(Expressed in US Dollars) Revised Total Difference 1 Percentane. of eSLimtes earlmated over/(under) obligariooa Activity 8s per obligations to revised 1976 es timarea
General Hensgement and Co-ordination ~xeeutivemanagement 98 942 Co-ordination with other agencies Research promotion and developmnt 60 642
Srrenprhenina of Health Services Sf~engtheningof health ~ervices 2 856 755 Family health 602 510
Health Manpower Development I 1 748 210
Disease Prevention and Conrrol Comnicable disease prevention and control Non-comuniceble disease prevention and control Prophylactic, diagnostic and therapeutic subsrances
Promotion of Environmental -Health
Health Information and Literature Heslth sfsriefics Health literature services WHO publications Health infanattan of the pub11
Support to Rexional Programs Regional programae planning and general activities A88istan~eto Country proqrames Regional generel support 8elviceB Regional comon services
Grand Totel