CEYLON HEALTH UNITS*

By W. P. JACOCKS, m.d., Dr. p.h. Advisory Health Officer to the Department of Medical and Sanitary Services, Ceylon Introduction m No unusual difficulty is now experienced planning a suitable public health organization are for a municipality. Numerous models available for study throughout the world. The question is only one of meeting the budge demands. , _ In rural sections the situation is differed j The means of raising revenue are often unsatis- the distances to be traversed are Srea, ' factory; th communications are frequently bad; and_ general educational, financial and sanitary levels are low. On the other hand, rural area contain the greatest number of people an^ fe they are the main sources of wealth of world, their sanitary environmental condition- should be promoted. i The establishment of health units in rural an semi-rural areas in Ceylon and India nf, aroused considerable interest among he. le workers and the In this artic general public. u^ the organization of an official unit in Ceylon described. Health units The health unit scheme presupposes t-h^ fundamental public health principles are unl versally applicable. Local financial and otne conditions should be taken into consideration* and the procedures which are followed sh?n be based on common sense and on a recogni^ ' of what is useful, reasonable and practical The object is to bring to rural areas the benen of health protection which are now enjoyed ^ large towns and cities. This end is accomplish? dividing rural areas into suitable distric. by y and introducing therein small but complete trained bodies of workers who remain PerI1% nently in the delimited area and undertake public health problems. Their activities eI\ c? brace health education, general sanitation, lection, tabulation and study of vital and m? bidity statistics, control of preventable endem and epidemic diseases, vaccination and PreXere tive inoculation, maternity and infant welia work, school health work, and adult hygiene- More than 600 of these organizations now in all of the functioning parts w-?r,g'' namely, Ceylon, India, the Straits Settlemen the the South PaC! ? Siam, China, Philippines, ' the West South Amerl1 Islands, Europe, Indies, ' Central America, Mexico, the United Sta and Canada.

Ceylon ^ The island of Ceylon is 20 miles south-e^ of India. It contains 25,322 square mil?s

* caxM The activities reported in this paper were apU out under the auspices of the Government of Ceyl0ll jjef the International Health Division of the Rockc Foundation. : JACOCKS 333 June, 1933] CEYLON HEALTH UNITS

units amounted to 12,702 giving a birth rate of 36.7, as to with 33.1, the rate for the 35 principal towns according the 1931 census, has a compared of populationof the Island. (Statistical collection in health units is 5,312,548. It lies within the to the collection in the 35 towns (6-10 north wholly tropicsmore comparable than coastal latitude) and embraces a wideto the collection in the Island as a whole.) plain and a narrow band of foothillsDeaths and death rates.?The deaths in seven of the total a crude death rate of as surrounding a central mountainous area, ineunits 7,668 giving 22.1, compared with 29.6, the rate for the 35 principal towns lnpredominating race?Sinhalese?are Buddhisof the Island. religion; the one and one-la total of infant millions remaining Infant mortality.?A 1,807 deaths are seven the an infant lans. Hindus, Mohammedans and Uiirist-occurred in of units, giving mortality- The as with 187 for the 35 principal diseases arerate of 142, compared principal preventable towns of the Island. malaria, infection hookworm and other in- testinal by Maternal mortality.?There was a total of 229 deaths parasites, enteric fever, dysen cn,among mothers at childbirth in seven of the units, leprosy, plague and tuberculosis. Cholera andgiving a maternal mortality rate of 18, as compared with smallpox rarely occur. 31.3 for the 35 principal towns of the Island. In for still-births are available normal the is Still-births.?Figures only and times, country prosperousfor the urban areas of the different health units. There progressive. estates of coconut and Large tea, has been a total of 86 still-births, giving a still-birth rubber are ( the principal sources of wealth.rate of 54, as compared with 73.4, the figure for the Ceylon has been in contact with western35 principal towns of the Island. countries and since the 16th and is well Maternity, infant pre-school hygiene.?The century number of health centres has increased from 22 in 1930 advanced in education. Vernacular and |ish Lng-l.o 35 in 1931. The number of child-welfare clinics held secondary schools are located throughoutis 1,276 as compared with 843 in 1930. At these centres JheCo Island, and good colleges are found 489 expectant mothers paid 1,259 visits, as against 136 ombo, Kandy and other large towns. expectant mothers and 561 visits in 1930; 1,313 infants A as 892 infants and visits medical full ion paid 9,917 visits, against 6,142 local college gives prepara in 1930; 1,360 pre-school children paid 8,476 visits, as practice, but those entering the publie 874 children and visits in 1930. wealth service against pre-school 6,198 lealth must offer, in addition, pu Forty-eight trained midwives attached to the health qualifications obtained abroad. units made 53,129 ante-natal visits to 8,538 expectant .The ^ at the rate of 5.8 visits and Director of Medical and oanitaiy mothers per mother attended vices is in at the delivery of 4,985 mothers, paying them 34,582 charge of all curative and iv piemen post-partum visits at the rate of 6.9 visits per confined 1J2 Distributed throughout the country ar case. Eleven public health nurses visited 10,450 homes all hospitals (9,436 beds) and 603 dispensaries,paying a total of 15,810 visits. staffed by doctors and Communicable diseases.?1,746 cases of communicable government-employed diseases were and were apothecaries. There are few reported 1,727 investigated; Private comparatively 2,911 doses of anti-typhoid vaccine were but their number is in- administered; creasing. practitioners, 10,670 vaccinations against smallpox were done in six of the units by health unit Hookworm The | inspectors. public health branch has 28 medical treatmentsI amounting to 17,689 persons were carried out officers of in all the health. For the most part,, the units. is School hygiene.?There are 313 schools with a school c^ntry divided into districts each ?der a medical population of 54,473; of this number 5,669 were medi- officer of activities consist of the health whose cally examined; 4,027, or 70 per cent, were found to promotion of sanitation and the cont be defective with a, total of 8,376 defects, or 2.1 defects c?mmunicable diseases with the ai per defective child; 1,647, or 19 per cent of the defects tary found, were corrected. a inspectors. A district medical Wlt arSe Latrine construction.?135 public latrines in all the area and a small staff of offi(^r units received 8,235 172 defects were found only touch the I inspections. of the necessary public and 8 public latrines were newly built during the year. health work fringe insPec^snX still and in Ceylon this type of work, Latrine construction was carried out in all the units; under conditions 71,924 dwellings are provided with 29,886 latrines at necessar'y existing mmany the rate of one latrine to 2.4 houses. the now to During year Provinces, considered gr^ 1,853 new latrines were constructed, as against 1,713 in and is i i ^Its healtf > 1930. and 1.239 were altered to sanitary type, as against rapidly as being replaced by a^at? facilities permit. 994 in 1930. are with 255 one Health unit to 313 schools provided latrines, i.e., work, adjusted local:needs, latrine to 1.2 schools. During the year 19 schools that fas commenced in in 1926. In Dece - ber 1932, Cevlon were without latrines were provided with them. eight health units were m operation Public health education.?Public health education embracing 856 means 152 440 000 square miles and containing has been carried out by of lantern lectures, j 16 o people. The following data 145 lectures without lantern, cinema lectures, 684 this in: 215 work are taken in from school talks, 1,324 village talks, clinic talks; 4 health report of part weeks an estimated the of Medical and Sani- and baby reaching population of tary Department or 34 per cent of the health unit Services : 152,000, population: 325 conferences with health unit staffs have been held and training in health habits introduced in 14 schools s Personnel?The type of units. ^h^7?rrl\-nd c?ntinued as in the different oricinallv planned and the personne employed is as ^ to these detailed } medical foTows medical officers of health, In addition activities, 20,101 houses officer, 51 oanitarv inspectors, 12 public health were surveyed; 1,594 consultations and 123 adult ? were 133 SSTncl, mid?ives, 9 clerks, 8 peons, and 1 orderI.es examinations given; public wells received 2,616 labourers A ^as 197 1,041 tea and coffee each of the hookworm dispenser attached to inspections; bakeries, boutiques, Part of units for vSSe periods during the latter 194 eating houses, 11 aerated-water manufactories, 66 < the year. meat stalls, 83 fish 174 83 in 1931 The eighth unit was organized too stalls, vegetable stalls, dairies, ?

94 brick and lime kilns received 80,220 inspections necessary, they should pass laws to enable the medical revealing 35,666 defects of which 46 per cent were officer of health to carry out the required work. remedied; 8,099 cattle were inspected and 7,852 passed; (11) The first area should be developed with the 4,381 goats inspected and 4,367 passed; 172 samples idea of utilizing it as a training centre for health unit of milk were examined, and meat, fish and vegetables workers. It is economical to have a training static0 were seized as unfit for human consumption on in the country as it avoids the expense of sending officers 31 occasions. away for training and enables them to study the home in the home environment. problems in This enumeration an idea of the scope With one exception, these requirements were met gives area of work in health units and indicates Ceylon with the selection in 1926 of the revenue performed known as (he Kalutara Totamune. which is carried the all-inclusive programme It is obvious that in the' selection of succeeding areas out. The Director of Medical and Sanitary all the points enumerated above need not be stressed* Services closes this part of the report with but a unit should not be established in any community 1 which does not evince an active interest in the subject these remarks: This type of work is now being and show a desire to co-operate in every way. Respon- the as the line which accepted by people along sible people of the locality can give the necessary health work in the Island should progress \ assurances. The first health Kalutara It is unwise to to interest village^s unit, Totamune, probably attempt Is as a in serious health work in those sections where there is used by the department training station, to not a fair of If a has and as a has a staff and a degree prosperity. villager consequence larger for to struggle his daily bread, and be content _ Medical officers of no larger budget. health, pub- scanty and mean clothes and primitive shelter, it is lic health nurses, midwives and sanitary reasonable to expect him to listen to health propaganda inspectors now attempt no field work until they of any sort. After his poverty is somewhat reduced) his food and his fte have an allotted of time at clothing reasonably assured, spent period speci- and hia house he will have tin*? fied tasks in the health unit productive respectable, organization. and inclination to consider other matters. Consequently Twenty-two public health officials from nine remote or backward districts should first receive othe countries have visited the Kalutara Totamune fundamental attention. and other units to study the methods in use in Area of work Ceylon. Experience in Ceylon indicates that a p0^' Map.?In order to visualize the complete problem lation of about 80,000 can be successful the Island was divided into 63 health unit areas which a handled the health unit although are indicated by differential colouring on a map. To by staff, simplify statistical collection, the existing revenue smaller population is preferred in the beginning* boundaries were utilized. The first area included Ceylon representative' Selection care was taken of first area.?Considerable groups living in small towns and villages in selecting the first demonstration area. The points on estates. The people included doctors, which were kept in mind were as follows:? servants) (1) The leading people should earnestly desire the yers, teachers, priests, government 0 work. Unless this frame of mind is present or secured, planters, shop-keepers, fishermen, cultivators it would hardly be worth while making the attempt. village gardens and estate labourers. This is probably the most important factor in the whole field of selection. ? Value of hospital and dispensary (2) It is essential that the early co-operation of The line between curative officials should be secured. dividing medic11^1 and health is not defined. ^ (3) It should be located at a district administrative public clearly centre. The work is thus recognized as having received true that the functions in certain instances the definite approval of government and as a conse- widely separated and in others closely j ?'infyi quence this establishes it as a government effort. The tendency is towards a more intimate (4) It should be at or near the seat of the central ^ ance in health unit work. Hospitals are government in order that the work can be given super- ^ in and work vision by higher officers and guided along proper assistance maternity infancy channels, and in order that it can be frequently inspected in correcting defects found at school medic* and visited by officials, and easily accessible as a inspections. This is feasible in Ceylon inasm11 demonstration to visitors and others who are interested. as the curative work and public health (5) It is self-evident that the area should contain are under a direction. the usual health of the country. There should single ft problems o1f be a reasonable amount of prosperity and educational Staff.?The health unit organization consists j advancement. staff of trained workers as follows:?Medl ? permanent sa (6) It should contain town, village and rural officer of health, public health nurses, midwives, populations. If the first unit embraces all groups, the tary inspectors, clerk and peon. These are j to a work can be in any of the country. workers with applied part recognized qualifications acceptable s ^ (7) It should contain the desired number of people. approved by government. The use of government rea If groups are too small, the overhead expense is great is advantageous as the officers can be transferred are insufficient work and the numerical data collected for if circumstances require. As in all types of ^ proper statistical analysis. quality of accomplishment depends upon the chara (8) It should be well connected with roads. A medi- of the staff selected. ^.jj cal officer of health spends most of his time in the These workers undertake all the public hea j field in contact with the people of his area. It should activities in the area, but specialists from the advTc^njc'e. be possible for him to reach them easily and promptly. office may be called on to make surveys and give It should a 0 (9) contain hospital which will supply All health units are supervised by a senior staff feg- medical and surgical treatment for the sick who are Medical officer of health.?In addition to the Pr?jcer found during the survey, and assist in correcting defec- sional qualifications already mentioned, a medical and ?^ejd tive children, in complications of pregnancy. of health should be a competent person with (10) All organized towns and villages in the area experience and thoroughly interested in his subject. ,s should contribute financially up to their capacity. If directs the health work done in his area and insp june, 1933] CEYLON HEALTH UNITS : JACOCKS 335

? more is sent Ule Worl* i requiring complicated procedure to the in for QUencv tn 1 subordinate staff with sufficient nc-central laboratory Colombo examination. He js touch with all phases of each activity. Cost.?The cost of the work varies with the scale of uses n J3 fdmiuistrative officer of the organization and in operation in a country and of the number of f?r pay h traveL The cost should be divided between the Public n^r1 staff employed. to as th nurse.?The nurse is frequently referredcentral government and the local authority in accord- of Certain IP?-S^ *mPortant member the staff. It isance with agreed upon in advance. th m arrangements Work she re'at'on to maternal and child-welfareActivities paid for by the local authority are confined be ^n.essential cog in the machine. She mustto the limits of the area controlled by the local interc/f her forceful ; ^ work, tactful, sympathetic butauthority. out ber duties. She should be well known f11 It is that the central government, as well tfry'ngPeoPle and able to enter the homes important without j16 as the local authority, contribute towards the work. .ce- the confidence of the Mothers By gaining few rural communities in any part of the world if secure their and becomeVery acquainted co-operation will be able to a competent health programme the actual situation in the homes. support Publio i W,^b from the village or town finances. In Ceylon local n?t uurses should be self-reliant, elder! healthy,organized communities are asked to contribute the Work and able to do outdoor at beginning, necessary number of sanitary inspectors and midwives Unlike the nurse who Works ex- I ?SeasofS- hospital and to continue to pay the cost of and health nurse scavenging bouie indoors, the public does The central the rest visVS1Ve^g'ves bome and attendsconservancy. government provides Pre-natal demonstrations, and correlates the activities in all units. work .P?st-natal clinics. She supervises the of thne members of the staff whether the local of (jle midwives, and after ten days takes charge All paid by keeping ti? and child, and devotes her energies to or central government are placed under the control of a and the medical officer of health of the health unit. nee at. u n We". by home visits by urging attend- ? cost to of 7 He-r activ'f c''nics till the child reaches school age. In 1931 the government operating units demonstr'/t *?c'bide also smallpox vaccination, home was Its. 2,12,381, or 2.2 per cent of the department's ance in !ons m the care of minor ailments and assist- expenditure. The expenditure of the local authorities health work. She lives in the district is not recorded as these would have assigned i | expenditures and travels motor car, rickshaw or occurred if there had been no health unit. A hackery i, by budget q? an(1 as a area is Well as sin I wagon). Young married women for typical appended. Public honuu Woinen have been found to be satisfactory Procedure.?After the area was selected and the staff CeyIon nnKr ?lIrses- Under the present methods a chosen and located, the following procedure was found a 8,000 to innnn alfb nurse deals with population of suitable. Work *his uumber will be altered as the dev 1^ut Educational.?(?) An inaugural public lecture was anc* as more nurses become available. Ceylon m by a prominent official. This point should be nurses are trained 4 given ?^erVl health years (in decided in accordance with local conditions. The in mSic 3 years, in 6 and pub- Duhlin l!S11?g midwifery months, licity gained in a formal public opening is often of 6 months). great nursing assistance in getting satisfactorily started, but a quiet ^teiteal5h,h a^ *be staff, the midwives are has aPproved of beginning advantages. training j government after 6 months successful 'he ininjpi^f 1 un^ work they are placed under (b) A series of subsequent lectures were given at suPervision of the public health nurse. various points in the area by the medical officer of They locat' health detailed information Prior to j,e.oxPectant mothers, ana take care of them containing about procedure One confinement and for ten days thereafter. and! describing methods of co-operation. ?f mid^-v8 *S a 4,000 exPected to deal with population , (c) Steps were taken by 'the medical officer of 12 xviJh- a c?nfiner radius of 3 miles and to do at least |health for the formation by the people of local societies area nts a and f month. They live in the assigned to assist in carrying out the work. wife ravel on foot. It is desirable that the mid- ? be (d) A effort was made to enlist the active ^Gr in and that the entire with systematic thr>aniec^ family stay of leaders in all rePlacinn- The health unit midwife is support prominent persons including fi,area" gradually phases of local endeavour. Sanitary 'G Untramed woman. ment mo/; lll?T>ectors.~Inspectors are trained by govern- Survey.?A detailed house-to-house survey of the Their work-3" officers of health for a period of 6 months. area is made on a special form to secure an accurate inspection control of communicable diseases, understanding of the health needs. The survey is all- hotels ^udeswater supplies, houses, dairies, markets, inclusive and enables the staff to become acquainted andS with the and the area, to find out the a?d the nr restaHrants, tea kiosks, bakeries, and housing people general conditions of the environment and to learn the *hey are of latrine construction. In addition sanitary t^1T?otionne(^ to vaccinations diseases. ?'Ve mass j do smallpox and to prevalent inspector i ?kworm and malaria treatment. Each Activities.?After the survey is finished, the data are and to eaf Quired to become well known in his area analysed and the public health problems so revealed other memh co-operation of the people. As with are taken up in the order of their importance. tfle staff he works on a approved h programme staff work on a definite fu?f of and The entire pre-arranged activities a t me(iical officer health, his in accordance with the to J visited. An is able programme, prepared problems deal win? reQuently inspector to be the and the local Population of 8,000. He lives in his met, seasons, general conditions. assigned In their work consists of the following activities:? . terV and uses a for travel. part Oftice \ ** bicycle m is means of the area Wlth necessary clerical staff located Health education by press articles, t^1CG that a lectures with lanterns and 0l! municin 1 u freQuentIy happens government pamphlets, cinemas, village can secured for an individual talks nurses without pay Siding be office and school talks, by and sanitary office, but V nted buildings are used for the central inspectors and exhibits. A small library is developed. 'n,V ?*her is the local Population as building supplied by Securing co-operation by the a part of their enlisting interest of ' co-operation. ine ? individuals and organizations and obtaining financial clerk m selected for u-S .government clerical service. He is help from "individuals; by utilizing existing societies to and to deal with corre- if there are none, the sPondence <1 |S a.bibty type and, organizing of social service office Wlth forms and which reach and other co-operating bodies. fmmr?m ohe reports the field sanitation ooratom a Promoting through the development, by ?quippe(j fQ room at each health unit office is experiment and practice, of suitable methods of general stoois Kin *?akmg simple laboratory examinations sanitation, particularly the control of soil pollution by rnedical urine. The work is done the use of of ofpc r off^nd by the latrines, inspection food, markets, eating health or a trained assistant. Material 336 THE INDIAN MEDICAL GAZETTE [June, 1933 places and houses, and the establishment of water (a) Entrust all the municipal health work to the supplies and sewage disposal plants. medical officer of health of the health unit. Controlling communicable diseases by the prevention (b) Pass the necessary regulations and bye-laws to of cholera, smallpox, chicken-pox, measles, plague, enable the medical officer of health to carry on his work malaria, enteric fever, dysentery, hookworm disease and in a satisfactory manner. filariasis; by organizing special treatment campaigns Contribute the and allowances for the against hookworm, malaria, yaws and leprosy; and (c) salary collecting morbidity statistics. required number of approved sanitary inspectors and midwives. Vital statistics, collection, tabulation and study. Personal hygiene, which is promoted by child-welfare Objections clinics at various centres, home visiting by public health nurses, midwifery service, and medical inspection of In spite of the success attained by health unit school children and correction of defects. work, criticisms of health units have been made Weekly conferences.?A weekly conference attended by some well-informed and responsible people, all members of the field staff and over by presided by but for the most part those who know the medical officer of health is held every Saturday by of the Some of the criticisms morning in the health unit office. At that time each nothing system. member of the field staff presents his own problems are that health units are :? of the week which are discussed and decisions as to the procedures to be followed are arrived at. At this (?) A western idea and not suited to the conference advance programmes for the following week conditions or the people of the east.?After are The prepared. conference is useful in maintaining careful consideration, this does not seem to be interest by keeping members of the staff informed a real as many western ideas have concerning all phases of the work and is a regular objection activity in all health units. already been adopted in the east. Furthermore, the statement has been made that in ancient village governments, sanitation was an import-" Co-operation ant item of the administration. If that is true, Public health work done by compulsion has the health unit only attempts to restore these no sound foundation. A health unit should be early usages. able to carry out its work without being com- In 1933 this lacks force as there to enter Resort to law is objection pelled prosecutions. are 8 units in in and the final A conviction makes enemies operation Ceylon several step. in the Straits Settlements, and secures with the India, Burma, Siam, compliance only particular the Islands and other eastern item under consideration. Java, Philippine countries. In all these units the adaptation to To must be get lasting results the work local conditions were kept in mind and put into on a placed co-operative basis which is the practice. ? foundation of the health unit system. Co- operation is obtained by carefully explaining in (?) Too costly.?It is true that the cost lectures and personal conferences to those con- greater than district work in a similar area, but to than cerned the objects be attained and the even so the per capita expenditure is less assistance which may be given in carrying out that usually recognized for carrying out efficient the programme. Types of co-operation are : public health work. Although more is pald Community.?Social service organizations were out, more is received for the outlay. A m^n totamune at Kalutara and at Beruwala formed in the must pay more for a silk suit than for a cotton to assist in the child-welfare work. They promoting suit as he gets a better article which gives to function in the manner. Sub- continue original and better service. The health unit pre' committees were named for each health centre and a longer member attends the weekly clinics at the centre, fers to accentuate quality of work. for the distribution of milk to those needing it, arranges units into the and conducts the of the little-mother A to introduce health sewing activity proposal on classes. The leagues are supported by private dona- entire area of any state or any country at ' ' for tions, monthly contributions and our-day collections, time has not been made and is not feasible activities are not a the health and their charge against numerous reasons. Trained staff is not avail- unit budget. At Beruwala the local league furnishes many areas are not suitable for any typ a building as a centre for holding the weekly well-baby able; nve clinic. of efficient health service; and the people Private.?Two public-spirited people rented and frequently not prepared to co-operate. Sinc_ furnished two buildings for holding weekly well-baby health units meet the needs better than clinics at two centres. Two other people donated land, other rural health organization, it seems for one clinic. One reaE!^ building and furniture operating able that they should be established as rapiov superintendent provided a good building on his estate as on a yearly nominal rent, and one person provided a practicable. pump for a public well in a village. (c) Small in area.?In a large country Municipal.?When the health unit includes a self- health unit may seem to reach a sma governing town or village, it is necessary to have an only as the tota understanding with the local officers. A conference is group of people compared with lar^ arranged and after the details are explained, the local population and as a consequence a any authority learns that it loses no power over its majority of people will thus be deprived of but gains considerable without addi- ^ employees, help health service. On the other if , tional expense. The rules have been hand, following adopted health unit staff should be out to rea? and have proved satisfactory. The local authority spread s agreed to: these other people, the workers would be JUNE, 1933] CEYLON HEALTH UNITS : JACOCKS 337

The district work in has much not be Ceylon improved widely scattered that it would since the advent of health units. work. As a* to do any effective health Other criticisms have been offered, but they no the good would accrue to people were mostly of a trivial nature. All real criti- of a the district. , ? u nos- cisms have ceased when health unit has been area , In health unit work in rural ^us visited and its work given careful study. sible to carry out intensive actrnti Based upon experience health units are suit- results. in accomplish definite TTpqith units able for Ceylon and it is the purpose of the not feasible in a district plan. to develop this of work. se pxample government type act as a areas, stimulus to other other Given a fair trial, health units may meet the to Of effective work and tend needs of other states or countries. health work higher standards brmgJort*^

APPENDIX I Korale Health Unit?Paranakuru 1931 Statement of expenditure?January-December, Central Government

Number

Personal emoluments:

. ? 1 Medical officer of health

1 Clerk

4 Sanitary inspectors 5 Midwives

1 Office peon

1 Labourer

.. 1 Labourer for field work

1 Field attendant

Other charg

Travelling expenses Transport of stores Rent

Conservancy charges

Cost of stores

Photographs Cost of stationery

Cost of drugs .. Labourer?field allowance

Sundries

Source of funds, Government 338 THE INDIAN MEDICAL GAZETTE [June, 1933

Statement of expenditure?January-December, 1931 Local Board

Number Description Salaries Allowances Total Grand

cts- Personal emoluments: Rs. cts. Rs. cts. Rs. cts. Rs.

1 Sanitary inspector 1,039.92 256.00 1,295.92

1 Midwife 600.00 60.00 660.00

10 Labourers?Conservancy 2,424.00 2,424.00

7 Labourers?Scavenging including 2 park labourers 1,841.74 1,841.74 6,221 -66 Other charges:

Travelling allowance to sanitary inspector 240.00

Uniform allowance to sanitary inspector 74.28

Upkeep of scavenging carts 1,069.59

Repairs to latrines 114.42

Repairs to slaughter house and cattle pound .. 53.50

Repairs to conservancy carts 55.15

Maintenance of markets 346.56

Cost of latrine buckets 91.48

Cost of disinfectants 278.80

Upkeep of cattle sheds and stores 19.58

Maintenance of I. D. H. .. 69.65

Supplying meals to I. D. H. patients 102.51

Building temporary buildings for I. D. H. camp 44.04

Despatching milk samples to Colombo 9.57

Wages of labourer employed at I. D. H. camp 7.00

Wages of guards at I. D. H. camp 45.20

Source of funds, local board

Statement of expenditure?January-December, 1931 Village Committee

Number Description Amount Total

Ra. cts Rs. cts Wages of scavenging and conservancy labourers at 990.00 Dippitiya, Aranayake, Morantota and Undugoda. Cost of latrine requisites 15.15 Fixing a latrine 51.00 Repairs to latrine 35.60 Cost of disinfectants 36.50 1,12855

Summary Rs. cts Rs. cts. Government 21,584.07 Local board 8,842.99 Village committee 1,128.25 31,555.31

Per capita cost, 60.8 cents. I 1 "TP