Regional Office for South East Asia

WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR SOUTH EAST ASIA

SIXTEENTH ANNUAL REPORT OF THE REGIONAL DIRECTOR TO THE REGIONAL COMMITTEE FOR SOUTH EAST ASIA

1 AUGUST 1963 - 1 AUGUST 1964 iii

TABLE OF CONTENTS

Introduction vii

PART I - GENERAL REVIEW OF ACTNlTIES

Communicable Diseases Malaria Eradication Tuberculosis Quarantinable Diseases Smallpox Cholera Plague Typhus Other Endemo-epidemic Diseases Bacterial Diseases Virus Diseases Parasitic Diseases Zoonoses

Epidemiology

Health Laboratory Services

Vaccine Production

Health Statistlcs~

Public Health Administration Rural and Urban Health Services Maternal and Child Health Nursing Environmental Health Health Education Nutrition Mental Health Dental Health Industrial and Occupational Health Radiation and Isotopes Human Population Genetics Cancer Drug Addiction Education and Training Direct Assistance to Medical Institutions Fellowships

Assistance to Research Malaria Insecticides Tuberculosis Smallpox Cholera Leprosy Treponematoses Migratory Birds in their Role as Disseminators of Arthropod-Borne Viruses Measles Vaccine Trials Rabies Respiratory Viruses Filariasis Environmental Health Nutrition - Anaemias Human Population Genetics Radiation Cancer

Technical Publications, Documents and Reference Services 68 Preparation and Distribution of Documents 68 Sales and Sales Promotion 69 Library 70

PART I1 - ORGANIZATIONAL AND ADMINISTRATIVE MATTERS

Regional Committee 73

Administration General Organizational Structure Personnel Staff Welfare Finance, Budget and Accounts Accommodation for the Regional Office Constitutional and Legal Matters

Procurement of Supplies and Equipment Collaboration with Other Agencies United Nations United Nations Technical Assistance Board (UNTAB) and United Nations Special Fund (UNSF) Economic Commission for Asia and the Far East (ECAFE) United Nations Children's Fund (UNICEF) International Atomic Energy Agency (IAEA) World Bank Specialized Agencies Food and Agriculture Organization (FAO) United Nations Educational, Scientific and Cultural Organization (UNESCO) Bilateral Agencies United States Agency for International Development (USAID) Colombo Plan Other Bilateral Agencies Inter-Governmental and Non-Governmental Organizations Other Organizations

. 5. Public Information

PART m - ACTN~IESUNDERTAKEN BY GOVE-NTS WITH THE HELP OF WHO

Introduction to Project List

Afghanistan Burma Ceylon India Indonesia Maldive Islands Mongolia Nepal Thailand Inter-Country Inter-Regional

ANNEXES

Organizational Chart

Geographical Distribution of International Staff Assigned to the South-East Asia Region, as of 30 June 1964 ANNEXES (continued)

3. Conferences and Meetings in the South-East Asia Region Called by the United Nations and Specialized Agencies at Which WHO Was Represented

4. Conferences and Meetings of Governmental, Non-Governmental and Other Organizations Held in the South-East Asia Region at Which WHO Was Represented

5. Fellowships Awarded by WHO

6. List of Reports and Papers by the Tuberculosis Chemotherapy Centre, Madras

7. List of Papers Published by the National Tuberculosis Institute, Bangalore

8. List of Technical Reports Issued by the Regional Office from 1August 1963 to 1August 1964

9. Training Activities Carried Out by Governments with the Assistance of WHO Staff (1 August 1963 - 1August 1964)

INTRODUCTION

This has again been a very difficult year for the Scuth-East Asia Region. Political difficulties and ever-tightening budgets have continued to hinder public health work in a number of countries, and even some of the past achievements have been threatened.

Chronic shortage of most categories of health personnel has persisted. With growing populations and ever-increasing swistication, the demand rises steadily while the supply lags far behind: the very size of the demand prevents adequate remuneration, and this in turn prevents an adequate supply. Excellent projects, launched with great zeal and financial sacrifice, famder on the rock of insufficient personnel. Theoretically it would seem possible to prevent such shortages by sound planning, but planning for one sector of public activity impinges m that for others, with the result that the various sectors compete with each other and all remain understaffed.

The continually increasing need for qualified doctors, met by a wide expansion of medical schools without adequate teaching staff, has given rise to some serious thinking on how to improve the quality of medical education in the Region. This subject was brwtbefore the 1963 session of the Regional Committee, which asked us to look into this matter. Although an increased number of felluwships is of some help, it is not possible to send too many fellows abroad for further study when the strength of the existing teaching cadres is already so low. It is also very difficult to get teachers from advanced countries to come to this region for reasonably long periods of, say two to three years, to strengthen the local institutions: firstly, there are not enough of them available, and, secondly, they lose their places m the ladder of promotion at home if they choose to come out to help us. An experiment has therefore been conducted in the way of seeking some form of "institution-to-institution" support, and a six-year contract has been entered into with the University of Edinburgh Medical School, which provides teachers for WHO in support of the Baroda Medical College in Imiia. This experiment has just completed its first year, and, although it is too early to make any prophecies for the future, we are hopeful of success. Efforts are being made to promote one other such scheme for another country in the Region.

Mass campaigns for the control of communicable diseases have continued to show good results. In addition to the great strides made in the eradication of malaria, some progress towards the goal of smallpox eradication has been achieved. The spectacular success of some of the malaria eradication programmes in this region is a matter of justifiable pride to our countries. But this initial success should not blind ua to the need for sustained effort. The laat remnants of malaria, often in difficult areas, are the hardest to uproot. I would again caution against any premature relaxation of effort which may jeopardize eradiaation. Two essentials for success in the campaign againat smallpox are an efficient administratim and an adequate supply of potent vaccine which will remain stable in the climatic conditione of the Region. WHO has been able to arrange for considerable donations of freeze-dried vaccine and, with UNICEF collaboration, has continued to assist in the development of laboratories for ita manufacture. The problem of cholera still remaim: it is possible that we may get some lead from the WHO-assisted vaccine trials in Calcutta.

The Regional Committee at its last sessim again focussed atwxth m the serious problem of tuberculosis. It was agreed that **openncases should be the main target of case-finding, that case-finding was of no value unless caees could be properly treated, and that an effective treatment programme calls for an adequate free supply of drugs and an extensive treatment service as a part of the general health services.

Further advances in the development of maternal and child health services can be noted, but the vulnerable group of pre-school-age children hu still not generally been reached. In order to give effective service to this age-group, maternal and child health services within the framework ob general health services and, in particular, home visiting by nursing peramme1 call for crrmiderable expansion and strengthening. An inter-country asllesemeat team visited Thailaad to assist that government in carrying out a study of rural maternal and child health services. The finding8 of this team generally andord, the pattern of development being followed and the programme of assistance adopted by WHO and UNICEF. I am also glad to record the Launching of an initial project for WHO adUNICEF assistance to the development of maternal adchild health services in Nepal.

A number of schemes for rural water supply, with the help of equipment from UNICEF, have been promoted during the year, and WHO sanitary engineer advisers are helping to develop some small urban schemes. The Calcutta Water Supply Project, with assistance from the United Nationrr Spacial Fund, cmtinues to make progress. WHO ie assisting the Indian Gwenunent in obtaining loans and further support from international and national financing agencies.

It is becoming increasingly recognized that the planning and administration of heaith services cmstitute a specialty,for which specialist training is necessary. The inauguratim by the Indian Gwernment of a National htitute of Health Administration and Education, primarily as a staff college for senior public health administrators, may well set a pattern which can be adapted to the needs of other countries. WHO participation in the newly-established Asian Institute of Economic Development and Planning, Bangkok, in co- operation with ECAFE as Executing Agency for the United Nations Special hmd, Ls an interesting attempt to integrate health planning into the broad field of economic and special development. A WHO public healtb Ivlminintm- tor has been assigned to this Institute.

WHO assistance to governments has, over the years, followed a pattern which has become familiar. Because of the magnitude of the problem there has been primary concentration on projects designed to control or eradicate the major communicable diseases,and Chapter 1of this report describes in some detail WHO assistance to programmes in communicable diseases, which accounted for about 46% of the regional budget, including about 25% for malaria eradication programmes. The second broad field of assistance has been education and training, mainly through aid to individual institutbne. Over the next few years control over major communicable diseases, except those due to defective environmental sanitation, will become stabilized, and our emphasis will shift more and more to education and training, and to post- graduate training in particular.

During the year,146 projects were assisted, 16 of which were inter- country projects. These projects included 9 in malaria emlication, 8 in tuberculosis, 6 in leprosy, 12 in other communicable diseases, 5 in health statistics, 9 in public health and rural health services, 18 in nursing, 8 in environmental sanitation, 10 for direct assistance to medical institutions, 31 in other special public health services,and the remaining 30 in miscellaneous activities.

Approximately 165 WHO field staff were engaged in these projects. In total, 136 fellowships were awarded, 43 for studies within the Region. Provision was made for participation in six study tours and seminars. WHO staff took part in about 250 training courses of various kids (see Annex 9).

We have succeeded in maintaining our usual close collaboration with international and bilateral agencies the activities of which concern public health; the scope of this collaboration has been even widened. I have previously mentioned our co-operation with ECAFE in the Asian Institute of Economic Development and Planning. Regional Office staff visit and hold discussions with the United Nations Resident Representatives during their tours of countries of the Region. These discussions are in addition to the liaison maintained with Resident Representatives by the WHO Representatives accredited to govern- men&. During this year, for the first time, a United Nations Resident Representative was appointed in Nepal.

Our relations with UNICEF have remained as close and important as ever: the meeting of the UNICEF Executive Board in Bangkok and the visita of Board members to countries of the Region gave an opportunity to acquaint the Board closely with the health needs of the Region. WHO has continued to co- operate with UNESCO in the health aspects of education projects and to collaborate with FA0 in a number of nutrition projects; we have had frequent diecussions with USAID, the Colombo Plan, the Ford Foundation and the Rockefeller Foundation, mainly on assistance to medical education.

WHO Representatives have continued to do excellent work in every country of the Region. Mongolia does not yet have such a representative, but my two visits to the country have convinced me of the need for such a position. The last visit, made during July of this year, was in compaqy with the Director- General, who was impressed with the needs and opportunities for public health work in the country during this first visit.

The functional advantages and the good working conditions provided by our new Regional Office building have resulted in imprwed standards of performaxe. The Regiooal Office has been functioning for over fifteen years now, and it would perhaps not be amLs to express here appreciation of the loyal and devoted services of the hard-working corp of staff - both profeseid and sub-professional - some of whom have been with the office from the be%nning and who have made such a substantial contribution to the success of our work. The staffing picture is changing: many of those who have been with us for many years have left on transfer to other offices, and for the past two to three years, the Regional Office has been rapidly losing its very senior public health staff due to retirement. Fresh blood has come in and promises well for the future, but this will take some time to blend into the traditions of the pet. In this connection I must place on record grateful recognition of the distingufehed service8 of Dr R.L. Tuli, Dr R. H. Bland, Dr L.G. Eddey and Mr R.S. Garg, who for so many years have been pillars of strength in our work. Another precious colleague, Dr D. P. Nath, died suddenly on 9 July while on leave in Ediaburgh. The beneflts of his wise counsel and charming personality will no longer be avall- able to us, and we all mourn his sudden passing away.

Indeed, the year 1964 has taken away from us several outstanding persme. It is with great sorrow that I have to record the death of Mia's great Prime Minister, Jawaharlal Nehru, on 27 Kay 1364. Mr Nehru was an inspiration to those working toward international understanding and goodwill and was a strong supporter of the United Nations and the World Health Organization. This Regional Office was located in New Delhi at his invitation, and he maintained a personal interest in our work throughout these years. Earlier, on 8 December 1963, we learned with regret of the death of H. E. Field Marshal Srisdi Dhanarajata, the Prime Minister of Thailand. It was only in September last year that he inaugurated the sixteenth session of the Regional Committee in Bangkok and extended to us the warm hospitality characteristic of his country. And another great friend of WHO and one of the distinguished former Presidents of the World Health Assembly, Rajkumari Amrit Kaur, who was, earlier, for ten years Minister of Health in Indii, also passed away in February. Tireless in her efforts towards achieving better health and social conditions in her country, adactive until the end, she will be sorely missed.

The governments of this region have, as usual, given generous support to our work throughout the year. For their understanding and unfailing co- operation we are all grateful.

Regional Director GRAPH 1-EXPENDITURE ON PROJECTS BY BROAD SUBJECT GROUPS, 1963 WHO SOUTH-EAST ASIA REGION

Expenditure

.~~~~ ~ ~.-~ ~ - - -. Subject Group 1963

Amount (US X) I Per cent

~-~ . ~ ~ ~ - ~- -~~- Communicable-disease projects .. . 1 913 799 46.01

Other projects ...... 2 245 862 53.99 All projects ...... 4159661 , 100.00 GRAPH Z-EXPENDITURES ON COMMUNICABLE-DISEASE PROJECTS BY MAIN SUBJECT GROUPS. 1963 WHO SOUTH-EAST ASIA REGION

Expenditure

~ ~~ Code Subject 1963

~ ~ Amount (US 'I Per cent

- ~p MAL Malaria 1 032 758 53.96 TB Tuberculosis 494 200 25.82 VDT Venereal diseases and treponematoses 39 510 2.06 EE Endemo-epidemic diseases. including virus diseases 181 008 9.47 L Leprosy 166 323 8.69 All communicable diseases 1 913 799 100.00 PART I

GENERAL REVIEW OF ACTIVITIES SEA/RCII/Z Page 3

1. COMMUNICABLE DISEASES

A study of the national expenditure on communicable diseases, which continues to make up an appreciable proportion of health budgets in the Region, shows that these expenditures are mostly related to a few major problems - malaria, smallpox and yaws eradication on the one hand, and the control of tuberculosis, leprosy and trachoma on the other. However, apart from the work on malaria and yaws, in which cwsiderable progress can be reported, only a start has been made with these diseases: much still remains to be done. For example, it is estimated that only about 10% of the total number of leprosy patients in India have so far been registered and put on treatment, and the technical discussions held at the sixteenth session of the Regional Committee pointed to the fact that tuberculosis remains the greatest single unsolved public health problem in the Region. Other examples of programmes in which the rats of progress continues to be discouraging are those pertaining to filariasls and venereal diseases.

In view of the above situation, several reappraisals of efforts and resources were made during the year, with a view to:

(a) Pressing on with long-term plans for national programmes for the eradication of malaria, smallpox and yaws;

(b) Directing increased efforts against leprosy, tuberculosis and trachoma, more critically than in past years, and concentrating on selected areas with the highest prevalence. In Mia, for example, the Central Government will provide 100% assistance to concentrate efforts in thwe States known to have the highest prevalence of leprosy and trachoma; similarly, in Burma, the previous organization for limited case-finding through contact tracing and school surveys is being strengthened by house-to-house surveys in those districts known to have the highest prevalence of leprosy;

(c) Accepting as part of these programmes the necessity for routine assessment and independent appraisal at different stages of the campaign;

(13) Continuing to strengthen and expand basic rural health senices and to plan how, when and in which way these services should participate in, and subsequently take over, in an orderly manner, from specific disease-control campalgDa SEA/RC17/2 Page 4

in the consolidation and maintenance phases. Such a development cannot be rapidly attained without employing very large numbers of trained multi-purpose health auxiliaries to work under the supervis~onof professional personnel. .kt thc last session of the Regional Committee, it was accordingly recommended that governments should take up well-planned five to ten-year programmes to train these health auxiliaries, with WHO assistance if required.

The morbidity and mortality from otherpreventable diseases such as the enteric group, diphtheria, whooping cough and tetanus - even if judged only from hospital returns - remain heavy. Admissions in one infectious-disease hospital in a principal city of India amounted to over 5 700 cases of diphtheria and over 4 000 cases of typhoid during the year, whilst case-fatality rates in respect of tetanus admissions appeared to average 40 - 48%, and among newborns up to 76%. Yet no systematic study of and approach to these diseases, for all of which an effective vaccine is available, have so far been made. Further reference is made to this group of diseases in Section 1.4.1 (5) below.

As long as one is faced with a relatively high level of typhoid morbidity, maintained by very low standards of sanitation and food hygiene, immunization retains considerable importance. Studies carried out in Yugoslavia adBritish Guiana under WHO auspices have shown striking protection with an acetone-killed typhoid vaccine and, again, god results with the heat phenol vaccine. There is, thereforc, a strong case here for systematic programmes of protection, particularly among accessible and susceptihie age-groups such as school-children. It was recently noted that three-fifths of the typhoid cases admitted to a hospital in Delhi belonged to the age-group of five to fourteen years.

Concern was also expressed during the year at th~unexpected change in the epidemiological pattern of certain diseases within the Region, notably haemorrhagic fever of the dengue group complex, cholera El Tor, poliomyclitis and plague. Haemorrhagic fever continued to occur in a severe and frequently fatal form in urban areas of Thailand and broke out in epidemic form, for the first time in history, in Calcutta, in the s$cond half of 1963. A large outbreak also occurred in the Rangoon area, due either to classical dengue or chikungunya viruses, probably the latter. Several distinct and different types of dengue and chikungunya viruses were responsible for the 1962, 1963 and 1964 outbreaks in Thailand, India and Burma, and because of the variety of different strains which may be involved, one cannot entertain any immediate hopes of a specific vaccine, and the urgency, therefore, remains for stricter and more organized Aedes aegypti control measures and for making the disease notifiable in the principal urban areas. SEA/RC17/2 Page 5

Haemorrhagic fever also spread to.some countries in the Western Pacific Region. Cholera El Tor, previously cc nfined to Sulawesi Selatan (South Celebes), and mostly affecting debilitated persons, not only has caused periodic outbreaks of increased severity similar to that of classical cholera, spreading to other parts of Sou#-East Asia (principally to other islands of Indonesia, and to Thailand and Burma) but also appears to have secured a "permanent" foothold in Java, possibly in Sumatra and in the Philippines. Poliomyelitis is endemic in all countries of the Region, and the epidemic in Mongolia in 1963, the one in Ceylon in 1962, those in Andhra Pradesh, Gujarat and Rajasthan in India in 1961, and the one in an island of Indonesia in 1959 are all reminders that careful watch must be kept for increases in the incidence of paralytic poliomyelitis. How much of this increase is due to improvements in environmental conditions (which lead to the postponement of infection until later in life) or in better reporting, and how'much is due to the introduction of fresh virulent strains or to a mutation in virulence of the strains, is a matter for conjecture and further study. The persistence of human plague in South India and in some provinces of Burma, and the ' presence or suspected presence of sylvatic plague in Indonesia, Mongolia, India and Burma all call for renewed surveillance.

1 '. In the preceding pqragraphs, examples have been cited of problems important enough to give cause for greater concern than in past years, but for which preventive and control measures are fortunately available. How- ever, these measures cannot be adopted to the best advantage in view of the many gaps in knowledge of basic facts, resulting m a situation when health departments can act only in the face of an emergency, rather than in anticipation of such emergency or chan-e in the epidemiological or imrnuno- logical pattern of a disease. The need ror ep~demiologicalintelligence and reporting, and for surveillance of the major commun~cablediseases, on a national, regional and global basis has become increasingly evident, and this in turn calls for the speedier development within the Region of the three, so far neglected, inter-dependent disciplines - epidemiology, microbiology and health statistics - as reviewed in other sections of this report.

Considerable emphagis has been placed on the independent epidemiological assessment of mass campaigns against communicable diseases. The careful work by independent appraisal teams which have assessed the smallpox eradication programmes in various districts in India proved to be of the greatest value in revealing certain gaps in the programme in time to allow further improvement. The methodology of these teams and also their findings are probably applicable to most other smallpox eradication or control programmes in other countries of the Region. In addition to assisting with the annual assessment of the national SEA/RC17/2 Page 6 malaria eradication programme of India, WHO teams have also carried out assessments of the Ceylon and Afghanistan malaria eradication programmes in line with the resolution adopted at the fifteenth session of the Regional Committee (see SEA/RC~S/R~).WHO teams cllso assisted in the assessment of the leprosy control program~min Burma, the BCG vaccination programmes in Burma and Indonesia and the trachoma control projects in some States of India and in North-East Thailand.

During the year, a *3H0 consultant assisted in a general and specific appraisal of the larger infectious-disease hospitals in India, with regard to their quality as instruments for dealing with communicable diseases and their potential value as teaching centres. His report showed up a much neglected service. This subject merits further attention in all countries. Four points need stressing: (1) Infectious-disease hospitals must be radically improved so that they may be recognizable. as institutions in which adequate medical care and attention are available and in which intensive investigative work is carried out; (2) It is an important task of the infectious-disease hospital to supply accurate records of a sample of all the infections with which it deals. These demand a much higher quality of clinical and bacteriological endeavour and closer collaboration with epidemiological services than is discernible today; (3) There is need for more attention to be paid to the planning of such hospitals, for if they are properly constructed and properly maintained, they could, with a minimum of expense, have their function changed at some subsequent date so as to be able to treat other conditions; (4) It is necessary to recognize that infectious-disease hospitals should be suitable as teaching centres for health personnel. They are not so today.

As part of the global medical research programme of WHO, assistance has also continued to be given to fundamental and applied rcsearch in the wide field of communicable diseases (see Chapter 8). In this comcction, the following developments in chemotherapy and prophylaxis are noteworthy. In tuberculosis important developments are the preliminary observations of the Madras Tuber- culosis Chemotherapy Centre that treatment through supervised, intermittent (twice weekly) dosea of isoniazid plus streptomycin is 3s effective as the standard regimen of daily unsupervised isoniazid plus PAS. bi cholera, recent work in Calcutta demonstrated that all paticnts admitted in shock with bacteriologicnlly proven V. cholera infection markedly improved, becoming normotensive and able to stand unassisted within four hours of admission, following the intravenous administration of an average of 3 000 CC of isotonic saline and 1 300 cc of '/6 molar sodium lactate, supplemented by the oral administration of green cocoanut water, which is a potassium-rich fluid. Studies demonstrated that therapy could be further improved by the addition of tetracycline to this fluid replacement regimen. SEA/RC17/2 Page 7

Trials with anti-viral drugs in the chemoprophylaxis and chemotherapy of smallpox were continued in Madras. A WHCbassisted controlled field trial with classical cholera vaccines, covering a population of 100 000, was started in Calcutta in March 1964.

1.1 Malaria Eradication

This year marks a further step towards the eradication of malaria in this region, and WHO has continued to collaborate with UNICEF and USAID in assisting Member Countries to implement their malaria eradication programmes.

.The following data. based on reports received from the governments. summarize the present status of malaria eradication in South-East Asia:

Total population 664.3 million

Population at risk (originally malarious areas) 626.4 million

Population protected 582.7 million Under attack phase 212.1 million Under consolidation phase 276.0 million Under maintenance phase 94.6 million

Population under preparatory phase 9 miilibn Population still unprotected 34.7 million

The major achievements of the programmes have been the expansion of areas under consolidation in Afghanistan, Burma, Ceylon, India and Thailand; the entry of a population of 15.4 million in Jndonesia into the coaaolldatios phase and of 93.1 million in India into the maintenance phase, and the extension of activities in Nepal for spraying in the East Zone and for making preliminary surveys in the West Zone. It is noteworthy that Ceylon is the first eountry in the Region to withdraw spraying from the whole country.

During the year, plans of operations were concluded for a pre-eradication programme in the West kian Province of Indonesia and for malaria eradication programmes in Ceylon and India covering the entire period of eradication,

With the advance of national programmes, WHO assistance is being re-oriented to meet changing needs. Thus, with the entry of more and more SEA/RC17/2 Page 8 areas into consolidation, considerable ~mphasishas been laid on the development of epidemiological services necessary for the surveillance activities of the programmes. With the collaboration of the National Institute of Communi- cable Diseases, Delhi, and the National Malaria Eradication Programme of India, a course on advanced malaria epidemiology was held in the Regional Office for the benefit of senior national malaria officers. Participants from Ceylon, India, Nepal and Thailand and from Pakistan and Iran of WHO'S Eastern Mediterranean Region attended this course. Opportunities were also provided, under the scheme for the exchange of scientific workers, for senior nationals to visit other programmes.

The annual assessment of the Indian programme by a panel of three consultants and nine teams and the methodology of evaluation that bas been thus evolved continued to attract considerable international interest. As mentioned above, independent assessments of the programmes in Afghanistan and Ceylon were also undertaken during the year.

Training of personnel, both professional and sub-professional, formed a major activity. All the countries in the Region which have malaria eradication programmes have training centres for sub-professional staff; however, it has been the experience of most of them that their training centres lack sufficient numbers of full-time national staff with adequate experience to undertake the training effectively. WHO personnel assigned to the programmes continued to assist in the training activities. For all these countries (except India, which has adequate training facilities), the training given to professional staff within the country is supplemented by attendance at international training centres, and WHO has provided felIowships for such training. However, for various reasons it has not been possible for some of the Member Countries to make candidates available for these fellowships.

So far, technical problems have not been a serious hindrance to the overall progress of the programmes. The resistance to insecticides of the vectors A. sundaicus and A. aconitus in Indonesia and A. culicifacies and A. stephensi in India continue to present problems in localized areas: these have been dealt with generally by suitable changes in the method of attack, either by increasing the dosage of DDT or by changing the insecticide, and by a judicious use of drugs through an intensified surveillance organization. In India, antilarval measures, using aviation petrol, have been intensified in urban areas to deal with the vector A. stephensi,breeding in wells. A few instances of chloroquine-resistant strains of plasmodia have also been reported from Thailand and in some of the neighbour- ing countries in the Western Pacific Region, but so far this has not presented any serious problem for eradication GRAPH 3-POPULATION AT MALARIA RISK IN THE AREAS UNDER VARIOUS PHASES OF MALARIA ERADICATION IN THE SOUTH EAST ASIA REGION-1 AUGUST 1962. 1963. 1964

POPULATION (Ylllonrl (SOURCE: GOVERNMENT RETURNS- W H 0 QUESTIONNAIRE I

400

Preparatory Attack Phare Conrotidation Mainternnee Not covered by Phrre Phase Phase ME operations

Populrt!on in mtllionr -

Year Preparatory Attack Consolidation Maintenance Not covered by malaria eradication phase phase phase phase operations

NOTE:

The increase in population not covered by the malaria eradication operations in 1963 is due to (a) thc inclusion of West Irirn, and (b) inclusion of areas in Thailand originally considered non- malariour but subsequently detected at malrriour. Shortage of imported commodities and limitation of national funds have continued to be the major handicaps to country-wide expansion of some of the programmes. In one country, even the sprayiog operations had to be temporarily suspended for lack of funds. Even so, it is gratifying to note,that in spite of the limited financial resources, governments continued to give high priority to malaria eradication in the allocation of national funds.

Assistance in the exchange of technical and operational information and in co-ordinating malaria eradication activities between countries with common borders continued to be important activities of WHO.

The following intercountry meetings were held during the year:

O The Seventh Burma-India-Pakistan Malaria Co-ordination Conference, in Tounggyi (%an States, Burma), from 25 to 27 November 1963.

(2) The Anti-malaria Co-ordination Board Meeting, in Saigon (Viet-Nam) from 10 to 13 December. This conference was attended by delegates from Thailand, Laos, Malaysia, and Viet-Nam and by WHO staff from Member Countries and from the Regional Offices of the Western Pacific and South-East Asia Regions. There were also observers from USAID.

(3) The Third India-Nepal Border Malaria Co-ordination Conference, in Darjeeling (India), from 5 to 6 June 1964.

A significant advance in the evolution of malaria eradication is the entry of a population of 93.1 million into the maintenance phase in India. Prevention of the re-establishment of endemicity in the areas concerned presents a serious challenge to the general health services. The Government of In& has made elaborate arrangements to augment and expand its health services to enable them to meet the vigilance needs required to sustain malaria eradication. This is an experiment that will be watched with great interest by health workers in many countrie s.

In April 1964 a preliminary study was made of the malaria situation in the Maldive Islands, where plans will be made for anti-malaria activities, in collaboration with the existing WHO-assisted project for strengthening public health admjnistration.

L 2 Tuberculosis

The recognition which tuberculosis control is increasingly receiving in all countries of the Region was reflected in the selection of the theme "Case- SEA/RC17/2 Page 10

Finding and Domiciliary Treatment in ruberculosis Control" for the technical discussions held during the last (sixteenth) session of the Regional Committee. The recommendations arising from these discussions underlined the fact that since the onset of tuberculosis is insidious (entailing many difficulties in control), measures invoked to deal with the problem have to be carefully planned so as to obtain the maximum benefit within the resources available, and control programmes must be continued for a long period. Although the discussions centered on finding realistic procedures through which case-finding and treatment programmes would ultimately contribute to control, they also emphasized the continued major importance of adequate BCG vaccination programmes. It was recognized that even the most community-oriented case- finding programme would be of no value per s unless the patients found could be effectively treated. This requirement, it was pointed out, demands an adequate free issue of anti-tuberculosis drugs as well as an extensive treatment organization, which, together with the diagnostic services, could be provided most economically by an integrated programme to be developed along with, and as part of, the general health service*.

Pilot control projects in India, Indonesia and Thailand have reinforced the concept that the establishment of adequate and effective treatment services must take the lead in any tuberculosis control programme. This concept is now generally accepted. Early integration into existing general health services is the aim of the recently started tuberculosis control projects in Rangoon and in the rural districts of Malang in East Java. The district tuberculosis control programme in India is also designed to use to the maximum the general health services in the district as the peripheral extension of the respective district tuberculosis centre. In Nepal, it is pAannedto combat tuberculosis and leprosy in a joint project, with the long-term objective of paving the way for gradual integration of tuberculosis and leprosy control, as well as other communicable- disease control programmes and hLalth measures, into a general health service organization.

WHO and UNICEF have continued to give assistance to BCG vaccination and tuberculosis control programmes in Afghanistan, Burma, India, Indonesia and Thailand,and plans are also in train for WHOIUNICEF co-operation in tuberculosis control prognmmes in Ceylon and Nepal. A WHO short-term consultant visited Mongolia to study the BCG vaccination and tuberculosis control services and to advise on further progress.

In Afghanistan, BCG vaccination of all school-children in Kabul was completed, and arrangements were made to ensure that in future all new entrants to schools and those who leave should bc covered. BCG vaccinations are now being carried out not only in the Tuberculosis Centre but by the maternity home SEA/RCl7/2 Page 11 and the maternal and child health centres in Kabul. The work of the Kabul Tuberculosis Centre was reviewed, and it i3 now intended to expand the ambulatory treatment services throughout the city, with further extension to the adjacent Shewaki District.

In Burma, the integration of the BCG vaccination programme into the rural health services made good progress. A community-oriented tuberculosis control project,designed to give first priority to the expansion of treatment services throughout the city of Rangoon as an internal part of the city's health scheme, has been started Later, when case-finding operations are geared to treatment capacity, it is planned to collect epidemiological base-line data by means of systematic case-finding amongst a randomly selected sample population. It is hoped that a similar control programme may be developed in Mandalay.

In Ceylon, the proposed new riJn+prnjert han for its objective the study of the useful employment of a mobile x-ray unit in a rural area. It is aimed at developing a more satisfactory treatment organization in such areas, at working out methods by which a mobile unit can best be employed for rural ca* finding, and at ensuring that treatment services operate to capacity. Here, as in other cowries of ,the Region, the introduction of freeze-dried BCG vaccine is plamed,in order to overcome the difficulties due to the instability of liquid vaccine.

., , In India, the Tuberculosis Chemotherapy centre in Madras continued with itsvaluable research on effective and economic anti-tuberculosis treatment regimens. The national tuberculosis:programme. is receiving full support and has so Ear been fully imple~aentedin.£ifteen districts, WICEF equipment has been released to 39 districtqwhere specia1ly:trained .personnel are in position . . I... ,.; . ,

1 In Indonesia, the operations at Jogjakarta, (the original urban pilot area) were continued by means of a streamlined mass approach. A similar programme is being started in Surabaja. In the non-urban qrea of Malang Regency in East Java, another pilot project is being planned, with the purpose of making the maximum use of the existing rural hqialfi services for organizing treatment and case-finding. The quality of the J3GG yacoination programme has been improved by the introduction of freeze-dried mine, although expansion to more widespread operations is hampered by administrative difficulties. The WHO inter- country BCG assessment team continued to give assistance in the reorganization of the programme. SEA/RC17/2 Page 12

In Thailand, the rural pilot area project in the north has been completed. Recommendations for an economical and efficient tuberculosis control programme in rural areas are being formulated. In Bangkok, a city-wide case-finding and treatment scheme proceeded according to plan, with the employment of five mobile x-ray units. The question of more permanent tuberculosis control services following the "first round" has been further studied, with the aim of making the maximum use of the health centres and maternal and child health centres already in existence.

1.3 Quarantinable Diseases

The figures of notifications of quarantinable diseases reported for the countries of the Region for the years 1961, 1962 and 1963 are given in the table on the following page.

1.3.1 Smallpox

The year 1963 proved to be a relatively bad year for smallpox in the Region, with epidemics occurring in Afghanistan, India, Indonesia and NepaL Previous epidemic peak years were 1951, 1957 and 1958. In all, 70 545 cases and 19 714 deaths were notified in the Region in 1963 (see table),

In spite of this, tangible progress and encouraging prospects can be recorded. At its sixteenth session, the Regional Committee recommended that the attention of the World Health Assembly be drawn to the urgent need for the supply of freeze- dried smallpox vaccine, and emphasized the necessity of promoting the synchroniza- tion of smallpox eradication activities in adjoining areas of countries where smallpox is endemic (see SEAIRClGIR4 and R8). It also decided to hold technical discussions on the subject of smallpox eradication at its seventeenth session in 1964. The keynote of this programme is the determination of governments to undertake long-term intensive vaccination campaigns, utilizing exclusively freeze- dried vaccine whenever possible - campaigns aimed at the ultimate elimination of the disease from the Region.

Assistance was given in evolving and carrying out smallpox control and eradication programmes, by provision of personnel and freeze-dried smallpox vaccine, either directly by WHO or arranged by WHO from bilateral sources.

The need to establish and maintain an independent organization for appraisal of smallpox eradication programmes has already been stressed earlier in the chapter @age 5). SEA/RC17/2 Page 13

quarantinable Diseases Notified for Countries of the South East Asia Region. 1961 to 1963 (Sources: WHO Epidemiological and Vital Statistics Report, 1963, l6, 279-350, 1964, l7, 153-234)

Typhus and other Country Year Smallpox Cholera Plague rickettsia1 diseases* Cases Deaths Cases Deaths Cases Deaths Cases Deaths

Afghanistan 1961 174 - - - - - 6 - 1962 303 - - - - - 12 - 1963 571 1 - - - - 39 9 Burma 1961 88 5 1 - 41 12 - 1962 21 - 1 - 73 16 - - 1963 18 - 2 481 516 34 16 - Ceylon 1961 34 8 - - - - 39R - 1962 12 4 - - - - 1963 1 - - - - - 2 India 1961 45 204 12 341 48 028 16 436 402 55 ...... 1962 42 478 11 402 25 566 8 671 697 88 ...... 1963** 60 971 19 452 24 ... Indonesia 1961 4 894 ...... 1962 3 582 "' ... - ... T 1963 8 213 ? + ..a .-. t + Nepal 1961 5 2 ...... 1962 t t ...... -a ... .a. 1963 779 261 ...... Thailand 1961 33 ------1962 2 ------1963 - - 2 204 15# - - - -

*Figures generally refer to louse-borne epidemic typhus **Recorded cases and deaths are 69 768 and 21 341 for smallpox, 51 156 and 18 307 for cholera, and 204 and 24 for plague respectively (communication from the EHS, India, 2 July 1964) .Data not available +Data not yet available - -Nil or of negligible magnitude =Revised data aIncludes one imported case %3ther rickettsia1 diseases S~crubtyphus ETft~lTor" cholera SEA/RC17/2 Page 14

Of particular significance has been WHO and UNICEF assistance in establishing or expanding local production of freeze-dried smallpox vaccine in countries of the Region& order to produce the quantities required in the maintenance phase of the programme. The introduction of the shelf-drying technique, with automatic filling and sealing, has made such increased production targets a practicable proposition (see Chapter 4, Vaccine Production).

The WHO-assisted smallpox control pilot project in Afghanistan,which was started at the end of 1962 in Kabul City,was successfully completed, with more than 80% of the population vaccinated. Although outbreaks occurred in the Logar Valley area, which is connected by a main road to Kabul, Kabul itself remained unaffected. In view of the results, the Government decided to embark on a national eradication programme, to be carried out over a period of five years. A WHO medical officer has been assigned to this project, and supplies of freeze-dried vaccine are provided by the Organization.

In Burma, preparatory to planning a country-wide eradication programme, pilot projects were started in Rangoon City and seven districts in 1963. The Government launched, early in 1964, a national long-term programme, utilizing freeze-dried smallpox vaccine supplied by the USSR and WHO. The Burma Pharmaceutical Institute is being assisted by WHO and UNICEF in shifting from the production of glycerinated lymph to that of freeze-dried vaccine.

With respect to Ceylon, a satisfactory immunization state is maintained through the general health services.

In India, from the start of the national smallpox eradication programme at the end of 1962, a total of 224 511 461 vaccinations - 25 484 375 primary and 199 027 086 revaccinations - were performed up to March 1964. At the end of the year there were 150 eradication units working;each unit consist~of72 vaccinators, 12 supervisors, 2 health educators, 1 para-medical officer and 1 medical officer. A total of 450 million doses of freeze-dried vaccine has been donated by the USSR, and much of this has already been received However, the requirements of the programme during 1964 exceeded the amount which could be delivered monthly. As a result of an appeal by the Director-General of WHO, additional supplies of freeze-dried vaccine were obtained early in 1964 from the United Kingdom, the Netherlands and Switzerland. Following the independent assessment of the programme in the Union Territory of Delhi, reported last year, the Indian National Institute of Communicable Diseases,was entrusted, as from September 1963, with the assessment and evaluation of the programme at the end of the attack phase in each district; its findings have proved most valuable. A careful review of the progress of the programme was made at an all-India smallpox workers' SEA/RC1712 Page 15 meeting held in New Delhi in February 1964. The remendations of the first meeting of the WHO Expert Committee on Smallpox held in January 1964 were taken into consideration at this meeting,and useful revisions of the programme were suggested. The national programme has now been extended up to the end of the Third Five-Year Plan period, i. e. until March 1966, with the intention of vaccinating by then over 85-9058 of the population. WHO and UNICEF assistance & the production of freeze-dried vaccine in India is mentioned in Chapter 4.

Emergency vaccination programmes were undertaken in Indonesia to control outbreaks of smallpox as they occurred during the year, moatly in West Jaw. A WHO consultant recommended additional equipment necessary for further production of freeze-dried vaccine in that country.

In Mongolia, smallpox is not endemic.

The vaccination activities in Nepal's smallpox control pilot projact were intensified within the valley of Kathmandu, with greater health education efforts to overcome current prejudices against vaccination. A WHO smallpox control officer assisted the project, and freeze-dried vaccine was supplied by the Organization,

Iq Thailand, the country-wide vaccination campaign is being maintained, with no cases recorded in 1963. The production of freeze-dried smallpox YBCEine in the WO/UNICEF-assisted centre is satisfactory.

-. - 1.3.2 Cholera

The year 1962 was one of relatively low incidence of cholera in India, but, as may be seen in the table given above, it occurred in severe epidemic form in 1963, with a total of 51 (182 notified cases and 18 298 deaths. The following States in particular were affected: Orism (3 91311 421), West Bengal (16 575/5 999), Maharashtra (4 53111 064) and Bihar (6 359/2 049). This necessitated mass vaccination measures and emergency chiorination of the raw water supply in Calcutta City. A most useful all-India cholera workers1 meeting was held in Delhi in November 1963, at which new knowledge on the subject was reviewed; several observers from WHO and other agencies in two regions attanded. Noteworthy were the very encouraging results in Calcutta from the combined use of improved methods of rehydration and antibiotic therapy, as mentioned earlier @, 6) in this report and also described in the WfIO Bulletin (1963)a 297-305. Plans were under way to organize training courses in these techniques at the Infectious Diseases Hospital, Calcutta.for workers from SEA/RC17/2 Page 16 those States mostly affected. WHO is planning an international training course for cholera workers in June 1965, in Calcutta, where the latest developments in epidemiology, patho-physiology and treatment, as well as in prevention, will be reviewed.

The concern over the spread of cholera El Tor in the Western Pacific and South East Asia Regions has been referred to earlier @. 5). During the year, a WHO consultant was assigned to review the present situation in the countries affected. Outbreaks occurred in 1963 in five provinces of Thailand, in Djawa Tengah (Indonesia) and in five districts of Burma The facilities established in Calcutta at the Indian Institute for Biochemistry and Experimental Medicine proved most helpful in constituting a reference centre for various countries for phage-typing in the differential diagnosis between strains of classical cholera and of El Tor vibrios.

At the sixteenth session of the Regional Committee, We desirability of ascertaining the degree of effectiveness of vaccination for classical cholera and for cholera El Tor was expressed. In this connection, a controlled field trial of cholera vaccine was started in Calcutta in March 1964 as a joint undertaking of WHO, the Government of West Bengal and the Indian Council of Medical Research (see Chapter 8).

Pending further research, the Organization has recommended that the countries concerned concentrate their efforts on the following practical actions to combat cholera:

(1) Management of cholera: The modern management of cholera based on the combined use of rehydration and antibiotic therapy, referred to above. should be made available ti all concerned, by (a) establishing a national centre (or centres) for the treatment of cholera in each country, @) organizing in such centres national training courses for medical personnel and auxiliaries, and (c) establishing the production of rehydration fluid of approved quality, properly packed, so that it can be readily and easily used not only in hospitals but also in the field. These measures will facilitate and improve the present standards of treatment .and considerably lower the high fatality rates.

(2) Sanitation: Although sanitation, particularly the provision of an adequate and safe water supply. is a long-term and costly undertaking, this is certainly the most effective measure for cholera control available at present. In national programmes and projects for sanitation, high priority should be given to all those areas where cholera is endemic. SEA/RC17/2 Page 17

(3) Other measures: Other measures such as immunization and quarantine should be more vigorously pursued than in the past.

1.3.3 Plague

In Asia, plague was reported from three foci, all already known - i. e., in South-Central India, Burma and Viet-Nam.

In India, cases of human plague continued to occur in adjoining districts of Mysore, Madras and Andhra Pradesh, notwithstanding the control measures in operation. The statistics are as follows:

States 1961 -1962 1963 1964 (Jan. - April)

Mysore (Kolar, Bangalore) Cases 383 5 73 120 . 5 Deaths 48 66 11 3

Madras (Salem, Coimbatore) Cases 18 105 33 46 Deaths 6 20 , 7 1

Andhra Pradesh (Chittoor) Cases 19 51 46 Deaths 2 6 Y)

A11 States Cases 402 697 205 97 Deaths 55 88 24 14

The responsibility for co-ordinating investigations and control in these three States of India is now that of a team of the National Institute of Communicable Diseases, Delhi. The first co-ordinating meeting on plague, attended by WHO, was held in October 1963. Early in 1964 a WHO consultant assisted in the study of factors responsible for the persistence of plague in South India; he successfully isolated P.pestis from field (wild) rodents or their fleas in some of the affected zones (see India 198 in Part III).

In Burma, a few cases occurred in the Mandalay (Myingyan) District. SEA/RC17/2 Page 18

In Indonesia, no cases have been notified since 1960. During the year, anti-plague services ceased to be a separate division of the Cepartment of Health and were integrated into the epidemiological services.

In view of the persistence and possible reactivation of natural foci in countries of the Region, in particular Burma, India and Indonesia, the need for vigilance, research and search for sylvatic foci becomes more evident each year, the more so in view of reports of alarmingly increasing uncontrolled rat infestations. Regarding the latter, greater collaboration with the Ministries of Agriculture is urgently indicated.

1.3.4 Typhus

Cases of louse-borne typhus were reported from Afghanistan. The Government is aware of the risk of outbreaks, especially among the migrating population groups, and of the need to conduct tests on the resistance of human body lice to insecticides and also to keep vigilant for any notification so as to enable prompt action.

1.4 Other Endemo-epidemic Diseases

1.4.1 Bacterial Diseases

(1) Leprosy

The magnitude of the leprosy problem has already been referred to above (page 3). Sulphones are the main arm of anti-leprosy campaigns, but treatment must be continued in some cases for as long as three to six years. WHO assessment teams in Burma and Thailand have observed that because of the prolonged treatment required, the regularity of treatment decreases with the length of treatment: 70% or 80% of patients may be regular in the first year, but as the years go by this proportion drops greatly unless there are constant supervision and follow-up. This is the most difficult part. Therefore, these assessments serve as caution against expanding the campaign too rapidly to new areas without ensuring consolidation and maintenance of achievements in the original areas of operation, by further case-finding, contact-tracing and follow-up of regularity of treatment. With this in view, Burma, India, Indonesia and Thailand have renewed their provisions for long-term plans, giving priority to strengthening anti-leprosy activities in areas of high prevalence by means of more and better trained personnel, both senior and auxiliary. Afghanistan has planned to undertake a preliminary survey of the leprosy problem in the Hazarajat area with the assistance of a WHO consultant leprologist. SEAlRC1712 Page 19

Although campaigns will still need to he carried out by special workers, more thought and action are needed to co-ordinate the work with that of the general health services. The latter should, whercver feasible, help in the treatment of leprosy cases and also follow up patients living within a reasonable radius from a health centre. However, these activities should not be handed over all at once or to personnel who are not well prepared.

WHO-assisted campaigns in the four countries mentioned above - Burma, India, Indonesia and Thailand - continued to evolve along technically agreed lines, and the personnel assigned by WHO (leprologists, consultants and a leprosy advisory team), and supplies and transport from UNICEF have been increased.

In Burma, a WHO leprosy advisory team assisted in an evaluation of the programme. Considerable progress was notedgs evidenced by the fact that the number of cases under treatment rose from 46 000 in 1958 to over 114 664 at the end of March 1964; of these, 88 216 were in 14 districts of the thirteen WHO-assisted project areas. Case-finding, contact-tracing and treatment were intensified. Additional leprosy medical officers and auxiliaries were recruited and trained for appointment to existing project areas and to new ones to be opened. A WHO leprologist continued to assist the project, and, in view of the increase and extension of activities, the services of a second such leprologist have been arranged In April 1964, a WHO team began assistance in a long-term trial of BCG in the prevention of leprosy (see Chapter 8).

In India, the national cxpzrt committee on lcprosy made a critical review of the achievements and difficulties encountered and prepared a priority plan of action,designed to intensify leprosy control activities in areas with the highest prevalence, principally in the States of Madras, Andhra Pradesh and Orissa, and to open ten additional training centres for thc purpose. The number of WHO Ieprologists was increased from two to three, and UNICEF gave additional support to the field activities and training centres. The Danish "Save the Children" Organization's leprosy control project in Srikakulam District of Andhra Pradesh, India, which is also being assisted by WHO, has progressed satisfactorily. From a total of 81 patients in attendance at the start of the project in January 1962, the number of registered and treated cases rose to 15 283 in April 1964. The estimated number of leprosy cases in the project area is between 20 000 and 25 000. Expansion to new districts is under consideration.

An assessment of the WHOassisted leprosy control programme in Indonesia indicated satisfactory progress in Java and Bali, where activities have been integrated into the general health services. Programmes in Sumatra and the SEA/RC17/2 Page 20

uuter islands are at an early stage of development. A WHO leprologist is assisting with the project, and it is planned to extend the provision of UNICEF su2plies and equipment to 192 regencies in fifteen provinces by tho md of 1965.

Following a visit by a WHO consultant leprologist to Nepal, preparations h~vebeen made to start a combined leprosy and tuberculosis pilot control proj6ct in the ~ithmanduValley.

In Thailand, based on recommendations made by the -WHO leprosy assessment team in 1962 and by a 'WHO consultant leprologist in 1963, the leprosy control programme was satisfactorily strengthened in all areas of operation. WHO has increased the number of its personnel from four to five, and the Government has appointed additional senior and auxiliary staff. The programme now covers a total of 26 provinces, in addition to the Bangkok, Thonburi and Prapradaeng areas.

The past year has been one of maintained surveillance to detect and control any remaining foci of yaws in Ceylon, India, Indonesia (Java and Bali), and Thailand. However, yaws remains a public health problem in some islands of the Indonesian archipelago other than Java and Bali, and UNICEF has provided supplles to ~na~ea total mass treatment programme possible.

In Thailand, after a period of thirteen years of determined mass treatment, yaws has now been reduced to an insignificant level. An equally great achievement is the integration of yaws surveillance into general health services in all the 45 provinces in which yaws has been endemic. WHO assistance has been directed to another project concerned with the strengthening of rural health services, starting on a pilot basis in a selected province.

(3) Venereal Diseases

Venereal diseases - syphilis and gonorrhoea in particular - remain a growing problem in the principal cities of the countries of the Region. Partly responsible is the scarcity of doctors wo'king in venereology; also, the extent of the problem, which continues to be masked by indiscriminate and inadequate use of antibiotics, is not sufficiently appreciated; there is also a shortage of suitable preparations of penicillin in some countries; diagnostic laboratory facilities and follow-up are often inadequate, and there is insufficient co-ordination between the anti-venereal disease. services and maternity and child health services, with the consequence that congenital syphilis is still seen in paediatric wards. SEA/RC17/2 Page 21

In April 1964 a WHO consultant was assigned to assist in a study of the nature and extent of venereal diseases in Thailand. He advised on practical control measures. A WHO laboratory technician continued work on the upgrading adexpansion of diagnostic laboratory services. Another consultant was assigned to Ceylon in July 1964 to introduce and demonstrate immuno-fluorescence techniques in diagnosis.

(4) Diarrhoeal Diseases

The morbidity and mortality caused by diarrhoeal diseases in the Region remained unchecked. In Ceylon, for example, 20% of all hospital beds continued to be occupied by patients suffering from intestinal infections, which also caused 24% of the deaths among children under five. The problem is indeed a formidable one, intimately linked with wide-spread insanitation. h-iority approaches to the prevention, treatment and control of enteric diseases have to be developed by each country. Epidemiological investigations need to be carried out,to determine and guide on a realistic &lance between programmes for prevention of disease and prevention of mortality. Educational programmes, especially guidance as to weaning practices, through maternity and child health services and peripheral health centres, should be more actively pursued, the people at the same time being made aware of the need to seek medical attention in the early stages of illness. This in turn calls for greater organization and improvement of oral and parentera1 rehydration centres.

In Ceylon, a WHO bacteriologist assisted in the improvement of diagnostic services in diarrhoea1 diseases at the Infectious-Disease Hospital and other hospitals, as part of a diarrhoea1 diseases study and control pilot project in the Colombo area.

In India, studies on the subject were continued,uoder the sponsorship of the Indian Council of Medical Research,in Delhi and in Vellore.

In Indonesia, the results of surveys conducted by the University of Djakarta are being processed and analysed.

On WHO fellowships, participants from the Region attended the WHO I\raining Course on Enteric Infections held in Teheran in1963 andthe me given in Alexandria in 1964.

(6) Diphtheria. Whooping: Cowh and Tetanus

In all countries of the Region there is a growing awareness of the importance of this group of diseases. Reliable data are not available, but recenUy limited, but well-planned, epidemiological surveys and studies of hospital statistical data SEA/RC17/2 Page 22

have been started in Ceylon, India, Indonesia and Thailand, to determine the nature and extent of these diseases and to define the most susceptible age- grqs and the most practical and economical immunization schedule. Ceylon decided to start a systematic diphtheria, pertussis and tetanus immunization programme in the Western Provinces, and Burma in the Rangoon area, in the first instance, both with WHO and UNICEF assistance. Burma, India, Indonesia and Thailand are actively planning to establish or increase local production of triple vaccine, in anticipation of further immunization programmes, but critical epidemiological and immunological studies need to be carried out urgently.

(6) Streptococcal Infections and Their Sequelae

With improvements in medical care, the importance of rheumatic fever, rheumatic heart affections and glomerulo-nephritis and their association with sbrep~aco~7-1 infections are being increasingly noticed. A more critical appraisal throuefi a study of hospital and laboratory data is indicated, along with education of the medical profession and the public.

1.4.2 Virus Diseases

(1) Trachoma

The experience of previous pilot studies on trachoma and associated bacterial conjunctivitis and results of their treatment have enabled the development of a practical methodology for mabe treatment, applicable to countries of this Region. However, the difficulties inherent in any control programme relating to a mass disease affecting populations living in insanitary and overcrowded conditions, and often not provided with adequate basic health services, are being increasingly realized. The continuation of such programmes on a long-term basis is prwing logistically and financially difficult. The present approach is therefore to try to induce the people themselves to participate actively in their own treatment from the very beginning, by making attractively-priced antibiotic ophthalmic ointment available on the local market, and to persist in attempts to change habits and attitudes by means of health education of the people.

In Afghanistan, following the training of national ophthalmologists and other workers on WHO fellowships, the Government has started a trachoma control pilot project in Herat Province, to which WHO has assigned a consultant and has provided transport and drugs. SEA/RC17/2 Page 23

In India, the pilot skgcs of projects in two States were completed, andron the basis of the experience gained, the Government decided to embark on a national trachoma control programme in the States of Punjab, Rajasthan, Gujarat and Uttar Pradesh, where trachoma and bacterial conjunctivitis occur in hyperendemic forms. Intensive training of medical officers and auxiliaries was carried out. A WHO trachomatologist has continued to assist in this work, and UNICEF has provided the necessary transport and drugs.

In Thailand, the WHO-assisted trachoma control pilot project in the North-Eastern Provinces showed that it would be possible to establish an economical control programme leading to self-treatment by the population with ointment provided by the Govenunent at subsidized prices, and an expansion on this basis was therefore undertaken. UNICEF gives supplies and equipment for this programme as well.

(2) Poliomyelitis

Immunological surveys and strict notification of paralytic poliomyelitis are essential to forewarn governments of changes in the epidemiological picture. This has been amplified earlier @. 5). The Organization can assist in forwarding to WHO reference laboratory centres the sera necessary for these surveys.

Following the outbreak of poliomyelitis in Ceylon in 1962, a national immunization campaign was started in May and July 1963,to protect children in the age-group 0 - 8 years as rapidly as possible,with two doses of stabilized live attenuated oral polio vaccine: 81.6% of the children were immunized in the first round but only 66.9% in the second round. In 1963, a further 166 cases of paralytic poliomyelitis were recorded, giving a morbidity rate of 1.6 per 100 000, with 90% of the cases occurring among children under eight years of age. In 1963, the highest incidence vras in Batticaloa and Jaffna, whereas in the Vavuniya area, which in 1962 had the highest incidence (73.41100 000) and had the most successful immunization programme, there was only one case in 1963. There is now urgent need to make a critical assessment of this immunization programme, the first of its kind in this region, so as to benefit from the lessons learnt and to advise on further immunization of susceptible age-groups and of areas requiring further attention.

In India, the Enterovirus Unit of the Indian Council of Medical Research continued immunological studies in various urban and rural communities, Satisfactory progress was ma& in the establishment of production facilities for oral polio vaccine at the Pasteur Institute, in Coonoor, South India. WHO SEAIRC1712 Page 24 fellowships were given for training in ~roductionand in virologic and neuro- virulence testing, The first batches of oral polio vaccine are expected to be produced in the second half of 1964, and WHO has agreed to assist in the testing of the seed virus and the first batches before the vaccine is released.

In Mongolia, a limited outbredt of poliomyelitis occurred in 1963 in Ulan Bator and some of the main towns in the provinces. The WHO epidemiological team which is carrying out serological surveys for brucellosis in Mongolia has started utilizing these surveys for a simultaneous study of the immunological levels of poliomyelitis in the population in various parts of the country, in coIlaboration with a WHO reference laboratory.

(3) Dengue and Haemorrhagic Fever

There are many so-called hemorrhagic fevers in the world, a number of which are of recognized arbovirus aetiology. The haemorrhagic fever reported here is a very severe and frequently fatal syndrome caused principally by members of the dengue virus complex, but quite certainly not by a single immunological type of this complex In some of the same areas a disease closely resembling this, but probably never or rarely fatal; is caused by chikungunya virus and possibly by other viruses not yet isolated. The severe disease is due to agents of the dengue virus complex, transmitted principally, if not entirely, by Aedes aemti in urban areas. Chikungunya virus has been isolated most frequently from A. aesrpti and occasionally from Culex quinauefasciatus (fatigans).

Haemorrhagic fever was first described as an epidemic disease syndrome in Manila in 1954. In 1958, a major epidemic occurred in Bangkok (with about 3 000 hospitalized cases and 300 deaths),and subsequently there were many urban epidemics throughout Central and South Thailand. The largest one occurred in 1962 in the Bangkok areqwith about 6 000 hospitalized cases. The year 1963, which was expected to be one of minor incidence in the usual sequence, turned out to be a major one, with 1 500 hospitalized cases and 150 deaths in the Bangkok area; substantial numbers of cases were still occurring in early 1964. Haemorrhagic fever has recently also involved Singapore, Penang, at least two areas in Viet-Nam, including Saigon (1963), and Calcutta in the second half of 1963. A dengue-like epidemic also occurred in the Rangoon area in July 1963, reaching its peak in August and tapering off from September onwards.

In Thailand, viruses of dengue types 1, 2, 3, 4, 5 and 6,and probably others, have been isolated from patients and/or mosquitoes (A. aemuti). Chikungunya virus causing disease in the same epidemics has also been isolated in Thailand. In the 1963 Calcutta epidemic, both dengue viruses and chikungunya virus were active: here haemorrhagic fever appeared in a severe and fatal form among adults as well as in infants and children, thus revealing that its potential SEA1 RC17/2 Page 25 for causing morbidity and mortality was even greater than was previously recognized in areas to the east, since in Thailand only children and infants had been affected. The Rangoon epidemic was due to either classical dengue or chikungunya viruses, more probably the latter.

As a result of making a study of the epidemiological trend of haemorrhagic fever in the Western Pacific and South East Asia Regions, as described above, a WHO consultant concluded that, under modern conditions of transport and in areas of unrestricted Aedes aegvpti breeding,viruses of the dengue-complex had become endemic and epidemic in a rapidly growing pattern now extending through major ports from Manila to Calcutta. He found the disease presenting a pattern and threat essentially similar to urban yellow fever, to which it is closely related epidemioiogically (vector and host cycle), aetiologically (arbovirus group B) and pathologically (liver pathology and liver function tests). The consultant recommended that cases of haemorrhagic fever caused by viruses of the dengue complex should be made reportable nationally and internationally and that much stricter disinsection be enforced at ports and airports. It is not possible to recommend vaccine prophylaxis at this time, since none is available. He suggested that before attempting large-scale general control, it would be wise for each municipality to set up one or more field control areas to obtain epidemiological and immunological information and to determine the most effective and economical method or methods for vector control in their particular areas. By the term "control", eradication is not implied and is probably not a reasonable goal for the near future; control itself will be difficult enough.

An Aedes aemti pilot control project has now been started in a selected area of Bangkok (see Thailand 70 in Part UI).

It is planned to advance the Inter-Regional Seminar on Haemorrhagic Fever from 1965 to 1964,on the recommendation of the laet seesion of the Regional Committee. It is to be held in October. . in Bangkok (4) Other Arbovirus Infections

The viruses causing the arthropod-borne encephalitides, such as Japanese B encephalitis (JBE); fevers with and without rash and sometimes with arthralgia, such as dengue, West Nile, phlebotomus and chikungunya; the haemorrhagic fevers,such as Kyasanur Forest disease and haemorrhagic fever of the dengue group complex as described in (3) above, are all being gradually unravelled in some countries of this region, notwithstanding the limited virological diagnostic facilities. SEA/ RC1712 Page 26

In India, the laboratory of the Virus Research Centre, Poona, continued its epidemiological studies on Japanese B encephalitis and West Nile infections, which were first confirmed in 1956 in South India. The hope that Kyasanur Forest disease, at least as a human disease, was dying out has not been sustained in the last two years; new cases have occurred A study of cases in human beings and monkeys indicates that this disease seems to be slowly spreading southwest of the hitherto known infected area in Mysore State. The reasons why such a centrifugal spread is not also taking place in other directions are still not understood, and Kyasanur Forest disease remains a public health problem of unaeeeesable importance.

In Ceylon there was an increase in the number of cases of encephalitis admitted to the Children's Hospital, Colombo, in the first quarter of 1964; during the period from 1957 to 1963, on an average,l3O cases were treated annually in that hospital. During the same period (1957-1963) the average of cases treated annually in all government hospitals was 245, and the incidence of the disease appears to be increasing. Rising titres against a number of arboviruses were demonstrated in paired sera from cases of "influenza". Serological surveys, as well as specimens of blood from cases of encephalitis, have also revealed the presence of Japanese B encephalitis antibodies in high titre.

Encephalitis cases in young adults and adults are relatively frequent in Bangkok. Serological studies have shown a significant rise of antibody level to Japanese encephalitis virus in many of these cases.

(5) Respiratory Viruses

A collaborative study in this field is described in Chapter 8 (Assistance to Research).

1.4.3 Parasitic Diseases

(1) Filariasis

Filarial infections continue to cause increasing concern in Burma, Ceylon, India and the south of Thailand The present difficulty in the control of -Culex fatigans and in mass treatment and prophylaxis has been discussed in earlier sessions of the Regional Committee. Satisfactory machinery for large- scale special control campaigns remains to be evolved. Anti-larval measures with oiling and drainage, along with chemotherapy, particularly for early overt SEA/RC17/2 Page 27 cases of fihbsis, are valuable. In the meantime, research through pilot projects and the building up of trained medical officers, entomologists and ancillary staff should be pursued. Recruitment of WHO epidemiologists and entomologists for filariasis projects in Burma, Ceylon and Thailand has been greatly handicapped by the world shortage of these specialists.

In Burma, the WHO Filariasis Research Unit carried out valuable work on the ecology and bionomics of mosquito vectors of filariasis in the Rangoon area. This is described in Chapter 8.

In Ceylon, a WHO consultant reviewed the present problem of W. bancrofti filariasis in the coastal belt and advised on further parasitological and entomological surveys and on chemotherapeutic trials.

In India, filariasis surveys were carried out in 1963 in Assam, Andhra Pradesh, Madhya Pradesh, Laccadive, Minicoy and Amindivi Islands, Goa and Cochin' Port. A pilot project for the control of B. malayi infection in Kerala State is proposed in 1964, and the prospects of control through residual insecticide house spraying against adult mansonoides and chemotherapy are encouraging. Control of W. bancrofti remains baffling, mainly because it depends on proper disposal of sullage and improvement in sanitary conditions, and such improvements remain beyond the reach of this region today.

(2) Dracontiasis (Guinea worm)

Attention was drawn last year to an important public health problem caused by Guinea-worm infections in India, which are endemic in large areas of Rajasthan, Maharashtra, Andhra Pradesh, Madras, Madhya Pradesh, Mysore, Punjab and Jammu and Kashmir States. It is roughly estimated that at least five million people are at risk in these endemic areas, the worst area affected being Udaipur District in Rajasthan. An agreement has been reached by the Government, WHO and UNICEF for the development of a rural water supply project in that district as a spearhead for an integrated environmental sanitation programme, and aiming, among other things, at the control of Guinea-worm infestation.

(3) Bilharziasis

Only two foci of bilharziasis - both limited in size - are known to be present in the Region - one in South Thailand due to S. japonicum, and the other in Gimvi, Maharashtra State, India, due to S. haematobiurn.

Three bilharziasis infections are being studied, in particular, by the Faculty of Tropical Medicine in Thailand: (i) S. japonicum, which affects some people in locallzed area of Nakornsrithamaraj Province; (ii) S. spindale, a SEA/RC17/2 Page 28 natural parasitic infection of cattle and water buffaloes which causes cercarial dermatitis in man in the northeast, and (iii) Ornithobilharzia harinasutai, recently found producing S. mansoni-like eggs in water buffaloes in South Thailand.

Surveys of bilharziasis carried out during the year in the Punjab State of India by a team of the National Institute of Communicable Diseases, Delhi, proved negative.

The diseases of man transmitted from domestic animals and known or suspected to be present in the Region would constitute a long list, including rabies, brucellosis, tuberculosis, hydatid diseases, anthrax, leptospirosis, Q fever, psittacosis and trichinosis, to mention a few. Yet our knowledge in this region is insignificant. There is need for fuller reporting of morbidity in man and in animals and for closer co-ordination of efforts between the respective public health, veterinary and agricultural services. Health departments are consequently feeling the need for veterinarian services.

In Ceylon, a veterinary public health officer works within the Department of Health and closely with the Epidemiological Unit. Such an arrangement would be appropriate in other health departments as well. During the year, preparations were made to launch an anti-rabies immunization scheme in dogs, using an avianized vaccine.

In India, studies on pathogenesis and immunization in rabies were continued at the Pasteur Institute, Coonoor, and at the Central Research Institute, Kasauli, with assistance provided under the WHO research programme. Surveys of brucellosis were also started by the National Institute of Communicable Diseases in Delhi.

In Mongolia, brucellosis and hydatid diseases are major public health problems. The work of the WHO epidemiological team, which includes a veterinary public health officer, is described in Part ILI (see Mongolia 1).

In Thailand, vigilance for leptospirosis, trichinosis and anthrax is maintained through surveys and co-operation with the Departments of Health, Agriculture and Livestock and the provincial authorities. SEA/ RC17/2 Page 29

2. EPIDEMIOLOGY

Until very recently, the teaching of epidemiology has been incidental to the teaching of specific disease control and has not been recognized as a discipline in its own right having the closest association with all public health activities. Teaching has also suffered,because the most important supporting services of epidemiology, namely microbiology and health statistics, have so far been in an embryonic state of development. The result is gaps in the . knowledge of basic facts concerning a number of problems amenable to solution, as mentioned in Cha~ter1 of this report. It is considered that the teaching- of epidemiology, as far as countries of this region are concerned, should aim at imparting knowledge and confidence in modern epidemiological approach and method, and should be carried out in the field, laboratory and hospital. It is therefore gratifying to report that the National Institute of Communicable Diseases, Delhi, inaugurated- its first training course in epidemiology along these realistic lines in July 1984. WHO assistance in microbiology, epidemiology, entomology and health statistics is being provided, to help in the development of departments in these fields and to strengthen the teaching.

A WHO consultant visited eight States in India, to which national medical officers trained on WHO fellowships in epidemiology had returned and where they had been appointed,to Epidemiological Units at the Directorate of Health level. He reviewed developments in these services.

Assistance was provided to the Microbiological Department of the Public Health Institute, Kabul, so that it might give more effective help to the Epidemiological Unit in the Institute.

In Burma, WHO has provided the services of a statistician and a microbiologist to support the Epidemiological Unit, which is now under the direction of an Assistant Director (Epidemics).

The Epidemiological Unit,set up in Ceylon, previously assisted by WHO, continued its epidemiological studies and the assessment of the poliomyelitis immunization programme.

In Indonesia, WHO assistance was completed. In addition to the Epidemiological Unit in the Ministry of Health, new epidemiological centres were established in Bali and in the provinces of Java. The Unit was engaged in the study of outbreaks of cholera El Tor and smallpox, and assisted in the planning of future investigations of diphtheria, pertussis and tetanus. SEA/RC17/2 Page 3b

The WHO epidemiological team which was sent to Mongolia has, in its first year of work, established co-ordination with existing laboratory and veterinary health services and helped to initiate surveys on brucellosis in man and in domestic animals. It plans to carry out epidemiological and immunological surveys for other prevailing communicable diseases, such as poliomyelitis (see Chapter 1).

The Epidemiological Unit set up within the Division of Communicable Diseases in Thailand undertook, in particular, studies on haemorrhagic fevcr.

During the year, several fellowships were awarded to countries of the Region for participation in seminars on epidemiology, respiratory virus diseases, rabies and diarrhoea1 diseases.

3. HEALTH LABORATORY SERVICES

The organization of laboratories in the Region is not satisfactory. A few institutions offer a high standard of services and research work, but most laboratories remain poorly staffed and equippeaand their work is of an un- acceptable standard. WHO continued to promote and support an integrated national health laboratory service, on the lines recommended in the Third Report of the WHO Expert Committee on Health Laboratory Services (Technical Report Series No. 236, 1962).

In Burma, the Ministry of Health is reorganizing the national laboratory services,following a scheme prepared by a local committee.

In India, the importance of organization of laboratories, with regard to medical care, public health,and teaching in medical colleges and in schools for laboratory technicians, was emphasized at the annual meeting of the Indian Council for Medical Research and by the Central Council of Health.

In Indonesia, the Government has prepared a plan for the strengthening of laboratory services in Java,which aims at developing a central public health laboratory and a public health laboratory in every province. The central public health laboratory will give technical (methodology) and material (diagnostic sera, standard strains, etc. ) support to thc provinciql public health laboratories and will control and co-ordinate their activities,

In Thailand, there has been further development in virological diagnostic facilities and research. Reorganization of the health laboratory services is being considered. SEAlRC1712 Page 31

The WHO Regional Office, strengthened by the appointment of an Adviser on Health Laboratory Services, continued to assist the development of health laboratory activities in three directions - towards organization, training and technological activities.

In Afghanistan, a WHO microbiologist and a laboratory technician assisted in the establishment of a Microbiology Department at the Public Health Institute, Kabul- Supplies and equipment were provided by UNICEF for this department as well as for the further upgrading of the central public health laboratory in that city.

In Burma, a WHO microbiologist was assigned to assist the laboratory services in Rangoon and later sent to the lzboratory at the General Hospital, Mandalay.

In Ceylon, there are centralized laboratory services under the direct responsibility of a Deputy Director of Health, who is also the Director of the Medical Research Institute, which operates as a central health laboratory. A well organized School of Medical Laboratory Technology in Colombo, which received WHO assistance until 1961, is now training high-grade laboratory technicians, including fellows from other countries of the Region. A WHO bacteriologist has helped to establish diagnostic facilities, especially in the field of enteric infections, at the InfectiousDisease Hospital, Angoda, and in another hospital, as part of the investigations of the Diarrhoea1 Diseases Project (Ceylon 66).

h India, a WHO microbiologist was assigned to the Department of Microbiology of the NatlonalInstitute of Communicable Diseases, Delhi. A request for assistance in the development of training facilities in laboratory technology in two medical institutions in India was followed up.

In Mongolia, a WHO consultant assessed laboratory facilities in Ulan Bator and in the provinces and made recommendations for upgrading them. Fellowships in microbiology, including virology, were awarded.

In Nepal, the Regional Office assisted in the planning of a new laboratory in Kathmandu.

During the year, the Regional Office awarded a total of ten fellowships in bacteriology, clinical pathology, serology, and hboratory techniques, including water and food analysis. SEA/RC17/2 Page 32

4. VACCINE PRODUCTION

Appreciable assisrance has been given by WHO and UNICEF in helping to establish or expand facilities for producing the following vaccines for the immunization programmes in operation or in planning: freeze-dried smallpox, diphtheria-pertussis-tetanus, and oral live attenuated poliomyelitis vaccines. WHO also assisted in the independent testing of vaccines being iocaily produced.

UI Afghanistan, a WHO bacteriologist continued to assist the Vaccine Institute, Kabul, and UNICEF provided additional equipment needed to increase the quality and quantity of smallpox, rabies, 'TAB and cholera vaccines under production. Preparations were started for the establishment of a vaccine control section at the Public Health Institute, Kabul.

In Burma, -WHO consultants recommended additional equipment to help shift over from glycerinated lymph to freeze-dried smallpox vaccine and to start the production of diphtheria-pertussis-tetanus vaccine at the Surma Pharmaceutical Institute, Rangoon.

In India, a WHO consultant advised on the suitability of four vaccine institutes to undertake the production of freeze-dried smallpox vaccine. The shelf-drying technique, with automatic ampoule-filling and sealing, has been introduced in order to bring the output of freeze-dried smallpox vaccine up to 120 million doses a year as from 1965; this will help to meet the country's total requirements for the maintenance phase of smallpox eradication. Additional equipment was supplied to the Central Research Institute, Kasauli, to enable them to increase the quantity and quality of their diphtheria-pertussis-tetanus vaccine. As stated under Section 1.4.2(2), the Pasteur Institute, Coonoor, is expected to produce the first batches of oral poliomyelitis vaccine in the second part of 1964. UNICEF, on be advice of WHO, is assisting the BCG Vaccine Laboratory, Guindy, Madras, in the production of freeze-dried aCG vaccine.

In Indonesia, WHO consultants recommended additional equipment to increase the production of freeze-dried smallpox vaccinc and of diphtheria- pertussis-tetanus vaccine at the Bio Farma Institute, Bandung. UNICEF has agreed to providc equipment.

In Mongolia, a WHO consultant advised on the upgrading of vaccine production facilities at the Sanitary/Bacteriological Institute, Ulan i3ator.

A fellowship is being awarded to a Thai medical officer for training in the production of diphtheria-pertussis-tetanus vaccine. SEA/RC17/2 Page 33

5. HEALTH STATISTICS

There has been notable progress in the field of health statistics in the various countries of the Region during the year under review.

National Committees on Vital and Health Statistics or their squivalents were formed in two countries. In India an advisory body called the National Council on Population was formed in 1960: this now has three sub-committees. dealing with demography, vital statistics and health starnos respectively. The sub-committee on health statistics was formed in 1964. In Nepal, a N8thkal Committee for Yital a~$Health Statistics was m~tib&d by the Ministry of Planning. Its Chairman represents the Ministry, and members include representatives of the Departments of Health, Statistics, Education and Legal Affairs.

The publication of available health statistics by the countries of the Region as part of their annual health reports, or separately, is still far from complete. During the year under review, the Director of Health Services, Ceylon, published his Administration Report for 1961-62; the Director-General of Health Services, India, issued "Health Statistics of India, 1958"; the Directorate of Health Services, Punjab, brought out a booklet , "Health Statistics, 1962"; the Department of Health, Thailand, published "Health Progress, 1961-62". and the Ministry of Public Health, Thailand, issued the fourth edition of "Public Health in wl', which presents a series of health data, up to and incl* the year 1962. Among the countries which do not publish annual health reports, three were able to supply health statistics data for the WHO Supplement to the Second Report on the World Health Situation, 1961-1962.

As it has been considered that an up-to-date manual on the subject of annual health reports would stimulate activities in this field, a revision of WH@s "Manual of Instruction for the Preparation of Annual Health Reports*' is under preparation.

The collection of hospital statistics continued to &prove in coverage and scope in various countries. In Afghanistan and India (West Bengd), the collection and processing of in-patient morbidity statistics were maintained. In Burma and Thailand, approximately 25% and loo%, respectively, of the hospitsl beds of the medical services were covered by a modern reporting scheme for in- patient morbidity statistics, and improved systems for the collection of administrative statistics of the hospitals were introduced. These activities were assisted by WHO. In Ceylon, the procedures for the collection of in-patient morbidity statistics were revised, with a view to obtaining more detailed data. In Nepal, the collection of administrative statistics from hospitals in Kathmandu Valley began in April 1964. In order to improve the quality of morbidity statistics and of patient care, medical record departments in major hospitals were planned, established or consolidated in most of the countries of the Region. The training of medical records officers continued at the Christian Medical College, Vellore (India), and a similar course, sponsored by WHO, was started in Bangko!~in June 1964.

The recording and collection of relevant data for the assessment of activities of the rural health services has continued to be a problem for most countries in the Region, and this is being accentuated by the integration of various specialized disease-control programmes into the general community health services. With WHO support, some progress has been made in designing generally suitable maternal and child health records and reports. In addition, the Regional Office is developing records and reports for leprosy control programmes, and, with -WHO assistance, a similar system is being worked out for programmes of tuberculosis control.

Want of completeness of vital statistics registration rdsa problem in several countries of the Region, as reflected by the documentation and discussions at the ECAFE-sponsored Asian Population Conference held in Delhi in December 1963, at which WHO was represented. The lack of reliability of vital statistics data makes simple assessment of important social and health programmes difficult.

In Burma, steady progress is being made towards complete vital statistics coverage of the urban population. A new registration scheme has been introduced in 72 out of 78 townships. The Vital Statistics Section in Rangoon was transferred from the Ministry of Health to the Central Statistics and Economics Department under the Ministry of Planning. In India, the Registrar General issued a report on the study of "Default in Submission of Returns by Vital Registration Units in Rural Areas of Gujarat State (1962)". Other States were encouraged to undertake similar studies. The State of West Bengal has published vital statistics for the years 1961 and 1962. In Nepal, the development of a vital registration system was entrusted to the Central Bureau of Statistics of the Ministry of Planning. In April 1964, the Bureau initiated birth and death registration on a trial basis in one township and two villages (aggregate population 34 000). Here, certificates of vital events are to be signed by the chairman of the community council concerned, and copies of the certificates are sent directly to the Central Bureau of Statistics for processing. SEA/RC17/2 Page 35

6. PUBLIC HEALTH ADMINISTRATION

6.1 Rural and Urban Health Services

Of major importance during the year has been the attention given by governments to the amalgamation of specialized mass campaigns with the general health services. In Thailand, the programme for the control of yaws has passed from special teams into the care of provincial health services. The Government of India is entering the initial stages of integration of the national malaria eradication programme into general community health services; in April 1964, more than 65 million persons at risk came under the vigilance of these services. Similar considerations are exercising other governments.

Depending upon the circumst~cesprevailing in different countries, this process of integration may call for the adoption of different techniques. Basically, however, the principles remain the same. Thus, domiciliary workers operating within the viable and tested systems of special campaigns constitute in themselves a basis for a general health service. Depending upon the development of general health services in the same area, these workers can be absorbed in the existing general service. Where this is lacking, they form the framework by means of which the general population can initially be covered. At higher levels, special supervisory and other personnel can either fit into the general structure or form the nucleus around which general services can be introduced.

It has been found that the use of trained workers who have operated in a special programme is not only highly acceptable to the community served by these workers, but also a valuable and economical means of covering the whole population with a basic health service. While retraining or reorienta,tion of personnel may be necessary, the basic framework supported by these workers has been so fundamentally organized that the task of initiating general, comprehensive services is greatly simplified.

In anticipation of the rapid expansion of general services, governments have been promoting the preparation of different cadres of auxiliary personnel. Because of shortages of professional workers and the need, at the same time, for the provision of comprehensive care, it has been increasingly recognized that these auxiliaries should be multi-purpose in function. Where single-purpose workers are in use, methods for broadening the scope of these categories are being examined.

Governments have continued to express concern over the difficulties in obtaining the necessary professional staff for service in rural areas. In solving this recruitment problem, some have adopted policies of compulsory service; SEA/RC17/2 Page 36

some have provided subsidized training in return for bonds of service; some have utilized both methods; a11 are seeking suitnble incentiv~sfor employment. In this respect some information has become available. Apart from financial reward.. -orofessional staff have shown that factors which influence them include: housing, family education, transportation, assured transfer from less developed to more highly developed areas, opportunities for advancement, opportunities for post-graduate study, communication or contact with other professional personnel and ability to maintain diet and home at a reasonable cost. Apparently these motivations express feelings symbolizing a desire for security, but whatever the factors involved, it is evident that for most persons some inducement is necessary to give satisfaction to them in rural work.

In Afghanistan, health centres continued to develop in association with the community development programme. Control of an outbreak of smallpox in thc Logar 11 area emphasized the success of measures jointly adopted by the Ministry of Public Health and the .Rural Development Department,with assistance from WHO. The approach of the maintenance phase in malaria eradication has accentuated the need for the development of programmes involving general health services and malaria eradication. Activities to this end have been pursued with the help of WHO personnel at Culzar, the rural training unit, and also in other training programmes. Also, UNICEF support to the rural health programme has been maintained. Collaboration with all international agencies in the community development programme has been fruitful.

In Burma, WHO has continued to assist in the further choice of township hospitals to be upgraded. These hospitals are the bases of rural health services, and the doctors stationed there supervise health assistants and nursing personnel in peripheral units. Two reorientation courses for thirty of these doctors were held during the year. UNICEF has supported this programme considerably,with supplies, equipment and stipends. During the year, the report of a WHO consultant on the training of rural health personnel in Burma was forwarded to the Government.

In Ceylon, the Government has planned the training of health personnel at a national institute and has requested WHO assistance in the development of training and service programmes.

The Government of India reviewed its health programme in a mid-term appraisal of the Third Five-Year Plan. The Central Council of Health, in which all State Health Ministries are represented, discussed the progress of all facets of health work. In the rural context, both the rate of development of primary health units and the rate of producing staff to man them were slower than had been expected. The rate of expansion has continued to be slowed down by scarcity SEA/RC17/2 Page 37 of staff and lag in building constructior,. The Council has noted that the pressure of integration accentuates the need for rapid development of rural health services to cover malaria, smallpox and tuberculosis programmes. Therefore, Central and State authorities have reappraised and reassessed their requirements. As a result, auxiliary nursing personnel are being produced in increasing numbers; plans are developing in several States for the training of other auxiliary workers; statutory service by graduates for a specific term has been enforced by a number of States, and financial commit- ments are being readjusted to meet the cost of additional buildings and staff.

A revised master plan of operations, the basis for WBO/UNICEF co- operation with the Government, was signed in November 1963. Through this plan, the parties are collaborating in improving services at centres and sub- centres and in hospitals and laboratories, in strengthening district supervisory services, in training and in improving facilities for such various activities as health education, water supplies, maintenance of transport and repair. States have been visited individually and programmes designed according to the specific circumstances existing.

Of importance in India also has been the further growth of Panchayat Raj, or local self-government. Several States have now decentralized the control of services, including public health activities, to local authorities. This system aims at the close co-opcration of offici,als, non-officials and technical and non-technical personnel. This seems good in theory, but its practicability remains to be seen

Associated in some respects with these developments has been the circulation by the Government of India of a draft Model Public Health Bill.

WHO is assisting the Indian Government in studying the relationships, functioning and upgrading of health services in different situations. h WHO team is co-operating with national health personnel in strengthening district health services in Gujarat. A WHO consultant also studied the health programmes of the city of Bangalore.

The Indian National Institute of Health Administration and Education, jointly financed by the Ministry of Health and the Ford Foundation, was inaugurated in January 1964, as was its first seminar for health administration and planning officers.

The Government of Indonesia is preparing to extend its rural health services, in conjunction with the malaria eradication programme, to cover populations in the outer islands. WHO has assisted in the preliminary stages of planning for this effort. UNICEF has arranged to support the development of the health service SEk/RCl7/2 Page 38

structure. I21 West Irian a programme for further development of health services has been initiated. WHO/UNICEF co-operation with the Government has been agreed, in a plan of operations for technical and material assistance, with the object of providing integrated health services. It is associated with the total programme of assistance by the United Nations Special Fund for West Irian

The Maldivian Government has continued to make progress in providing health services. With the assistance of a WHO public health officer and a public health nurse, male health assistants have been trained, and nurse aides are undergoing training. Work in communicable-disease control and in slanning health centres has progressed.

In Nepal, the Government continued to train health assistants. A W2C team, consisting of a public health officer and a sanitarian, has assisted in the organizaticn and conduct of a revised course, and has also helped to study the present administrative pattern, day-to-day activity and pattern of work of the health centres. The Government is planning the approach of the maintenance phase of malaria eradication and its integra'tion into basic health services. WHO has discussed the plan outlines with national officers.

Discussions were held in the Regional Office with an official of the Government of the Peoples1 Republic of Outer Mongolia on the further develap- ment of health services in that country, with particular reference to peripheral maternal and child care.

The Goverim~cntof Thailand has further developed its rural health services according to a planned procedure. Community participation by donation of labour or materials has played a large part in the provision of physical facilities for health and midwifery centres. WHO staff have assisted the Government with community health services at the provincial level. This programme was derived from the WH3-assisted yaws control campaign, the integration of which into the general health services formed the basis for the present project. In addition, the planning of comprehensive urban health services has been the subject of study by a WHO consultant assigned to Bangkok.

During the year, WHO participated in several meetings concerning rural and community development, such as those sponsored by ECAFE in Bangkok and Delhi, the rural health conference in Narangwal (Punjab), and the annual conference of the Indian Public Health Association (see complete list given in Annexes 3 and 4). SEA/RC17/2 Page 39

6.2 Maternal and Child Health

Throughout the Region, the needs of the pre-school child have received increasing emphasis,but the difficulty of reaching this age-group continues to hamper progress. The most important measures adopted to meet these needs are the strengt&ening and upgrading of maternal and child health services within the framework of general community health services, the intensification of health and nutrition education, more particularly as an integrated part of feeding programmes, and effective immunization programmes for children.

WHO provided a team consisting of a senior paediatrician and a public

, health nurse to assist in evaluating rural maternal and child health services, jointly assisted by WHO and UNICEF, in Thailand. The results of the findings endorsed, on all major points, the policy adopted by the two agencies to support the Government in the development of these services. Arrangements were made for a similar study to be undertaken in Indonesia towards the latter half of 1964.

Recommendations emanating from the studies carried out in two major cities of the Region by WHO short-term consultants on public health administration provided guiding principles for the development of maternal and child health services within the framework of urban community health services. These are important, as many cities in the Region are experiencing very rapid population increases.

The first maternal and child health project to be undertaken in Nepal started in December 1963, with personnel from WHO and.supplies and equipment from UNICEF. In Afghanistan, the Maternity Hospital in Kabul was included among the teaching hospitals of the Medical Faculty. The first group of fourteen medical women complcted their training during the year and were posted to women and children's departments of the hospitals in Kabul. Expansion of maternal and child health activities to the provinces,under the auspices of the Government-aided Rozentoon Society,is being considered.

WHO'S assistance to the maternal and child health project in Ceylon terminated in November 1963. The project was successful in promoting further development of comprehensive maternal and child health services in the country.

In India, the activities of the National School Health Council developed further. The requirements essential for the provision of minimum school health services, including those for nursery schools and kindergartens, were considered in a seminar arranged by the Council. Periodic medical examination of teachers, central assistance to the development of school health services at district level, strengthening of district health and educational organizations as related to medical hcalth activitics,and health insurance schemes for collcge students were all major subjects reviewed by thc Council.

Two projects of the World Food Programme - one in Bombay concerning the production of reasonably cheap, balanced food for weaning and pre-school children, and the other in Kabul relating to school feeding at the hostels of the Teacher Training College - were reviewed.

A substantial advance was made in the programme of paediatric education and services in India. By the middle of 1964 the total number of medical colleges and district hospitals receiving assistance had risen to 41 and 44 respectively. Surgical paediatric departments were included in the programme of assistance. Initial steps were taken to promote model pediatric units in major epidemic- disease hospitals associated with medical colleges, and attention was given to the introduction of social obstetrics in the medical course of studies; a major obstetric department was chosen for initial trial. In one State, where medical officers with a diploma in child health were posted to all district hospitals, a network of paediatric and obstetric services was developedfor the purpose of providing regular consultation service by senior paediatricians and obstetricians on the staff of medical colleges to district hospitals, and by district paediatricians and obstetricians to primary health centres.

A WHO visiting professor of paediatrics was posted to Rang0011 to assist in the development of pediatric education and services at the three medical colleges in Burma.

Details of assistance to paediatric education in the various countries of thc Region are given in Part 111 of this report.

6.3 Nursing

During the year under review it has become possible to isolate with some clarity those trends which should influence the nursing component of national health services in the future, and which have already begun to shape the direction of WHO'S work in nursing in the Region.

Although WHO has continued to give assistance to all levels of nursing education and programmes in basic nursing education and midwifery have been in progress in Afghanistan, Burma, India, Nepal and Thailand, efforts are steadily being directed towards support in the post-basic field. SEA/RCl7/2 Page 41

Often post-basic programmes have been established in isolation, and under much the same administrative and educational control as the programmes in hospital nursing schools. Recent trends, however, have indicated a growing awareness of the need to provide for both basic and post-basic nursing education within the university. As a result, a re-examination of the purposes of post-basic education for nurses has already begun, and the role of the urdversity in this regard is being defined. Along with this examination, there is growing a better understanding of nursing as a separate and important health science,along with a real need to develop strong, co-ordinated educational patterns. In India alone, five WHO nurse educators are assisting with four post-basic schools which either already are, or hope to be shortly, affiliated with a university.

Assistance to the Post-basic School in Colombo was continued, and has been extended to include the post-basic public health nursing course. This course has been re-located in the newly constructed Public Health Institute at Kalutara.

The premise that the quality of both medical and nurfing education depends as much on the effectiveness of the learning experience provided in the clinical practice fields as on the quality of the theory taught in the classroom has long been accefled. The urgent need for improving clinical experience for nursing students at all levels has brought about, particularly in the large teaching hospitals, an increasing interest in in-service education However, the concepts and practices which provide for effective in-service education are not yet being widely followed throughout the Region: in-service programmes are frequently confused with the ad hoc, short type of training course. Awareness of the need to clarify thinking on this subject and to develop programmes offering effective co-ordination of orientation, training emphasizing special skills and continuing education is growing rapidly. Throughout the year WHO nurses have taken part in discussions in which in-service training has been a recurring theme.

As medical specialists become more numerous and their skills more complex, the need for nurses who are also specialists in corresponding areas of nursing is becoming more urgent. This is particularly evident in the field of maternal and child health. Paediatric nursing in all its phases - medical, surgical, infectious-disease, preventive, rehabilitative - is gradually becoming a well- defined component of the basic nursing course and a priority need in post-basic training. There is an increasing demand for teachers, administrators and staff nurses qualified to teach maternal and child care, to supervise in pediatric hospitals, clinics and wards, and to provide expert nursing care to both the well and the sick child. WHO has continued to assist with paediatric nursing education in India SEA/RC17/2 Page 42

Assistance to the development of nursing administration at the national and state level has continued. Nurse advisers have been assigned to Ceylon, Indonesia and Thailand and to the States of Punjab, Orissa and Gujarat in India, and every encouragement has been given to national nurses to prepare themselves for effective participation in the planning of the nursing component of the health services. It is regretted that in some situations the nureing unit which was active during the tenure of the WHO nurse has been allowed to fall into disuse when there was no longer international staff in position.

Clarification and stabilization of the categories and functions of nursing personnel have progressed during the year in most of the countries of the Region. This trend has further emphasized the need for continued definition and co- ordination of WHO assistance to nursing. To this end,a conference of WHO nurses stationed in India was held in the Regional Office in February and provided guidelines and recommendations which should help to shape future WHO aid to Mian nursing and which may be broadly applicable to all countries.

Recruitment problems reported in last year's review have persisted. There remains the long-standing difficulty in attracting the large numbers of young women needed in nursing, which is now further complicated by the need for candidates who possess increasingly higher standards of secondary education. In order to attract young people who have the requisite basic education, better working and living conditions for student nurses must be provided, and employment practices and policies must be on a par with the standards of other professional groups.

At the request of the Indian Nu sing Council, WHO provided a nurse specialist to work with committees throughout India with the aim of revising the required minimum curricula for the basic nursing and midwifery courses conducted in India.

6.4 Environmental Health

WHO has continued to assist in the provision of community water supplies (urban and rural), in public health engineering education and training, in rural sanitation, including training of sanitarians, and in research.

The increasing importance attached to the development of water supplies was reflected in the discussions at the sixteenth session of the Regional Committee in 1963, which followed the technical discussions on thc subject at the session in 1962. "Community water suppliesffalso was thc topic for technical discussions at the Seventeenth World Health Assembly in 1964. SE4/RC17/2 Page 43

WHO sanitary engineers have been assigned to Afghanistan, Ceylon and Nepal. Consultants in the financing and management of water and sewerage undertakings have been provided to India,and advice and assistance have been given to secure essential background information and technical data for a comprehensive review,to be followed by specific plans for design, construction, operation and proper maintenance of water and sewerage works.

A typical example of the type of assistance provided is in Ceylon,where, following the decision of the Government to create a Water Resources Board, steps have been taken to establish a Water Supply Authority to deal with all aspects of water supply and waste water disposal. Attention has been paid to a more economical approach in regard to engineering designs, use of chemicals in water treatment plants and preparation of water rate structures, in order to put the operation and maintenance of urban water supplies on a self-sustaining basis.

Assistance was provided to the Government of India in organizing and conducting a "Seminar on Water and Sewerage Works Financing and Management", which took place in Delhi from 24 to 30 April 1964. Commissioners, mayors, and chief public health engineers of States participated. The discussions covered policies and methods for expediting the implementation of urban water and sewerage schemes. After the seminar, the WHO consultants in sanitary engineering and financing visited Bangalore, Madras and Bombay,and discussed with the local authorities plans for the development of urban ,water supplies and the mode of presentation of fully documented requests for financial support from international financing agencies.

The master plan studies for the provision of water and drainage in the Greater Calcutta Metropolitan Arca have made considerable progress. Basic data on population projection, hydrology, municipal maps, etc., were collected and classified. Deep ground-water exploration in the South Section of Greater Calcutta has been initiated It is planned to effect early presentation of portions of the studies on a regional basis in order to allow implementation of interim water and sewerage schemes ahead of the final engineering report. Care has been taken to co-ordinate interim schemes with the pattern of the overall master plan. Emergency water supply schemes are also under study; negotiations for financial assistance from the World Bankare in train. Representatives of the World Bank made two visits to Calcutta after having engaged in prior discussions in the Regional Office. A draft bill to create a Calcutta Metropolitan Sanitation Authority is being presented to the State Legislature. The WHO/UNICEF assisted rural water supply programmes in India and Afghanistan have made headway. Projects in five Indian States have been prepared in detail, and it is proposed to develop one scheme in every State. The use of locally made pumps in Afghanistan was an encouraging development.

In the field of education and tra~ningfor environmental health personnel, assistance was provided to a "Seminar on Public Health Enginocring Education", held in Nagpur in October 1963 and attended by leading teachers and practicing engineers in the field. Subsequently, a preliminary study was made of the present necds of the institutions imparting graduate training in public health engineering. The WHO fellowship programme for advanced training in sanitary engineering abroad was continued.

The training of sanitarians, which is associated with demonstration and pilot projects in different rural areas, was assisted in most countries of the Region.

In the field of research, assistance to the Central Public Health Engineering Research Institute, Nagpur, entered a new phase. Laboratories and administrative facilities have been moved to new premises. WHO has assisted in the setting up of equipment provided by the United Nations Special Fund and in obtaining further equipment required. Consultants in instrumentation, research planning, water pollution and sewage treatment were assigned to work with the staff of the Institutc for various periods.

Another problem of great importance for the countries of the Region is that of urbanization,asswiated with accelerated industrial growth and the shift of population from rural to urban areas. The populations of th~;cities, especially of the larger cities, arc increasing rapidly, sometimes explosively. Health services which were already strained are being further diluted, and environmental conditions relating to housing, provision of water and drainage, removal of refuse and prevention of spread of communicable diseases are deteriorating.

During the year WHO took part in surveys of two major cities in the Region in an attempt to define the associated public health problems and to consider how to approach them. The health problems are closely related to social and economic difficulties also encountered in urbanization, and this subject is one which will demand increasing attention from health planners. SEA/RC17/2 Page 45

6.5 Health Education

The image of health education is changing from one of publicity and propaganda alone to education as an integrated part of the general health services,carried out by health workers as part of their regular duties. It is recognized that health education has to play a more prominent part in the implementation of health programmes. It is essential to place health education specialists at strategic places in health administrations, to help administrators and programme directors plan health education as carefully as the other aspects of the work and to provide training for health workers. It is through the body of health workers and others who come into direct contact with the people that the main impact of health education can be made.

The trend is towards an increased use of findings from studies dn the community as a basis for planning community health services. A survey has been started in this region to collect information on studies relevant to people's beliefs and attitudes which have implications for health planning.

There is a great challenge to provide more effeetive teaching-learning situations for the education of the general public, especially those persons engaged in training programmes, in accordance with the modern understanding that educ'allonis a process within the individual himself: it cannot be imparted by one person to another; each individual must learn by his own efforts.

The development of health education units at directorate level has progressed. This is important in providing the leadership necessary for strengthening health education in the general health services and other programmes.

Interest in health education in schools has continued to grow, and activities have been increased towards the fuller utilization of the schools to influence the health practices of the people. It is necessary to have a good.workahle relationship between the Ministries of Health and Ministries of Education so as to ensure that what is included in the teacher-training courses taught in the schools adprinted in the textbooks is up to date a@ that health information is geared to each countw s health problems and programmes.

A preliminary document prepared by WHO/UNESCO on "Planning Health Education in Schools" has been used for curriculum development in several countries of the Region. Comments by governments on the content of this draft adcopies of relevant materials have been collected for use in the preparation of the final document. SEA/RC17/2 Page 46

Health education is playing an increasingly important part in various special health programmes. During the year, WHO health education personnel assisted programmes for the control of smallpox, trachoma, malaria and tuberculosis, and for the improvement of nutrition.

Two issues of a technical circular on health education were brought out during the year and distributed to health and health education leaders in the countries of the Region. Copies of the publication "Review of research related to health education practice", by the Society for Public Health Educators, and "Health educator's bookshelf", reprinted from the American Journal of Public Health, were obtained and distributed.

In Afghanistan, in addition to assisting in developing health education in the general health services, the WHO health educator has been continuing to advise on health aspects of the curriculum in the UNESCO-assisted projects on teacher education.

A WHO health educator was assigned to the Government of India'in July to assist in developing a plan for integrating health education into the basic training courses for primary and secondary school teachers.

State health education bureaux in India are being strengthened, with the assistance of WHO and provision of supplies and equipment by UNICEF. During the year, a WHO health educator was assigned to one Indian State, and a similar assignment to another is planned. UNICEF equipment has now been released to nine States which have established health education bureaux on the pattern outlined by the Central Health Education Bureau. This national health education programme is also assisted by USAID. The Government of India has continued to have the services of two health education consultants from the Ford Foundation, and a third has been assigned to assist with the health education aspects of projects aided by that Foundation.

The activities of the National School Health Council, organized in India in 1963, have been continued and expanded; councils or committees for co- ordination have been organized in several States.

An All-India Conference for Health Educators, convencd by the Government of India to review progress and make proposals for the Fourth Five- Year Plan, was attended by more than 100 participants and observers from all the States of India, as well as representatives of various agencies, including WHO. During this conference discussions were also held on proposals prepared jointly by the Ministry of Educatios and the Ministry of Health (Central Health Education Burcnu) to provide training in health education for two strff members from cvcry teache~trainingcollege and institution in the country. SEA/RC17/2 Page 47

During the course of the year, the Assistant Research Officer attached to the Nutrition Research Laboratories, in Hyderabad, India, who had been awarded a WHO fellowship, went to the United States of America for health education studies. The medical officer in charge of health education in Afghanistan and the health educator in Bekasi, Indonesia, also left for the United States in June 1964, on WHO fellowships.

WHO is participating in education projects in Burma, Indonesia and Thailand.

6.6 Nutrition

WHO has continued to co-operate with FA0 in assisting applied nutrition programmes in the Region and to advise UNICEF on the provision of supplies and equipment and assistance to the training of personnel who will be responsible for the training aspects of these programmes. Various countries in which these applied nutrition programmes have been in progress were visited during the year.

UNICEF, with the technical approval and advice of FA0 and WHO, is giving material support to the programme in ten States of India. The projects in Orissa, Uttar Pradesh, Andhra Pradesh and Madras entered the second phase of development in 1964. By the end of 1963 a total of 221 community development blocks, 105 training institutions and 99 production centres had been established. It is now considered desirable to undertake an evaluation of the present degree of efficiency of the programme in order to guide further development.

Several joint meetings have been held with the'Government of India, UNICEF and FA0 for determining the pattern of assistance to the applied nutrition programme, and WHO staff have participated in the meetings of the co-ordination committee on this subject, and in those of its sub-committee, to review the progress made in the implementarion of the training programme, to indicate priorities to be given for training certain categories of persons, and to decide on the schedule.

A first three-month course in nutrition for medical graduates and nutrition officers was held at the Nutrition Research Laboratories, Hyderabad, India, from December 1963 to February 1964. Sixtekn candidates from various countries of the Region attended. ~repa&tionswere made for conducting a second course SEA/RC17/2 Page 48 in 1964-1965 for teachers of preventive and social medicine, teachers of paediatrics, public health officers and maternal and child health officers entrusted with the administrative responsibility for or supervision of public health nutrition programmes. Assistance was given in the preparation of a suitable programme for the course, including a revised syllabus, in which greater emphasis was placed on the epidemiological, health educational, teaching and administrative aspects.

UNICEF, with the technical approval of WHO, has agreed to expand its assistance to the goitre control programme in India in the shape of supplies of plant equipment. A second iodization plant of two lines will be installed at Sambhar Lake, and two more plants of two lines at Kharagoda, to augment the production of iodized salt to at least 50 000 metric tons per annum.

In 1963, a medical nutritionist was assigned by WHO to the nutrition project in Thailand. The goitre control project in Thailand continued to make progress.

Attention of the public health authorities in the countries of the Region was drawn to the importance of giving due regard to the health aspects involved in World Food Programme projects and to the advantages of Using these projects for purposes of health education in nutrition.

Preparations were under way for holding a FAO/WHO high-level training course in "The Fundamentals of Nutrition and their Application" in Bangkok in November-December 1964.

6.7 Mental Health

In countries of the Region there is an increasing awareness of the importance of mental health, promoted significantly by the assignment of consultants in a number of disciplines in this field and by the award of fellowships.

The Government of Afghanistan is now considering the construction of a small mental hospital with out-patient facilities at Kabul.

The Government of Burma is undertaking a project to develop the training of psychiatric nurses.

Ceylon is establishing a chair of psychiatry, for which assistance has been sought, hut recruitment of a suitable professor has presented difficulties. SEA/RC17/2 Page 49

Increasing concern is being expressed in India at the pressure of mental stress flowing from rapid industrialization and the consequences of growing urbanization. A research-cum-survey programme on a pilot basis has been undertaken by the Indian Council of Medical Rcsearch in one rural and one urban area, to study the extent of the problem and to work out methods by which it can be solved

Indonesia now has a Division of Mental Health within the Department of Health. Although at present the Division is predominantly concerned with the administration of mental institutions, it has recognized the need for developing out-patient clinics, for organizing the care of psychotics so that the need for hospitalization can be lessened, for building up after-care of patients discharged from hospitals, and for providing services for school health and for child health generally.

Thailand has considerably expanded its provision of physical facilities for mental hospitals and other institutions concerned with mental health, but there is still a shortage of psychiatrists, clinical psychologists, psychiatric nurses and psychiatric social workers. A WHO psychiatric consultant has made important recommendations for the promotion of mental health on a long-term and country- wide basis.

6.8 Dental Health

Work on dental education has been encouraged by.the award of fellowships to teachers in dental colleges in three countries and by the assignment of a consultant professor to India.

The Government of Burma has decided to open a dental college in 1964 which will offer courses leading to the degree of Bachelor of Dental Surgery.

A WHO consultant assigned to Ceylon bas recommended that the Colombo water supply. should be fluoridated so that the high incidence of dental caries in the city may be reduced, and fellowships are being awarded to suitable candidates for studyingfluoridation programmes in countries overseas.

A survey of the prevalence of dental caries in school-children was carried out in Ceylon in December 1963, covering 34 schools and 23 890 students. In the survey, a total of 18 936 students was examined (i.o. 79% coverage); the rate of dental caries was found to he 39.8%. There are 47 dental clinics in Ceylon served by 114 school dental nurses. This service is available to children under thirteen years. Because of the great demand for such a service, the Government has planned to establish eight new dental clinics each year. The training of school dental nurses has progressed satisfactorily, and they are rendering very useful service. SEA/RGl7/2 Page 50

The WHO professor assigned to India has been able to assist in the improvement of methods of teaching dentistry in three dental colleges. Teachers of dentistry have been trained on WHO fellowships in countries overseas. India is now undertaking training of dental hygienists and of dental mechanics. The WHO professor attended the All-India Dental Conference held in hngalore in January 1964.

As for Indonesia, the training of school dental nurses in Djakarta is being continued. Qualified school dental nurses are being posted to schools, where each of them take charge of approximately 3 000 school-children annually. The Federal Republic of Germany has provided a team of two dental surgeons, together with equipment and supplies, on a bilateral basis, to operate a dental clinic and to teach students in Djakarta.

6.9 Industrial and Occupational Health

It may be stated that, whereas extensive industrial development is taking place in a number of countries of the Region and hazards posed by industry are mounting, the national health services are not organized to take care of the health of the industrial population or of the general public subjected to the physical, biological, chemical and psychological environment of industrial activities. Accidents and cases of poisoning are occurring in increasing numbers. Silicosis, pneumoconiosis, ferro-manganese poisoning, chrome-ulceration and many other purely industrial disabilities are being reported by one country. Governments are much concerned and, in consequence, have asked for assistance in this field

A WHO consultant paid a visit to Ceylon and has made recommendations for the development 3f an orthopedic appliance workshop. The School of Physiotherapy in Colombo, which was established with WHO assistance and which had suspended recruitment of new students for some time, has been re-started, with the help of physiotherapy tutors trained under WHO fellowships.

In India, personnel experienced in industrial health as well as some essential institutes are available for such work A number of surveys have been carried out, most of them providing excellent material. 'The difficulty has been the promotion of health in industry within the resources available. ';VHO has now recruited a consultant for a period of six months, who will have the co-operation of a WHO industrial toxicological engineer, to study this problem and to prepare guidelines for the promotion of occupational health in industry and for the establishment of an occupational health service as a function of the national health authority. SEA/RC17/2 Page 51

Two short-term consultants on medical rehabilitation, assigned by WHO to the Government of India, have made far-reaching recommendations for a country-wide programme of medical rehabilitation for the large numbers of physically handicapped persons.

In Indonesia, the WHO-assisted School of Physiothera~in Solo has been able to record very encouraging results. Since joining the project in March 1963, the physiotherapy tutor has assisted in training 67 students of various categories.

The World Veterans' Federation assigned a physiotherapist to Thailand to explore the possibility of giving assistance to a School of Physical Therapy in Bangkok.

India was able to send two students to the WHO-sponsored training course for industrial hygienists which is being given in Zagreb, Yugoslavia (February - September 1964).

In collaboration with the World Confederation for Physical Therapy, WHO has started an inter-regional training course for physical therapy teachers, from 6 July 1964, in the United Kingdom. The course is of ons year's duration. Some countries of this region have been able to send participants.

6.10 Radiation and Isotopes

There is an increasing appreciation of the dangers arising from poorly controlled use of radioactive isotopes and radiation applications. A number of countries are in agreement with the view held by WHO that radiation protection, health laboratory competence in radiation, measurements of environmental contamination with radionuclides, decontamination, treatment of casualties and all other measures related to protection of the public from the effects of ionizing radiation should be the responsibility of the national health authorities; others feel that it would be hazardous for health departments to assume this function now, ae they do not always have within them the necessary competence to undertake the responsibilities entailed. One country in the Region, however, has already entrusted this work to its national health authority, and, with WHO assistance, laboratory competence in this field is being gradually developed.

During the year, WHO consultants have visited radiological departments of hospitals and other institutions in countries of the Region and have recommended improvements in radiation protection. SEAJRC1712 Fage 52

In Bombay, the Atomic Energy Establishment is conducting a number of courses in radiation protection. The WHOassisted course in radiological physics has been able to train some 30 candidates during the last two years. With more such trained persons becoming available, radiotherapeutic departments of hospitals in India should soon have the necessary staff to ensure therapeutically effective dosage with the least possible damage to other tissues in the treatment of many diseases.

The Radiation Medicine Centre in Bombay has seen considerable develop ments and should soon be in a position to undertake advanced research activities and training of candidates in the various disciplines involved.

One participant from Thailand attended the WHO Seminar on Medical Radiation (Radiation Protection and Radiation Measurements in relation to National Health Laboratory Services), held in Athens (Greecc) from 21 to 25 October 1963.

6.11 Human Population Genetics

An inter-regional training course in human population genetics was held in the Biology and Medical Group of the Atomic Energy Establishment, Bombay, from 18 November to 14 aecember 1963. The course was designed to make available recent advances in simple laboratory and field techniques that are of practical importance in routine diagnostic work as well as in research It was planned exclusively for qualified medical and scientific workers with experience in research, coming from institutes which are in a position to make immediate use of these techniques in their medical work and research programmes. A faculty of eight consultants assisted with the course, which was attended by seventcen participants - fourteen from this region and three from the Eastern Mediterranean (see Inter-regional 133 in Part 111).

It is hoped that the participgting workers will develop the u;c of thew important techniques as diagnostic aids in pathology departments,medical and paediatric clinics, etc., and as research tools in studies of human genetics and anthropology.

In some of the countries of South-East Asia,oropharyngeal tumours are of such high prevalence as to justify a special study. Ln consequence, two SEA/RC17/2 Page 53 projects have been started, one for classification and nomenclature of these tumours, for which an International Reference Centre has been established at Agra (India), and the other for the determination of their epidemiology.

A meeting of investigators on the epidemiology and pathology of oropharyngeal turnours was held in the Regional Office in 1963. It was attended by six participants and three observers from India, one participant each from Ceylon, the Union of South Africa and the USSR, and a representative of the International Union against Cancer. The meeting studied procedures for gathering information on oropharyngeal tumours and their classification from various co-operating centres.

The Second All-India Cancer Conference was held in Madras in January 1964 under the aegis of the Cancer Society of India. It was attended by a WHO epidemiologist.

6.13 Drug Addiction

Opium and heroin dependence has become a public health problem of some magnitude. Poppy growing in Burma and Thailand is usually carried on in areas which are not easily accessible, and this presents considerable difficulties in efforts to suppress illegal production of the drugs. Rehabilitation of the addicts themselves has been made extremely difficult by the lack of national resources and essential technical personnel. There is also a dearth of suitably trained staff for post-discharge placements and supervision.

Consultants from WHO and the United Nations Bureau of Social Affairs have visited various countries in this connection, and their reports have emphasized both the need for doing something in this field and the considerable difficulties that will have to be faced if any significant achievement is to be made.

7. EDUCATION AND TRAINING

The combination of an increase in the number of medical colleges, heavy expansion in the intake of students in existing colleges and the increased amount of new knowledge and techniques which must necessarily be imparted to the future practitioners (in genetics, hormonology, radiation medicine, use of radioisotopes, aviation medicine, etc. ) has resulted in serious dilution of teaching SEA/RC17/2 Page 54

staff and overcrowding of curricula. It is urgent and imparative to take measures to check the tendency towards deterioration of the quality of teaching. In addition, there is urgent necessity for a re-evaluation of the present teaching methods in the Region as well as the content of the courses, so as to bring them into line with modern advances in developed countries. Many of the teaching methods have stood still for the last thirty years.

The Regional Committee in1963 recommended that WHO pay increased attention to the development and strength~ningof post-b~aduatemedical education,with a view to training teachers and specialists. Plans have been made to study the existing conditions as regards the quality and content of post-graduate education facilities in countries of this region and to make recommendations to governments for improvement.

In Afghanistan, a new medical faculty has been opened at Jalalabad, with an annual ink~keof 50 students. An rrgrecment with the University of Lyon (France) for technical assistance to the Faculty of Medicine, Kabul, has been signed.

In Burma, the new Niedical Faculty of the University of Rzngoon at Mingaladon started functioning in 1963 and has now 50 students in the first pre-medical and another 50 in the junior pre-clinical class. The introduction of pre-medical training in the Faculty itself has appeared to be successful.

.The new medical school at Peradeniya in Ceylon continued to develop

The number of medical colleges in In&a has further increased to 80 tpom 66 in 1962 and 73 in 1963 - thus attaimng the numerical target set in the Indian Third Five-Year Plan (1961-1966) well ahead of timc. The Central Council of Health, in its meeting held at Madras during November 1963, recommended that during the remaming period of the Five-Ycar Plan, the State Governments should lay emphasis on consohdating and strengthening the colleges already established,rather than opening new ones. It, however, envisaged the opening of 20 more medical colleges during the Fourth Five-Year Plan (1966-1971) m order to achieve the target of one doctor for evcry 3 500 of the population. A mform pattern of compulsory housemanship of one year's duration has now replaced the many variations of internship existing hitherto.

The Government of India is fully aware of the acute shortage of teachers required for the 80 medical colleges in the country and is therefore concentrating its attention on establishing regional post-graduzzte medical institutions for training sm/rEbi'/z Page 55

qualified medical teachers. It is intended to transfer State institutions of post-graduate medical education to the Central Government and to improve the co-ordination of international and bilateral assistance,for the benefit of the whole country. It was envisaged that initially four institutions would be included under this scheme, followed by two more at a somewhat later date.

The Indian Association for the Advancement of Medical Education held its second "Teaching Institute" in Madras in February 1964; the subject was the clinical disciplines. It decided to hold a conference on post-graduate medical education in Delhi in 1965.

Early in 1964, the Medical Council of India sent out a questionnaire seeking data on all aspects of medical post-graduate education. It is hoped that the replies will form a guide to the planning of future policies in the sphere of medical education The Council also plans to hold a conference on post- graduate medical education,in November 1964.

India has also received technical assistance in medical education from some bilateral agencies. The Rockefeller Foundation has been assisting. as usual, in various fields, concentrating on the All-India Institute of Medical Sciences, New Delhi. The Ford Foundation's assistance is largely directed to post-graduate education and training in the field of public health, incw assistance to the new National Institute of Health Administration %nd.Education, New Delhi, through provision of capital equipment, e library and consultants. . USAID has assisted two medical education training centres, in Hyderabad fmd in Trivandrum.

In Indonesia, the affiliation of Airlingga University with the University of California,. sponsored by USAID, is now in its fourth year. The contract lasts up to 30 June 1966, and so far buildings and other facilities, thirteen visiting professors and 75 fellowships for advance studies have been provided. Other universities have also been assisted by fellowships. Much attention is now being paid to post-graduate training, in particular in the basic sciences.

The development of Surabaya as 3 "mothcr" university, fallowing the lead given by Djakarta, for the training of teachers for other universities is'being pursued.

The West German Government is assisting in the construction of a Parasitology Department in Bandung and is also providing a professor for that -ent. 11 2 Page 56

The Government of Thailand has planned to hold the Second Thai National Medical Education Conference in Bangkok in August 1964.

The USAID-sponsored affiliation of the University of Cliiengmni with the Univer.sity of Illinois enabled Chiengmai University to have visiting professors and other technical personnel, including a hospital administrator, nursing adviser and an architect, from the US4 during the year.

Training activites in other specialized fields ape mentioned in other sections of this report.

7.1 Direct Assistance to Medical Institutions

WHO continued to give assistance to certain departments of the Faculty of Medicine, Kabul. Similarly, assistance was provided to the Department of Pathology of the Medical College, Mandalay.

In Ceylon, a WHO professor of physiology assisted the Departments of Physiology of the Medical Faculty, Colombo, and the Medical School, Peradeniya.

With the technical advice and approval of WHO, UNICEF gave supplies, equipment and transport vehicles to twenty departments of preventive and social medicine and forty departments of paediatrlcs in medical colleges in India. Further extension of this programme is planned in India and some other countries.

A WHO professor of preventive and social medicine was assigned to the Medical College at Pondicherry (India) to assist in developing the teaching programme of the Department of Preventive and Social Medicine.

A WHO professor of physiology was assigned to the Department of Physiology, Jogjakarta.

Following the report of the WHO consultant who visited Nepal, further discussions were held with the Government on the establishment of a medical college. The problems of finance, staff, accommodation, medical literature, equipment and supplies appenr formid;lble.

A medical education study tour for deans and principals of medical colleges, with nine participants from the Region, was conducted from 26 January to 23 February 1964. It was guided by a WHO consultant,and visited Delhi, kadras, GRAPH 4- FELLOWSHIPS AWARDED BY WHO, SOUTH-EAST ASIA REGION ( 1959-- 1963)

By Number of Fellow~hlps.Malor Sublectr and Year of Award

PUBLIC HEALTH SERVICES AND COMMUNICABLE DISEASES ADMlNlSTRATlON

MALARIA MEDICAL EDUCATION

mOTHEM(ClInlcaI medicine. laboratory, etc.)

1961 1962

OF AWARD GRAPH 5-FELLOWSHIPS AWARDED BY WHO. SOUTH-EAST ASIA REGION ( 1959-1963)

By Number of Fellowship Months. Major Subjects and Year of Award

PUBLIC HEALTH SERVICES I ADMINISTRATION COMMUNICABLE DISEASES

MALARIA

MEDICAL EDUCATION OTHERS (Clinical) medicine, laboratory, etc.)

YEAR OF AWARD SEA/RC17/2 Page 57

Vellore and Bangkok. A visit was also paid to Ambala to see the factory for manufacturing physiology instruments. Further details are given under SEAR0 75 in Part III of this report.

WHO has continued to provide fellowships for teachers in medical colleges.

7.2 Fellowships

(1) WHO Proflamme

During the period under review, 136 new fellowship awards, includmg 38 for participation in WHO-sponsored courses, were issued. Particulars showing the number of awards by country, source of funds, subject of study, etc., are given in the tw tables in Annex 5. Awards under "Health Organization and Services" were generally directed towards strengthening and broadening health organizations, and included fellowships in public health planning, tropical public health, nutrition, health statistics and medical records, environmental sanitation, health education, epidemiology and nursing education.

For the first time there was a decline in the number of awards under "Communicable Diseases", except in respect of malaria eradication, in which. as in previous years, large numbers of fellowships. were dd.Subjects of other awards were tuberculosis, leprosy, filariasis and quarantine.

Fellowships under "Medical Sciences and Education'? were awarded mainly to wn-clinical teachers, primarily to study teaching methods and organization. Other important subjects for fellowships were: manufacture of polio vaccine, production of freeze-dried smallpox vaccine, public health aspects of radiation, medical radiology, laboratory services, and electro-medical engineering. Some fellowships were awarded for attendance at inter-regional training courses on tuberculosis control, enteric diseases, industrial hygiene, human genetics, application of basic sciences in surgery, clinical biochemistry, anaesthesiology and physical therapy teaching.

A majority of the fellowships awarded during the year were for regular academic courses or for in-service type of training. Travel fellowships were awarded only to suitable senior officials in charge of overall programmes.

Training possibilities within the Region were continuously kept in view, and as many as 43 fellowships were awarded for such training. Fellows returning from training courses abroad werefrequently sent on study toursin the Region. SEA/RC17/2 Page 58

Placements were arranged for studies it the School of Medical Technology in Colombo, the All-India Institute of Hygiene and Public Health, Calcutta, and the National Institute of Communicable Diseases, Delhi, and for training in leprosy control in Burma, India and Thailand, in tuberculosis control in India and Thailand, and in malaria eradication and surveillance in Ceylon, India and Indonesia.

As in the past, delays in receipt of applications for fellowships and lack of competence in the language of instruction have hampered speedy implementation of fellowships.

Cases of non-payment of full salaries by governments are still being reported by fellows. It is essential that during their training period fellows should receive their full salary and allowances which they would have been paid had they continued in their posts at home.

During the year, 36 fellows from 18 countries or territories outside the Region (Argentina, Australia, China, Fiji, Iran, Iraq, Korea, Malaysia, Mexico, Pakistan, the Philippines, Ryuku Islands, Sudan, Turkey, the United Arab Republic, the United Kingdom, the United States of America and Viet-Nam) visited South-East Asia on study tours for periods varying from a week to twelve months.

As usual, placement was arranged for persons from outside the Region who were awarded UNICEF fellowships to attend a ten-month certificate course public health nursing at the All-India Institute of Hygiene and Public Health, Calcutta; there were 16 such fellowshi-s. Also, technical advice was given on nomination of candidates for UNICEF tellowships for attending (1) a paediatric training course at the Institute of Child Health, London, to be held in October 1964, and (2) an advanced training course in nutrition and food science, starting in March 1965 in LonQn/Ibadan (Nigeria).

The following is an analysis of a total of 693 reports received from former WHO fellows on the utilization of their studies abroad, on their return There have been a £ew cases of non-exploitation by governments of the knowledge, skill and experience of returned fellows.

663 (95.7%) fellows are employed in the subject of their fellowship studies;

415 (59.9%) have assumed greater responsibilities in their former fields of activity; SEA/RC17/2 Page 59

299 (43.1%) have begun lew activities in keeping with their fellowship studies;

475 (68.5%) have been able to introduce new methods;

... . 285. (4i,l%'a) have established new services; , .. 452' (65.2%) have imparted the knowledge gained to others by means of conferences and by articles in medical journals;

580 (83.7%) are engaged in training activities;

203 (29.3%) are engaged in some type of research work;

128 (18.5',$) have maintained some degree of contact with othcr fellows and officials whom they came to know during their studies, and

27 ( 3.9 5%) have been on international assignments.

(2) Fellowships in iMedical Subjects from Other Sources

According to available informatlon,'~f~haniatanreceived 7 fellowships in medical subjects from the USSR; 3 from Czechoslovakia, 2 from France and 9 from the Federal Republic of Germany; the Colombo Plan granted 28 such fellowships to Burma; 10 to Ceylon; 19 to India; 7 to Indonesia; 7 to Nepal, and 12 to Thailand; the USAID awarded 47 to India; 3 to Indonesia; 9 to Nepal and 24 to Thailand. In addition, Ceylon receivcd 1 from the United States Education Foundation; India received 18 from the Ford Foundation and 13 from the Rockefeller Foundation; Indonesia received 5 from the Swedish Agency for International Assistance and 2 from two other sources; Thailand received 1 from the Rockefeller Foundation, 1 from the British Council, 2 from France, 2 from Israel, 1 from Switzerland, 1 from the International ~tomicEnergy Agency and 5 from otiler sources.

8. ASSISTANCE TO RESEARCH

Since its inception, WHO has been engaged in assistance to and p.romotion of research. Increased impetus was given to &is effort, with the introduction of the WHO Intensified Medical Research programme in 1958. During the ensuing years, the role of the Organization in international research has been increasingly SEA/RC17/2 Page 60 felt. The scope of its co-operation in research endeavour has broadened from its early concentration on communicable diseases to such new fields as studies concerned with cancer, cardiovascular diseases, radiation medicine, immunology and human genetics. In this context, attention is called to the Director-General's report on "The Medical Research Progrmme of WHO'^^, oovering tbc period 1958-1963, presented to tbc 33rd meeting of the Executive Board and the Seventeenth World Health Assembly.

Although responsibility for research activities under the intensified programme rests with the Director-General, the Regional Office has, from the start, been in touch with projects undertaken in the Region Certain of these projects have been reinforced by staff provided by the Regional Office.

During the year the Regional Office issued a further number of Research News (No. 'I),describing research activities in some of the institutions in India. Research News (No. 6), issued in 1963, contained a description of research projects undertaken in Ceylon, Indonesia and Thailand.

The following sections of this chapter are an attempt to summarize WHO assistance to research in the Region during the past year.

8.1 Malaria

Vector Resistance to Insecticides

The field research on the selection of resistant strains in anophelines conducted in Central Java has yielded useful results. In this study, different insecticides were used singly or in mixtures. The following results were obtained: (a) Under local conditions in Central Java, malathion at a dosage of 2 gm/d gave satisfactory residual effect for nearly four months; @) The selection of dieldrin- resistant strains might be delayed by using a mixture of insecticides, the most suitable mixture being gamma BHC 0.5 gm/m2 plus malathion 1 gm/m2 or dieldrin 0.25 gm/m2 plus malathion 1 gm/mZ.

Dynamics of Drug-Resistance of Plasmodia

A research programme on the dynamics of induced resistance of malaria parasites to drugs was continued at the National Institute of Communicable Diseases, Delhi, with a grant from WHO. This work indicated that the selection of ~ramethamine-resistant strains of P. bastianellii was more rapid when large

'A special publication issued by WHO, Geneva SEA/RC17/2 Page 61

populations of the parasites were ex.>osed to single high doses of the drug than when small populations were exposed to gradually increasing small doses. It was also observed that a coinbination of DDS and pyramethamine is likely to reduce the chances of selection of resistant strains. The results also showed that these drugs potentiate each other and that, therefore, when the drugs are used in combination much smaller doses of each drug are required than when they are used singly.

Simian Malaria Parasites

Simian malaria parasites, P. cynomol@ and P.found as natural infection in monkeys in South India, were shown to be capable of completing their development in A. stephensi and A. fluviatilis in the laboratory. However, human volunteers bitten by these infected mosquitoes have not developed the infection. This work is being continued by the National Institute of Communicable Diseases, Delbi.

8.2 Insecticides

A document on "The WHO Collaborative Scheme for the Development, Evaluation and Testing of New Insecticides" was presented and discussed at the sixteenth session of the Regional Committee. The Thirteenth Report of the Expert Committee on Insecticides was published during the year. It contains an up-to-date series of recommended methods of vector control. The latter have been drawn up with the collaboration of scientists throughout the world and include the results of studies undertaken by the Organization in evaluation programmes.

As part of the general programme for the control of Culex fatigans (associated with the work of the WHO Filariasis Research Unit in Rangoon), the Organization is undertaking investigations into (1) compounds that might be used for the control of Culex fatigans, and (2) the existing cross-resistance to these materials.

8.3 Tuberculosis

The Tuberculosis Chemotherapy Centre, Madras, has continued to contribute decisively to She development of appropriate and suitable tools for the control of tuberculosis, especially in countries in which the prevalence of the disease is high and the resources for comprehensive control measures are limited. SEA/RC17/2 Page 62

The main feature of the Centre's research work last year was the firm recommendation of an intermittent regimen consisting of streptomycin and isoniazid, which makes complete supervision of the administration of drugs possible. This can ensure maximum therapeutic effect and prevent wastage of costly drugs. Following the success of this twice-weekly regimen, in which streptomycin is given together with isoniazid in high dosage,and which has proved not only as effective as the standard daily treatment with PAS plus isoniazid at conventional doses but also three times cheaper than the standard treatment, another study has recently been started, to compare the therapeutic efficiency of a once-weekly regimen with streptomycin plus iso~azid.

Besides investigating the relative efficacy of intermittent chemotherapy with other drugs and the importance of drug dosage in relation to therapeutic effect and occurrence of drug toxicity, studies of the comparative efficiency of isoniazid plus PAS (as standard treatment) with other cheaper double-drug regimens containing isoniazid as the base have been started. This involves a variation of the companion drug to isoniazid on a variation of dosage and/or the duration of administering the two drugs for the initial period, after which isoniazid is given alone for the remaining period of treatment. The use of thiacetazone as a companion drug to isoniazid effects a fall in the cost of treatment to one fifth of that of the PAS/isoniazid standard treatment; lowering the dosage, while also shortening the period during which PAS is given together with isoniazid in the initial stage of treatment, may cut the cost to one third of the standard regimen.

Another line of research carried out by the Centre is concerned with studies on the prevention of relapse after one year's chemotherapy and with the treatment of patients in whom primary chemotherapy has failed, owing to resistance to one or more of thc three common "first line" drugs. It is of immediate importance to establish firm knowledge on the various "second line" regimens as regards their respective therapeutic efficacy as well as their overall economy. In this context, the results of a controlled comparison of cycloserine plus ethionamide with cycloserine plus thiacetazone were published during the year, indicating that cycloserine plus ethionamide is a valuable combination, whereas the latter combination with thiacetazone is of little value in the treatment of tuberculosis when the organisms are resistant to streptomycin and/or PAS. A list of papers emanating from the Tuberculosis Chemotherapy Centre, Madras, which have been published or were under preparation during the year, is given as Annex 6. SEA/RC17/2 Page 63

In addition to the new studies referred to above, earlier studies such as the study on isoniazid plus PAS compared with three regimens of isoniazid alone and the comparison between home and sanatorium treatment of the patients treated as well as their contacts, were continued or followed up. Almost the whole of the study population which was originally included in the trials is still available for examination after five years.

Along with the foregoing clinical trials, the laboratory of the Centre has embarked upon a number of related special studies, e. g., on new and more complex methods of determining bacterial drug sensitivity before and during treatment; on techniques for measuring the proportion of resistant organisms in a given population of tubercle bacilli; on improved methods to prevent contamination of cultures of M. tuberculosis without interfering with its growth; on serum concentrations of chemotherapeutic drugs, biochemical tests for drug toxicity and urine tests for drug taking; on the association between guinea- pig virulence and susceptibility to hydrogen and catalase activity in isoniazid- sensitive and isoniazid-resistant strains on the one hand and between thiacetazone and PAS sensitivity on the other.

The last-mentioned study is of great interest in connection with previous investigations on the geographical distribution of attenuated tubercle bacilli. At present, tuberculosis cultures from Afghanistan, Burma and Indonesia are bcing collected, to cxtcnd the scope af these invcstigatiom on geographical differences to countries outside India and Thailand, for which relevant data have already been collected and published in co-operation with the British Medical Research Council.

The laboratory capacity of the Tuberculosis Chemotherapy Centre, Madras, has been increased in order to meet the extra work-load in connection with a drug resistance survey in India carried out by the Indim Council of Medical Research.

Pilot trials on the applicability, acceptability and general suitability of thiacetazone plus INH on a mass scale are now being carried out at Bangalore (India) and Bangkok in continuation of previous studies undertaken by the .' Tuberculosis Chemotherapy Centre, Madras. A list of publications of the National Tuberculosis Institute, Bangalore, is given in Annex 7. This reflects the wide range of applied research in the field of epidemiology, sociology, operations research, etc., performed by the Institute.

The Tuberculosis Research Unit at Madanapalle (India), with financial assistance from the Indian Council of Medical Research and with a grant from WHO, has continued its tuberculosis control programme in Madanapalle town SEA/RClI/Z Page 64

and villages. It has also maintained studies on domiciliary drug therapy on a community basis, and is preparing for a co-operative study of the character- istics of Indian mycobacteria. A report on the incidence of tuberculosis in the Madanapalle study population was completed and is being published in the WHO Bulletin under the title "Observations on the protective effect of BCG vaccination in a South Mian rural population". From this study it is concluded that BCG vaccination has produced a significant reduction in tuberculosis cases. The degree of protection may be about 50 -60 per cent, although no precise estimate can be given yet,owing to the limited material available.

8.4 Smallpox

The Smallpox Research Unit established at the Infectious Diseases Hospital, Madras, was assisted with further grants from the WHO Medical Research Fund. Studies in the last two years showed that (a) the administration of a specific gamma-globulin to intimate family contacts was effective in the prevention of the disease; (b) the virus was absent from the mouth and throat of patients during the first two days of the disease and was found only occasionally on the third day, after which it was found regularly; (c) the virus was found in only one of 38 attempts in air samplings from smallpox wards, and (d) dried smallpox vaccine was much more effective in revaccinations than a fresh buffalo calf lymph vaccine, even after this had proved effective in primary vaccinations. Studies on the epidemiology, immunology, prevention and treatment of smallpox, in particular trials with anti-viral drugs, were carried out in Madras during the year.

8.5 Cholera

The present WHO-assisted cholera research programme was outlined by the Scientific Group on Cholera which met in 1962. During the year under review, emphasis was placed on a few items of immediate, practical importance for the control of the disease and eventual eradication Priority was given to (l)cholera vaccine studies and (2) bacteriophage study. As a joint undertaking of WHO, the Government of West Bengal and the Indian Council of Medical Research, a controlled field trial of cholera vaccine was started in Calcutta in March 1964.

The following studies were also supported by WHO:

(1) Studies for bacteriophage-typing and subsequently for the possible effect of bacteriophage on the prevention and treatment of cholera, by the Mian Institute of Biochemistry and Experimental Medicine in Calcutta. SEA/RC17/2 Page 65

(2) Genetic studies of vibrios, by the Calcutta Institute of Public Health.

(3) Patho-physiology of cholera and experimental work, by the Haffkine Institute, Bombay.

8.6 Leprosy

WHO assistance was given to continuing research on the value of chemoprophylaxis of healthy child contacts with sulphones, on trials with anti- leprosy drugs, and on the standardization of lepromin. These studies are being undertaken by the Central Leprosy Teaching and Research Institute, Chingleput (Madras State).

In April 1964 a long-term research project was skirted in Burma with a trial of BCG in the prevention of leprosy.

Through the Medical Research Fund, assistance was continued to the Venereal-Disease Laboratory of the Institute of Venereology. Madras, for studies which aim at defining certain survival factors of treponemes in vitro and in vivo.

Assistance was also given to the Venereal Disease and Yaws Research Institute in Surabaya, Indonesia, in undertaking research on survival of treponemes on the body surface.

8.8 Migratory Birds in their Role as Disseminators of Arthropod-Borne Viruses

In collaboration with the Bombay Natural History Society, WHO continued its long-term studies on the epidemiology of the arboviruses and the role played by migratory birds in their dissemination

8.9 Measles Vaccine Trials

With some assistance from WHO, the All-India Institute of Medical Sciences and the Irwin Hospital, New Delhi, continued to participate in the WHO collaborative studies on measles vaccines. SEA/RC17/2 Page 66

8.10 Rabies

WHO assistance to collaborative studies in India, with the Pasteur Institute, Coonoor, and the Central Research Institute, Kasauli, was continued. This research concerns the pathogenesis of rabies and immunization in man and animals.

8.11 Respiratory Viruses

WHO has planned a collaborative survey on respiratory virus infection in children under five years of age from various countries. The aim of this survey would be to ascertain thc importance of the various respiratory diseases as a cause of morbidity and mortality in children. Such studies have been planned in Celcutta.

8.12 Filariasis

The WHO Filariasis Research Unit in Rangoon continued its basic studies on mosquito vectors of filariasis, particularly on their ecology, bionomics, genetics, vectorial capacity, insecticide susceptibility and cross-resistance to different compounds. It is hoped that the Unit will serve as a centre foi! visiting research workers on filariasis throughout South-East Asia.

8.13 Environmental Health

The various divisions and field laboratories of the Central Public Health Engineering Research Institute, Nagpur (India), have been engaged in many fields of research, including evaluation of the performance of water treatment plants (rapid filtration plants) and sewage treatment plants; the use of indigenous materials like Nirmali seeds in coagulation; defluoridation and demineralization of water; disinfection of rural water supplies; use of synthetic media for examination of coliform organisms in water; hydraulic studies of a water distribution network: river and reservoir survey and hydro-biological studies; nightsoil digestion; cowdung digestion; sewage farming; oxidation pond treatment, including entomological studies; industrial waste treatment (dairy, citrus, canning, straw board and textile mill waste); industrial hygiene studies in the manufacture of ferro-manganese alloys, fertilizers, and insecticides. SEA/RC17/2 Page 67

The Institute has also been the centre for symposia on environmental sciences and engineering education, mch as a Seminar on Public Health Engineering Education, and another on Waste Treatment by Oxidation Ponds - bdh held in October 1963, with WHO assistance.

The United Nations Special Fund has provided equipment to the Institute; WHO has assigned short-term consultants (see India 176 in Part III).

8.14 Nutrition - Anaemias

Studies to determine the lowest level of supplementation with iron and/ or folic acid which would be effective as a prophylactic measure have been continued under the Indian Council of Medical Research. A grant was made by WHO Headquarters to assist with the continuation of these studies.

Haematological studies to determine the availability or iron in food have also continued at the A1 1-India Institute of Medical Sciences, New Delhi, with some assistance from WHO.

A WHO research fellow from India continued receiving special training in research methods on iron deficiency in anaemia in the United States of America.

8.15 Human Population Genetics

Collaborative field research investigation by a WHO research team and Indian staff in the genetical structure of populations in the malarious areas of Andhra Pradesh was undertaken from mid-December 1963 to the end of March 1964. The main aim of this investigation was to study the distribution of thalassaemia, sickle cell trait and Glucose-6-Phosphate Dehydrogenase deficiency (GGPD deficiency). in an area where malignant malaria is still active. In this way it should be possible to draw a final conclusion with reference to the hypothesis that malaria might have been the ecological factor responsible for the selection of these genetical traits which share the peculiarity of disturbing the required symbiosis between the host red cells and the Plasmodium parasite. The additional data collected might possibly lead to information regarding the interaction at a population level between GGPD deficiency and colour blindness of the severe type. If the hypothesis of the selection of deuteranopia via close linkage with G6PD locus is correct, the excess of coupling phases should be at the maximum in active malarious areas. SEA/RC17/2 Page 68

8.16 Radiation

The anslysesef the data collected by a WHO team for studies in human population genetics in areas.of high natural background radiation in Ceylon and in India have been forwarded to the respective governments. Chronic natural irradiation is high enough in certain places to justify cytogenic and other research activities which are likely to yield useful information.

8.17 Cancer

An International Reference Centre for the histopathology of oropharyngeal tumours has been established in the S. N. Medical College, Agra (India), to which a grant was made from the WHO Medical Research Fund, A WHO epidemiologist has been carrying out epidemiological surveys in India and in Ceylon. A pilot project for the assessment of the degree of prevalence of oropharyngeal tumours has been started in Mainpuri District of Uttar Pradesh (India).

9. TECHNICAL PUBLICATIONS. DOCUMENTS AND REFERENCE SERVICES

The Regional Office continued to distribute various WHO publications. documents and other technical information material, The scheme introduced by the Regional Office for taking over the sales of priced WHO publications has now completed its first year, and the results are encouraging. Many more books and pamphlets were added to the Library in the course of the year. These and other developments are described below.

9.1 Preparation and Distribution of Documents

In view of the large demand, the following reports issued by the Regional Office were printed and widely distributed: (1) Report on the FAO/UNICEF/WHO Nutrition Seminar for South and East Asia, held in Hyderabad in October 1962; (2) Report on the Inter-country Seminar on Protein Malnutrition in Children, also held in Hyderabad in January 1963; (3) Assignment Report of Mr D.R. E. Ernborg, Engineeqon Improvement of X-ray Services in India.

Other important documents brought out and distributed were: (1) the Report on the Regional Seminar on Health Statistics (Hospital Statistics), held in Bangkdr in December 1962; (2) two further numbers of the Medical Education Bulletin; (3) Research News (No. I), and (4) two further issues of the Technical Circular on Health Education (TC/HE/13 and 14). SEA/RC17/2 Page 69

The final report and minutes of the sixteenth session of the Regional Committee and the conclusions and recommendations arising from the technical discussions on the subject of "Case-finding and Domiciliary Treatment in Tuberculosis Control", held during that session,were issued and distributed.

Various documents relating to helqinthology, malaria, community water Apply, etc. ,and the WHO publication entitled "Terminology of Malaria and Malaria Eradication" were distributed to health workers in the Region. Bulk distribution was made of the document "Practical Entomology in Malaria Eradication1'. A document issued by the European Regional Office on the technical discussions on "The Organization of Resuscitation and Casualty Services" was also distributed. Copies of the quarterly publicittion "Environ- mental Health", issued by the Central Public Health Engineering Research Institute, Nagpur (India), and several numbers of the Government of India publication "National Malaria Eradication News" were distributed both within and outside the Region.

About 300 copies of the second (revised) edition of the Manual of Paediatrics for South East Asia, by Dr P. Robinson, were supplied to those who had received the first edition.

Altogether, 61 assignment and final reports of WHO project staff, 13 field visit reports by technical advisers of the Regional Office, and 22 miscellaneous reports were edited and distributed (see Annex 8).

Documentation services were provided for the "Meeting of Investigators on the Epidemiology and Pathology of Oropharyngeal Tunours", held in the Regio~lOffice.

The documents stored in the Regional Office were re-arranged,and a system was worked out to enable staff members to take out for themselves the documents which they require.

9.2 Sales and Sales Promotion

Intensive efforts were made to make the concessional rates at which -WHO publications are offered throughDut thc Region more widely kn~wnto health workerfi. About UVO order= were handled.for des of single copies and subscriptions. Though this was only a 25% increase over the corresponding figure for 1962, the value of sales during 1963 was much higher. Subscriptions to publications amounting to $9 220 and orders for single publications costing $3 200 were complied with. These amounts represent the concessional rates allowed on WHO publications. SEA/RCII/~ Page 70

As a part of the sales promotion programme, WHO publications were displayed on several occasions, at national and international meetings (see Part II, Chapter 5). The Editor of the Journal of the India Medical Association kindly agreed to distribute 25 000 copies of a leaflet relating to the sale of WHO publications at concessional rates with the issue of the journal in February 1964. More than a dozen new publications were reviewed, and annotated lists of over fifty publications prepared.

Students in medical colleges, research workers in post-graduate medical institutions and private practitioners have shown interest in WHO publications. The reviews of several, for example the monograph on Milk Hygiene, have evoked considerable response. This monograph is now being used as a textbook by students of veterinary sciences in some places.

9.3 Library

During the year 882 new books and pamphlets and 119 WHO publications were added to the Library and 100 subscriptions taken out. In addition, arrangements were made to obtain from the Headquarters Library current periodicals after they had been circulated to the staff in Geneva. The Iibrary is now regularly getting 206 journals, including those received free or in exchange for WHO publications.

Library News continues to be issued once a month, listing all publications received and also giving in the Bibliography Section, references to articles of WHO interest. Altogether, 1 710 books were issued on loan and many photocopies and reprints of articles supplied to staff members.

As another step towards keeping the technical staff of the Regional Office aware of the latest developments in their specialties, arrangements were made to supply them every month with Current Literature Cards in subjects of their interest. These cards, prepared by WHO Headquarters, contain bibliographic information on articles published in about 2 000 periodicals regularly received in the Headquarters Library.

A standard list of reference books for the libraries of WHO Represen- tatives was prepared by the Librnry Committee in order to bring these libraries up to date, and the books selected were supplied.

Close co-operation has been maintained with the Headquarters Library whose help has been very valuable. SEA/RC17/2 Page 71

PART I1

ORGANIZATIONAL AND ADMINISTRATIVE MATTERS SEA/RC17/2 Page 73

1. REGIONAL COMMITTEE

The sixteenth session of the Regional Committee was held from 10 to 16 September 1963 in Bangkok. The meeting was attended by representatives of all the Member states1. Representatives of the United Nations, the United Nations Technical Assistance Board, UNICEF, ECAFE, FA0 and LO, and of one inter-governmental and nine non-governmental organizations were also present.

The meeting was inaugurated by the Prime Minister of Thailand, Field Marshal Srisdi Dhanarajata. Thailand's Minister of Public Health, Dr Phra Bamras Naradura, also spoke at the opening session. The Committee elected Dr Kamdhorn Suvarnakich, Director-General, Department of Health, Thailand, as Chairman, and Dr P. Dolgor, Chief Surgeon, Mongolia, as Vice-Chairman.

The Committee endorsed,for transmission to the Director-General, proposals for the regional programme and budget estimates for 1964, providing for an expenditure of $13.5 million (including the cost of equipment and supplies which it was expected would be provided by UNICEF). The Committee reviewed the annual report of the Regional Director on the work done during the preceding year and considered a number of other subjects.

It noted that the successful achievements in mass campaigns against some of the major communicable diseases were outstripping the development of the general health services in the Region, and stressed that top priority should immediately be given to strengthening these basic services. It recommended that governments organize well-planned training programmes for multi-purpose medical auxiliaries, to work under the supervision of professional personnel.

The steady progress that had been achieved in malaria eradication was noted with satisfaction, but attention was drawn to the urgency of maintaining an adequate and full-time surveillance organization in areas entering the consolidation phase of the programme. The Committee agreed that governments should be warned about the danger of premature diversion of malaria eradication personnel from their specialized task to other duties.

In a discussion on smallpox eradication, it was noted that smallpox control programmes were under way in almost all the countries of the Region, and attention was directed to the need for synchronizing national campaigns in adjoining territories. One of the chief difficulties was the shortage of adequate l~f~hanistan,Burma, Ceylon, India, Indonesia, Mongolia, Nepal, Thailand and the United Kingdom of Great Britain and Northern Ireland. SEA/RC17/2 Page 74 quantities of a potent and stable vaccine, and the Committee recommended that the attention of the World Health Assembly be drawn to the desirability of urging the more developed countries which produce large quantities of such vaccine to help by donating supplies of freeze-dried vaccine.

A paper ca water supply and sanitation, submitted by the Government of India, emphasized the tremendous task of providing safe water supplies and drainage to both urban and rural communities in countries of the Region, and the fact that intestinal infections were a major source of illness. The paper stated that India, under its three Five-Year Plans, had spent $150 million on rural water supply, and that an estimated further expenditure of $600 million would be required to provide even the minimum facilities for all rural communities of the country.

Other subjects discussed were the recent spread of cholera El Tor and the necessity for ascertaining the effectiveness of the cholera vaccine at present in use; tbe mass immunization programme against pdiomyelitis which had been carried out in Ceylon; the urgent need for assistance in the training of teachers and specialists for medical colleges,and the need for medical literature and teaching equipment.

The Committee agreed that greater attention should be focussed on tuberculosis, now the greatest single public health problem in the Region. Technical discussions were held on the subject of "Case-Finding and Domiciliary Treatment in Tuberculosis Control" (see Section 1.2 of Part I for details). To meet the demands for drugs necessary for treatment programmes, the Regional Director was asked to explore ways in which help could be given to governments, including assistance with local production where feasible, so that adequate supplies of such drugs would be available. Training of multi-purpose medical auxiliaries was stressed once again.

"Smallpox Eradication" was selected as the subject for technical discussions in 1964.

The Committee decided to hold its 1964 session at the Regional Office in New Delhi and accepted the invitation of the Government of Afghanistan for the 1965 session to be held in Kabul. SEA/RC17/2 Page 75

2. ADMINISTRATION

2.1 General

An evaluation of a few WHO-assisted projects carried out during the year (see below) revealed that substantial progress had been made in various health programmes being supported in the Region. There was a marked increase in the number of requests received from Member Countries for assistance from the Organization in the ensuing years. This has had a corresponding effect on the administrative work-load of the Regional Office.

Since its move in November 1962 to its permanent headquarters in "World Health House", the Regional Office has settled down well and adjusted itself to its new environment. Measures were continued to improve the efficiency of the office, more particularly to meet the growing demands on some of the Administration and Finance Units. For example, a TELEX service has been established to facilitate direct communications in India, and it is hoped that shortly the Regional Office will be connected to the international TELEX system, thus permitting direct communication with WHO Headquarters in Geneva; two Thermofax photocopying machines have been installed, and this has partially relieved the pressure of copy typing, and a Kardex system has been introduced in the Reports and Documents Unit, thereby improving and simplifying the collection of various data concerning sale of WHO publications.

In addition to their normal functions, the administrative services were occupied in making arrangements for a number of meetings held in the Regional Office and outside. In order to co-ordinate the administrative arrangements needed for holding meetings, particularly inter-regional conferences and seminars, the Administration is developing a check list of actions which the host regional offices are normally required to take in connection with such meetings.

An analysis of a few selected WHO projects in the Region was undertaken as part of the "Organizational Study on Methods of Planning and Execution of Projects", sponsored by WHO Headquarters in pursuance of Executive Board Resolution EB 32.R10 on the subject; the data collected were forwarded to Geneva.

A fortnightly pouch service between the Regional Office and Mongolia, the newest Member Government of the Region, and vice versa, was established. SEA/RC17/2 Page 76

In view of the importance of the functions of the secretaries in the Regional Office, a series of lectures was delivered by some senior staff members on the occasion of the monthly secretaries' meetings. This is proving very useful.

2.2 Organizational Structure

While no major organizational change in the structure of the Regional Office took place during the year, certain reassignments were effected following the transfer and/or retirement of several senior staff members. Seven professional-grade posts in the Regional Office were filled. These included the post of Director of Health Services, which, on the retirement of the incumbent of the post, was filled by one of the Assistant Directors of Health Services, who, in turn, was replaced by transferring to the Regional Office the WHO Representative to Thailand. Another post filled was one of the two vacant posts of Regional Adviser in Communicable Diseases.

.The WHO Representatives in Afghanistan, India and,w.bpal kstiykd and

were, replaced. An acting WHO Representative was assigned to ~hailaqd, as a temporarymeasure. Six posts - those of the Regional kdviser in I. Communicable Diseases (second post), Health Statisti~ian,~dtomoldgist h the Malaria Eradication Unit, Informatim Officer,' ~udget.andFinbee Officer and, in.duly, the WH,O R,eprew+ati?!e to-Afghanistan (replacement) - which fell vacant, remained unfilled.

An organizational chart is attached as Annex 1.

2.3 Personnel

A list of the professional staff attached to the Regional Office is given as part of the organizational chart (Annex I).

The geographical distribution of the professional staff as on 30 June 1964 is shown in Annex 2. Additional countries represented this year are Afghanistan, Bulgaria, Ceylon, Colombia, Czechoslovakia, Korea, Malaysia, New Zealand, Pakistan and Poland.

The following table shows the number of professional and general service category posts established and actually filled during the period under review, SEA/RC17/2 Page 77 both in the Regional Office and in the field:

Established posts Posts actually filled for 1964 jas on 30 June 1964)

(1) Regional Office Staff (a) Professional Regional Office Regional Advisers WHO Representatives

(b) General Service Clerical Custodial

(2) WHO Representatives' Office Clerical 9 Custodial 7

(3) Project Staff (a) Professional Regular and TA MESA

(b) General Service Regular and TA MESA

(4) Staff on Leave Without Pay (a) Professional 5

(b) General Service - -

The salary scales for general service category staff in Afghanistan and Indonesia were revised.

2.4 Staff Welfare

The Staff Society continued to be active. During the year it started participation in a newly-formed "Joint Consultative Committee" made up of representatives of the staff of ail United Nations agencies in New Dew. The annual meeting of its General Body was held on 25 March 1964. SEA/RC17/2 Page 78

2.5 Finance, Budget and Accounta

The total obligations incurred on field activities from all funds during the past ten years (1954 to 1963) are as shown below:

Source of Funds (Expressed in US Dollars1 Other Extra- Year Regular TA MESA Total Budgetary Total FulKts*

L I 1 I I I I I *As budgetted ahrcludes $278 250 from the United Nations Special Fund bIncludes $472 185 from the United Nations Special hurd "Includes $127 730 from the United Nations Special Fund

In 1963, nearly 100% of the allocations under Regular funds and 99% of those under Technical Assistance funds were utilized.

The staff health insurance scheme continued to functlon eatiafactorily. The revised rules, which came into force on 1 January 1963, provide enhanced benefits at lower rates of contribution. The number of particfpante increased, and dental benefits for staff members have now been included: both these facts account for an increase in the number of claims settled and the amount of reimbursement made. Reporte on the working of the scheme, which are prepared at the end of each quarter, give the following figures from 1961 awards: SEA/RC17/2 Page 79

2.6 Accommodation for the Regional Office

Experience gained during occupancy of the new Regional Office building has shown the present accommodation to be highly satisfactory.

Cultural contributions to the building during the year included a beauti- ful Aubusson tapestry provided by the Government of France, formerly a Member State represented in the Region. The Mongolian contribution is expected shortly, as are some carpets from Afghanistan and some furniture from Ceylon.

The artist appointed by the Government of India completed two large murals depicting the history of medicine,on both sides of the Conference Hall.

2.7 Constitutional and Legal Matters

Relations with Member Governments continued to be cordial. Altogether, 89 plans of operations, exchanges of letters and addenda to existing plans of operations were under negotiation or signed during the year. These included a plan of operations for health education in schools in Burma; one for an applied nutrition programme in Ceylon; an all-India master plan for an applied nutrition programme; a master plan for development of health services in community development areas in India; a revised plan for the malaria eradication programme and plan of operations for a community water supply project in Ceylon, and an addendum to the master plan for a programme to improve nutritional standards in Central Java. Plans of operations for malaria eradication programmes in other countries of the Region have also been revised and are under negotiation with the governments concerned.

3. PROCUREMENT OF SUPPLIES AND EQUIPMENT

Supplies and equipment for field prwammes and also for various research projects sponsored by WHO in this region continued to be provided. The total cost of such supplies under Regular, Technical Assistance, MESA and UNSF funds was approximately $415 000. The supplies and equipment procured were mostly of a general nature, such as medical literature, laboratory equipment, chemicals, drugs, biologicals and transport vehicles.

Consignments of freeze-dried smallpox vaccine were received as gifts from the Governments of the USSR, the United Kingdom, Switzerland and the Netherlands,and distributed to four countries in the Region, as follows: SEA/RC17/2 Page 80

Afghanistan, 849 000 doses; Burma, 1 900 000 doses; Nepal, 399 000 doses and India, 7 225 000 doses.

Stores and the aluminium huts belonging to the malaria eradication programme at Amlekganj (Nepal) which had become surplus were disposed of, and reconstruction of one prefabricated aluminium hut, which was moved from Amlekganj to Hitaura, was completed.

Two 25 k. w. Russian diesel generators procured by the Regional Office for Afghanistan were installed, one at Jalalabad Hospital and tbe other at Khost Hospital.

A request from WHO Headquarters for an emergency supply of 500 000 cc of cholera vaccine to be sent to Korea was immediately dealt with. Supply was arranged with the Haffkine Institute, Bombay.

4. COLLABORATION WITH OTHER AGENCIES

Collaboration with the United Nations, its specialized agencies, and with inter-governmental, non-governmental and other agencies working in the field of health has, as usual, been well maintained through various interagency meetings. The WHO Representatives have been closely associated with the UNTAB and UNICEF Offices in their respective countries. The Regional Director, accompanied by the WHO Representative to India and the Chief of Administration and Finance, have continued to attend the quarterly meetings of the Heads of United Nations and its specialized agencies in New Delhi on matters of mutual interest. A meeting of the United Nations specialized agencies and bilateral agencies represented in India, held at the Directorate General of Health Services, provided an opportunity for discussions on matters relating to community health services.

4.1 United Nations .. Discussions were held on the health aspects of proposals for possible assistance to countries by the World Food Programme.

Co-operation with the United Nations Bureau of Social Affairs in the field of medical rehabilitation was continued. The Bureau provided fellowships for training prosthetic technicians. SEA/RC17/2 Page 81

Liaison was maintained with United Nations Information Centres in various countries of the Region and with the ECAFE Information Service in Bangkok. WHO was represented at the "Editors' Roundtable" held in Bangkok under the auspices of the United Nations Office of Public Information. The Regional Office also participated in an exhibition put up by the United Nations Information Centre in New Delhi on the occasion of Human Rights Day.

Discussions were held with the Executive Secretary of the United Nations Fund for the Development of West Irian (Indonesia) on the Fund's possible co-operation in health activities and related matters. The Fund has placed first priority on the development of communications in that province of Indonesia.

4.1.1 United Nations Technical Assistance Board (UNTAB) and United Nations Special Fund (UNSF)

The Resident Technical Assistance Representatives for Afghanistan and Ceylon were invited to the Regional Office to discuss relevant technical assistance programmes. Visits were also paid by several UNTAB personnel to the Calcutta water supply project to discuss UNSF participation in this project. Two UNSF consultants visited Afghanistan to undertake studies in respect of surface water development and agriculture experimental stations: discussions were held on WHO'S interest in this project.

Regular day-to-day contacts were continued in order to expedite the processing of changes in the Expanded Programme of Technical Assistance through the Various echelons of the governments and the TAB which are involved. A meeting was arranged in the Regional Office with the Special Consultant to the Managing Director of the Fund and the Director of the Bureau of Operations on UNSF-assisted projects in the Region.

The WHO Representative to Afghanistan held consultations with the Director of the United Nations Department of Economic and Social Affairs during the latter's visit to Afghanistan in August 1963, to discuss with the Government the plan of operations for ground-water availability studies.

4.1.2 Economic Commission for Asia and the Far East (ECAFE)

WHO has maintained close relations with ECAFE and has participated in the work of the Asian Institute of Economic Development and Planning. Mr P. N. S. Prasad, Director of the Institute, visited the Regional Office to SEA/ RC17/2 Page 82 discuss the mechanism of collaboration and consultation with WHO. A public health administrator (consultant) was assigned to the Institute by the WHO Regional Office early in 1964.

The WHO Representative to Thailand attended the ECAFE-sponsored Workshop on Development of Local Leadership in Community Development, held in Bangkok in August 1963.

Relations with ECAFE were further developed through attendance at a seminar on "Central Services to Local Authorities", sponsored by ECAFE and the Eastern Regional Organization for Public Administration, and also at the Asian Population Conference, both held in New Delhi.

4.1.3 United Nations Children's Fund (UNICEF)

As in the past, close relations with UNICEF were continued,through direct contacts and negotiations with governments on a number of jointly assisted projects. Discussions were held with the Director of the UMCEF Asia Reglonal Office, Ban&ok, and with the newly appointed UNICEF Resident Representative for Burma, when they passed through Delhi.

WHO undertook an evaluation study of WHO/UNICEF assistance to nursing education in India. It also assisted in conducting a survey of training activities and furnished material on a regional study on children's problems in Asia, for the meeting of UNICEF Executive Board held in Bangkok in January 1964. The Executive Director, UNICEF, and some delegates who were en route to Bangkok to attend the UNICEF Executive Board meeting visited the Regional Office.

4.1.4 International Atomic Energy Agency (IAEA)

Liaison continued with lAEA and the Thai Office of Atomic Energy for Peace in connection with the development of a Division of Radiological Health in the Ministry of Public Health, Thailand.

4.1.5 World Bank

Two representatives of the International Bank for Reconstruction and Development visited India and Thailand for discussions on the possibility of assistance by the International Development Association to water supply programmes. Such visits afford an excellent opportunity for WHO to promote these programmes within the guidelines provided by the repreeentatives. SEA/RC17/2 Page 83

4.2 Specialized Agencies

4.2.1 Food and Agriculture Organization (FA01

A number of meetings were held with FA0 and UNICEF on applied nutrition projects in Ceylon, Mia and hail and. WHO is also assisting in a joint study of evaluation methods in applied nutrition programmes.

WHO was represented at a technical meeting in Colombo on "Food Consumption Surveys", sponsored by FAO. A member of the Nutrition Division, FA0 Headquarters, Rome, visited the Regional Office for discussions. Consulta- tions were also held with FA0 on World Fwd Programme activities.

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

A UNESCO/ECAFE Regional Advisory Team on ducat ion Planning undertook a programme of visits to several countries of this region and came to the Regional Office for discussi~ns. The UNESCO-sponsored Fourth Regional Conference of the National Commission for UNESCO in Asia, held in Bangkok in February 1964, was attended by the WHO Representative. WHO was also represented at the third meeting of the Steering Committee for the UNESCO Research Centre on Social and Economic Development in Southern Asia, held in New DehL UNESCO has agreed to support this Centre for another two years. A meeting was held by the Government of India with UNESCO, UNICEF and WHO to discuss possible UNICEF assistance in the field of health and nutrition education at teachertraining colleges: the object of the programme is to equip each of the 2 000 teacher-training institutions in India so as to enable them to give comprehensive training in health education and nutrition to future teachers. WHO continued to participate in UNESCO-assisted education projects.

4.3 Bilateral Agencies

Liaison was maintained with bilateral agencies through frequent discussions on common problems of technical assistance.

4.3.1 United States Agency for International Development (USAID)

Co-operation was continued between USAID and WHO in malaria eradication programmes in India, Indonesia, Nepal and Thailand: during the year the two agencies assisted in an assessment of the malaria eradication programme in SEA/RC17/2 Page 84

Thailand. In addition, satisfactory co-ordination with USAID was maintained on various other public health programmes of mutual interest in almost all the countries of the Region. In Thailand, for example, the WHO Representative visited the USAID-assisted village health and sanitation project in the Songhkla- Haadyai area of South Thailand. Two USAID representatives visited the Regional Office in New Delhi before undertaking a study of local health conditions in Afghanistan to consider possible areas of USAID assistance.

In India, particularly, there have been very close contacts. USAID officials were given orientation on WHO'S activities in Aligarh (India), where they are preparing a composite plan for the development of Aligarh District. The USAID Regional Water Supply Adviser for the Near East and South Asia visited the WHO/UNSF-assisted Calcutta water supply project. Representatives of USAID and WHO attended a meeting on rural water supplies and ground-water resources, held in the Ministry of Health, New Delhi. Contact was established with a consultant appointed by USAID to work with the Central Health Education Bureau, New Delhi. The United States of America has made a grant to the Indian Council of Medical Research for planning, supervision and execution of the virus research programme at the Virus Research Centre, Poona. Discussions were also held with USAID representatives on proposals for tuberculosis research and a major BCG trial in India and for possible support to water supply programmes.

4.3.2 Colombo Plan

The Regional Office continued to keep in touch with the Colombo Plan with respect to activities in the field of medical education and training. 'Almost all the countries of the Region have benefited from the large number of fell6wehips in the health field which have been awarded by the Colombo Plan, figures are given under Section 7.1 of Part I. Possible co-operation in assistance to post- graduate medical education was discussed with members of the United Kingdom's Department of Technical Co-operation,both in Delhi and in London.

The Colombo Plan has provided a consuitant to the Government of Burma for assistance in setting up a School of Medical Technology, where technologists in physiotherapy, radiography, laboratory methods and pharmacy will be given training.

In Ceylon, the consultant provided by the Colombo Plan to the School of . . Dental Nurses, Maharagama, is continuing her work. SEA/RC17/2 Page 85

4.3.3 Other Bilateral Agencies

Co-ordination has been developed with the Federal Republic of Germany, which has provided some staff and equipment to assist the Institute of Public Health, Kabu1,and is helping Indonesia by providing a professor to the Depart- ment of Parasitology in Bandung and by aiding with the construction of that department.

WHO has assigned a staff member to assist in the new development of the Indo-Norwegian health project in India, mentioned in last year's annual report.

Discussions were held with the representative of the Danish "Save the Children" Organization in connection with the expansion of the leprosy project in South India, which is also being assisted by WHO (see Section 1.4 in Part I).

4.4 inter-Governmental and Non-Governmental Organizations

As stated in Chapter 1 above, representatives of one inter-governmental and nine non-governmental organizations in official relations with WHO attended the sixteenth session of the Regional Committee. WHO, reciprocally, was represented at various meetings of the regional and national organizations,affi- llated with these international non-governmental organizations. Such meetings included the Second All-India Cancer Conference,sponsored by the Cancer Society- of Mia, the Annual Conference of the All-India ~ental~ssociation, the First National Conference on Paediatrics, held under the auspices of the Indian Academy of Paediatrics, the Fourth Annual Conference of the Indian Association for Chest Diseases,. the Annual Conference of the Indian Association for the Advancement of Medical Education, and the Asian Regional Conference on Increasing Inter- national Understanding through Teaching about the United Nations, which was sponsored by the World Confederation of Organizations of the Teaching Profession. A list of conferences and meetings of governmental, non-governmental and other organizations at which WHO was represented is given in Annex 4.

The Regional Director held discussions with representatives of the Asso- ciation for the Prevention of Tuberculosis, the Society for the Prevention of Blindness and the Cancer Society.

4.5 Other Organizations

Contacts were maintained with representatives of the Rockefeller Founda- tion. The Foundation has made a grant to the Medical College, Pondicherry (India), SEA/RC17/2 Page 86

for the provision of supplies and equipment needed for further research in virology. WHO has provided a visiting professor of preventive and social medicine to that college.

fierluent discussions were held with the staff of the Ford Foundation on reorganization of rural health services in India and on the establishment of an Institute of Public Health Administration and Education in India with the help of the Foundation.

The Asia Foundation is offering short study tours for education and training purposes in Afghanistan.

Co-operation with a large number of national organizations - governmental, non-governmental and private - has also continued, the Regional Office and.other staff attending a large number of meetings to maintain this co-operation (see list given in Annex 4).

5. PUBLIC INFORMATION

Public information activities were concentrated on .stimulating and assisting the outside production of television and radio programnies, films, baoks and articles on the work of WHO and on public health and related fields in general,and on making WHO and its aims known through schools.

Scripts were prepared and recordings made for programmes on tuberculosis control,which have been bmadcast by the British Broadcasting Corporation, and for programmes on medical education and medical research presented by the United Nations Radio and several Asian networks.

In co-operation with "Voice of America", a programme was produced on the WHO Meeting of Investigators on the Epidemiobgy and Pathology of -eal Tumours,held in the Regional Office. This programme was also transmitted by All-India Radio. In co-operation with the United Nations Information Service, ECAFE, Bangkck, a series of programmes on the work of WHO and other agencies is being planned for Thai television and radio.

Arrangements were made, in co-operation with UNICEF, with the Delhi- based South-East Asia Film Unit of West German Television for the production of a 45-minute television programme on some of the main aspects of social and economic development: education and its relatiod to health, urbanization, food production and nutrition, and water supply. Material for the programme, which will stress the importance of international co-operation through WHO, UNICEF, SEA/RC17/2 Page 87

FA0 and UNESCO, is being filmed in Tl~ailand,the Philippines, Monesia and India.

Discussions were held with "Asia Films" and West German Television about the production of television programmes on smallpox eradication in South- East Asia, with the Danish "Save the Children" Organization about the joint production of a documentary film on leprosy based on the WHO/- project in India, and with the Film Unit of Shell Oil Company, London, about the production of a series of films on health promotion in Asia.

Ftlms on leprosy control and malafia eradication; produced with tbe assistance of the Regional Office, were released by "Bayerr', West Germany.

A series of 120 colour-slides on public health work in the Region, produced with the assistance of WHO field staff, was completed and made available to the National Citizens' Comrrittee for WHO in the USA and the American Medical Women's Association. The slides have been used extensively in connexion with talks on WHO in the United States of America.

Efforts to make WHO and its work known through schools continued. The Regional Office co-operated with the Indian National Commission for Co-operation with UNESCO in its experimental programme in education in international understanding. This programme includes teaching about the United Nations and its specialized agencies. Suggestions for study-projects on WHO were prepared for teachers' workshops organized under this programme, and study material, including films, was sent to several schools on request.

Talks were given and a WHO study group was organized at an Asian Conference of the World Confederation of Organizations of the Teaching Profession, held in Bangkok, and attended by a representative of WHO. The theme of the conference was "Increasing International Understanding through Teaching about the United Nations"; 700 teachers from 16 countries participated. WHO also participated in the 13th Annual Conference of the United Schools Organization in New Delhi.

The theme of World Health Day, 1964, was "No Truce for Tuberculosis". The Day was observed in all countries of the Region and helped to arouse public interest in support of tuberculosis control work. Besides the radio productions on tuberculosis already mentioned, the Regional Office prepared twelve articles and messages on the theme of the Day. Together with a set of eleven articles issued by WHO Headquarters, this material was published in a large number of newspapers and periodicals all over the Region, including, for the first time, Mongolia. SEAlRC1712 Page 88

Subjects on which articles were prepared on request from outside publications included nutrition, child health, tuberculosis control in South-East Asia, tuberculosis chemotherapy, WHO'S work in South-East Asia, health education, nursing, and malaria eradication, Articles on public health nursing and town planning were prepared, and material on other subjects was commis- sioned for World Health.

A number of exhibits were prepared by or with the assistance of the Regional Office in various countries of the Region, on the occasion of WHO meetings, World Health Day, and meetings of other organizations such as the First Asian Population Conference, Conference of the Tuberculosis Association of Nepal, and the Conference of the World confederation of the Organization of the Teaching Profession. The Regional Office also contributed material to exhibitions at the 17th International Tuberculosis Conference, Rome, and to the Indian Pavilion at the World Fair, New York.

The number of requests for information on WHO and its work and on matters of health in general is increasing each year; during the period under review these requests exceeded 1 600.

World Health House continued to attract groups of teachers, students, nurses, civic associations, etc., and a programme of taks on, -WHO and of film shows has been established. SEA/RC17/2 Page 89

PART 111

ACTIVITIES UNDERTAKEN BY GOVERNMENTS

WITH THE HELP OF WHO SEA/RC17/2 Page 91

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. A short review of health developments during the year is also given for each country. Inter-country and inter-regional projects are listed at the end.

Projects (even though mentioned in last year's report and planned to continue in future years) for which no active assistance, in the form of field staff, fellowships or supplies, was given during the period covered are not included. Also omitted from the list are projects for which technical advice from the Regional &ice or Headquarters was the only assistance given, and projects assisted only by grants-in-aid.

In the first column (under "Project No., Source of Funds, Co- operating Agencies") "R" rn eans the Regular budget; "TA" means Technical Assistance funds; "UNSF' the United Nations Special Fund; "UNICEF" the United Nations Children's Fund, t'CWS' the Special Account for Community Water Supply, "MR" the Special Account for Medical Research, and "USAID' the United States Agency for International Development. Names of co- operating agencies, except for UNICEF (see above), whether or not they have contributed funds, are given in parentheses.

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" are those in which fellowships are considered as projects in themselves; other fellowships are shown under the title of the project of which they form a part.

It should also be noted that there are a number of projects not included in the list for which UNICEF is furnishing supplies and WHO technical advice only (with no special personnel being provided). Advice of this type continues to be a' growing responsibility of the Regional Office.

SEA/RC17/2 Page 93

1. AFGHANISTAN

A winter of exceptional severity with very heavy snows made communications to some outlying areas difficult and hampered development work and services. The need for an effective system of vital and health statistics, which will facilitate a more accurate assessment of health needs and will guide planning, has been increasingly recognized. Efforts have been made to accelerate the rate of growth of rural health services, and it has been planned to increase the scope of the rural development programme from three to six project areas a year. Steps have been taken to promote a more integrated rural health service which will be capable of absorbing such mass campaigns as malaria and smallpox eradication and tuberculosis, leprosy and trachoma control.

A major organizational step has been the division of the country into 29 provinces, whereas previously there were only 13 (seven major provinces and six districts). There will be a provincial medical officer in each province.

A new medical college was opened at Jalalabad in Nangarhar Province. It is appreciated that a considerable effort is necessary to provide adequate staff and teaching facilities, including a satisfactory teaching hospitaL The Rector of Kabul University and the Dean of the new medical college were assisted to visit India to study recently established medical colleges. It was expected that admission to the Medical Faculty of Kabul University would be increased by about thirty per cent. Co-ordidtion between the Health Ministry and Kabul University has permitted the use of medical institutions under the Health Ministry as teaching fields for medical students.

With the concurrence of the Ministry of Education, in order to improve the quality of candidates for para-medical training, a decision has been taken by the Medical High Council, chaired by the Minister of Health, that candidates who have passed the sixth grade will be admitted to the Academy of Teacher Training and to a special school connected with the Masturat Hospital (for male and female candidates respectively), where they will receive three yearst schooling with bias on science subjects and subjects related to th~irfuture profession. After passing the course they will then be admitted to schools dealing with training in their special professions.

The first year of the programme for training nurse-midwives at Shararah Hospital progressed well. The older established nurse-training programmes also continued to operate. A nursing course to enable senior midwives to qualify as nurse-midwives promised to produce future leaders in nursing education. SEA/RC17/2 Page 94

It has been decided to givc auxiliary-nurse-midwife training at the provincial headquarters. It is understood that such training has already been started at Kandahar and also at Lashkargah, at the latter with the assistance of CARE/Medico.

Many of the initial difficulties hindering the full development of the Public Health Institute are being gradually overcome. The training of sanitarians and the health education activities in the Institute have progressed well. A blood bank was brought into operation, with technical assistance from West Germany.

The Central Health Laboratory was transferred into a new building in the compound of Avicenna Hospital, and continued to do work of high quality.

The smallpox control pilot project in Kabul City was satisfactorily concluded, with a coverage of over eighty per cent. The work was facilitated by donations of freeze-dried vaccine from bilateral sources, promoted by WHO. Plans for a country-wide eradication programme were in train.

A BCG immunization campaign covered most of the school-children in Kabul., The work has been transferred to Kandahar, and plans were made to start a BCG campaign in Shewaki District.

Work was started by the Kabul Municipality on an extensive programme to improve accommodation and sanitation in the older areas of Kabul. The plan envisages complete reconstruction of these areas within twenty-five peara. PROJECT LIST

Prulact N?. Source of Fund; Co-cpcratinc A~encies -Title

-I,f,:hanistLn 11 Malar~aEradication R (nus 1756 - ) UNICEF

Aim of the prolcct. Tc eradicate malaria from the entire country and to prevent the re-establishment of endemicity.

Assistmce provided by k?iO durini: the year. (a) Thrcc malariologists, an entomologist, a sanltari:m, three laboratory technicians and three secretary-stenograms; (b) one four-month fcll.>wship to attend the malaria t.ralning course in Jamaica, three four-munth and onc thrce-month fellowships for study in Nigeria, and three three-month fellowships for study in India; (c) supplies and equipment and four vehicles.

(In addition, a six-week international fellows.dp was awardec! under the scheme for ixchange of Scientific Workers.)

Probable durxtion of azsistance. Until the end ut' 1/67.

Work done during the year. In 196q, spraying operations are planned to cover a populaticn of appraximztely 4.2 million, including 581 190 people in new areas. S?>rayingwas withdrawn frcm Pulikunri Unit; this ilas increased the pcpulation under cunsolldaticn to 541 UClO. Following the discovery of a few cases of mnlarla in the Kabssl a:c:l, actic:n has hecn takcn to intensify antilarval operations and to deal with fici by residual spraying. Thcrc bras an outbreak of malarla in Sarobi area, whcrc thl:r.c is an segregation of labour for construction works. Special measurcc were takcn to deal with this outbreak.

Entomolcgical ac';ivities have been reorganizer;. M investigation is in progress in Kataghan Province to ascertain if there are any undetected vectors responsible fir the persistance of law-grade transmission in some areas.

M assessment i:f thc prlgraimc ccvcring the ar,ens Jiroposed for withdrawal of spraying in 1965 hcs been undertaken by a Regional Assessment Team (see SEAR0 7). Based on the findings of this assessment, action is being takan to improve the supervision of surveillance cperatlons.

Jfdznistan 13 Medical Educatior. R (Jan. - Aug. 1952; Sept. 1953 - )

Alm of the project. To build up departments ~f the Faculty of Medicine and to train staff. SEA/~cl7/2 Page 96

As5iStanCe DrOVided by WO dUrinK the year. (a) A professor of pathology and a professor of physiology; a consultant for three weeks and a secretary-stenographer for six months; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1968.

work done durine the year. The visiting professor of pathology started his assignment in March 1963. He has assisted in organizing the teaching of pathology and hist>logy by preparing lecture notes in English, which were translated by the national counterpart into Farsi, ty setting or a teaching laboratory and by developing sets of slider, for. study. A pathology diaejlostic service was introduced at the University hospitals, far whlch an automatic tissue-processing machine, provided by UNICEF, was a very useful item. Integration of activities wlth Clinical departments was established.

The visiting professor of physiology joined the project in November 1963. After making an assessment of the status of the Department and its future needs. he assisted in organizing a student laboratory in the premises recently evacuated by the Bacteriological Department. An order fcr supplementary equipment was prepared. Books and periodicals Were added to the library; lecture notes in English were prepared for translation into Farsi by the national counterpart.

Assistance was also given to the new medical college at Jalalabad by both the visiting prcfessors.

Secretarial assistance was provided by WHO, to help with clerical work in the project and the typing of pathology records.

A short-term consultant visited Jalalabad far three weeks wlth a view to reccmmending a programme of development for a medical college.

Afuhanistan 20 Vaccine Production, Kabul TA . (Jan. 1955 - Nov. 1960; July - Oct. 1961; Dec. 1962 - ) UNICEF

Aim of the ~roject. To reorganize, expand and improve facilities for vaccine production far the national health programmes; to train local personnel in the production of biological substances.

Assistance provided by WHO during the year. A bacteriologist.

Probable duration of assistance. Until the end of 1964.

Work done during: the year. This project has been assisted since 1955 with full- time bacteriologists and consultants. Several fellowships in bacteriology and supplies and equipment from WO and UNICEF have been provided. The Vaccine Centre produces vaccines meeting internatianal standards. During the year much improvement was effected in the physical facilities Of the Centre and in the accommodation for animal breeding. The production of vaccines continued to be improved. The control cf these vncrlnes by sterility tests, and in some cases by potency tests, was introduced. Larger quantities of bacterial vaccines (TAB and cholera) and virus vaccines (rabies and smallpox) were produced. In the production of TAB vaccine, local strains have been introduced; the Centre has also started preparing agglutinable diagnostic "0" suspension fcr the Widal test.

From 1965 onwards the Institute will work closely with the Microbiological Department of the Public Health Instltutc, Kabul. wllere, by chat time. a vaccine control section will have been established to assay independently the batches cf vaccine Droduced at the Institute.

Af~hanistan24 Health Education R (oct. 1958 - Sept. 1959~May 1962 - )

Aim of thc prsject. TLI develop health cducatlon service in the ccuntry; tG promote health education in teacher training; to train health staff in health education; to establish and develop a health education section in the Institute of Public Health, Kabul.

Assistance provided by WHO during the year. (a) A health educator; (b) supplies and literature.

Probable duration of assistance. Until the end of 1966.

Work done during the year. Developing the Health Education Section, including a field laboratory; adding a health education c3mponent to training programmes; providing assistance to various health programmes in planning health education activities, and preparing health education materialr were the main activities of the project during the year.

Teaching in health education was provided to first and secund-year students in the School for Sanitarians; classes for seccmnd-year students were held in lthe field laboratory once a week.

Throughout the academic year, health educatidn was included in training courses for trainees in Class XI11 and for female trainees in Class XI at the Teacher-Training Institute, Kabul. It was also included in two seminars for trainees in the Faculty of Education and for teache1.s attending the three-month mid-winter in-service training course. Activities were continued with the Health Committee in the Teacher-Training Institute.

Advice was given in connection with the develupment of the health content of the curriculum,undcr the UNESCO-assisted project on teacher education.

The smallpox ccntrol project was assisted by providing training in health education to the workers, by preparing health education materials and through SEA/RCI 712 Page 98

community activities in Kabul. Logar and Jalal.abad.

Work was started on the preparation of a long-range plan for the development of health education in the country, considering the number of health educators required, their placement in the health organization and the procedures for their recruitment and training.

Assistance was given in planning the World Health Day programmerin co- operation with the staff of the Tuberculosis hospital. A weekly rad1.i feature has been arranged by the Health Education Section, with the co-operation of other health workers.

Medical students undergoing courses in social and preventive medicine at the Medical College, Kabul, and male nurse trainees were assisted during their field experience at Shewaki.

The doctor in charge of the Health Education Section left for study at the Schuol of Public Health, University of Mtnnesota. USA, on a WHO felluwship. Another doctor and a sanitarian joined the Sectlun - the latter on his return from a USAID fellowship in Beirut for study in sanitation and health education. Another sanitarian trained in the School for Sanitarians, Kabul, was also assigned to the Section.

Afghanistan 26 Rural Health TA (April 1956 - ) UNICEF

Aim of the project. To further the development of rural health services in which effectively directed and supervised curative and preventive services are integrated at all levels.

Assistance provided by WHO during the year. (a) A public health officcr, a sanitarian and a public health nurse; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1968.

Work done during the year. The provision of slx-monthly travel permits has facilitated field work.

Considerable attention was given to the training aspects af the project. A curriculum for training of dais was prepared, but the lack of a national nursing counterpart has been a handicap tc midwifery training.

Improvements in water supply continued to receive close attention. A scheme for more systematic execution of water supply programmes was prepared. The scheme envisaged a planning process,followed by implementation and subsequent intensification of the work. Thc projsct has succeeded in producing spare parts for pumps. Prototypes of pumps suitable far this area have alsa been made locally and are under trial. At Larjynshar and Nuristq pipe-dlstributibn systems are nearing completion and will scrve a population of 3 000 and ? 000 respectively.

The work at Shewaki is well established. Though the emphasis has been on curative aspects, increasing integration with preventive aspects has been secured thrcugh arientatlcn training of health staff, village-level workers and village leaders.

Training of health personnel continued satisfacturily. A national counterpart to the WH3 nurse would help to cxtend the training to female personnel outside the ;I:e.waki Rl'd:i.

A two-week ln-service training ccurse fcr all Rural Development Department sanitarians was plmed,and the training of village-level workers given a more practical bias. Male nurses of Aliabad Hospital were, for the first time, given four weeks' oricntatlcn at the Shcuaki Training Centre,ln public health in rural areas.

The WHO public health officer and the senior WHO malariologist in Kabul assisted in organizing the training of laboratory technicians (engaged ln passive surveillance) in the method of t&ing blsod slides. Givin at Shewaki, this training !;?is extented Li, st,hir r~ralhezlth stzdf.

A scheme for. intensifying treatment of tuberculosis patients in the PPoject area was worked out. The pwject has established cisse cu-ordination with those engaged in control of communicable diseases, particularly malaria and tuberculosis. It has also carried out field activitles in collaboration with the Public Health Instituta.

Prcject staff devoted much time to help combat a large outbreak of smallpox in Logar I1 area. Arrangements were made fcr train:- villdge-l;vcl workers and females in vacclnatiun 3galnst smallpox.

Cases of typhus were reported from the Yakolong area in April 1964, ana control measures were zdopted. Throat and nasal swabs were collected in the Shewakl area, where cases of diphtheria had been reported.

Sixteen health centres have been established. It is aimed tc set up ?5 health centres before the completion of thp Scc nd Five-Yertr Plan in 1966.

Co- operation with UNICEF and other United Nations agencies engaged in community development work continued to be satisfactory.

-Af~hanistan 28 School for Sanitarians. Kabul TA (July 1955 - I

Aim cf the project. T? train sanitarians for comurlity health services throughout the country. Assistance provided by WHO durinii the year. (a) Two sanitarians; (b) supplios and equipment.

P1,obable duratiun of assistance. Untll the end rf 1969

Wr,rk done durinp, the ycar. Thr tralning programme was cintinued in the accepted pattcrn,with 21 students in the senior course 3nd 25 students in the juniur course.

A field laboratory has been developed :it Drh Sabz,with full co-operation frcm the villagers and th~autho:.ltles concerned. It has added cunsiderably ti: thc value of the practical 351)cct~ruf training. Theoretical and pr.actical training has betn strcnzthmed by the additir~n!'f spccial 1rctur.e~and demonstrativns on chemistry and bacteriology of water, sewage and fijud, glven with the assistance of the Mlcrobiclogy Section of the Public Health Institute.

Visits to the townships of 531111b1d, Kand*.ar and Glrlshk have +.nabled supervision and guidance tu be given tc sanitarians formerly trained in the School and have promoted appreciation rmf the si!rvices of this catigory of health worter.

Af~hanistan31 Institute ,~fPublic Health, Kabul R (April - May 1956; Nov. - Dec. 1958; March - UNICEF May 1961; May 1962; Aug. 1962 - )

Alm of the project. Tc. duv~ll'r? thc Institute .;f Public Health for invcstigations. research and training cf public health workers.

Assistance urovided by WHO durin$ the year. (a) A public health specialist, a microbiologist, a lilbc~l~3t:orytechnici.lzi and a sanltary engineel.; a consultant for tw: 'io=ks; (b) a twel:rr-m,ntll fr:ll?:rsl:lp for study in the United Kingdom; (c) SGpplies and equipment.

Prwbable duration sf assistance. Until the end of 1968.

Work dme during thc year. The WHO senl:,r offlcer nf the pri,ject (public health specialist) completed his assignment in January 1964. His repcrt has been sent to the Government.

The WHO microbiclogist left in February on reassignment ti the Western Prcific Rc.@i::n, and ;i rtpl~c~zinthas br.rl, f..uld. In We neantina, the Reglonal Adviser in Health Laburatorics assist6:d in the fur,ttier urganizatlon of the Microbiological Department and in starting bncteriuloglcal lnvfstigatians fr,r dighthsria, salmcnell? and shigellae and far watcr-testing. Bacteriological examinatian of watcr samples and investigations of thrc'at swabs for diphtheria were carried out.

A consultant was assig~~dfor two weeks In January/Fcbruary to study the pr~>bli.mIT drug control. SE."./RC17/2 Page 101

A WH3 laboratory technician took up his position in March 1964. Teaching and training activities were expanded. Material for the technicians' course, which stai,ted in March 19611. ~35prspared, l~ldth? i~chniciansnd~rt<.ck thir, activities in the Microbiology Department. A survey cf Tinea capitis infection, in which 147 cases were cxamined, wa:; cumplctcd.

Equipment supplied by UNICEF and WHG has bcen received and installed.

A WJ Sanitary engineer was nssised to the Institute in July 1964. He will also wiil'k with thc Natianal Housing and Plmlng OrganizatiDn, ldvise Sn water supp1ius. EtC.

A statistician has bcen selected and 1s expccted to be in position by October 196U.

Afghanistan 33 TuberculGsls Adv1sor.y Services TA (June - Dec. 1958; June - July 1961; Nov. 1962 - ) UNICEP

Aim of the project. T>)expand tuberculosis cont:,cl scrvices for Kabul and its environs in the first instance.

Assistance provided by bIHO during: the year. (a) A medlcal officer; [b) a four- munth fellowship fl;r participation in the tubzrculusts trnining course in Rome (awarded under Intrr-regionil 1lJ.i:); (c) supplies and equipment .

Pi,obablc duratl-n of 3ssistanct. Untll thc and uf 1967.

Work dona during the year. The BCG vnccinzt'ir. proqa%lit in Kabul has cintirxxd successfully. Completc coverage of the school-going papulaticn was achieved. It is planned to give BCO systematically to all school-mtrants. BCO vaccinatisn has

been extended ti; military personnel. and factory work.:rs, and ti- sume larger schools outside Kabul. Thjs cxpansi?n I:as be

To prepare f:~,' an cxpanilrln of the case-findin;< and treatment programme under the Chaman 'Ilrbe~culnsisCent1.c :at Kabul, thc r'mtinr praccdurcs r:f tlrt. work being carrld cut there have bi?cn reviewi:d. The implementation of a truly ccmmunity-oriented tuberculosis control prugramme throughout the city of Kabul, by making use c.f exist in^ general health facilities and institutions,and an eventual expansion of ths activities to the rural area of the Sheualci community dcvelcpment programme, is und~,rci.nsider.atlon.

Vie WHO medical officer lcft the pr~jrctat tht end of' March 1964, on expiry of her contract; ? succ.s5, r :s iindcr recr~itmirit. SEA/flcl'7/2 Page 102

~fnhanistan35 Nursing AdvisOrY Services TA (June 1957 - )

Aim of the project. To organize and develop nursing and midwifery training programmes and to co-ordlnate and expand nursing education and nursing services of the country.

Assistance provided by WHO during the year. (a) A nurse advisor and thre~nurse educators; (b) a twelve-month fellowship for study in Lebanon; (e) supplies and equipment.

Probable duration of assistance. Untll the end of 1969.

Work done during the Year. !4HO assistance under this project continued to be provided to three schools of nursing in Kabul: the Mastoorat Hospital School for Remale Nurses, i a three-year programme for general nurses; the Aliabad Hospital School for Male Nurses, with a comparable three-year programme; the Shararah Haspita1 School, which has a three-year conrsu fcr nurse-midwives. All the three programmes continued to progress satisfactorily.

A sipificant development during the year was the start of a one-year nursing programme for five senior midwives, who will be qualified eventually to pursue post-graduate studies in nurslng education or administration. This wlll prepare them to take up senior positions in nursing and midwifery.

The students in the different schools continued to show enthusiasm for nurslng as a career. It has also been noted that midwives are now interested in having an oppertunity to become nurse-midwives.

In-service education by way of regular staff meetings of faculty members led to improved nursing care and made for a better understanding of the programmes. This also resulted in strengthening the existing curricula, better teaching practices, closer co-operation and joint planning.

The WHO nurses attended several meetings at the Mnistry uf Public Health and the Ministry of Education at which future plans for nursing education in the country were discussed; a system of grading nurses for comparable salarles and the principle of equal salary for men and women were established. It was also decidsd to raise the entrance qualification for nursing students.

The WHO team leader was reassigned to another country,and a replacement was appointed. Vacant posts of two nurse educators were also filled.

Af nhanistan 44 Trachoma Control* H (my - June 1958; Sept. - Oct. 1962; July 1963; April - May 1964; -

Aim of the nroject. To study the epidemiological aspects of trachoma in Herat Province; to initiate cilntrol activities; to develop a programme of health

'Previaus title: Trachoma Ccntrol Pil~tProject

Afghanistan 201 Fellowships TA

Medical Radiology: Two twelve-month fellowships for study in the Union of Soviet Socialist Republics.

Health Education: A twelve-month fellowship for study in the United States of America.

Food and Water Analysis: A twelve-month fellowship for study in India.

Medical Education: Two one-month fellowships for .>bscrvatiuns in India.

SEA/RC17/2 Page 105

2. BURMA

The health budget for the year 1963-1964 represented just over 6 per cent of the total budget for current expenditure and over 4.5 per cent of the total budget for capital expenditure. The figures compare favourably with the provision made for the previous year.

A Foreign Aid Supervision Committee was established to examine projects proposed for implementation with international or bilateral assistance and to recommend priorities.

The shortage of health staff, particularly doctors, in rural areas codtinues. In order to fill vacancies in civil government and army posts, it was decided to conscript doctors for a minimum of two yeare' service.

Thc Medical College of Mingaladon was opened in 1963. This will relieve the pressure of student overcrowding in Rangoon Medical Faculty and in Mandalay. Orientation training courses for township medical officers and assistant district health officers were continued. Plans were laid for opening a dental college in 1965.

A scheme for the reorganization of laboratory services was developed by the Health Ministry. The former Pasteur Institute has become the National Health Laboratory, destined to be the centre of public health laboratory services for the whole country. The former Harcourt Butler Institute has been converted into the Burma Medical Research Institute, which will co-ordinate medical research programmes. The Burma Pharmaceutical Industry is responsible for the production of all kinds of vaccines and biologicals.

The Paediatric Section of Rangoon General Hospital has been transferred to a separate building and will operate as an independent Children's Hospital; this will be valuable for teaching.

There are now 233 hospitals, 102 dispensaries and 495 health centres in the country. A further 29 new hospitals are under construction, and 100 more health centres arc planned.

An outbreak of cholera El Tor occurred in certain districts in 1963.

The malaria eradication programme was maintained, under national leadership. The leprosy control programme extended its field and continued to operate satisfactorily. Plans for a smallpax eradication programme were advanced. The tuberculosis control campaign was extended towards further case-finding and domiciliary treatment. SEA/RC17/2 Page 106

The vital registration system introduced in Rangoon in 1961 was gradually extended to other towns. The Vital Statistical Report for Burma, 1962, was published. Progress was made in the development of hospital statistics.

The policy of concentrating midwifery training in a limited number of upgraded schools was maintained. A total of twelve upgraded schools was envisaged.

A School of Medical Technology has been opened, with assistance from the Colombo Plan; training of physiotherapists, radiographers, laboratory technicians and pharmacists will be undertaken.

The Government has ratified the Convention on Narcotic Drugs, thus becoming the seventeenth government to accede to this international agreement drawn up by the United Nations Commission on Narcotic Drugs in 1961. SEA/RC17/2 Page 107

PROJECT LIST

Project No. Source of Funds Co-o~erating Agencies -Title

Burma 17 Leprosy Control R (April 1960 - ) UNICEF

Aim of the project. To expand and intensify the leprosy control progrannne to cover all endemic areas of the country, and to train personnel for this purpose.

Assistance provided by WHO during the year. (a) A leprologist; (b) a twelve- month fellowship for study in India.

Probable duration of assistance. Until the end of 1968.

Work done during the year. This programme maintained very satisfactory progress. An assessment was carried out during the year jointly by a WHO Leprosy Advisory Team and the Government. The estimated number of leprosy patients in the country is 200 000. UP to February 1964, a total of 121 389 patients were registered and 112 875 of these were having regular treatment. A notable achievement of the leprosy control programme was the further intensification of school surveys and contact tracing and the introduction of house-to-house surveys in the districts known to have a high prevalence of leprosy.

Rurther attention was given to the training of medical officers, leprosy inspectors and auxiliary workers.

In view of fxtended activities, the Government has increased its personnel to 21 medical officers, 57 leprosy inspectors and over 420 auxiliary workers. UNICEF assistance was continued.

Burma 22 Vital and Health Statistics. Rangoon R (Dec. 1955 - June 1961; Jan. 1962 - )

Aim of the project. To establish machinery for prompt notification of health statistical data; to improve processing and train staff in statistical methods.

(The specific aims in the present phase of the project are: to organize an efficient system for the maintenance and flow of records in selected hospitals; to collect, process and present hospital statistic; data efficiently on a national scale,and to train medical records and hospital statistics personnel.)

Assistance provided by WHO during the year. (a) A health statistician; (b) supplies and equipment and a vehicle. SEA/RC17/2 Page 108

Probable duration of assistance. Until the end of 1967.

Work done during the year. The operations of the new medical records system in Rangoon Oeneral Hospital were strengthened with the appointment of a medical rrcurds officer to the hospital. Tabulation of individual discharge reports during the first six months of 1963 was completed.and diagnostic and operation indexes were prepared. Discharge reports from July to December 1963 were coded and punched; machine-processing of the cards proceeded.

A new system of Clinical record forms (obstetrics and gynaecology) was introduced in the Dufferin Hospital. Rangoon, in January 1964.

Also, a monthly administrative return (with necessary instructions) far all provincial hospitals was introduced in January 1964. An interim hospital morbidity report, which will be gradually replaced by individual discharge reports, was also drafted for use in these hospitals.

From the beginning of 1964, the administrative responsibility for vital statistics was transferred to the Mlnistry of National Planning.

mrma 28 Medical Faculty, Rangoon* TA (Peb. 1955 - Feb. 1959; Feb. 1961; Sept. 1963; - )

Aim of the project. To strengthen selected departments of the Faculty of Medicine, Rangoon, and to improve undergraduate teaching and promote research and post- graduate activities.

Assistance provided by WHO during the year. A ten-month fellowship for study in the United Kingdom.

Probable duration of assistance. Until the end of 1968.

Burma 31 Malaria Eradication (Feb. 1957 - )

Aim of the project. To eradicate malaria throughout the country in prugressive stages.

Assistance provided by WHO durinK the year. Two four-month fellowships to attend the malaria training course in Jamaica and a three-month fellowship for study in India.

Probable duration of assistance. Until the end of 1967.

Work done durina the year. Data on operations received from the Government show an increase in the population under consolidation phase. The present status of the programme has been shown as 9.488 million people under consolidation and

*Previ:ius title: Assistance to Medical College, Rangoon s~~/RCl7/2 Page 109

9.668 million under attack phases. The spraying operations in remote areas were carried out by paid spraymen, while in others voluntary labourers were used. The Government is preparing a detailed, long-term plan of action.

Burma 44 Stren~thenin~of Health Services (Epidemi010,rfgrr TA (Jan. - Dec. 1961; suly 1963 - )

Aim of the project. To strengthen the Epidemiological Unit in the Directorate of Health Services; to study further the prevailing pattern of communicable diseases in the country and provide information for sound public health planning and appropriate control measures; also to develop public health laboratory services to support the activities of the Epidemiological Unit.

Assistance provided by WHO durinu the year. A microbiologist.

Probable duration of assistance. Until the end of 1967.

Work done during the year. In order to support the Epldemiologlcal Unit's activities in the country, the WHO statistician assigned to project Burma 22 and the microbiologist assisted in the strengthening of the health statistics and microbiology services. The microbiologist also helped in the further development of the public health laboratory services in the Rangoon area and later in Mandalay. hrma 56 Nursing Advisory Services TA (March 1959 - 1

Aim of the project. To upgrade and co-ordinate basic and post-basic education for nurses and midwives on a country-wide basis, In order to establish satisfactory standards of nurse and midwife training and nursing and midwifery services.

Assistance provided by WHO during the year. A nurse educator and a paediatric nurse.

Probable duration of assistance. Until the end of 1968.

Work done during the year. The programme,designed to improve eight midwifery schools and consolidate in them the training formerly given in some twenty schools in the country.continued as planned. The midwifery schuols at P&oWtu and Pegu have been well establ1shed.with adequate training facilities.

Project staff visited several other schools and made recommendations for their upgrading. These recommendations are under consideration. It is expected that all the eight schools will have been established in 1964 andthat further WHO assistance to this aspect of the project will not be needed. However, in suly 1964, when the nurse educator completed her assignment, a WHO paediatric nurse was added, to assist in upgrading pacdiatric nursing at the Children's Hospital, Rangoon. SEA/RC~~/~ Page 110

Wlm 59' Medical Colle~e.Mandalay R (Nov. 1959 - March 1960; Oct. 1960 - April 1961; Jan. 1962 - )

Aim of the Project. To assist certain departments af the Medical College. Mandalay.

Assistance Provided by WHO durine the year. (a) A professor of pathology; (bl Supplies and equipment.

Probable duration of assistance. until the end of 1968.

Work done during the Year. The visiting professor of pathology assumed his duties in August 1963. He assisted in improving the teaching of pathology by organizing working relations with the hospital and increasing the nmber of post-mortems.

A Journal Club was started, with meetings scheduled at monthly intervals.

A research project on anaemia of pregnancy and on subcutaneous phycomycosis was started.

Plans are being made to provide a professor of anatomy to the college.

Tuberculosis Control (Jan. 1964 - ) UNICEF

Aim of the Drolect. To develop community-oriented tuberculosis control services in the Country, starting with Rangoon and Mandalay, and to collect epidemiological base-line data on tuberculosis for future planning and assessment.

Assistance provided by WHO durinu the year. (a) A medical officer and a public health nurse consultant; (b) a seven-month fellowship for participation in the tuberculosis training course In Prague (awarded under Inter-regional 113.1); (c) supplies and equipment.

Probable duration of assistance. Until the end of 1968

Work done during the year. On the basis of previous information and recommendations, it was agreed that.as a shcrt-term objective, the expansion of treatment services from the Tuberculnsis Centre at Rangoon to the whole Of the city's population should be undertaken through a number OF peripheral treatment (sub-) centres, to develop a true community-oriented tuberculosis cuntrol programme. The capacity of the treatment service will determine the speed of the case-finding operations, nith priority on the infectious case-load. The treatment of patients with infectious tuberculosis is a supervised regimen,cansisting of isoniazid and streptomycin given on an intermittent (twice-weekly) schedule. To assist in organizing such treatment on an ambulatory basis through peripheral (sub-) centres, a public health nurse was assigned. as short-term consultant, to the project in May 1964.

*In future this project ;ill be merged with a new project, Burma 79 (Medlcal Education) SEA/RC~~/~ Page 111

It has been arranged to provide a short-term consultant in statistics to assist in the correct designiw and administration of the base-line survey,which all be carried out among randcmly selected population groups. Assistance in laboratory techniques and mobile mass radiography by means of short-term consultants are envisaged.

Burma 67 Paediatric Education Regular (June 1964 - ) UNICEF

Aim of the ProJect. To strongthen the Departments of Paediatrics in the three medical colleges of the country. to improve Lhc teaching of paediatrics,particularly in its preventive aspects, and to develop peripheral services as training fields.

Assistance vrovided by WHO during the Year. A professor of paediatrics.

Probable duration of assistance. Until the end of 1967.

Work done during the year. A WHO professor of paediatrics was assigned in June 1964. He started a preliminary survey of paediatric services and education in the country.

Burma 76 Survey of Economic and Social Requlrements TA of an Gvium-ProducinK Refion In Burma (March - April 1964)

Aim of the uroJect. To study the problem of opium addiction In the KacNn States and the medical measures necessary for the Pehabilitation and treatment of opium addicts in poppy-growing areas.

Assistance provided by WHO during the Year. A consultant for three weeks.

Work done. In collaboration with a Uhited Nations' consultant, the WHO consultant carried out a survey in the poppy-gruwing areas of Burma. His report is under study.

It is proposed to provide further consultant services in 1965.

~urma77 Burma Pharmaceutical Institute R (Peb. 1964; July 1964 - ) UNICEF

Aim of the project. To develop modern methods of production of vaccines, antitOXin and toxolds. and other biological products.

Assistance vrovided by WHO durinK the year. (a) A zhort-term consultant on freeze-dried smallpox vacclne production (assimed under SEAR0 38) and another short-term consultant on DPT vaccine production. s~~bc17/2 Page 112

Probable duration of assistance. Until the end of 1966.

Work done durinR the Year. In February 1964, a short-term consultant visited the Burma Pharmaceutical Institute, Rangoon, and found that it could suitably change over from its present production of glycerinated lymph to freeze-dried smallpox vaccine. Equipment will be supplied by UNICEF. Training on WHO fellowships for a bacteriologist and an engineer of the Institute is planned to take place late in 1964.

In July 1964, another short-term consultant was assigned to Bum,to study the suitability of the Institute to undertake the production of diphtheria- pertussis-tetanus vaccine.

Burma 201 Fellowshi~s TA

Public Health: Two fellowships - one of twelve months for study in the United Kingdom, and one of ten months for study in India.

Preventive and Social Medicine: A ten-month fellowship for study in the United Kingdom, Yugoslavia and Israel.

Medical Laboratory Technoloqy: A twelve-month fellowship for study in Ceylon.

Filariasis Control: An eight-week fellowship for study in India (awarded under project Burma 63,wNch is no longer current).

SEA/RC17/2 Page 113

3. CEYLON

Although curative health services have attained a relatively high level, emphasis has continued to be placed on preventive measures. It is recognized that an approach through health education and preventive programmes is necessary to reduce the excessive numbers seeking medical treatment. Preventive health work is based on a health unit system and is effected through the close co-operation of central and local authorities. Systematic communicable- disease control has resulted in the absence of plague, cholera and smallpox and in the near eradication of malaria and yaws. Quarantine measures at ports of entry help to prevent import of major infectious diseases.

In 1964 a successful course in hospital administration for selected medical officers was conducted, with WHO assistance.

Expansion of maternal and child health care continued, with widespread community acceptance. The increasing amount of work done is reflected in a continuous decline of morbidity and mortality rates in mothers and young children. Recognition of fairly widespread malnutrition has directed the policy of stimulating local focd production, particularly of protective foodstuffs.

The interruption of the transmission of malaria achieved in 1962 was maintained. Strengthening of the tuberculosis control programme included the introduction of BCG vaccination of new-born infants in certain hospitals. Plans were in train to extend this precaution, and x-ray examination of school-teachers and trainee-teachers was introduced. A project involving prophylactic treatment of tuberculin-positive school-children with INH was initiated.

Diarrhoea1 diseases continued to be an urgent public health problem. It was estimated that about one quarter of the deaths of children between the ages of one year and five years and about one fifth of all admissions to hospitals were due to these conditions. As a control measure, efforts were undertaken to expand laboratory facilities.

Filariasis due to W. bancrofti continued to be a serious problem in the south-western coastal region. An early solution is not in sight, and intensification of research is envisaged.

The outbreak of poliomyelitis experienced in the previous year was under control. The initial mass immunization campaign, using oral vaccine, was successful, although the response to the second round was less complete SEA/RC17/2 Page 114 than to the first round. The continued routine immunization of susceptible age groups needs to be firmly established, and the expansion of rehabilitation facilities requires urgent attention.

A programme designed to undertake mass immunization against rabies of the entire dog population of the Western Province was initiated.

The construction of the building for the Institute of Hygiene, Kalutara, is nearing completion, and the Institute should begin its training and research functions towards the end of 1964. Considerable thought was given to the programme of work and staffing pattern of the Institute.

The Post-basic School of Nursing has been firmly established. Courses for psychiatric nurses, ward sisters and sister tutors have been organized, and the basic nursing syllabus has been revised. An eighth school of nursing has been built at Anuradhapura. The training of nurse-aides was dropped.

Preliminary studies directed towards the expansion and improvement of the water supply systems in Colombo and in some other major cities were started. In view of the high prevalence of dental caries in urban arpas, the feasibility of fluoridation of the Colombo water supply, with WHO/UNICEF aid, is under examination. PROJECT LIST

Prodect No. Source of Funds Co-o~eratinq A~encies -Title

Ceylon 4 Maternal and Child Health TA (Sept. 1955 - Nov. 1963) UNICEF

Aim of the project. In the first instance, to upgrade the Children's Department of the Kalutara Health Unit Hospital; to integrate the preventive and curative aspects of child care at the hospital and in the field; to improve public health nursing in the Health Unit and to train various categories of health personnel; when these objectives have been achieved, to upgrade child health services in a number of provincial hospitals and to link child-care activities in rural areas with those in the hcspitals.

Assistance provided by WHO during the year. A medical officer.

Work done. This project was started in September 1955 under the title "Rural Health Development, Kalutara" and was redesignated "Maternal and Chlld Health, Ceylon" in March 1961.

WHO provided a paediatrician and a public health nurse in 1955. They left at the end of their assignments in 1958 and 1959 respectively. The paediatrician was replaced in March 1959 by a medical officer. During 1960-1962, a paediatric nurse tutor was assigned.

From May 1960 to June 1961, a national paediatrician, appointed in Kalutara, acted as counterpart tu the WHO medical officer. Although the revised plan of operations envisaged the appointment of a maternal and child health officer at health directorate level as the national opposite number, no posting was effected. As an alternate measure, close co-operation was established with other officers of the Health Directorate.

During the period of 'NHO assistance, a number of paediatric wards in hospitals throughout the country were opened and several paediatricians appointed. A well-organized referral system between the paediatric hospital and domiciliary services was established in Kalutara and introduced in other areas,within the limit set by the availability of staff. Special attention was paid to nutrition education. Demonstrations of preparation of infant food were planned and carried out in the Kalutara training centre,and assistance was given in the preparation of a series of leaflets on feeding and nutrition.

Longitudinal studies on premature infants and pre-school children and anaemla in pregnant women were organized. SEA/~C~~/Z Page 116

Close co-operation was established with the WHGassisted health statistics project (Ceylon 45) for revision of maternal and child health and school health records, and assistance was given in the implementatirm of a new record system and revision of Instructions for the guidance of the public health nurses and midwives.

Evaluation. The project was successful in assisting in the development of comprehensive maternal and child health services throughout the country.

Ceylon 5.2' Venereal-Disease Control (Fluorescent R Laboratory Technique in VDT1 UNICEF (July 1964 - )

Aim of the ProJect. To develop laboratory diagnostic facilities as part of the National Venereal-Disease Control Programme.

Assistance Provided by hMO during the year. (a) A short-term consultant; (b) a supply of vaccine.

Probable duration of assistance. Until the end of 1966.

Work done durinp, the year. Following WHO'S recommendations, UNICEF supplied fluorescence microscopy equipment required to upgrade laboratory dia~ostic facilities at the Venereal-Disease Control Centre in Colombo. A consultant was assigned by WHO to demonstrate the use of immuno-fluorescence technique in the fiia,g~osisof treponematoses and ganarrhoca; speclal reagents also were supplied.

Ceylon 42 Medical Education R (~ov.1963 - )

Aim of the project. To organize the various departments of the new medical callege at Peradeniya and to assist wlth the teaching.

Assistance provided by WHO during the year. (a) A professor of physiology for five months; (b) a twelve-month fellowship for study in the United Kingdom, Denmark and India.

Probable duration of assistance. Until the end of 1967.

Work done durinx the year. The visiting professor of physiology took up his position in November 1963. His assistance was divided between Colombo and Feradeniya, both collr.ges helng under one Faculty. He participated in teachine and delivered special lectures on research methods to the staff. Recommendations for the improvement in the teaching of physiology were made to the Curriculum Committee of the Faculty. Research on the effect of pregnancy and lactation in rats on oxygen cunsumption and para-aminohippurate uptake of kidney cortex slices --in vitro was undertaken.

*WHO'S assistance to project Ceylon 5.1, Venereal-Disease Control, terminated in 1960 sEA/'Rcl7/2 Page 117

Ceylon 5J NursinR Advisory Services R (~uly1960 - )

Aim of the project. To develop all aspects of basic, post-basic and auxiliary nursing education, with emphasis on planning, organization and development of a post-basic school of nursing,and to develop a nursing unit within the Depart- ment of Health responsible for overall administration of nursing education in the country.

Assistance Drovided by WHO during the year. A nurse adviser, a psychiatric nurse educator and a public health nurse educator.

Probable duration of assistance. Until the end of 1968.

Work done during the Year. The project continued to function satisfactorily, with thc main emphasis on post-basic nursing education within the Post-basic School of Nursing, Colombo, which has established programmes In nursing education, nursing administration, paediatric nursing, and psychiatric nursing.

The WHO nurse adviser visited various basic schools to advise on optimum utilization of the existing equipment and on the use of UNICEF equipment ordered for the nurse-aide pr0gramme.whic.h was discontinued at the end of the year. The WHO nurse adviser also assisted the school faculty in reviewing the content of courses offered at the Post-basic Schoo1,with a view to providing a more comprehensive nursing programme.

The WHO psychiatric nurse assisted in an in-service education programme for nurses in position who had not studied psychiatry as part of their previous educational programmes. He has also helped in the teaching of the post-basic students In their specialty. Psychiatric nursing experience was provided to all men students in the basic nursing course.

Several meetings were held with the officials in the Directorate of Health, at which future plans for nursing in Ceylon were discussed and recommendations made.

A public health nurse educator was added to the WHO team in April 1964, to assist in upgrading public health and improving paediatric nursing.

Ceylon Pilariasis Control TA (Dec. 1959; April - July 1961; Sept. 1961; Aug. - Sept. 1963; - )

Aim of the project. To strengthen the filariasis control programme and introduce new control methods as necessary.

Assistance Drovided by WHO during the Year. (a) A consultant for two months; (b) supplies and equipment. SEA/RC17/2 Page 118

Probable duration Of assistance. Until the end of 1967

Work done during the year. The WHO consultant assisted in an assessment of the problem of filariasis in the south-west coastal belt and advised on a plan of action for further filariasis studies, surveys, drug trials and control measures.

It is planned to provide an epidemiologist and an entomologist to assist this project on a long-term basis.

ceylon 58 Malaria Eradication R (nus. 1960 - ) (USAID)

Aim of the Project. To eradicate malaria from the entire country and to prevent the re-establishment of endemicity.

Assistance provided by WHO during the year. Part payment of local costs for intensifying surveillance activities.including the provision of spare parts for motorcycles provided by WHO earlier.

Probable duration of assistance. Until the end of 1966.

Work done during the year. Insecticide spraying has been totally discontinued from the entire island since May 1964. During NovemberDecember 1963, the Regional Assessment Team (SEAR0 7) carried out an assessment of the programme. The urgent need for establishing total coverage in surveillance has been emphasised.

During 1963, Ceylon recorded only 16 parasite carriers; of them, ten were imported from the Maldives; five were relapses of P.malariae, and one was indigenous. Arrangements for screening arrivals from the Maldive Islands were continued. ceylon 62 Xsdical Rehabilitation poliom my el it is^* TA (April 1962 - )

Aim of the project. To provide facilities for the management and rehabilitation of paralytic cases, and to carry out an immunization programme for the control of the disease.

ASSiStanCt. Jrovided by WHO during the year. (a) A physiother.apist and a crnsultant Ln medical rehabilltaticn; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1966.

Work done during the year. A WHO physiotherapist took up her second assignment with this project in October 1963 in Order to assist in the rehabilitation Of polioparalytics. She helped the physician in charge of the Department of

*Previous title: Control of Poliomyelitis Epidemic ~EA/kC17/2 Page 119

Physical Medicine, Children's Hospital, Colombo, for four months, to develop and strengthen the rehabilitation facilities in the hospital. She also visited rehabilitation centres in other hospitals and submitted an interim report.

A WHO consultant on medical rehabilitation assiaed to India visited Ceylon for a week and recommended the expansion of the orthopaedic workshop in Colombo.

Ceylon 64 csmmunity Water Supply R (oct. 1963 - )

Aim of the project. To develop piped water supplies in major toms and other community areas.

Assistance ~rovidedby WHO during the Year. A sanitary engineer.

Probable duration of assistance. Until the end of 1967.

Work done durin~the year. The WHO sanitary engineer took up his assignment at the end of October 1963.

A considerable amount of data, highlighting the necessity for numerous improvements to existing installations and the provision of water supply systems, has been collected.

The present design criteria have been revised with a view to reducing the capital cost of schemes and the unit cost of water. With this new approach, water supply systems will come closer to financial self-sufficiency,which is an essential prerequisite for consideration for eligibility for loans from international lending agencies.

Ceylon 66 Study on Diarrhoea1 Diseases R (Sept. 1963 - )

Aim of the project. To make long-term studies of the epidemiology and control of diarrhoea1 diseases.

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

Probable duration of assistance. Until the end of 1967.

Work done during the year. As a follow-up of the WHO Diarrhoeal Diseases Advisory Team's cross-sectional epidemiological surveys of enteric diseases in the Colombo area last year, a programme for the continuation of ~pidemiologlcalstudies on intestinal diseases on a long-term basis was agreed upon. WHO assiaed a bacteriologist in September 1963 to assist in the establishment and further development of bacteriological diagnostic facilities in enteric diseases, both.in the principal hospitals and in the field,in the Colombo area. SEA/RC~~/~ Page 120

Laboratory facilities at Angoda Fever Hospital, Ragma Hospital and the Medical Research Institute have been improved. A course on current laboratory methods of identification of entero-bacteriaceae. with particular reference to Salmonella and SNgella, was held at Angoda Hospital.

A plan was prepared for an ascariasis control pilot proJect.

Ceylon 69 Paediatric Traininp. and Services R (July - Sept. 1963)

Aim of the Project. To assist the University of Ceylon to develop the training of medical students in social paediatrics and to provide field training eltperience.

Assistance Drovided by WHO durinp; the year. A consultant in paediatric training and services.

Work done. A short-term consultant was assigied to Ceylon in July 1963. She made an assessment of current paediatric courses for medical undergraduate and post-graduate students and studied the local pattern of promotional and preventive child-care services. She also assisted in improving the teaching of social paediatrics and in developing peripheral paediatric services for training purposes.

She completed her work toward the end of September. Her asslgnment report provided a set of guiding principles for the further development of paediatric education and services in Ceylon.

Ceylon 70 Water Fluoridation R (Dec. 1963 - Jan. 1964)

Aim of the Project. To reduce the incidence of dental caries by fluoridation of the water supply of the city of Colombo.

Assistance Provided by WHO durinp. the year. A consultant for one month.

Work done. The extent of dental caries in Colombo was determined,and the statistical information available was analysed. Water treatment works were visited. The consultant completed his studies and rrcomended the fluoridation of Colombo water supply as a means vf reducing the high incidence of dental caries In the city. His assignment report and recommendations have been sent to the Government for canslderation.

Ceylon 71 Course in HosDital Administration and Management (21 Jan. - 4 April 1964)

Aim of the project. To organize a three-month course in hospital administration and management for senior hospital personnel and to prepare a syllabus as the basis for holding similar courses frGm time to time. SEA/%C~~/~ Page 121

Assistance provided by WHO durinR the year. A consultant in hospital administration for four months.

Work done. The course was held from 21 January to 4 April 1964,under the direction of a WHO consultant. The Regional Adviser in Health Statistics also assisted in the course by delivering a series of lectures on hospital statistics. The course was attended by twelve trainees.

Ceylon 74 Institute of W~iene,Kalutara TA (July 1964 - )

Aim of the project. To develop the Institute as a centre for training and orientation courses for public health staff; to upgrade and integrate the services planned at the Institute.

Assistance provided by WHO durinu the year. A consultant for two months.

Probable duration of assistance. Until the end of 1967.

Work done during the year. The consultant was assigned In July 1964. He has studied the prospects for the training of Public health personnel and the provision of health services, including laboratory services, in the Kalutara Health Unit area.

Ceylon 200 Fellowships

Electro-medical Engineering: A four-month fellowship for study in the United Kingdom. Germany and Holland.

Enteric Diseases: A five-week fellowship for participation in the course on enteric-disease control held in Teheran (awarded under a Headquarters' allatmcnt).

Physical Therapg: A twelve-month fellowship for undergoing the Physical lherapy TeachersSTraining Course in the United Kingdom.

Ceylon 201 Fellowships TA

Epidemiolom and Advanced Statistics: A twelve-month fellowship for study in the United States of America (awarded under project Ceylon 45,which is no longer current ) .

Nutrition: A twelve-month fellowship for study in the United States of America.

Medical Laboratory Technology: A twelve-month fellowship for study in the Uhited Kingdom. S~A/Rcl7/2 Page 122

Sanitary En~ineering: Two fellowships - one of twelve months for study in the United States of America. and one of six months for study in the United States of Amer,ica and the United Kingdom.

Clinlcal Biochemistry: A ten-month fellowship for study in Denmark (awarded under Inter-regional 239).

Hwoan aenetics: A three-month fellowship far study in Denmark (awarded under Inter-regional 137.2).

Biostatistics: A twelve-month fellowship for study in the United States of Amerlca.

Physical Therap~: A twelve-month fellowship for undergoing the Physical Therapy Teachers'Training Course in the United Kingdom (awarded under Inter-regional 181).

SEA/RC17/2 Page 123

4. INDIA

The Central Council of Health has recommended realistic estimates of the requirements in medical staff, equipment and drugs for the remaining period of the Third Five-Year Plan as well as for the Fourth Plan. The Council has also advocated that overcrgwding in hospitals be reduced, that specialists in all the major disciplines be established at district hospital level and that maternal and child health services be reinforced so as to reach every village. The Nursing Sub-committee of the Central Council has recommended that during the training period student-nurses should be assigned to primary health centres for training in rural public health.

In view of the national emergency, admissions to medical colleges in India have been raised by about thirty per cent. The risk of lowering standards inherent in increasing the intake of students and shortening the period of the course may have been reflected in higher failure rates. The shortage of medical teachers continued to be severe. Means of improving and expanding post-graduate education with the aim of increasing the production of medical teachers were under serious consideration.

The Malaria Institute of India, now converted into a "National Institute of Communicable Diseases", has started research and training in the broad field of epidemiology and control of communicable diseases. A parallel advance was the inauguration of the National Institute of Health Administration and Education, designed as a staff college for senior health adminstrators and as a research centre in the field of organization and administration of health services.

Coverage by primary health units established in community develop ment blocks reached nearly 75% of all blocks, but staffing difficulties remained severe. In recognition of the need for improved health coverage in rural areas, particularly in connection with the malaria and smallpox eradication campaigns, the Directorate General of Health Services recommended the establishment of three additional sub-centres, making a total of six sub-centres in each primary health unit. It was also recommended that wider use should be made of multi- purpose health auxiliaries in rural health services, in order to extend the work of the doctors and also to relieve them of avoidable routine work, thus enabling more adequate supervision and leadership of the health unit team.

The urgent need to provide adequate and safe water supplies in both urban and rural areas was further studied by the central and state governments and appropriate recommendations were made. Diseases due to defective environmental SEA/RC17/2 Page 124 sanitation were bracketed at the top, with malnutrition and tuberculosis, as the major public health problems at present and as serious obstacles to economic and social betterment.

The increasingly rapid transition to an industrial economy in Iudia emphasized the need for improved industrial and occupational health services. Recognition of the widespread prevalence of remediable physical disability led to proposals for providing a network of medical rehabilitation centres. sEApc17/2 Page 125

PROJECT LIST

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

India 52 Tuberculosis Chemotherapy Centre. Madras TA (Dee. 1955 - 1 (mc) (ICMR)

Aim of the project. To undertake controlled trials in the search for simple, effective and inexpensive methods of tuberculosis control through domiciliary chemotherapy of ambulant patients.

Assistance Drovided by WHO during the year. (a) no medical officers, a bacteriologist, a laboratory technician and two short-term consultants; (b) a six-month fellowship for study in the United Kingdom. Africa and Switzerland; (c) supplies and equipment and a vehicle.

Probable duration of assistance. Until the end of 1969.

Work done during the year. The Government and thd :~gi-nciesSponsLring the project have held Purbher di~aussionson the permanzncy of the ccntre as a research unit. A special coninittee has andertaken the preparation of a report, to be presented to the Governing Body Of the Indian Council of Medical Research, in which the need for basic research of the kind carried out at Madras will be evaluated and future lines of research and the relationship of the Madras Centre to other Indian institutions in the field of tuberculosis defined. In February 1964, a national candidate for the post of Dircctor cf thu C~ntrewas selected by a specially formed committee; he assumed duties in July 1964.

The high standard of the research work undertaken by the Centre have bcen maintained. After the departure of the WHO nurse, the four national public health nurses continued to carry out the ever-increasing work at the clinic most satisfactorily, under the guidance of medical staff assiped to this section. New studies on intermittent treatment have considerably increased the workload at the Clinic, 3s the treatment in these studies is given twice weekly at thc Centre, and, in consequence, the number of attendances by pxtients has grown 1arger.while the number of home visits carrled out by the health visitors has remained unchanged. Regular meetings of the publie health nurses and the health visitors have ensured continuous co-ordination and review of the work. Every defaulting patient requires at least one home-visit, and more may be necessary,in connection with the once-weekly regimen. The close follow-up of all patients which has been maintained by the staff of the Centre has made it possible to keep almost the entire group of patients from the earlier studies under constant observation for more than five years. SEA/hCl7/2 Page 126

In view of the heavy workload in the radiological section, which amounted to 17 213 x-ray exposures and 2 831 tomograms during one year, expansion of accommodation was santioned in April 1964. After completion of the new building for the x-ray section, new xsay ~quipmcntwill be provided by WHO.

In the laboratory, a new biochemical section has been constructed and has greatly relieved the pressure on the bacteriological laboratory. The work has included 18 244 spiltm smear examinations, 20 028 cultures, 5 020 scnsitivity tests, 26 161 urine examinations, 811 haematological examinations and 373 microbiological assays of anti-tuberculosis drugs. In addition to the work carried out in connection with the clinical trials undertaken by the Centre, the laboratory has also carried out bacteriological examinations in connection with a drug resistance survey organized by the Indian Council of Medical Research.

Numerous reports and papers have been published by the Centre or are under preparation. These are listed in Annex 6. A paper was read by a national medical officer at the Nineteenth Tuberculosis and Chest Diseases Workers' Conference held from 5 to 7 April 1964 in Delhi.

India 81 Le~rosyControl

India 81.1 Leprosy Control (National Pro~rammel R (Jan. 1961 - ) IJNICEF

Aim of the project. To develop s country-wide programme for leprosy control.

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

Probable duration of assistance. Until the end of 1968.

Work done durinn the year. The WHO consultant 1eprologist.in close co-operation with the Director of the National Leprosy Control Programme,prepared an appraisal of the programme with recommendations for the further implementation of the project during the remainder of the Third Five-Y.ear Plan and during the Fourth Five-Year Plan. A second WHO leprologist was assigned in February 1964. It was agreed that case-finding, contact-tracing and treatment bc Intensified, particularly in the States of Madras,Andhra Pradesh and 0rissa.which are known to have the highest prevalence of leprosy. In order to support this intensification of work, ten centres for the training of leprosy auxiliary workers were sanctioned. UNICEF assistance was accordingly increased.

The following consolidated data from the National Leprosy Control Programme were reported towards the end of 1963: SEA/RC~~/Z Page 127

Number of centres 160 371 29 560 Number of cases registered 166 571 kli 653 17 706 228 930 Number cf cases registered 146 613 45 157 15 206 206 976 for treatment Number of cases under regular 103 791 40 566 12 212 156 569 treatment

Total number of cases registered (inside and outside project areas) 380 6011 Total number of cases under treatment (inside and outside project areas) 358 650

India 81.2 Leprosy Control. Srikakulam R (Jan. 1962 - )

Aim of the Project. To provide technical direction for a leprosy control project organized and maintained by the Danish "Save the children" Fund, and to train leprosy auxiliary personnel.

Assistance provided by WHO during the year. A leprologist.

Probable duration of assistance. Until the end of 1968.

Work done durlnp the year. Field activities, including school surveys and contact- tracing,proceeded satisfactorily, and. these case-finding activities were further increased by starting house-to-house surveys. Training of new groups of auxiliary womers was continued; this has enabled the total number of field units to be increased to 31.

The total number of registered and treated cases up to April 1964 was 15 283 - an increase of 7 272 in a period of ten months.

A 3C-bed hospital was opened at Srikakulam. This will greatly facilitate the treatment of reaction cases, advanced and/or infected perforating ulcers and other conditions necessitating hospitalization.

India 84 hvironmental Sanitation. uttar Pradesh TA (March 1958 - ) UNICEF

Aim of the DroJect. To set up in a rural area a pilot project for improving water supplies and excreta disposal; to plan and carry out a sanitation programme, including the design, operation and maintenance of simple, practical and cheap sanitary installations; to organize a programme of health education; to train technicians, sanitarians and other personnel. sEApc17/2 Page 128

Assistance provided by WHO durinR the year. (a) A sanitary engineer and a sanitarian; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1964.

Work done durina the year. Latrine-construction programmes were extended throughout the State at an accelerated pace. Cornunity co-operation has improved. In one Of the pilot projects where the programme is subsidized up to 75% of the cost of installation, progress was even more rapid.

The activities of this project were further directed towards rural water supply as planned, and training and pusting of t~omsof workers for well-boring as well as installation of hand pumps are being intensified. Efforts were made to secure the services of more field teachers for health education work in order to cover more commqnity health blocks.

In the rural piped water-supply programme, the tuba-well f;r th~Banki piped water-supply scheme was constructed,and the distribution system was being laid.

India 91 wain in^ in Preventive and Social Medicine TA (Peb. 1956 - Dec. 1957; %rch 1959 - Sept. 1960; UNICEF Aug. 1961; July 1962 - Jan. 1963; Dec. 1963 - )

Aim of the prolect. To develop the departments of preventive and social medicine in selected medical colleges, incorporating preventive medlcine into the general curricultm and organizing courses in preventive md social medicine for under graduates; to establish urban and mral public health practice fields for training; to train national countePparts to take over from the WHO professors.

Assistance Drovided bv WHO durinR the Year. A professor of preventive and social medicine at Pondicherry Medical College.

Probable duration of assistance. Until the end of 1968.

Work dane during the year. The WHO visiting professor took up his position in December 1963.

The project laid emphasis on integration. Intdgrated bedside teacbing was organized,and the possibility of providing practical experience in preventive and social medicine was explored. Classes cvmbiniw the teaching of paediatrics, prevcntlvc. medicine and child psychiatry were started.

India 98 Short courses for Nursing Personnel* R (July 1957 - 1 Chandiaarh: (7 Oct. - 2 NoV. 1963)

Aim of the project. To plan and conduct short courses for nurses, incqrporatlng theoretical and practical instruction adapted to local conditions.

*Previous title: Refresher Courses for Nurses SEA/RC17/2 Page 129

Assistance Provided by WHO during the year. (a) Half the cost of travel and maintenance expenses of participants in the courses; [b) assistance from WHO staff.

Probable duration of assistance. Until the end of 1968.

Work done durina the year. A short course of one month, attended by twenty nursing superintendents from all over India, was held in Chandigarh from 7 October to 2 November 1963. In the course,emphasis was placed on the role of the nursing superintendent in improving nursing education. Courses for the current will be held in the last quarter of 1964.

An overall evaluation of project pruposes and methods was undertaken. As a result. the original aim of the Project has shifted from the provision of refresher- type courses to those which will introduce nurses to new concepts md practices which were not a part of their basic education. Plans have been made to give attentian to new knowledge and skills in the fields of patient care, curriculum development. ln-service education and nursing admlnistration. As a result of this shift in emphasis. the title of the project has been changed, as noted above.

India 92 Nursing Education [Public Health Intenrationl: Assistance to States*

Emphasis in this project has begun to shift from a primary concern with integration of the public health nursing principles and practlcas into the basic curriculum toward the following:

(1) Assistance ill s~ttingup educational progrimnes for nursing personnel. both auxiliary and professional. in areas where no nurse education on the pattern laid down by the India Nursing COUncil exists.

2 Assistance to basic hospital nursing schools and associated public health fields which are serving as clinical practice areas for students from post-basic schools of nursing.

India 99.2 Nursing Education (Public Health Intearation). Orissa TA (my 1958 -

Aim of the Project. To integrate training in public health into the basic training of nurses; to Provide supervised practical observation and experience for student nurses in a selected undergraduate school of nursing.

Assistance Provided by WHO durinR the year. A public health nurse.

Probable duration of assistance. Until the end of 1964.

*The project started in September 1957 and is expected to continue until the end of 1965. Assistance to two States (Madras and Maharashtra) has been completed. SEA/%C~~/Z Page 130

Work done during the year. The integration of public health principles and practices into the basic curriculum of the school at Cuttack has been further advanced. Rural and urban public health experience has becn improved by better selection of learning experiences and by more adequate supervision of nurse students in the field. Health teaching and other preventive health practices have been given emphasis both in the curative and public health experience of the nurse. Examination methods have received attention.

Policies related to the practice of selecting a portion of the student body and offering only to this portion an integrated educational experience have been reviewed. As a result, all nurse students are now offered the same curriculum and have the same opportunities to develop knowledge and skills in the public health field.

It: has remained difficult for part-time lecturers to complete their schedules within the alloted time. Consequently, both the sequence and integration of learning experience were interrupted.and clinical experience was frequently undertaken many months bcf7rc formal teaching in the specialty was given.

Development of the project continued to be hampered by the laok of provision of a separate budget for the school.

India 99.4 Nursina Education (?ublic Health Intearation). Himachal Pradesh TA (kg. 1961 - Sept. 1963)

Aim of the ~roJect. To integrate training in public health into the basic training of nurses; to provide supervised practical observation and experience for student nurses in a selected undergraduate school of nursing.

Assistance provided by WHO durinR the year. A public health nurse.

Work done. WHO assistance to this project terminated in September 1963, with the transfer of the WHO nurse from Simla to Chandigarh.

Luring the period of assignment of the WHO nurse, public health nursing as an integral part of the general nursing curriculum was established at Snowdon Hospital. Simla. Each phase of the programme was in operation for a sufficient length of time for the national counterpart and others concerned to acquire a sound knowledge of the organization and implementation of the project. Practice fields, both urban and rural, were developed,and the preventive aspects of patient care were introduced into the hospital wards and outpatient clinics. Special courses in public health, nutrition and mental hygiene were developed. The total curriculum content was studied in order to introduce preventive teaching throughout. s~~/RC17/2 Page 131

India 99.5 Nursing Education (Public Health Integration), Cfoa TA (Sept. 1963 - )

Aim of the project. To introduce in Cfoa patterns of basic nurse/midwife and auxiliary nurse/midwife education similar to those laid down by the Indian Nursing Council; to develop in-service training in all teaching hospitals; to improve patterns of nursing administration for the nursing component of all health services.

Assistance provided by WHO during the year. A nurse educator.

Probable duration of assistance. Until the end of 1965.

Work done during the year. The project started in September 1963, with thc arrival of the WHO nurse educator in Panjim.

Nursing needs and resources were studied and plans drawn up for the initiation of one basic hospital nursing school and three schools for the training of auxiliary nursemidwives. Curricula for both types of programmes were reviewed. Recommendations for the provision of teachlng and hostel facilities for all schools were put forward.

An evaluation of nursing service at the Medical College Hospital. Panjim, was carried out and a report prepared. As a result, new schedules based on an eight- hour working day and a 48-hour week were put into operation.

Programmes of on-the-job training were introduced in several hospitals in an effort to improve patient care and prepare trained staff for the increased responsibility of student educatiun.

India 101 National Trachoma Control Programme R (Feb. - May 1956; oct. 1956 - ) UNICEF (1Ci-R)

Aim of the project. To reduce transmission of infection, morbidity and disabling conditions in the community to such a level that trachoma and secondary bacterial infections will cease to be a public health problem in the areas under opcratlon; to continue to give training in control measures to ophthalmologists, general physicians and field personnel; to pursue the programme of health education at all levels; to further the implementation of the policy of integration of communicable eye-disease control into the general health services.

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

Probable duration of assistance. Until the end of 1966. SEA/Rc17/2 Page 132

Work done during the year. A large-scale trachoma control progrme was launched with 15 field units in Punjab and 25 field units in Rajasthan. A rural population of about 1.6 million was under treatment in these States. The Government of Uttar Pradesh has sanctioned the initiation of the progranrme in the State - the attack phase period to start from August 1964, with six field units. Small-scale treatment programmes were initiated in Gujarat (by four government and two voluntary organization units). Bihar, Jammv and Kashmir and Madhya Pradesh (by one unit in each State).

The Government has decided to continue and further extend the programme in the States of Funjab, Rajasthan, Cujarat and Uttar Pradesh.

India 102 National Tuberculosis Programme TA (Oct. 1956 - Oct. 1957; Nov. 1957 - ) UNICEF

Aim of the project. To develop a national tuberculosis control programme by providing technical guidance and assistance based on model rural and urban control programmes, epidemiological findings and operational research; to train a requisite number of public health workers of various categories to be employed in tuberculosis control centres at district and state level; to develop adequate methods and procedures for assessment of the country-wide programe.

Assistance Provided by i4UO during the year. (a) Three medical officers, a sociologist, a statistician, an x-ray engineer, a laboratory technician and a public health nurse; (b) a six-month fellowship for study in the United States of America, and a five-month fellowship for participation in the tuberculosis training course in Prague (awarded under Inter-regional 113.1); (c) supplies and equipment.

Probable duration of assistance. Until the end of 1968.

Work done during the year. The development and implementation of the national tuberculosis programme have received increasing attention by the Government. This is reflected in the preparation for the next Five-Year Plan from April 1966. The Central Council of Health has recommended that the States establish one tuberculosis centre in each district. Information on appropriate training of key staff at the National Tuberculosis Institute and of other additional personnel by the respective State tuberculosis centres, and on staffing patterns and requisite budgets necessary for a country-wide tuberculosis control scheme at district level, has been given by the Central Government to administrative medical officers of the States and Union Territories at a conference and bya circular Letter.0.n addendum to the plan of operations is beins negotiated with the Government, to cover the needs fOP the remaining period of the current Five-Year Plan.

Twenty-eight medical officers, 28 x-ray technicians, 21 laboratory technicians, 23 health visitors, 20 BCG team leaders and 12 statistical assistants were trained during the fifth and sixth training courses at the National Tuberculosis Institute. They are intended to work as key district personnel. Twenty-five more teams have entered training in the seventh course. This will bring the total number of key staff trained at the Institute up to about 350 persons. SE@Cl7/2 Page 133

Moreover, 28 senior medical tuberculosis workers, delegated from 16 States. participated in the Second Tuberculosis Control Seminar held at the Institute in May 1964; talks and lectures at this seminar laid special emphasis on organization as a key factor in developing adequate control programmes.

To meet the request for a speedy development of the national tuberculosis programme, UNICEF has agreed, in addition to providing newly established district tuberculosis centres with standard x-ray and laboratory equipment, expendables and a transport vehicle, to make up deficiencies of equipment in tuberculosis centres previously set up and equipped by the Government, provided that they comply with the conditions set out in the official recommendation for n district tuberculosis programme.

The diverse activities under the respective sections of the National mberculosis Institute are partly reflected in the list of publications from the Institute (see Annex 7). Model u~banand district progrmes,run in close co- operation with the Institute, have been used as training and demonstration areas. Epidemlologlcnl investlgations, operational research and test-runs have been carried out to evaluate and elucidate problems in cmnection with truly community- oriented, economical case-finding and treatment sch,mcs on a country-wide basis.

The WHO sociologist completed his assianment at the end of September 1963. and the WHO X-ray engineer and WHOlaboratory technician left the project at the end of December 1963. However. five WHO staff members continued service in the project.

India 108 Health Education: Assistance to StatesC

India 108.5 Health Education, Orissa TA (July 1964 - )

Aim of the project. To develop tho Health Education Bureau in the Health Mrectorate on the lines of modern education methods, including a field study and demonstration centre: to provide training in health education to health workers and teachers, and to plan for health education of the general public.

Assistance Drovided by WHO durinR the year. (a) We health educator; (b) health education literature and a vehicle.

Probable duration of assistance. ?C~Gyears.

Work done during the year. Zhe health educator joined the project towards the end of July 1964 and began a study of the present sltuation,in preparation for the development of the State Health Education Bureau along the lines of the plan of the Central Health Educatim Bureau.

he project started in March 1958 and is expected to continue until the end of 1968. Assistance to three States (Maharashtra, Uttar Pradesh and Bihar) has been complcted and is bcing planned for one more (aujarat). SEA/RC17/2 Page 134

India 110 Nursing Advisers to States*

India 110.2 Nursing Adviser to Punjab TA (AU~US~1961 - )

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

Assistance ~rovidedby WHO durlnR the Year. A nurse adviser.

Probable duration of assistance. Until the end of 1965.

Work done durinu the Year. The Assistant Director,Health Services [Nursing), who is the national counterpart to the WHO Nursing Adviser (stationed in Chandigarh), has been away during the yfar on a WHO fellowship.

Routine advisory and supervisory visits have continued to be paid to hospitals, nursing schools and public health centres throughout the State. Advice and assistance were given to lmprovo both nursing service and nursing education.

Proposals regarding budget allotment for nursing schools and service rules for nurses and the nursing cadre were put forward.

Assistance was given to committees plannlng for the development of the nursing component of health servlces during the next Fivc-Ycar Plan period.

The MO nursing adviser participated in committees concerned with the ddevelop- mcnt of plans for the initiation of a post-basic degree course for nurses at the Punjab University.

India 110.4 Nursing Adviser tu Orissa TA (oct. 1962 - )

Aim of the project. To organize and expand nursing education and nursing services in the State, and to co-ordinate supervisory services so as to ensure unlfomly high standards of nursing and mldwifefy in the health programmes.

Assistance provided by WHO during the year. A nurse adviser.

Probable duration of asslstance. Until the end of 1966.

Work done during the year. Consolidation and development of the Nursing Unit in the Directorate of Health Services in Bhubaneswar continued. Routines for advisory and supervisory visits to institutions employing nursing personnel throughout the State were established. Proposals related to better utilization and further education of

*The project started in December 1957 and is expected to continue until the end of 1968. Assistance to two states (Madhya Pradcsh and Madras) has been completed. S+C17/2 Page 135

'both graduate nurses and health visitors were put forward. Recruitment patterns and policies were studied and recommendations made for encouraging girls from Orissa State to take up nursing. Attention was given to living and 14orking conditions for both graduate and student nurses.

The post for a senior nurse at Directorate level has not yet been established, and the WHO nursing adviser continued to work with the Superintendent of Medical Aid to Women and hildren in relaticn to nursing Staff and services, and with the Additional Director of Education and Planning in relation to all levels of nursing education.

India 110.5 Nursing Adviser to Oujarat TA (Sept. 1963 - )

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

Assistance provided by WHO during the year. A nurse adviser.

Probable duration of assistance. Until the end of 1966.

Work done during the year. MI10 assistance to this project started in September 1963, with the arrival of the WHO nursing adviser in Ahmedabad. A study of nursing needs and resources was made. The study began in October, when hospitals, nursing schools and auxiliary nurse/midwifery programmes in Ahmedabad were visited. Up to the end of March 1964 a total of thirty hospitals and twenty primary health centres throughout the State had been studied. Plans for the development of the nursing component of health services, based on the findings of the study, have been placed before the Director of Health Services.

India 114 Paediatric Education: Assistance to States*

India 114.1 Paediatric Education, Kerala R (Aug. 1958 - Aug. 1959: March - Sept. 1962:

Aim of the project. To expand, upgrade and reorient the teaching of paediatrics in Trivandrum Medical College.

Assistance provided by WHO during the year. A paediatric nurse tutor and periodic visits to the project by the WHO professor of paediatrics assigned to Mysorc State.

Probable duration of assistance. Until the middle of 1965.

Work done during the year. Assistance was given to improve paediatric patient care and nurse education. Better ward staffing and supervision have been introduced. Development of good practice fields in social paediatrics has been slow, but improvement has been achieved in both urban and rural peripheral centres.

*Previous title: Paediatrio Education and~services: Assistance to States. Assistance to thc: projxt is expected to continue until the end of 1966. SEA/RC17/2 Page 136

IInrd teaching has been improved and expanded. The flow of students through tho pncdintric wards has been stabilized. Health teaching has been given priority in patient care and student education.

In-service classas have been organized for graduate nursing staff and ward assistants.

The development of an expanded and more effective series of paediatric lectures has not been fully achieved. The appointment of a full-time paediatric nursing tutor to the staff of the basic nursing school should improve this aspect of the teaching.

In June 1964 a two-month refresher course in paediatric nursing was organized in mivandrum for graduate nurses from the State who were working in.paediatric units.

The WHO nurse tutor left the project at the end of July.

India 114.2 Paediatric Education. Uttar Pradesh R [May 1961 - March 1964) UNICEF

Aim of the project. To expand, upgrade and reorient the teaching of paediatrics in the medical colleges of the State.

Assistance provided by WHO during the year. A professor of paediatrics and a paediatric nurse tutor at Sarojini Naidu Medical College, Agra, and a consultant paediatrician at Kanpur Medical College for two months.

Work done. WHO/UNICEF assistance to the project started in May 1961 and was ccmpleted in March 1964. WHO provided a visiting professor of paediatrics from May 1961 to May 1962 and another from October 1962 to April 1964. A WHO paediatric nurse tutor was assigned to the project from'october 1961 to December 1963. Both were located at Agra Medical College. The national professor of paediatrics and a senlor staff nurse were counterparts to the WHO tern members.

Paediatric services in the Department and the out-patient clinic were further developed,and three peripheral paediatric centres established. Reorientation of undergraduate and DCH courses of studies towards social paediatrics was effected. Co-ordination with the Departments of Obstetrics and Preventive and Social Kedicine in the field of training was accepted and fairly well-developed. The staff of the Paediatric Department was strengthened, but the building of the new Children's Hospital suffered delays. In the field of paediatric nursing, improved nursing techniques were introduced, better house-keeping practices encouraged and planned regular rotation of both graduate and student staff implemented. Clinlcal instruction, with emphasis on health teaching and involvement of mothers in patient care, was startod. Two regular all-India paediatric nursing refresher courses provided supplementary training in paediatric nursing for thirty-seven nurses.

The project was fairly successful in developing improved paediatric services and in introducing social paediatrics as an integral part of the paediatric courses of studies. SEA/Rcl7/2 Page 137

A short-term consultant was assigned to the project from January to March 1964. Working in Kanpur, he made an assessment of current courses for medical undergraduate and post-graduate students and studied the local pattern of promotional and preventive child health services. He xlso assisted in improving the teaching of social paediatrics and developing peripheral paedlatric services for teaching purposes. His report included a recommendation for the further upgrading and expansion of paediatric education and services of the medical college at Kanpur.

India 114.2 Paediatric Education. Mysore R (Oct. 1961 - ?lay 1364) UNICEF

Aim of the project. To expand, upgrade and reorient the teaching of paediatrics in the medical colleges of the State; to establish a paediatric unit in a district hospita1,and to develop a nucleus of an advisory and consultative paediatric service for referral hospitals and primary health centres in the district.

Assistance provided by WHO durinp; the year. (a) A professor of paediatrics and a paediatric nurse tutor; (b) supplies and equipment.

Work done. WHO assistance started in Dct~bcr1961 and was cnmpletcd in May 1964.

In each of the paediatric departments of the four medical colleges of the State, the professor of paediatrics acted as the national counterpart tu the tlH0 visiting professor. A national nurse counterpart nas in position at the arrival of the WHO nursu tutor.

During the period of assistance, targets laid down in the plan of operations were fully met. All building plans or extensions were completed. The medical staff of associated paediatric departments was strengthened by additional appointment of 7 qualified paediatricians, 11 medical officers with DCH and 13 house physicians. There was no significant increase in nursing staff in any of the 11Gspital departments and units included in the project.

A comprehensive paediatrlc course for medical undergraduates was introduced in the medical curr.icul~v. Mcdem teaching methods of co-ordinating and intcgrating teaching of paediatrics with other course6 of related subject matter were demonstrated. Considerable success was achieved in the develupment of peripheral paediatric clinics for teaching purposes. Attention was given tc the development of research as an integral part of teaching activities. Paediatric services in the pilot district were developed satisfactorily and consultative scrvices introduced at sub-district level.

The necessity for improvement of paediatrie training in the basic nursing curriculum was recognized, but the limited opportunities did not justify concentration on this aspect. Three all-India refresher courses in paediatric nursing, conducted in Bangalore during the project period, have Provided an opportunity for re-orientation of a number of nurses. S~~/Rc17/2 Page 138

Evaluation. The project was successful in bringing up the standard of the teaching in departments of paediatrics and stimulating the develupment of modern teaching methods in all existing medical colleges; specifically,considerable success was achieved in the establishment of peripheral paediatric clinics for teaching purposes.

India 114.4 Paediatric Education, Maharashtra R (oct. 1963 - ) UNICEF

Aim of the Droject. To expand, upgrade and reorient the teaching of paediatrics in the medical colleges of the State.

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

Probable duration of assistance. Until the end of 1965.

Work done during the year. The project is based in Bcmbay.

Considerable attention was paid to the development af a sound policy in the learning and practices of comprehensive child health. An encouraging feature was the expansion of the project to the 175-bed B.J. Wadia Hospital for Children and the introduction of comprehensive immunization programmes in the field-training areas.

UNICEF stipends were awarded to seven MD students. A co-ordinated post- graduate programme, providing for rotation between the paediatric departments of the three medical colleges,was drawn up.

The WHO professor undertook teaching of medical undergraduate and post- graduate students through informal discussions, seminars and case-demonstrations in wards and out-patient clinics. He also gave lectures to local professional societies and participated in pan~ldiscussions, cnnfcrenccs and visits to paediatric departments of ~thermedical colleges in the State.

The major problems continued to be heavy w;rlclcads,inadcquatc barrier nursing in general wards, limited capacity of the central paediatric laboratory and shortage of textbooks.

India 114.2 Paediatric Education. Madhya Pradesh R (Dec. 1963 - Jan. 1964) UNICEF

Aim of the DroJect. To develop a biochemicnl section in thc existing 1aboratc.ry of the P;ii~d~.atr:i.cDc~nrtaent of the M.G.M. Medical College, Indore.

Assistance provided by WHO during the year. A consultant inbiochemistry for two months. Work dme. The WHO consultant was assigned to the Paediatrlc Department of M.G.M. Medical College, Indore,from December 1963 to January 1964. Efforts tc fill the post of a biochemist in the Department were unsuccessful, but a paediatrician on the staff was seconded to act as a national counterpart.

The consultant made an assessment of existing biochemical laboratory facilities in the Medical Collrgc for the purpose of establishing a complementary service in the Paediatric Department. She assisted in introducing routine biochemical Procedures in the side-room laboratory attached to the Department and in developing a separate biochemical laboratory for post-graduate students in paediatrics. The project achieved some success in introducing routine biochemistry methods and developing a nucleus Of a working unit from whlch expanded biochemistry services can emanate, subject to the appointment of appropriate staff and provision of supplementary equipment.

mdia 121 Indian Council of Medical Research R (Aug. 1962 - Feb. 1963; Dec. 1963 - )

Aim of the project. To assist the Indian Council of Medical Research in setting up a statistical unit at its headquarters, and in organizing and co-ordinating medical research activities.

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

Probable duration of assistance. Until the entl of 1967.

Work done during the year. A WO statistician was assigned to the project in December 1963. Recruitment of a national counterpart was in train.

The statistician attended the annual conference of the Indian Council of Medical Research,held in Visakhapatnam, and the meetings of its Scientific Advisory Board in Delhl.

He prepared the health statistics part of a training course in epidemiology organized by the National Institute of Cammunicable Disease, Delhi, and also delivered lectures at the course.

India 136 Post-basic Nurslnp, Education: Assistance to States*

The aim of this project has been expanded during the year to place emphasis on the development of post-basic nursing education within the university. Pro- grarrrmes leading to a bachelor's degree, whlch Includes advanced preparation in a nursing specialty, have been encouraged. Authorities responsible for operation of isolated advanced nursing cuurses have been urged to plan for the development

Previous titlcr Post-graduafe Training of Nurses.

"hc project started in January 1962 and 1s expected to continue until the end of 1970- Rssistancs.to one State (Uttar Pradesh) ha3 beco oomglcted. ~EA/k~l7/2 Page 140

of a post-basic school of nursing and the gradual association of the school with a university. A phased programme outlining this type of development has been prepared by the Regonal Office, and assistance has been given in every State where the project is in operation so as to develop thlnking and planning which will eventually lead to a post-basic degree programme. This shift in emphasis is reflected in the change in the title of the project as shown above.

India 136.2 Post-basic Nursing Education. Qujarat R (Jan. 1963 - I

Aim of the project. To expand post-basic nursing education and upgrade public health and institutional nursing services in the State.

Assistance Drovided by WHO durlnn the Year. A nurse educator.

Probable duration of assistance. Until the end of 1966.

Work done during the year. Expansion and development of the course for public health nurses, wbiob is being gven in Ahmedabad Medical College,continued. Methods for selecting both students and learning experiences were improved. Physical facilities were added, and teaching equipment and reference materials were expanded.

Preliminary discussions directed towards laying a foundation for the development of the course tuwnrds a post-basic school and university affiliation were held.

Sost-basic Nursina Education. -lab -R (March 1964 - ) Aim of the project. To develop a university-affiliated post-basic school of nursing in the State.

Assistance provided by WHO during the year. lCro nurse educators.

Probable duration of assistance. Until the end of 1970.

Work done during the year. Work has progressed rapidly toward the development of a post-basic degree programme for nurses. A Board of Nursing Studies has been established under the Faculty of Medicine of the University of Punjab. The syllabus and regulations for the two-year post-basic degree progranrme, which will offer a specialization in teaching and administration, have been prepared. Faculty, teaching and hostel facilities have been allocated in the Post-graduate Institute of Medical Sciences, Chandigarh. It is planned to hold clinical teaching in the hospitals and health centres in and adjacent to Chandigarh. The first class of students was enrolled in July 1964. ~EA/Rcl7/2 Page 141

India 136.4 Post-basic Nursing Education. Mysore R (Feb. 1964 - )

Aim of the Droject. To expand post-basic nursing education and upgrade public health and institutional nursing services in the State.

Assistance Drovided by WHO durinR the sear. A nurse educator.

Probable duration of assistance. Until the end of 1968.

Work done during the year. Direct WHO aid to the project began with the appointment of a nurse educator.wh0 arrived in Bangalore in early Pebruary 1964.

Assistance was given in upgrading the current post-basic courses for ward sisters and tutors.

Preliminary discussions have been started with the object of laying the foundatim for the expansion and developraent of the educational programme toward a post-basic school with, eventual, university association.

India 136.i Post-basic Nursin~Edueation. Madras R (June 1964 - )

Aim of the Drodect. To establish a university-affiliated post-basic school of nursing in the State.

Assistanoe Drovided by WHO during the year. A nurse educator.

Probable duration of assistance. Until the end of 1968.

Work done during the sear. The WHO nurse educator took up duties in Madras in June 1964. Exploratory discussions on the development of the current post-basic courses into a university-affiliated school have been started.

India 145 Public Health Programme. Bihar R (Jan. 1958 - Feb. 1964) UNICEF

Aim of the Project. To train personnel and to expand the health services in canmunity development areas.

Assistance Drovided by WHO durin~the year. A public health officer and a public health nurse.

Jork done. This project was developed from an earlier project. Maternal and Child Health/Nursing, Bihar (India 56). assisted by WHO with UNICEF support from 1954. sEn/Rc17/2 Page 142

In January 1962 WHO assigned to this continuing project a public health officer and a public health nurse. both based at Patna (Bihar). The counterpart to the WHO public health officer was the Assistant Director of Health Services (Planning). Tho WHO public health nurse had no counterpart but worked in close co-operation with the Assistant Director of Health Services (MCH) and other national staff.

The work of the project was concentrated on the establishment of orientation training courses for medical officers in charge 'of primary health centres; the development of rural centres to be used for training; assistance to primary health centres, referral hospitals and laboratories, and assistance in the nursing aspects of the programme.

Orientation training for Primary health centre doctors at the Public Health Institute, Patna, with rural field experience at Rajgir FieldTraining Centre. began in November 1962. By November 1963, 34 medical officers had undergone orientation training in four groups. Each course lasted for four weeks.

The WHO nurse assisted schools of nursing in planning the integration of public health into the basic curriculum and also in the organization of training programmes for auxiliary nurse-midwives.

Evaluation. The project developed an orientation training programme for medical officers, a rural training centre and curricula for nursing personne1,and aided in the upgrading of health centres and referral hospitals.

India 141 Public Health ProKramme. Kcrala R (June 1960 - ) UNICEF

Aim of the DroJect. To train personnel and to expand the health services in community dtv~lopmtntareas.

Assistance Drovided by WHO durinn the year. A Public health nurse.

Probable duration of assistance. Until the end of 1965.

Work done during the year. In October 1963, the duty station of the WHO public health nurse was transferred from Trivandrum to the Indo-Norwegian Health Centre at Neendakara. At this health centre a practice field in public health nursing for all categories of nursing personnel has been established. Home visiting has been well developed. Maternal and child hcalth clinics at the Centre are being utilized, and students have opportunities to follow the mothers and children from the maternity and paediatric wards of the Centre into their houses in the community. Health teaching is being glven priority.

Public-health nursing students, basic nurse/midwife students and auxiliary nurse/midwives are receiving training at the Centre. srn/Rc17/2 Page 143

Difficulties have been encountered in assuring a steady flow of a single category of students through thc whole of the practice field.

India 150.2 PuUlic Health Pro~mmme. Naharashtra* TA (April 1963 - ) UNICEF

Aim of the project. To develop a rural envirGnmenta1 sanitation programme and to improve the training of environmental sanitation staff.

Assistance Drovided by WO durina the Year. A sanltarlan.

Probable duration of assistance. Until the end of 1965.

Work done durinR the Year. The twelve-month training course for sanitary inspectors at the Public Health Institute. Hagpur, was conducted,with the active participation of the WHO sanitarian and his nation31 counterpart. There were approximately 1 000 applicants far seventy-five places.

An orientation training course of five weeks' duration for medical officers of primary health centres was held in January 1964. The sanltarlan and national counter Part assisted with lectures and practical field demonstrations in general sanitation.

Assistance was also provided to rural water supply and latrine construction programmes in selected National Extension Service blocks of the Public Health Units of Sirur, Saoner, and Palghaf.

India 151 Malaria Eradication R (AM. 1958 - (USAID)

Aim of the project. To eradicate malaria from the whole country and to prevent the re-establishment of endemicity.

Assistance Drovided by HHO durlna the Year. (a) Three entomologFsts and two laboratory technicians (for part of the year); (b) a two-month international travel fellowship; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1969.

Work done durina the year. This programme continued to maintain its steady progress. The annual assessment for determiang the areas for withdrawal of spraying was carried out during the first quarter of 1964 by nine teams and a panel of consultants from the Government, USAID and WHO. As a result of this assessment, an additional 60 units entered the consolidation phase early in 1964. The programme has now 1C4 units in the attack phase and 288 units in the consolidation phase, of which 80 are in the process of entering the maintenance phase. Some reorganization of the units still

*The first phase of this programme was completed December SJ.hC17/2 Page 144

in the attack phase has been undertaken.with a view to concentrating efforts on sparsely populated hillforest areas. The transmission of malaria in some urban areas, where A.steohens1 is the vector, has also been cffectively tackled by intensifying anti-larval measures and surveillance operations.

Elaborate arrangements have been made for the maintenance phase: these include expansion of basic health services to provide total vigilance cover; provision of facilities for routine mioroscopic diagnosis of fever cases at health centres, district laboratories, etc.; development of epidemiological services. and training and reorientation of various categories of health personnel in accordance with the requirements of their duties.

India 1% Curriculum Guide for Nursing and Elidwifery Training R (Jan. 1963 - j

Aim af the Droject. To revise the currently required mir.imum syllabi for general nursing and midwifery; to prapare a curriculum guide to the revised syllabi.

Assistance Drovided by WHO during the year. A specialist in nurse training.

Probable duration of assistance. . Vntil March 1966.

Wor!i done during the year. The WHO nurse returned from study-cum-home leave in November 1963, since when the first two stages of the project have been completed.

The first stage consisted of the collection of material from all over India In order to obtain a general picture of the present situation in nursing, basic nursing education and the health problems and health services of the country. This was completed in March 1964.

The second stage consists of the revision of the present Indian Nursing Council syllabus for general nursing and midwifery, and the regulations for recognition of ~choolsof nursing. This is under consideration by the Co-ordinating Committee.

In carrying out these activities, the project operated through 19 sub-committees which were appointed by the State Nursing Councils,with representatives from all States, Mission Boards and the Army Nursing Services, and through special sub- committees in Delhi with which the WHO nurse worked more closely. All activities have been co-ordinated by a special comittee of eleven, appointed by the Indian Nursing Council. This comittee has held meetings every six months.

Preparation of the guide has been started.

India 170 Survey of Water SUDD~YResources of Qreater Calcutta R (Oct. - Nov. 1959; Sept. - Nov. 1961; Reb. 1963 - ) UNSF

Aim of the project. To improve the water supply and drainage of Greater Calcutta. SEA/RCl7/2 Page 145

Assistance Provided by WHO during the year. A resident sanitary engineer and a sanitary englneer (planning).

Probable duration of assistance. Until the end of 1966.

Work done during the year. Wo& on collection and final compilation of basic technical data for the preparation af the Master Plan on watcr supplies,sewerage and drainage for Greater Calcutta has proceeded.

me project has been visited twice by representatives of the World Bank (IDA) to discuss the prospects of financial assistance for interim water supply schemes and future water supply and sewerage schemes. WHO has participated in these discussions.

Deep ground-water exploretion with suitable drilling rig equipment has been started in the southcrn par'ts of Qrclter Calcutta.

A draft bill to create the Calcutta Metropolitan Watcr and Sanitation Authority has been prepared and submitted to the Legislature.

The Government of India has requested the extension of the services of the Consulting Engineer, in order to carry out deep ground-water source studies as well as to cover a greater area in metropolitan Calcutta and to effect the reglonalizatlon af sewerage and drainage schemes.

India 176 Central Public Health Enaineerinn Research Institute, R Nanuur UNSF (Feb. 1961 - )

Aim of the vroject. To develop the Institute as a major research centre fur environ- nental sanitation problems, to co-ordinate research programmes and to traln research workers.

Assistance provided by WHO during thc year. Short-term consultants in instnuncntation, public health engineering education, water pollution control and sewage treatment, and sanitary engineering research.

Probable duration of assistance. Until the end of 1966.

Work done durfnn the year. Scientific equipment prgvidcd by the Uhited Nations Special Fund to thc Central Public Hcalth Engineering Research 1nstitute.on the advice of WH0,was delivered as planned.

A consultant on instrumentation was assigned and assisted in the preparation of a final list of equipment and materials. Another consultan! advised on long-term applied research programmes in a number of fields. SEA/?4~17/2 Page I46

A symposium on public health enaneering education was held at the Llstitute in October 1963 with asslstance from WHO in the form, of a professor of public health engineering. This consultant also visited several educational institutions and reportee on post-graduate Public health engineering education in India.

Research on development of local materials and cost-saving methods on systems of water and sewage treatment were among the important activities dertaken by the Institute.

A consultant on water pollution and sewage treatment completed a three-month assignment.during which he assisted in the establishment of rcasmable standads for streams and for effluent discharge. He also advised on the performance of water- pollution surveys and on industrial waste treatment.

India 180 Health Education in Schools R (July 1964 - )

Aim Of the project. To develop health education in the basic teacher-training courses and in thc teacher-training institutions in the country.

Assistance provided by WHO durlnR the Year. A health educator.

Probable duration of asslstance. Until the end of 1966.

Work done durinR the year. The health educator was asslgned to the project towards the end of July 1964. She is making a study of health education in the current basic teacher-training courses.

India 182 Stren~thenin~of Health Services (E~idemiolo~y~ TA (March 1963 - )

Alm of the prolect. To establish or improvo health intelligence units in state health directorates; to train staff in epidemiology, health statistics, microbiology and communicable-disease control; to develop further the National Institute of Communicable Diseases. Delhi.

Assistance provided by WO durin~the year. (a) Five consultants; (b) two fellowships - one of twelvc months and one of six months.for study in the United States of America, th~eten-month fellowships for study in Europe,and one three-month fellowship for study in Denmark and the United Kingdom; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1968.

Work done durin~the year. In the past three years, ton fellowships. in epidemiology were awarded by WHO to seldcted medical graduates with D.P.H., who on their return from training.would be responsible fur establishing an epidemiological unit at state level. In the latter part of 1963, a WHO consultant visited thc health directorates SEA/RC17/2 Page 147

of those States to which the fellows had returned after training,in order to follow up the progress made by them in setting up epidemiclogical units. He also advised on the priority of cpidemiolagicnl studies and the urgent need to develop supporting microbiological and statistical services.

A second consultant also visited the inf-cticus-dlseases hospitals in five principal cities of India and advised on their upgrading and on the role they should play in epidemiologicai intelligence and as teaching centres.

Three consultants assisted the National Institute of Communicable Diseases, Delhi, in developing facilities fur and in the teaching of epidemiology, microbiology and statistics, in the first five-month trainin8 course in Epidemiolom started at the Institute in July 1964. T1.ro fellowships wcre awarded to staff mcmbcrs cf the Institute for advanced training in serology and in insect physiology. Supplies and equipment were provided for the new fttcrcbiological Ikpnrtment.

India 183 Medical Education, aujarat State TA (Dec. 1962 - )

Aim of the DrGdect. To develop medical education and medical research in Baroda Medical College.

Assistance Drovided by WHO during the year. (a) A team of six visiting professors from Edinburgh University (up to May 1964). and another team of five visiting professors (from July 1964) from the same university; threi short-term consultants; (b) supplies md equipment.

Probable duration of assistance. Until the end of 1968.

Work done during the ycar. The WHO team of six visiting professors took part in seminars on "The Objective of the Project", "cross Infection", "Diarrhoea1 Diseases" and "Medical Education". They held consultations with their n3tional colleagues an0 prepared 3 report on thr nedic:l college cxnd huspitals, with recommendations for improvtme.ls of facilities and staff in each department under assistance, as well as for the hospitals in general.

The visiting professor of preventive and social medicine was designated as senior WHO officer. He co-ordinated the work of the members of the team. He also participated in the lectures to students and introduced preventive aspects in combined clinical lectures. Hr ilso gave lectlrcs on the hazards of nuclear radiation to man.

In ldditiln t.i instructing undcrgraduatcs and undertaking post-graduate clinical teaching and tutorials, the WHO professor of paediatrics assisted in the improvement of the facilities in the children's wards.

The WHO professc~of bacteriology, in collaboration with his national counter part, was able tc, establish a reliable diagnostic bacteriological service. He reviewed the serological methods in use and made suggestions for their improvement. SEA/UCl'I/Z Page 148

A laboratory technician, provided on a short-term basis, was able to train the laboratory staff and organize laboratory work. Several research projects were undertaken.

The visiting professor of obstetrics and ggnaecology, though handicapped by having no suitable counterpart, contributed to the improvement of the teaching of the subject and the organization of clinical work.

The visiting professor of medicine participated in the teaching of undergraduates and post-graduates. He introduced an integrated lecture course on the cardiovascular system for post-graduate students. A special course on nutritional anaemias was organized.

A therapeutic conunittee made a study of the availability and use of intravenous fluids in S.S.G. Hospital.

The visiting Professor of physiology besides taking part in the normal teaching, helped tu set up a neurophyslological laboratory, participated in clinical teaching on neurological patients, put up an electrornyographic apparatus and made photographic arrangements.

A professor of bacteriology and a biochemist were assimed for a short time. They made recommendations on the desirability of establishing independent departments of microbiology and biochemistry.

Recommendations for further development of the college included proposals for enhanced staffing of the hospital and college, appointment of full-time staff to be in charge of the clinical departments, improvement of the physical facilities of the hospitals, reorganization of hospital administration.and introduction of a suitable hospital records system.

Members of the WHO team, individually or in small groups, visitcd the other medical colleges in Gujarat and other centres of medical education in India. They have contributed by lectures, discussions and seminars to medical education in general. They also participated in the conference on medical education convened by the Indian Association for the Advancement of Medical Education in Febwary 1964 in Madras.

A second team ofvisitingprofessors (in internal medicine, clinical biochemistry. psychological medicine, surgery, hosPit3l administration) started work in Baroda Medical College in July 1964.

India 185 Strenathenin~of District Health Administration R (Jan. 1964 - ) UNICEF

Aim of the Droject. To study and develop the organization of district health services so as to provide the maximum effective service to the public, having regard to the health personnel available. SEA/RC~~/~ Page 149

Assistance Drovided by WHO during the year. A public health officer, a public health nurse and a sanitarian.

Probable duration of assistance. Until the end of 1968.

Work done durins the year. In keeping with the established system of district administration, the project is assisting to establish administrative patterns which will provide adequate technical guidance and supervision to district health personnel and will develop a more effective usi of hcnlth stnff at field levsl.

The project has been in operation in Jamnagar Mstrlct of Gujarat State since January 1964. The WHO team consists of a public health officer, a public health nurse and a sanitarian. Counterparts have been appointed by the State Government. The team has examined the existing health conditions with a view to preparing a programme of activities based on the findings. The Government of Gujarat has sanctioned a district tuberculosis programme, and the required staff are being recruited.

India 186 Assistance to Schools of Dentistry R (oct. 1963 - ;uly 1964)

Aim of the project. To demonstrate modem techniques and improved methods of teaching, and to organize research and tmining,in the field of dental health.

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

Work done. The WHO visiting professor of dentistry Ltrrived in early October 1963. After attending the meeting of investigators of epidemiology and pathology of oropharyllgeal tumours held in New Delhi from 8 to 15 Octobcr, he undertook teaching and other duties connected with his assignment at the following dental colleges: (1) Dental College and Hospital, Luchow, (2) Government Dental College, Bombay, (3) Nair Hospital Dental College, Bombay, (4) Dental College, Bangalore, and (5) Dental College, Trivandrwn.

He introduced modem methods of teaching dentistry, started research projects and provided an outline syllabus for teaching students in a systematic manner. His report has been sent to the Government.

India 189 Urban Health Develo~ment R (Nov. - Dec. 1963)

Aim of the Droject.. To organize and develop urban health services and train personnel for work in urban communities.

Assistance Drovidfd by WHO durinR the year. A consultant in urban health development. s~c17,L2 Page 150

Work done. Assistance was requested in a study of the health problems due to rapid urbanization and industrialization in Bangalore City. A WHO consultant was assigned in November to examine the urban health problems in all their aspects and make recommendations. He completed his work in December 1963. His recommendations are under consideration.

India 194 Medical Rehabilitation R (Nov. 1963 - Peb. 1964; - ) UNICEF

Aim of the project. To expand medical rehabilitation services throughout India and the facilities available at the All-India Institute of Physlcal Medicine and Rehabilitation, Bombay; to set up a Central Institute of Orthopaedics in Delhi as a training and research aentre; to develop 8 to 14 other departments in selected cities which already have well developed orthopaedic departments, and to establish a large plant in Delhi for the manufacture of standard prosthetic components.

Assistance provided by WHO during the year. Two short-term consultants.

Probable duration of assistance. Until the end of 1967.

Work done during the year. Two short-term consultants were assigned by WHO in November 1963. They visited various major hospitals/institutions concerned with medical rehabilitation and held discussions with local authorities in several of the principal towns, viz.. Bombay, Paona. Madras, Vellore, Bangalore, Calcutta, Chandigarh. Kanpur and Lucknow.

One of the consultants completed his work in January, and the other in ~ebruary.1964. In their report they have recommended a programme for the gradual development of a country-wide rehabilitation service for the physically handicapped. The report has been forwarded to the Qovernment.

It is proposed to provide the services of a technician in orthopaedic appliances in 1965.

India 195 Course in Radiological Physics, Bombay R (April 1962)

Aim of the project. To strengthen the training of radiological physicists.

Assistance provided by WHO during the year. A consultant for one month and payment of 5@ of the stipends to fourteen participants in the course.

Probable duration of assistance. Until 1966.

Work done during the year. The first one-year course in radiological physics was conducted by the Atomic Energy Establishment, Bombay, with assistance from a WHO consultant on radiation protection, who was working with project SEARO 42. The course was sEA/Rcl7/2 Page 151

completed ai thi en1 cf :'lrch 1963. For the second course, which started in May 1963, Wi:O providcd another consultan for one month. He gave a series of special lectures and also madc sorle useful suggestions for modification of the curriculum.

Similar courses will be given in 1965 and 1966.

India 196 illn~an.se Poisonine R (NVV. - DCC. 1963)

Aim of the p-. To promote safety mechanisms and procedures against manganese and ferro-manganese poisoning.

Assistance provided by Xi0 dllr-i_"g the year. A consultant for three weeks.

Work done. A 1?10 co:::lllt.r.nt was assigned to this Project at the end of November 1963. PC.. 'ri-rted thr ferro-manganese m'ncs and plants in Plysore and Orissa and held disc. uns w;,il gover;D.~ntal and conm?rcial authorities concerned in Bangalore. Madras and Orlrsa States. He also visited the All-India Institute af Hygiene and Public Health, Calcutt?. On his visit to Orissa he was accompanied by the professor of physiologiaal and L!:2a;trihl nygisne at the Institute.

He later addressed the Indian Academy of Medical Sciences, New Delhi, on "Exploring th., D .n:crGus Trades".

lie conplcted his assignment in December. His r.opart, s'~nttcv thi S~.vernmsnt, cutlines nath.ods rs:r tliri prcvdntlun ;f n?n&rtne;e pcisonine by dust and fumes.

India 197 In3ustrial--.-- and Occupa: anal Health R (ngrll 1764 - )

.t. To Aim of the--. p-oji. .- - .. . - study the m,?dical facilities available in the various industrial undt-rt;'

Assistance provided by 1210urini: the year. A consultant for six months.

Probable duratlon of assistanc~. Until November 1964.

Work done during--- the year. The WHO consultant arrived in April 1964. He visited Ahmedabad, Bonbay, Cochin, Coimbatore and Bangalore, to study the medical facilities available and protl?ms of iniustrlal and occupational health hazards at the industrial undertaWnps and trlinlnp institutions.

Action is bein6 taken to assign an industrial toxicological engineer for three months from August 1964. SEA/RC17/2 Page 152

India 198 Plague Control R (Jan. - April 1964)

Aim of the project. To investigate and determine the factors responsible for the persistenoe of foci of plague in South India and advise on suitable control~naasures.

Assistance provided by WHO during the year. (a) A consultant for four months; (b) supplies and equipmcnt. (A vihicle was made available from project India 153).

Work done. The consultant carried out a detailed study of rodents, wild and domestic. and of their ectoparasites,in order to determine their role in the persistent transmission of plague in the affected zones of Hysore, Madras and dndhra Pradesh States. The presence of sylvatic plague was successfully demonstrated by P. pestis isolations from three species of wild rodents and thew fleas. A study of the epidemiology of outbreaks of human plague was continued.

Co-ordination of the necessary investigations and control measures was undertaken by a team from the National Institute of Communicable Diseases. Delhi, in collaboration with the anti-plague services of the three States concerned.

India 200 Pellowships R

Production of Polio Vaccine: A twelve-month fellowship for study in the United States of America and Canada.

Nursing Administration: A twelvejnonth fellowship for study in New Zealand.

Health Education: A two-month travel fellowship in the United States of America and Europe.

Physical Therapy: A twelve-month fellowship for undergoing the Physical Therapy Teachers'Training Course in the United Kingdom.

gidemiology of Poliomyelitis and Production of Polio Vaccine: A twenty-inonth fellowship for study in the United States of Pimerica ard Canada.

Neuro-virulancc Testing: A three-month fellowship for study in the United States of America.

India 201 Fellowstiips TA

Sanitary Engineering: A six-month travel fellowship in the United States of America and Europe.

Paediatrics: A four-month fellowship for study in the United States of America. sm/Rc17/2 Page 153

m: A twelve-month fellowship far study in the United Kingdom. Quarantine Administration and Yellow Fever Control: Two ten-week international travel fellowships in Africa and Europe.

Clinical Biochemistry: Two ten-week fellowships for study in Denmark (awarded under Inter-regional 239).

Industrial Hygiene: Two eight-month fellowships for study in Yugoslavia (awarded under Inter-regional 180).

Basic Sciences for Surgeons: Two three-month fellowships for study in Denmark [awarded under Inter-regional 243).

India 209 Community Water Supply CWS (March 1964 , )

Aim of the project. To assist in the organization and conduct of a Seminar, and to assess and advise on the feasibility and presentation of definitive schemes of water supply and associated drainagc,in relation to the conditions and requirements of World Bank loans.

Assistance provided by WHO during the year. (a) ma consultant on financing and two consultants on engineering: (b) some supplies.

Probable Puration of assistance. Until the end of 1966.

Work done during the year. The WHO consultants and staff of the Regional Office assisted in the organization of the Government of India's Seminar on Water and Sewerage Works Financing and Management,held in Delhi from 24 to 30 April 1964. WHO staff participated in the deliberations of the Seminar and assisted in the preparation of the final report.

Immediately after the Seminar, the engineering and financial consultants visited typical water and sewerage schemes in the States of Mysore, Madras and Maharashtra and held discussions with responsible officials on proposed schemes and related problems. Their reports have been sent to the (ioverment.

It is planned that thesc preliminary visits will be followed by further visits at a time to be decided in the light of developments. Other areas will also be visited fcr the same purpose.

SEA/RC17/2 Page 155

Despite a number of economic measures taken by the Government, the inflationary.trend continued during the year. This has reacted unfavourably on health services, which have had difficulty in meeting the increased costs occasioned by rising prices. The national malaria eradication campaign has been hampered by shortage of funds. Many hospitals and health centres have operated to less than full capacity, owing to insufficient funds for staff and maintenance services. However, there has been a truly impressive axpansion of medical education. There are now fourteen medical faculties, of which only two (Djakarta and Surabaja) have been established long enough to have produced medical graduates. The shortage of teachers, equipment and textbooks is acute, and this problem has not yet been solved. The University of California and the China Medical Board have given substantial help to the Medical Faculties of Djakarta and Surabaja. Plans for WHO and UNICEF assistance to medical education in Jogjabrta and Bandung have been completed.

The rapid growth of population, particularly in Java, has emphasized the urgent need for increasing food production and providing safe water supplies. There is serious rat infestation in rural areas. In addition to their potential menace in the spread of disease, rats have been responsible for very grave wastage of food. Rodent-control measures were undertaken by the Department of Agriculture.

The Central Epidemiological Unit in the Ministry of Health maintained its present somewhat limited investigatory and training functions. The Unit has assisted actively in the control of outbreaks of communicable diseases. The system of reporting communicable diseases was continued, though reporting is still far from complete. The work of the Unit has stressed the necessity for further development of health laboratory services. Epidemiological sections have been set up in five provinces, and expansion to other provinces is envisaged as staff is trained

There were further outbreaks of cholera El Tor, assuming epidemic proportion during the rainy season. Cases of smallpox continued to occur: the disease appeared to have become endemic in West Java. Plans to increase the production of freeze-dried smallpox vaccine, with the assistance of WHO and UNICEF, were being developed

The success of the malaria eradication campaign in Java suggests that tuberculosis is the next serious public health problem. It has been estimated that nearly 5% of the population in Central Java have active, progressive SEA/RC17/2 Page 156

tuberculosis. The national BCG campaign has been intensified The tuberculosis control programme in Jogjakarta has made good progress, and the activities have been extended to MaLang, Surabaja and Makasear.

The first steps were taken for the extension of the leprosy control programme from Jam and Bali to some of the outer islands. It has been decided that leprosy control should be an integral part of the general health services. PROJECT LIST

Prodect No. Source of Funds Co-operating Agencies

Indonesia 2 Leprosy Control R (July - Sept. 1955; Sept. 1956 - ) UNICEF

Aim of the Project. To develop a leprosy contrgl programme withln the framework af the general hcalth services in all endemic areas of the country.

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

Probable ouration of assistance. Until the end of 1967.

Work done durin~the year. The national leprosy control programme has continued to receive the support of the Government, special emphasis being given to an integrated method and approach to leprosy control and to the training of specialized staff as well as of general health services personnel.

In view of the results obtained in Java and Bali, plans were made for further consolidation within Java and Ball and for the expansion of the Programme in the outer islands, particularly in Sumatra and Kalimantan.

The situation as reported at the end of 1963 can be summarized as follows:

Cumulative total of Po~ulation Total of new cases renistered up Province -examined in ghj cases in 1962 to the end of 1962

Djakarta Raya West Java Central Java East Java Bali North Sumatra South Sumatra South Sulawesi Jogjakarta

Total 703 033 2 273 36 978 SEA/RC17/2 Page 158

Indonesia 22 Strennthenina of Health Services (Epidemiolom~ TA (Dec. 1958 - March 1964)

Aim of the project. To set up an epidemiological unit in the Ministry of Health and in the pl,ovlnces in order tu determine the preuailing disease pattern and plan control measures; to advise all branches of the medical services on the use of epidemiological methods.

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

Work done. The Epidemiological Unit in the Ministry of Health continued its advisory activities and investigation of the prevailing diseases and their control. It promoted and helped to establish epidemiological sections in the Departments of Bealth of the Provinces of Java and Ball.

During the year. special investigations were carried out on the epidemiology of cholera El Tor, smallpox, diphtheria, pertussis and tetanus.

The Epidemiological Unit organized and assisted in various training courses in epidemiology for newly graduated doctors as well as for existing health personnel.

After a period of over five years of direct assistance to the Epidemiological Unit, WHO aid to the project teminated at the end of March 1964.

Evaluation. The principal aim of this project, namely to strengthen epidemiological services in the Ministry of Health, can be considered to be well on its way to achievement.

Indonesia 32 Malaria Eradication R (May 1955 - 1 TA UNICEF (USAID)

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

Assistance provided by WHO during the year. (a) Nine malariologists, three entomologists, one assistant malariologist, four sanitarians, an administrative Officer, three clerk-stenographers and one trarislator-typist; (b) a four-month fellowship for attendance at the malaria training czurse in Jamaica, a three-month fellowship for study in India and two fellowships of three-and-a-half months each for study in the Philippines and India; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1974. SEA^ cz 7/z Page 159

Work done durinp: the year. Spraying operations and case-detection activities were continued in Java, Ball and South Sumatra. During 1963 the spraying operations had to be suspended temporarily for administrative reasons. Efforts continued to be made to improve supervision of operations, including the maintenance of vehicles.

Insecticide resistance of the vectors A.sundaicus and A.aconitus in some parts of Java and demographic factors following the volcanic eruption of Mt. Qunung and the inter-island movement of population have presented some problems. There has been some increase in malaria cases in Ball, Madura and !Fulungagung Zone.

An internal assessment of the programme was undertaken during the first quarter of 1964, and,followlng this, spraying was withdrawn from some zones in Java.coverfng approximately 15.4 million people. Arrangements have been made to intensify surveillance activities in these areas.

In South Kalimantan, malariometric surveys were carried out along the &?reto River. Tnc building of offices and staff quarters for malaria eradication headquarters in BanJarbasu is progressing.

In the Province of West Irlan, pre-eradication activities were continued. Spraying operations covered a population of 182 000 in 1964. A national technical ,lirector has joined the programme. Six zones have been established with 23 sectors. A plan of operations is being finalised.

Indonesia 40 Vaccine and Sera Production TA (April 1959; June 1960; Feb. - March 1963; UNICEF Sept. - Dec. 1963; - )

Aim of the orodect. To improve methods of production of vaccines, antitoxin and tOxoids.

Assistance provided by WO durinp: the year. A three-month fellowship for study in the United States of America.

Probable duratlon of assistance. Until the end of 1966.

Work done during the year. As a follow-up of the recommendations for the establishment of a production unit for diphtheria, pertussis and tetanus vaccines, made by a short-term consultant who visited the Bi., Farma Institute. Pandung, in 1963, WHO'S technlcal approval was given to UNICEF for assistance with additional equipment needed. Further follow-up of the project Is envisaged in the next two years.

Indonesia 41 Nursing Advisory Services TA (Oct. 1957 - July 1959; Nov. 1960 - )

Aim of the project. To develop a Division of Nursing in the Kinistry of Health which will co-ordinate institutional and public health nursing services and upgrade and expand training programmes for nurses and midwives. Assistance provided by WO durinn the year. A nurse adviser.

Probable duration of assistance. Uhtil the end of 1968.

Work done durlnn the mar. The WHO nurse adviser left the project on study-cum- home leave in July 1963,and her replacement arrived in November 1963.

The need to define the functions of the Division of Nursing in the Mlnistry of Health as well as the duties and responsibilities of its ,personnel was emphasized,and assistance to this, end was given.

The WHO nurse participated in a committee to make recommendations for the development of a uniform curriculum which might be used in all basic nursing schools throughout the country. A review of the structure and functions of the Post-basic School for Nurses and Mldnives has been undert&en.nith a view to recommending more effective functioning.

In order to study the overall nursing needs of the country and to determine the functions of the Division of Nursing,it has been planned that the WHO nurse adviser will make field visits to areas which have not been visited by a nurse specialist so far. This will also provide an opportunity to give on-the- Spot assistance to some of the schools and institutions which have requested such help.

Indonesia 50 Tuberculosis Control R [~uly1961 - ) UNI CEP

Aim of the Project. To proceed wlth the national tuberculosis progranrme; to train national staff in rational case-finding and ambulatory treatment techniques and methods; to establish a central tuberculosis epidemiological unit which will direct the control operations throughout the country.

Assistance Drovided by WHO during the year. (a) A medical officer, a public health nurse, a laboratory technician, an x-ray technician and a statistician; [b) supplies and equipment and a transport vehicle.

Probable duration of assistance. Until the end of 1967.

Work done durinn the year. A re-examination of patients who had been under treatment for one year and an additional 2% sample of persons Known to have had normal lungs at initial examination were undertaken. This was concluded at the end of 1963, thus completing the urban pilot project in Jogjakarta. Mass control services, in which all persons over 9 years of age are covered by x-ray examination without preliminary tuberculin testing,have been instituted. All cases detected have been put on treatment with INH alone. More than 10 000 examinations were carried out in January 1964, and'operations have exceeded the target,nith a coverage of sEA/Rc17/2 Page 161

over 8%. The estimated Prevalence of cases of tuberculosis considered to be in need of treatment has remained on the same level as during the pilot project operations, namely 4.075.

The follow-up results of the pilot study population showed that more than 90 per cent of the infectious cases had become inactive during the one year of treatment with IETH only. However, the radiological "healing rate" appeared to be lower than 3%. and cases with extensive and/or cavitary lesions showed the lowest healing rate.

In Surabaya, a mass case-finding and treatment programme has been started, applylng the methods and procedures established in the Jogjakarta project.

A pilot project is being started at Malang (East Java) to ascertain the most suitable method for a tuberculosis control programme in rural areas of Java. Different approaches to the organization of mass treatment through existing health services vlll be evaluated under this study, and mass oase-finding in keeping with the capacity of the treatment service will be instituted.

Indonesia 2 Strengthening of Health Services R (Sept. 1959 - UNICEF

Aim of the project. To develop a comprehensive health service providing adequate health coverage, In both quality acd quantity.

Assistance provided by WHO durinK the year. A public health nurse and a sanitarian.

Probable duration of assistance. Until the end of 1967.

Work done during the year. A WHO nurse and a sanitarian assisted in the organization and conduct of training courses at Bekasi. They were also able to provide assistance in the work of health services within the surrounding area of the project .

The sanitarian advised m.and..asalsted in.the.lplprovement of UrJICEF-aided. water supply programmes tor hcmes and orphanages.

Transfer of the location of the project is under study.

Indonesia 62 Medical Education R (May 1964 - 1

Aim of the project. To assist selected departments of the Faculty of lkdicine in the country. SEA/~c17/2 Page 162

AssiStance Provided by WHO durin~the year. A professor of physislo~.

Probable duration of assistance. Until the end of 1968.

Work done durinK the year. A visiting professor of physiology was assigned to the Medical Faculty, Qadjah Mada State University, Jogjakarta,in May 1964. Since then he has made a study of the local problems and needs of the basic medical sciences in Indonesia.

Indonesia 64 School of Physiothera~y. Solo R (March 1963 -)

Aim of the DroJect. To improve, expand and upgrade the existing training of physiotherapists as well as to develop physical medicine and rehabilitation services in the country.

Assistance provided by 1M0 durina the year. A physiotherapy tutor.

Probable duration of assistance. until the end of 1966.

Work done durinpl the war. Twenty students, who had begun their course with a revised syllabus in September 1963. and 21 students entering their third year started work in Djakarta hospitals for practical experience. The 'dHO tutor assisted in the training of "physiotherapy-aides" at the Crippled Children's Centre, Solo; 26 of these aide8 were recruited in October for a me-year course, although this training does not fom a part of the Oovernment's training scheme for physiotherapists. Altogether, 67 students are in different stages of training. A further group of 12 students completed the examination and.9 of them were successful; the three unsuccessful ones remained in Djakarta until re- examination in April 1964,when they vere also successful.

Indonesia 200 Fellowships

Health Education: A twelve-month fellowship for study in the United States of America.

Enteric Diseases: A five-week fellowship for participation in the course on enteric-disease control, held tn Teheran (awarded under n Headquarters' allotment).

Indonesia 201 Fellowshie;? TA

Anatomy: A twelve-month fellowship for study in Belgium and Sweden.

PhySiolo&: A twelve-month fellowship for study in the United States of America.

Public Health: Two twelve-month fellowships for study in the United States of America. SEA/RC17/2 Page 163

6. MALDNE ISLANDS

Training of national health auxiliaries and provision of preventive and curative services in Male were continued. An auxiliary nurse training programme was started. One qualified national nurse, trained on a WHO fellowship, returned to Male and provided a welcome reinforcement to the health services.

Difficulties of communication have continued to dictate that the development of health services should be concentrated in Male, though occasional visits to other islands have been undertaken,mainly in connection with the treatment of leprosy and control of epidemics. The government hospital ship has rendered possible some extension of health services outside Male.

The possibility of initiating malaria control was studied.

Maldivian medical students and nurses continued training on fellawships from WHO and bilateral sources. SEA/RC17/2 Page 164

PROJECT LIST

Prolect No. Source of Funds Co- oDerating Auencies, -Title

Maldive Islands 2 Public Health Administration R (act. 1959 - 1

Aim of the Droject. To organize health services and facilities and train health personnel.

Assistance Provided by WHO durinu the year. (a) A public health officer and a public health nurse educator: (b) supplies and equipment.

Probable duration of assistance. Until the end of 1970.

Work done durina the year. The training of health assistants continued; out of the fifteen students who sat for the final examination in August 1963, fourteen were successful. A further course has been planned.

Nurse-aide training was initiated,with ten students in January 1964.

The health centre at Male was re-established and a new centre opened in Naifaru. Two health assistants were posted to Guraidu health centre. Other health assistants were occupied in home-visiting programmes in Male.

Treatment of leprosy and tuberculosis patients has been undertaen. An outbreak cf measles occurred during July-September 1963, and this interrupted the smallpox vaccination programme. The health assistants at Male have assisted in immunization with DPT, smallpox vaccination and routine treatment of leprosy md tuberculosis patients.

A preliminary study of the malaria situation was made by a WHO malaria epidemiologist in April 1964.

Health education work was intensified through radio and personal contacts.

SEA/RCI7/2 Page 165

7. MONGOLIA

The Director-General and the Regional Director visited Mongolia during July 1964.

The WHO programme of assistance has developed satisfactorily. A fuller understanding of the health needs of the country and of the possibilities of WHO co-operation was obtained in detailed discussions with the Chief Surgeon of the Ministry of Health during his visit to the Regional Office. An Assistant Director of Health Services from the Regional Office, accompanied by the Director of the Division of Communicable Diseases at WHO Headquarters, visited the country in April to study the operation of WHO-assisted projects and to discuss with the Government further patterns of programme development. Five WHO fellowships were awarded for training in various fields.

Despite the widespread development of arable farming, principally wheat-growing, and some industrialization, animal husbandry is of paramount importance in the national economy. A human population of about one million possesses twenty to thirty million sheep, goats, cattle, horses and camels. Poultry and rabbits are increasingly reared as valuable animal crops. This large animal husbandry is responsible for the importance of the zoonoses as a public health problem, and the -THO epidemiological team is assigned to assist in the study and control of these diseases.

Tuberculosis is a serious health problem. A WHO short-term consultant visited the country, and further assistance in strengthening control and immunization programmes is planned. SEA/RC17/2 Page 166

PROJECT LIST

Project No. Source of Funds Co- operatinq ngencies -Title

Mongolia 1 StrenRtheninn of Health Services (Epidemiolo~y~ R (July 1963 - 1

Aim of the P~oject. To undertake epidemiological surveys of the prevailing communicable diseases in order to plan practical control measures; to advise all branches of the medical and health services on the use or epidemiological methods.

Assistance Provided by WHO during the year. (a) ~n epidemiologist, a bacteriologist and a veterinary Public health officer; (b) two fellowshtps - one of twelve months and one if six months - for study in Czechoslovakia; (c) supplies and equipment. including two vehicles and a fully equipped mobile laboratory van.

Probable duration of assistance. .Until the end of 1967.

Work done durinu the Year. Pomembers of the WHO epidemiological team arrived in Mongolia in August 1963,and the thlrd member joined them in October. A full complement of national counterparts has been appointed.

After a period of preparatory and organizational work on basic training in the methodology of field epidemiology and in establish8 contact with Principal instituticns and laboratories, the team,early in 1964,started field epidemiologlcal investigations of brucellosis in man and domestic mimals - cattle, sheep, goats, horses and camels. Studies of the nature and extent of brucellosis will be continued in areas of different geographical and ecological conditions.in the central, northern, eastern and southern aimaks (provinces). In addition, the team started collecting data for planning brucella-vaccine field trials in man and animals,to be started early in 1965.

In collaboratlon with a WHO reference laboratory, the team started immunological surveys of diseases other than brucellosis, principallypolio- mYelitls, influenza viruses, the arboviruses and rickettsioses.

Mmgolia 2 Public Health Laboratory Services TA (my 1964 - )

Aim of the DrOject. To develop health laboratory services and train personnel in health laboratory procedures and practices.

Assistance Drovided during the year. (a) A short-term consultant; (b) a nine- month fellowship for study in Japan and a twelve-month fellowship for study in Bulgaria, Romania and Yugoslavia. SEn/RC17/2 Page 167

Probable duration of assistance. Until the end of 1967.

Work done during the year. A consultant was assigned for about three months in Kay 1964,to assess the existing laboratory facilities (micrcb1ological.and prophy?actic and diaprostic products) and advise on upgrading.

Equipment was supplied to the Central Hygiene and Epidemiological Station. Ulan Bator, for bacteriological and serological work connected with the work of the epidemiological team (Mongolia 1).

Mongolia 2 Tuberculosis Control TA (Dec. 1963 - Jan. 1964; - )

Aim of the ~roject. To study the epidemiology of tuberculosis for further development of a control programme.

Assistance provided by WHO durinu the year. (a) A consultant for two months; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1966.

Work done during the year. A consultant was assimed from 7 December 1963 to 23 January 1964,to essist in a study of the tuberculosis problem in the country and to recommend measures for tuberculosis control. In line with his recommendations, it is planned to provide a medical afficer, a public healthhca nurse and a statistician to assist in further development of a control programme.

Cardiac Surgerp A six-math fellowship for study in India.

Demtology and Venereologx: A six-month fellowship for study in Poland and Czechoslov&ia.

SEA/RC1?/2 Page 169

8. NEPAL

The budget for health services was maintained at about 6% of an increased total national budget.

A most important development was a decision to introduce free and compulsory primary education throughout the country within a period of ten years. A National Guidance Council, designed to promote social harmony and to forward community effort in development, was established. A plan for the reorganization of the Directorate of Health Services, including the creation of an increased number of divisions, was being formed.

Three bills of health designed to imprwe the control of communicable diseases and to create a Medical Council were enacted early in 1964. Development of a comprehensive health service based on the administrative division of the country into zones and districts was under planning.

WHO assigned a short-term consultant to advise on the preliminary requisites for the establishment of a medical college. The training programme in the School of Nursing made good progress, though there was some difficulty In obtaining enough suitable entrants: a number of educated girls prefer to accept fellowships from bilateral sources for basic nursing education abroad.

The requirements for accreditation of professional schools of nursing were apprwed by the Nepal Nursing Council.

The first-year course at the Auxiliary Health Workers' Training School was completed in January. It has now been decided to restrict training in the second-year course to the category of clinical assistants.

With the renovation of the medical block, the Bir Hospital has reached a capacity of 230 beds. Work started on the construction of a new surgical block. After its completion, it is intended that the existing surgical block should be adapted as a nurses' training school and hostel. Construction of three new zonal hospitals, each with 25 beds, was started.

Based on the Maternity Hospital at Kathmandu, a maternal and child health service, including domiciliary midwifery and home visiting, has been started.

Plans were in train for the construction of a new health laboratory in the compound of tbc Bir Hospital. SEA/RCl7/2 Page 170

Malaria remains a major health problem. Surveillance is complicated by the formidable problems of communication,which confront all rural health services in Nepal.

The magnitude of the tuberculosis problem has not been assessed, but it is certainly great. Plans have been made for a joint control programme for tuberculosis, leprosy and other communicable diseases, initially in Kathmandu Valley, with subsequent extension to other areas. Outbreaks of smallpox both in Kathmandu Valley and in other parts of the country have occurred frequently.

An important development was the first meeting of the National Committee on Vital Statistics. Certification of births and deaths was introduced on an experimental basis in certain areas outside Kathmandu.

A successful, government-sponsored conference on tuberculosis was held in Kathmandu in December 1963.

The first number of the Journal of the Nepal Medical Association made a welcome appearance in January 1964. SEA/RC17/2 Page 171

PROJECT LIST Project No. Source of Funds Co-onorating ~i~zencies -Title

Malaria Eradication (Juno 1954 - )

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

Assistance provided by WHO during the Year. (a) Three malariologists, an entomologist, a sanitary engineer, three sanitarians, a laboratory technician, an administrative officer, an administrative assistant, a supplies assistant, and three sccretary-stenographers; (b) four travel fellowships - one of two months in India, Ceylon and Indonesia, and three of 26 days in India and Ceylon; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1970.

Work done durina the year. The progranrme has made substantial progress. The training of surveillance personnel was continued. In thc Central Zone, surveillance activities now cover the whole of Sector B and part of Sector A. The second cycle of DDT spraying in the areas of perennial transmission started in November 1963 and was completed in January 1964. Special attention was paid to the preparation of maps and numbering of houses. In the East Zone, geographical reconnaissance has been completed,and spraying operatians have been planned to cover the entire area south of Mahabharat Range of mountains. The headquarters for the West Zone has been established in Nepalganj,and a rapid reconnaissance of the area for collecting preliminary logistic data has been undertaken. A long-tern plan of operations for malarln eradication is under preparation.

Nursing Education TA (Nov. 1954 - )

Aim of the pro.iect. To establish a nurse training school in Nepal in order to prepare qualified nurse-midwives for the country's health services.

Assistance provided by YHO during the year. (a) A nurse educator; (b) a twelve- month fellowship for study in Indla; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1968.

York done durina the year. The project continued to progress satisfactorily. Si~ificantchanges to inprove the theoretical aspects of the program SEA/Rcl7/2 Page 172

have been made in the curriculum. This should be reflected in a better quality of nursing service. Other teaching activities and clinical experience for student nurses continued as planned.

Efforts were made to get the llurring Council organized. The WOnurse educator assisted with the preparation and completion of material for the accreditation Of schools of nursing in the country.

A post of Nursing Superintendent, with gazetted rank, has been established, and the staff of the School of Nursing were given permanent positions retroactively from 1961. Thls stabilization of nursing staff is expected to provide for more effective operation of the prooject.

Another national nurse tutor returned from her fellowship study to join the staff, making a total of four qualified tutors within the School. Another candidate proceeded on a WHO fellowship to undertake studies which will qualify her as a nurse tutor.

Training of Health Assistants, Kathmandu (June 1955 - Jan. 1962; Dec. 1962 - ]

Aim of the ~roject. To establish a school for health assistants for service in rural areas and tc plan for their effective use in the rural health services.

Assistance Drovided by WHO during the year. (a) A public health officer and a sanitarian; (b) a twelve-month fellowship for study in India; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1968.

Work done during the rear. With the decision of the Government not to train sanitarians separately. in the second year of the course, the number of categories of health auxiliaries being trained has been reduced to one. There has also been a reduction in the number of students from the original 66 to 30.

The training of health assistants was suspended from 24 November to 7 December 1963,and the students wortred with the smallpox pllotprojcct in combating a smallpox epidemic in the Thimi area. They carried out vaccinations in Thimi and in the field practice areas of Bhurunkhel and Pode Tole. The WHO sanitarian also spent much time with the smallpox project.

Considerable improvements were effected in the training given to health assistants. The course now includes lectures in elementary chemistry as an aid to understanding physiology. Field work includes working wlth families in allot.ted houses three times a week for two hours a day, training in elelnentary nursing for a week in the Bir Hospita1,and public health field practice in the areas selected for this purpose at Bhurunkhel and Pode Tole. Improvements to sanitation in these field training areas were discussed with the hairman of Kathmandu Municipality. SEA/%C~~/~ Page 173

The Government plans to reorganize health services. This wlll include consideration of the training of public health staff required. WHO, through its staff in Nepal and in the Regional Office, has assisted the Government in preliminary reviews of the problems involved.

&&g-g Maternal and Chlld Health R (Dec. 1963 - ) UNICEF

Alm of the DroJect. To develop maternal and child health services and establish referral facilities.

Assistance Drovided by WHO during the year. A maternal and child health officer.

Probable duration of assistance. Uhtil the end of 1967.

Work done during the year. Assistance to the project started in December 1963 with the arrival of the WHO maternal and child health officer. A Maternal and Child Health Section in the Directorate of Health was created,vith a national counterpart in oharge.Three maternal and child health centres and one child health centre were established in and around Kathmandu. mrther development of Shri Wshmi Devi Paropakar Maternity Hospital, Kathmandu, and the development of domiciliary midwifery services in the vicinity of the hospital were started.

SmallDox Control Pilot Project (Feb. 1962 - )

Aim of the Drodect. To initiate a smallpox control pilot pro.tect.in Kathmandu Valley in the first instance and subsequently to expand the progrk gradually, as and when the situation permits.

Assistance ~rovidedby WHO during the year. (a) A smallpox control officer; (b) supplies and equlpment.

Probable duration of assistance. Until the end of 1968.

Work done during the year. The vaccination activities of the project were intensified within the Kathmandu Valley.aiming at obtaining better response and coverage if the pwulntlon. A fcw outbreaks of smallpox which occurred in the Valley were successfully controlled, and,in addition,useful preventive work was carried out at strategic check points during the influx of pilgrims to the Valley. Freeze-dried smallpox vaccine was supplied.

Prom the start of the project (February 1962) to 9 February 1964, a total of 187 249 vaccinations (33 277 primary and 153 972 re-vaccinations) was carried out. SEA/RC17/2 Page 171(

Nepal 14 Community Water Supply R (June 196u - )

Aim of the project. To plan and co-ordinate the development of activities in the field of community water supplies.

Assistance Provided by WHO during the year. (a) A sanitary engineer; (b) supplies and equipment and a vehicle.

Probable duration of assistance. Until the end of 1967.

Work done durinu the year. The WHO sanitary engineer arrived in Nepal at the end of June 1964. mring the period covered by this report, hls activities have been those of orientation and acquiring knowledge of existing conditions.

Public Health: A ten-month fellowship for study in India.

Vital and Health Statistics: TuQ ten-week fellowships for study in India.

Laboratory Techno1o.q: A twelve-month fellowship for study in Ceylon.

NeDal 201 Fellowships R

Food Analysis: A twelve-month fellowship for study in India;

SEA/RC17/2 Page 175

9. THAILAND

The creation of the Ministry of National Development was a significant feature of government reconstruction. The Department of Technical and Economic co-operatin is an important unit of the Ministry. The Department deals with the utilization of international assistance from all sources.

The increase in the gross national income was estimated as being maintained at 5.3%, apd the natural increase of population of the order of 3%.

Free primary education was started, and a large expansion of the teachertraining programme undertaken.

Improvements in the Bangkok water supply system made available an additional 160 000 cubic metres (4 220 000 gallons) of safe water daily.

Some progress was made towards the integration of specialized communicable-disease control programmes into the general health services. The need for more doctors and nurses to work in rural areas is still acute. There also remains the need for increased training of para-medical staff for medical rehabilitation and of radiographers.

An outbreak of cholera El Tor occurred during the latter part of 1963. A mass vaccination campaign was started just before the onset of the outbreak and is believed to have limited its course. Provsd cases of malaria (P. falci- parumf infections resistant to anti-malaria drugs were cawing concern. Fortunately, treatment with quinine was still effective. WHO assisted in a study of this problem.

The incidence of haemorrhagic fever was again high in 1963, a departure from the previous epidemiological pattern,in which the incidence in alternate years has been relatively low, and the fatality rate of the disease was serious. WHO provided two consultants to assist in a study of the problem and to advise on a pilot Aedes aemti control project.

The national tuberculosis control programme was continued in the semi- rural area of Chiengmai. A mass case-finding and treatment campaign was initiated in Bangkok. A successful diphtheria immunization campaign was undertaken,

Some encouraging results were achieved in the pilot project of applied nutrition in Ubol. A decision was taken to expand the project to include 42 villages. SEA/RC17/2 Page 176

Better co-ordination of nursing administration and nursing services has been achieved by reorganization of the nursing unit in the Ministry of Public Health. Separate divisions of nursing in the Department of Health and the Department of Medical Services have been discontinued. The Chief Nurse, Division of Nursing, Ministry of Public Health, has overall respo~ibilityfor all nursing affairs.

The Government of Thailand is the host to the United Nations Special Fund project "Asian Institute for Economic Development and Planning". The ' Institute has completed its first six months of operation.

The UNICEF Executive Board held its January 1964 meeting in Bangkok. This was the first time that the UNICEF Board had met in an Asian country. PROJECT LIST

Agencies Title-

Thailand 2 Strengthening of Health Services (Yaws Control T A a-Integration)l uNIC~ (May 1950 - )

Aim of the project. To integrate communicable-disease control programmes into the the general health services and further develop and organize rural services.

Assistance provided by WHO during the year. A yaws adviser, a public health officer, a public health nurse and a laboratory technician; a consultant on venereal diseases for two months.

Probable duration of assistance. Until the end of 1966.

Work done during the year. WHO has assisted this project for a period of thirteen years. Yaws, previously a Serious public health problem, has now been reduced to an insignificant level, and yaws surveillance has now been integrated Lnto the permanent public health services of 45 provinces in which the disease had been endemic. The project also helped promote the further development of the rural health services. The objectives of this aspect of the project can be said to have been achieved. The WHO yaws adviser completed his work in December 1963. His report has been forwarded to the Government.

The WHO laboratory technician helped in the further upgrading of laboratory diagnostic facilities.

Othur assistanoe to this project has been directed towards the improvement of rural health services and the consolidation and maintenance of comunicable- disease control activities.

A NiO public health officer was assigned to the project in August 1963. He and the government liaison officer studied activities in rural health services. Visits were made by car, horse, train and bicycle. Information was provided to tk provincial health officer regarding the work of the personnel. and suggestions were made for improvement of services. Studies have laid the foundation for developing a definitive plan of action.

Assistance was glven in dealing with an outbreak of cholera.

Discussions on the development of the project were held with the national authorities. -- *Previous title: Yaws Control s~..4/Rc17/2 Page 178

Liaison was maintained with the WliO-assisted programmes in trachoma,leprosy control and upgrading of laboratory facilities.

A WHO nurse has been engaged to join in August 1964.

A WHO consultant in venereal diseases assisted in a study of the nature and extent of venereal diseases in Thailand and advised on practical control measures.

Thailand 17 Mental Health Services* R (March 1955 - Feb. 1957; Nov. 1958 - Feb. 1959; June 1963; Dec. 1963 - Feb. 1964; - )

~imor the project. To strengthen training programmes for psychiatric nurslng services and to improve mental health services.

Assistance provided by WHO during the year. A consultant in psychiatry for three months.

Probable duration of assistance. Until the end of 1968.

Work done during the year. The WHO consultant arrived in Thailand in December 1963 and completed his work in February 1964. He has recommended a staged progrwe for developing the mental health services to cover the whole country, introducing further material in psychiatry into thc undergraduate.medica1 curriculum,und-t~aking post-graduates in psychiatry. His report has been forwarded to the Government.

Thailand 21 Nursing Advisory Services TA (April 1954 - Dec. 1957; Jan. 1958 - )

Aim of the project. To establish a Division of Nursing in the Ministry of Public Health which will co-ordinate nursing activities and nursing education within the country.

Assistance provided by WHO during the year. A nurse adviser(replacfng a nurse educator),a nurse educator and a short-term consultant.

Probable duration of assistance. Until the end of 1968.

Work done during the year. A WHO nurse educator was replaced by a WHO nurse adviser in Bebruary 1964.

A Division of Nursing has been established in the Ministry of Public Health, and a chief nurse and several deputies are now in position. Co-ordination and strengthening of nursing service and nursing education programmes have been undertaken. The WHO nurse adviser participated in discussions with national authorities in this development. 'Previous title: Mental Health The second WdO nurse educator continued to assist with clinical inf.tnc- tion and supervision of students in the school of nursing at the Women's Hospital in Bangkok. There has been notable progress in that the students are now better able to correlate theory with practice. Improvement has also been noted Ln patient-nurse relationship.

A short-term consultant was provided to assist in the evaluation of field experience at the Post-basic School of Public Health Nursing to strengthen this phase of the programme.

It was planned to hold a workshop of chief nurses from provincial hospitals to discuss their problems and difficulties and to formulate recommendations for solving them. A proposal to establish a Board of Nurse Examiners was under consideration by the Government; such a board will be a valuable means of securing uniform standards of nursing education and qualification.

--Thailand 30' Leprosy Control R I.-.. 1955 - ) UNICEF

Aim of the project. To expand and intensify the leprosy control programme to cover all endemic areas of the country,and to train personnel.

Assistance provided by WHO during the year. (a) A senior consultant leprologist, two leprologists and two leprosy control officers; (b) a twelve-month fellowship forstudy in the United Ktngdom; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1967.

Work done during the year. Pollowing tht joint assessment of the leprosy control programme by the WHO Leprosy Advisory Team and the Government in 1962, a WHO consultant leprologist was assigned in 1963. The latter, in conjunction with the Director of the national leprosy control programme, assisted in the organization of further consolidation of the leprosy control campaign, particularly in the Northern and North-Eastern Provinces,!monn to have the highest prevalences. A plan of action to cover the activities of all the 18 WHO-assisted project areas over the next few years was drawn up. In addition, control activities are in operation in ccight other provinces, plus Bangkok, Thonburi and Prapradaeng . areas, under government direction and supervision. In the North Eastern Provinces, further resurveys and ~provementsin the treatment prograinme were made,by intensification of contact-tracing and other case-finding activities, by opening further sub-centres and additional selected treatment services, paying special attention to irregular patients, and by - enlisting greater participation on the part of village headmen. Several training programmes were also organized. .. . - *Projects previously reported under two separate numbers, Thailand 30.1 (Leprosy Control - North-Eastern Provinces) and Thailand 30.2 (Leprosy Control - Northern Provinces), have now been amalgamated. SE~/%c17/2 Page 180

In the Northern Provinces, special attention was paid to the supervision of Static and mobile work in the Provinces of Udon, Nongkai. Sakon Nakhon, Nakhon Panom and Lampang. The number of patients on the provincial register and on treatment at the end of March 1964 was: Udon (2362); Nongkai (320); Sakon Nakhon (1218 ); NaWlon Panom (570); Lampang (825); Chiengrai (1201); Nan (320); Roi-Et (9067); Kalasin (4036).

Thailand 42 National Tuberculosis Programme - Pilot Project TA (Oct. 1958 - May 1959; Dec. 1959 - )

Aim of the project. To establish i pllvt project in an urban and a rural area, so a6 to demonstrate the organization of case-finding and treatment servlces for tuberculosis and to provide a training field for national personnel: to establish and develop an epidemiological centre for the collection and elucidation of information on the problem of tuberculosis in the country.

Assistance provided by WHO during the year. (a) A medical officer, a statistician. n public hoaltk nurse, a laboratory tecbnici?n and an x-ray techniciul; (b) two four. month fellowships for study in India; (c) supplies and equipment,

Probable duration of assistance. Until the end of 1969.

Work done during the year. The pilot area project in hiengmai town and in twenty randomly selected villages throughout the Province of Chiengmai was completed. Routine mass operations have been started in the city,aimed at Luvcring the estimated total population of 71 526,and in the rural areas of the rovince. In Chiengmai town, 14 958 persons were examined during thc pilot proJect phase: 7.2 per cent showed shadows suggestive of tuberculosis,and 1.1 per cent had infectlous disease,either confirmed by laboratory examination or evidenced by the presence of cavities. In the selected villages of the Province, 18 058 persons were examined; the prevalence of lung pathology suggestive of tuber. culosis was found to be only 5.5 per cent, and only 0.6 per cent were found with infectious disease. Figures varied according to ease of access to the tom. Males were generally more affected than females in all age groups. The mean age of actlve disease was about 45 years in Chiengmai town, and more than 50 years in the villages. The prevalence of tuberculosis under the age of 14 year6,excluding hilar enlargement, was less than 1 per cent in all areas, compared with a prevalence of active disease in all areas as high as 10 per cent in the sixth decade of life.

Three different approaches to the organization of case-finding and treatment of the detected cases were evaluated. The most interesting approach,from a public health and practical organizational point uf view, was the "community approach" seeking persons who complained of broncho-pulmonary symptom. After an interview, these "symptomatic" patients were referred to the provincial headquarters for x-ray and laboratory examination. After completion of such examination on all symptomatic patients, the total population (97% coverage) of the 30 villages selected for this study was examined by x-rays and bacteriologically. It transpired that 50% SEA/RC~?/Z Page 181 of the total case-load and almost 505 of the patients with infectious tuberculosis were discovered by the "community approach". Females gave better response to this approach. It was found that the existing general health services were not very suitable for treatment organization. The use of village headmen as peripheral drug distributors,uith the support of mobile treatment teams visiting the villages monthly and seeing cases in their homes,gave fairly good results. he results of treatment after one year are under compilation.

In Bangkok, mass case-finding and treatment operations commenced in January 1964. Five mobile 70 nun x-ray units were used,with the aim of covering a population of about 1.7 million of the capital within a period of 4-5 years. The programme proceeded smoothly,and targets were aohieved or exceeded. About 2 000 nev patients were brought under treatment every five weeks as a result of this operation. A mass comparative study on the acceptability of isoniazid/ thiacetazone and two forms of PAS with INH has been undertaken on 2 000 cases. No evidence of major toxlclty oP thiacetazone has been f?und.

Treatment teams have not fully kept up with the pace of case-finding,owing to shortage of suitable personnel. The provision of sufficient junior medical officers, competent personnel for supervision, servicing and maintenance of the many x-ray units in operation,and laboratory technicians with adequate knowledge of the needs of public health work in rural areas poses training problems which demand solution. In an effort to meet the need, specially designed orientation courses and symptomatic in-service training have been introduced.

The statistical unit of the project has, in addition to its routine vork of planning and assessment of the project work, given much time to the construction of an epidemetrlc/econometric model of tuberculosis uhich is now under trial as to its ability to yield realistic forecasts.

In close collaboration with the Tuberculosis Control Divisi0n.a statistical/ epidemiological centre for tuberculosis is under development in Bangkok. A national statistical officer is undergoing training by participating in a special course of general and applied statistics.

Hass BCG vaccination operations have been carried out in Thailand for more than ten years. A more detailed, though preliminary, assessment was undertaken with the help of the national BCG assessment technicians. The results of :his assessment disclosed that the use of liquid vaccine had serious limitations and, moreover, that the population coverage was far below expectations and actual needs. Requisite steps were taken.to remedy these shortcomings. It is planned to carry out a further assessment in 1965, wlth the assistance of the WHO Inter- country BCO Assessment Team, on a more comprehensive and country-wide scale.

Expansion of tuberculosis control in the north-east of the country by opening a tuberculosis centre at Khon Xaen and with a mass programme on lines similar to those devised for Chiengmai was started. SEAPC17b Page 182

In May 1964, a new medical officer too& over as senior WHO officer on the departure of the previous tcm leader. The WHO public health nurse left the project in ~111964.

Thailand 43 Trachoma Control R (July - Aug. 1959; April 1961; Oct. 1961 - UNICEF April 1962; June 1962 - )

Aim of the project. To introduce a trachoma control programme and integrate it into the public health services in those areas where trachoma is known to be endemic.

Asslstance provided by WO during the year. (a) A trachomatologiat; (b] a ten- month fellowship for study in the United Kingdom; (c) supplies and equipment.

Probable duration of assistanoe. Until early 1966.

Work done durlng the year. Purther studies on the epidemiology of trachoma and attempts at integration of trachoma control activity in fifty villages around seven existing health centres were continued. Greater participation of health personnel and of villagers was establlshed. Self-treatment was encouraged, and the purchase of antibiotic olntment from village shops at a subsidized rate was made possible. 'he experiment of havlng teachers give treatment to school- children was successful.

Purther prevalence surveys were carried out in the Porthern ud Oorth- Eastern provinces.

Training and health education activities were carried out.

Thailand 57 Faculty of Tropical Medicine and Wdemic R Diseases (Aug. - Sept. 1959: June - Aw.. 1961: June 1962: June - July 1963; Jan. 1964 - 1

Aim of the project. To establish a Post-graduate School of Tropical Medicine and Endemic Diseaaes in the University of Medlcal Sciences, Bangkok.

AsslStancc provided by !rXO during the year. (a) A consultant in parasitology for three months; (b] a four-month fellOw8hip for study in India; (c) suppllPs and-cqulpnent.

Probable duration of assistance. Until the end of 1966.

Work done during the year. A WHO consultant was assigned in June 1964 for a period . of three months,to advise On research activities in parasitology and to assist in the tearhing of the subject. Be hw *ti&& Nawork.

Equipment and reference books have been supplied. S~~/aC17/2 Page 183

Thailand 58 Departments of Paediatrics R (May 1962 - July 1964) UNICEP

Aim of the project. To improve the child health services of the maternal and child health centres in Bangkok through technical guidance of the paediatricians, and to provide a teaching field in promotional and preventive aspects of child care for the undergraduate medical students of the two medical schools (Qlulalongkorn and Siriraj).

Assistance provided by W0 during the year. A professor of paediatrics.

Work done. The WHO vLsiting professor was assigned to the project from May 1962 to July 1964. The professors of paediatrics at the Siriraj and Chulalongkorn Medical schools acted as national counterparts. The curriculum in paediatrics for medical students was revised, and social paediatrics and field experience were added to the teaching. Close co-operation between the Departments of paediatrics, obstetrics and preventive and nocial Medicine was secured. Consider- able impetus was given to Fzsearch in the field of social paediatrios. The WHO Professor helped the Health Department of the Bangkok Corporation in the develop. ment of maternal and child health services assisted by UNICEF. An effective service for referring newborns to maternal and child health centres was established in four selected Obstetric Departments. The introduction of a registration system ensured the use of the most appropriately located centres and improved attendance.

The health staff of the Corporation was strengthened by the appointment of medical officers with experience in paediatrics and obstetrics.

The WHO professor lectured and also assisted in clinical sessions in the paediatric departments. In-service refresher courses were arranged for the Corporation's medical officers and nursing and midwifery staff.

At the Close of the project, a National Advisory Committee on Maternal and Child Health was created.

Evaluation. The project was successful in introducing social paediatrics into the paediatric course of studies, and stimulated the development of modern teaching methods,in close collaboration with related departments. A peripheral paediatric clinic for teaching purposes was established. Considerable success was aahieved in establishing close co-operation between medical schools and the Health Depart- ment of Bangkok Corporation.

Thailand 60 School of Pharmacy, Bangkok R (Nov. 1962 - )

Aim of the project. To train qualified pharmacists and post-graduate students to prepare them for teaching in schools of pharmacy; to carry out pharmaceutical research; to build up a cadre of qualified pharmacists to staff pharmaceutical departments. SEA/RC17/2 Page 184

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

Probable duration of assistance. Until the end of 1967.

Work done during the year. The WHO professor visited various places, from time to time, to study the situation in the field of pharmacy and to Advise on developments. He also shared instruction in various courses and advised on the development of laboratory and library facilities. The library has been improved by supplying books urgently required for reference purposes.

The WHO professor completed the first year's presentation of the courses in drug evaluation and professional c~mmunicationsand participated in the final examination for thc courses. Of the 79 students who took the course, only five were unsuccessful.

Thailand 62 Medical Education R (Sept. 1960 - June 1964)

Aim of the project. To develop the Departments of Preventive and Social Wediclne in the Faculties of the University of Medical Sciences at Chulalongkorn and Siriraj in Bangkok.

Assistance provided during the year. (a) A professor of preventive and social medicine; (b) two one-month travel fellowshipa in India and Taiwan.

Work done. At the Thai National Conference on Medical Education, held in Bang- Saen (Thailand) from 25 to 30 November 1956, it was recommended that a section of preventive and social medicine should be established in the departments of medicine of each of the medical schools in Thailand and that it should be given departmental status as soon as qualified staff becake available. It was also recommended that the teaching programme should run throughout the four years of the medical curriculum.

In order to assist with the development of this discipline, WHO assigned a visiting professor of preventive and social medicine from 1 September 1960 to 9 June 1964. By that time,the teaching programme had been developed to extend over all the four years of the medical curriculum. Urban training centres, with a "family study and advice servicet',were developed around each of the medical schools in Bangkok. Other associated activities included: a family advisory service to urban populations in the neighbourhood of the teaching hospitals; seminars on the results of the surveys madr by students on the immunization status of communities and children, and surveys carried out on (1) blood pressure levels in adults over 40 years of age, (2) tendencies towards developing hyperpiesla (essential hypertension), (3) problems resulting from personal habits related to consumption of foods containing a high percentage of saturated fats. cholesterol and the use of alcohol and tobacoo, (4) the proportion of family income used on food and the percentage of families not spending enough for adequate food, (5) the incidence of hflminthic bowel infestations and haemoglobin content of the blood, and (6) the use of the well-baby clinic by the population. sEA/kc17/2 Page 185

Two national counterparts to the visiting professor went abroad on WHO fellowships for advanced studies; the heads of the sections were awarded short- term travel fellowships for orientation visits to India and Formosa to acquaint themselves with the present trends in the teaching of preventive and social medicine. Preventive and social medicine is now fully established as a discipline: the recent decision of the Council of the University of Medical Sciences, Thailand, to establish independent departments for this subjrct in ooah of the medical sohoois is very encouraging and should result in further improvements in staff positions. Further fellowship assistance will be provided to younger members of the teaching staff tb enable them to obtain training abroad and thus to strengthen the departments.

The purpose of the project has been achieved.

Thailand 63 Nutrition R (AW. 1963 - UNICEF FA0

Aim of'the project. To strengthen the Nutrition Department of the Ministry of Public Health and to develop laboratory, clinical and field nutrition work, including an expanded nutrition programme.

Assistance provided by !4iO during the year. A medical nutritionist, assigned in October 1963; supplies and equipment.

Probable duration of assistance. Until the end of 1965.

Work done during the year. Assistance was provided in the reorgazaeim of the Nutrition Department at tho central level and in the planning and operation of school nutrition programmes. A study of the health aspects of an applied nutrition programme in the pilot area of Ubol was started. This included the organization of laboratory services for studirs on anaemia as related to parasitic infections. especially hookworm, in mothers and children. Prophylactic treatment for anaemia was introduced in maternal and child health centres.

Thailand 65 Malaria Eradication R an. 1962 - )

Aim of the project. To eradicate malaria from the entire country.

Assistance provided by WHO during the year. (a) An entomologist and a malariologist (epidemiologist); (b) four one-month travel fellowships in India and Ceylon, one four-month fellowship to attend the malaria training course in Jamaica and two three-month fellowships for study in Nigeria. (In addition, a six-week international fellowship was awarded under the scheme for Exchange of Scientific Wonlrcts.) SEA/~C~7/2 Page 186

Probable duration of assistance. Until the end af 1969.

Work done during the year. According to the detailed plan of action prepared for this programme for 1964,the spraying operations are planned to cover 18.5 million people; 2.25 million previously under spraying entered the consolidation phase. A population of 4.3 million has been placed under surveillance without spraying, as this area, as judged from available data, has only a low incidence of malaria. If,after twelve months of surveillance there is evidence of local transmission, these areas can be included in the attack phase. The 196U operations have eventually been adjusted to the available supplies. A concerted effort has been made to inprove the training of personnel. Instances of resistance of P.falciparum to chloroquine have been reported from Thailand. This is being carefully studied.

Thailand 68 Narcotic Drugs Control R (Peb. - March 1964)

Aim of the project. To establish a suitable program of ri!habilitation,5noIud~ post-discharge follow-up and placement of rehabilitated addicts; to organize an appropriate medical anti-addiction programme.

Assistance provided by WHO during the year. A consultant for five weeks.

Work done. The WHO consultant visited various hospitals and institutions where treatment and ruhabilitation of dru~addicts arL being undcrtakcn. Hts report 1s under study.

Thailand 69 Urban Public Health Administration R (Oct. - Dec. 1963)

Aim of the project. To assist the Bangkok lhlnicipal Corporation in assessing the health needs of the city and to recommend a plan of phased development of comprehensive and integrated basic health services for the city.

Assistance provided by WO during the year. A consultant in public health administration for three months.

Work done. A WHO consultant was assigned from October to December 1963. He made a study of health administration and services in the twin cities of Bangkok and Thonburi,to assess general coverage and standards in terms of current legislation, funds and staff.

Based upon his findings and taking into account the prevailing economic and social conditions, means were suggested by wflich short-term and long-range measures 3 might be applied to bring the standards of public health administration and services in the metropolis up to a level consistent with its growing international importance. Particular attention was paid to the delegation of more definite SEA/%C~~/Z Page 187

and effectual legal and financial powers to the municipal corporation, ,careful selection and appointment of qualified technical staff, reorganization of existing health services and progressive planning for expansion as opportunity offers.

Thailand 70 Vector-Borne Disease Control (Haemorrhagic Fever1 R (June 1963 - )

Aim of the project. To study the epidemiological factors responsible for persistence of haemorrhagic fever, principally the bionomics of the responsible vectors, in order to take effective control measures.

Assistance provided by WHO during the year. A consultant for two weeks.

Probable duration of assistance. Until the end of 1967.

Work done during the Year. Haemorrhagic fever contlnucs to present a public health problem in Bangkok and other urban areas. A Mi0 consultant made a study of the epidemiological situation and advised on the setting up of a pilot scheme for the control of Aedes aegypti, which is incriminated as the vector, in a selected district of Bangkok. The Government subsequently, in April 1964, started a pilot control project in the village of Hwai Kwang, on the outskirts of Dlndaeng, a suburb of Bangkok.

This project is conncctcd with thc inter-country project SEAR0 99 (Haemorrhagic Fever Control ).

Thailand 200 Fellowships R

Filariasis Control: An eight-week fellowship for study in India.

Sanitary Engineerink: A travel fellowship for twenty days in France, Oennany and Israel.

Venereal-Disease Control: A travel fellowship for fifteen days in Europe.

Thailand 201 Fellowships TA

Radiation and IsOtopeS: A twelve-month fellowship for study in the United Kingdom.

Anaesthesiology: Two twelve-month fellowships for study in Denmark (awarded under EURO 52). Nutrition: A ten-week fellowship for study in India.

Human Genetics: A three-month fellowship for study in Denmark (awarded under Inter-regional 137.2)

Physical Therapy: A twelve-month fellowship for undergoing the Physical Therapy Teachers' Tralnlng Coursc in the Unitcd Kingdon (awarded under Intcrsegional 1811. SEA~CI7/2 Page 189

10. INTER-COUNTRY

PROJECT LIST

Project No. Source of Rmds CO- operating Agencies -ntle

BCO Assessment Team

Bca Assessment Team. Indonesia (my 1963 - ) TJNI CEF

Aim of the ~roject. To strengthen BCO vaccination programmes and to introduce freeze-dried BCO vaccine.

Assistance Provided by WHO during the Year. (a) A medical officer, a statistician and a BCG nurse; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1965.

Work done during the year. The team succeeded in introducing the use of freeze- dried vaccine in all BCO teams in Java and Madura by the end of January 1964. Technicians were advised on vaccination techniques and the use of non-leaking syringes,which permit more accurate dosages. Field visits were made to vaccination teams. to assist them in planning the work,vith the object of increasing the output to a mor& satisfactory level. It was suggested that the teams could increase their performance by forming small sub-teams consisting-of two technicians, thus obtaining a wider population coverage.

Reorganization on these lines was also stressed at a meeting in Surabaja convened by the Inspector of Health for East Java, in February 1964. Tuberculosis and chest specialists and medical officers resp&sible for the BCO programme in seven Regencies have agreed to these recommendations. It has also been agreed that vaccination programmes should concentrate on the school-going population, since approach to organized population groups would certainly increase the output of the programme.

Administrative difficulties have hindered the uorlt of some BCO teams, particularly in East Java. Efforts are being made to reactivate operations; UIgICEP has been asked to replace >bsolcte vehicles.

Ihe WHO nurse helped to train the two national nurses destined to work with the planned permanent national BCG assessment team. The WHO team cmtinued an epidemiological study by carrying out tuberculin testing in sample groups in accordance with the protocol devised for BCO assessment work. SEA/~c17/2 Page 190

The team is expected to complete its assistance to the assessment in Indonesia at the end of 1964. s&g-J Regional Assessment Team on Malaria Eradication R (May 1959 - Dec. 1961; Nov. 1963 - )

Aim of the project. To make an independent appraisal of the status of malaria eradication or of any special aspects of thc programme in countries of the Region.

Assistance provided by WHO during the year. (a) A malariologist, an entomologist and a laboratory technician; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1968.

Work done during the year, me team carried out an assessment of the Ceylon programme in November-December 1969 and of the Afghanistan programme in April- June 1964. The laboratory technician of the team assisted the Regional Centre for External Cross -Checking of Blood Films during periods when 'there was no assessment work.

SEAR0 30 Smallpox Eradication TA (0ct. 1962 - )

Aim of the project. To assist the countries of the Reglon in carrying out the contro1,and ultimately the eradication. of smallpox.

Assistace provided by WHO during the sear. (a) A medical officer working in Afghanistan; (b) supplies and equipment and two vehicles.

Probable duration of assistance. Until the end of 1967.

Work done during the year. The medical officer assisted in the planning and implementation of the smallpox control pilot project in Afghanistan. Later in the year, he was transferred to New Delhi to assist in plannlngiand carrying cut other campai&ns in the Region.

From July 1964 the Afghanistan project will continue as a separate Project, with the assistance of another medical officer (see Afghanistan 54).

SEAR0 38 Production of Freeze-dried Smalluox Vaccine R (Jan. 1958; 0ct.-Nov. 1958; Feb. 1961; Nov.-Dec. 1961; UNICEF Nov.-Dec. 1962; Feb.-March 1964; - )

Aim of the proJect. To assist the countries of the Region with the production Of freeze-dried smallpox vaccine. SEA/RCl7/2 Page 191

Assistance ~rovidedby WO during the Year. (a) A consultant for five weeks; (b) four six-week fellowships to candidates fmm hdia for study in the united Kingdom.

Probable duration of assistance. Until the end of 1966.

Work done during the Year. The first batches of freeze-dried smallpox vaccine produced in India at the State Vaccine Institute, Patwadangar, and King Institute. Ouindy, and those produced at the Bio Parma Institute, Bandung, Indonesia, met intematlonal requirements. Production in Thailand is proceeding satisfactorily.

A WHO consultant took up his assipment in Bebruary and visited Bum, mdia and Indonesia.

As for India, he recomended that two additional institutes, at Hyderabad and Belgaum, be assisted in orner to raise the number of production centres to four. He advised on new productlon techniques, with shelf-drying machines and automatic ampoule-filling and sealing, which will make it possible to increase production targets up to a total of 100 to 120 million doses a year. UNICEF vill assist with the equipment required.

The consultant visited the Bio Fama Institute in Indonesia and advised on an additional freeze-drying plant which will make it possible to increase the potential output to 25 or 30 million doses annually.

The consultant recomended that the Burma Pharmaceutical Institute, Rangoon. was suitable for the production of freeze-dried smallpox vaccine, provided that some of the staff could be trained in current methods of production and special equipment obtained. A potential output of seven million doses a year is envisaged. WHO and UNICEF will assist.

WHO has agreed to arrange for the testing of the first few batches of vaccine produced in the above-mentioned WHO-assisted vaccine production centres in the Region at no cost to the governments concerned.

SEAR0 42 Radiation Protection R (Dec. 1959 - March 1960; Feb. - Nov. 1963; - )

Aim of the eroject. To advise the ,-ovemments of the Region on radiation protection in all its aspects.

Assistance Drovided by WHO during the year. A consultant.

Probable duration of assistance. Mtil the end of 1966.

Work done durinK the year. During the year under review, the WHO consultant paid visits to the States of Uttar Pradesh. Andhra Pradesh, Madras (Vellore only). Mysore and Kerala. He completed his assieplment in November. His reports emphasize SEA/RC17/2 Page 192

the importance of the national health authority's acoepting responsibility for safe- guarding the public against the harmful effects of ionizing radiation, the staffing of major radiological institutions with radiological physicists and the need for improved medical undergraduate teaching in radiation.

Earlier, the consultant had visited the Departments of Radiology at various hospitals and tuberculosis centres in Ceylon, the Cancer Institute at Etaharagama, the University of Ceylon, the School of Radiography in Colombo and the Electro- medical Division of the Ccylon Department of Health, t3 discuss radiation prc%e&lOn, radiotherapy and the introduction of further materlal on radiation protection into the undergraduate medical curriculum.

The reports of the consultant have been sent to the governments concerned.

SEAR0 50 Reoruanization of Rural Health Records and Reports R an. 1961 - 1

Aim of the project. To organize a system of rural health service records and reports at selected centres and to train Personnel in the collection, Processing and presentation of vital and health statistics at the rural health centre level.

Assistance provided by WHO during the year. (a) A statistician; (b) supplies and equipment. (A vehicle was made available from project India 99.4).

Probable duration of assistance. Until the end of 1967.

Work done during the year. The project continued to be located in rlujarat (India). It took special interest in reorganizing the maternal and child health records and reports in rural health centres.

An ante-natal record and two delivery records (domiciliary and institutional) were drafted. Work related to maternal and child health was defined.

Tabulation of out-patient morbidity (1962) in one district in Oujarat State was completed.

Advice was given to a study on default in submtssion of birth and death returns in rural areas in the State.

SEAR0 61 Hosuital Records train in^ Course R (9 June 1964 - )

Aim of the project. To assist in the training of Personnel of different grades to work in hospital records and statistics departments.

Assistance Provided by WHO during the Year. (a) Six nine-month fellowships to enable candidates from Afghanistan, Burma, Indonesia, Nepal and Thailand to attend the course; (b) supplies and equipment. SEA/RC17/2 Page 193

Probable duration of assistance. Until the end of 1966.

Work done durina the year. The training course for medical records officers started in Bangkok on 9 June 1964. There were ten participants (2 from Afghanistan, 1 each from Burma. Indonesia and Nepal and 5 from Thailand). Rmong Thai candidates only the one who came from Chiengmai was awarded a WHO fellowship; the other f,>ur were residents of Bangkok.

The course is planned for nine months and includes lectures, laboratory exercises and supervised practical work on medical records science, as well as medical terminology, hospital statistics and basic medical sciences such as microbiology, anatomy, physiology and parasitology.

The course is conducted by the staff of the Hospital Statistics Project (SEARO 7Z),asslsted by guest lecturers from Siriraj College of Medicine.

SEAR0 72 HUs~italStatistics TA (Jan. 1963 - )

Aim of the project. To help governments of the Region to organize an efficient system for the maintenance and flow of records in selected hospitals; to collect, process and present hospital statistics data efficiently on a national scale; to train medical records and hospital statistics personnel.

Assistance provided by WHO durina the year. (a) A statistician, two medical records Officers and a typist; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1968.

Work done durine: the year. A second WHO medical reccrds officer was assigned to this project from May 1964.

Prom January 1964, the hospital statisttcs systemdcveloped by the project was extended to all the 88 general hospitals under the Department of Medical Services, cmtainlng about 11 400 beds. In addition, it also covered the Siriraj Hospital, Police Hospital, Bangkok Christian Hospital and Chulalongkorn Hospital.

Annual reports were completed for the year 1963 far the Women's and Children's Hospital, the Siriraj Hospital and the 33 ,-enera1 hospitals which had completed one full year of reporting at the end of 1963.

A special study was undertaken on the length of stay in general hospitals as a function of sex, age and status at discharge.

The project staff prepared the cui-riculum and conducted the trzining course for medical reccrds officers (SEARO 61) (see above). SEA/RC17/2 Page 194

SEAR0 75 Medical Education Study Tour (Deans and Princi~als TA of Medical Colle~esl (26 Jan. - 23 Feb. 1964)

Aim of the project. To enable a group of deans and principals from medical institutions in various countries of the Region to study the organization and administration of medical education.

Assistance Drovided by WHO durinc: the year. (a) A consultant for six weeks; (b) travel costs and subsistence allowances for all participants.

Work done. The tour was held from 26 January to 23 February 1964.. Participants included one from Afghanistan, three from India, twu from Indonesia and two from Thailand. The group visited Delhi, Madras, Vellore and BangJcok; in al1,nlne medical colleges were visited.

The team also participated in the Annual Conference of the Indian Associa- tion for the Advancement of Medical Education, held in Madras in February 1964.

A visit was paid to the Instruments and Ct.errlcn1 Company, Ambalo, to study the manufacturing of physiological instruments. The group also discussed the possibilities of training technicians for instrument repair shops of medical colleges.

SEARO 76 Studies on Filariasis R (NOV. 1962 - )

Aim of the Droject. To carry out further research on filariasis in order to evolve more effective methods of control.

Assistance Drovided by WHO durina the year. A consultant epidemiologist and a Statistical assistant (for three months),provided under the Regional Office budget as SupBlementary to the project which is being conducted by WHO Headquarters and funded from the Special Account for Medical Research.

Probable duration of assistance. Until the end of 1967.

Work done during the year. As stated in last year's annual report, the Regional Office is closely associated with this project,established in Rangoon in November 1962 as part of the wo global research programe.

During the year under review the epidemiologist studied available data On the epidemiology of fllariasis in.the Rangoon area and suggested a protocol for further studies.

The Headquarters' team,consisting of an epidemiologist, an entomologist. a parasitolcgist and other consultants, continued its studies cn mosquitc vectors of filariasis, particularly on their ecology, biunomlcs, genetics, vectorial capacity, insecticide susceptibility and cross-resistance to different compounds. SEAR0 94 External Cross-Checking of Blood Films R (June 1963 - )

Aim of the project. To provide facilities for external cross-checking of blood films from malaria eradication programmes in the South-East Asia Region.

Assistance provided by WHO during the year. (a) A laboratory technician; (b) a grant to the Government of India to meet the cost of employment of national staff and contingencies.

Probable duration of assistance. Until the end of 1966.

Work done during the year. This centre, established in Kasauli in June 1969,- received blood films from Afghanistan, Burma, Ceylon and Indonesia for checking. Altogether, 20 791 slides were examined in the centre up to the end of April 1964. The majority of the slides received were from Ceylon.

SEAR0 95 Maternal and Child Health Assessment Team R [Dec. 1963 - March 1964; - )

Aim of the oroject. To study the administration and organization of maternal and child health services in countries of the Region with a view to advising on further international assistance.

Assistance ~rovidedby WHO during the year. A maternal and child health consultant for three months and a public health nurse for six weeks.

Probable duration of assistance. Until 1966.

Work done during the year. The maternal and child health consultant was assigned to Thailand from December 1963 to March 1964. The public health nurse joined him in February. Two senior officers in the Department uf Health were assigned to co-operate uith the maternal and child health consultant. :he WHO nurs~worked closely with the Chief Nurse in tht Nursing Divlsi~,nof the Ministry of Hcalth.

The study included visits to 82 rural centres. A systematic approach to the collection of relevant material was obtained by the use of questionnaires. Special attention was paid to standard health promotion aspects of services, work-load, range of actlvlties, administration and supervision, record keeping, supporting services,and training and preparation of health personnel in maternal and child health at all levels. The findings of the project confirmed the soundness of current international assistance, lent support to the policy of the Department of Health in expanding health centres in rural areas of Thailand with special reference to maternal and child health, and emphasised that there should be a commensurate increase in training facilities for workers in all fields of Services concerned uith rural health. sEA/Rc~~/z Page 196

Similar assessments will be made in Indonesia in 1964 and in other countries of the Region In 1966.

SEAR0 97 Nutrition Training R (Dec. 1963 - 1

Aim of the ~roject. To assist in training in applied nutrition and,by means of a grant, to support the Nutrition Research Laboratories, Hyderabad (India), in carrying out the programme.

Assistance provided by WHO durinp: the year. A grant-in-aid to the Nutritlon Research Laboratories, Hyderabad. and four three-month fellowships for candidates from Afghanistan, Eurma, Ceylon and Indonesia to attend the training course on nutrition.

Probable duration of assistance. Until the end of 1966.

Work done during the year. The first three-month course in nutrition for medical graduates and State Nutrltion officers was held at the Nutritlon Research Laboratories, Hyderabad, between December 1963 and February 1964. It was attended by sixteen candidates - twelve from India and four from 0ther.countrles of the Region. The course conslsted of (a) lectures and seminars. (b) practical field work and visits to applied nutrition projects and clinical work In hospitals and (c 1 library work.

Preparations are being made for conducting the second course in 1964/1965 for teachers of preventive and social medicine, teachers of paediatrics, public health officers and maternal and child health officers oharaad with amnistratlye responsibility for or supervision of nutrition programmes. Assistance was given in the preparation of a suitable programme for the course, including a revised syllabus, with greater emphasis on the epidemiological, health education, teaching and administrative aspects.

SEAR0 29 liaemorrhaaic -Fever Control R (Jan. 1964 - 1

Aim of the project. To stress the urgency for global epidemiological surveillance of haemorrhagic fever and for studies on effective methods of control at national and International levels.

Assistance provided by WO during the year. A consultant for two weeks.

Probable duration of assistance. Until the end of 1966.

Work done durina the Year, me consultant reported on the present epidemiological situation of haemorrhaglc fever and dengue-like disease in Thailand, Burma (Rangoon area) and India (Calcutta area). In Thailmd, the disease has been present in n mzjor epidemic form since 1958, and it has now spread to other urban areas. (See project Thailand 70).

In Burma, the epidemic of a dengue-like disease, which occurred in the Rangoon area from July to September 1963, was either classical dengue or chikungunya, more probably the latter.

In India, haemorrhagic fever appeared for the first time in epidemic form in the Calcutta area,in the second half of 1963. The consultant submitted recommendations for a closer epidemiological surveillance and for stricter

Aedes aemti control measures in the Region and also internationally. '

Asian Institute of Economic DeveloDment and Planning (Jan. 1964 - I UNSF E CAFE UNICEF

Aim of the DroJect. To train personnel of Member and Associate tiember countries of the ECAPE region in planning and economic development; to undertake research and advisory services.

Assistance Provided by WHO durlng the year. A public health administrator (consultant).

Probablb duration of assistance. Until the end Of 1969.

Work done during the year. The 1nstitute.under the aegis of ECAPE as Executing Agency for UNSP,was inaugurated in January 1964. It is accommodated in the building which formerly housed the Faculty of Commerce and Accountancy of the University of ChulalongJcorn and is within the University campus. In addition to the Mrector, nine international staff were in position. Three additional staff members were subsequently posted and three short-term members were appointed. Thirty fellows (2 from Afghanistan, 1 from Ceylon, 4 from India, 3 from Indonesia, 2 from Nepal, J from Thailand, 2 from China (Taiwan). 1 from Iran, 1 from Laos, 2 from Malaysia, 3 from Pakistan, 2 from the Philippines, 3 from Korea, 1 from Viet-Nan) started studies from early February. The course was designed to provide an initial refresherorientation period of four weeks, followed by a period af five months covering "planning for econamlc growth and social planning and development", and a final three months devoted to elective subjects.

Teaching by means of seminars was largely adopted. Health topics, including health in social and economic development planning, the role of health promotion in a developing economy, planningstrategy for the health sector, health considerations in agricultural and industrial development,and health desips for the development of rural and urban areas, covered some twenty-flve per cent of the time allocated for the seminar. SE~/Ac17/2 Page 198

Under the chairmanship of the Director of the Institute, weekly staff meetings were held to discuss policy 2nQ admWstrative m?tta and technical problhs. iSpecial Course on Advanced Malaria Eaidemiolo . New Delhi

.".im of the-vrodect. (1) To provide training in advanced malaria epidemiology to senior national medical officers responsible for the planning and execution of epidemiologlcal evaluation of the malaria eradication programmes in their countries; (2) to provide basic cxperience tc-enzble the participants to conduct simllar courses in their' respectiv.? countries.

Assistance urovided by WHO during the vear. (a) Payment of travel costs and subsi~tenceallowance to participants and allowance to temporary advisers of the faculty; (b) books and reading material for the participants.

Work done. This Course was conducted with the collaboration of the National Institute of Communicable Diseases, Delhi,and the National Malaria Eradication Progrme, India.

Nine participants (from Ceylon, India, Nepal, Thailand, Pakistan and Iran) attended the course. The course consisted of lectures and group discussions for nine days,followed by field visits with instructors for ten days. The subjects covered included basic epidemiology, specific malaria epidemiology, use of statistical methodology, epidemiological requirements of the maintenance phase in an integrated health service, training of staff in epidemiology, health education, etc.

The course, besides providing instructions on the academic aspects of the epidemiology of malaria, also served to focus attention on the epidemiological problems of the countries from which the participants were drawn. All the parti- oipants took an active part in the discussions. The field visits were planned 4. in such a way that the success of sound epidemiological organization as well as the failures of defective epidemiological planning could be shown. The partic1patIts expressed their desire to hold similar courses in their respective countries.

Similar courses will be conducted in 1965 and 1966. 11. INTER-REOIONAL

PROJECT LIST Project No. Source of Funds Co- operating Agencies

Inter-reaonal 1% International Training Course on Laboratory and Field R Methods in Hwnan Population Genetics, Bombap (18 Nov. - 14 Dec. 1963)

Alm of the project. To make available current developments and methods in the field of human genetics to workers who are in a position to use them in teaching, in routine health work and in research.

Assistance provided by WHO during the year. A faculty consisting of four full-time instructors and four specially selected lecturers.

Work done. With the co-operation of the Government of India, a WHO-sponsored international training course on laboratory and field methods in human population genetics was held in Bombay from 18 November to 14 December 1963. There were 17 participants - 6 from India, 4 from Indonesia, 2 from Thailand. 1 each from Iran and Pakistan, and 3 nominated by the Councll for International Organizations of Medical Sciences (CIOELS) (2 from India and 1 from Pakistan). The course consisted of theoretical and practical instruction and also field studies.

Inter-replonal 190 Leprosy/BCG Trial. Burma MR (April 1964 - )

Aim of the project. To carry out a trial of BCG vaccination in the prevention of leprosy.

Assistance Provided by WHO during the year. A team consisting of a medical Officer (leprologist) and a laboratory technician.

Probable duration of assistance. Until the end of 1969.

Work done during the year. A WHO team consisting of a leprologist and a laboratory technician was assigned to mrma in April 1964 to start a long-term study 41 the epidemiology of leprosy and,in particu1ar.a trial of BCQ vaccination in the prevention of leprosy. A protocol Tor these studies and a plan of operations were Prepared and agreed to by the aovemment of Burma.

Inter-reaonal 218 Meetinn of Investinators on the Evidemiolom and Pathology of Oropharyngeal Turnours. New DelN (8-15 oct. 1963)

-. -. To disouss the pathological and epidemiological aspects of oropharyngeal tumours. SUhm7/2 Page 200

Assistance provided by WHO during the year. Assistance by two staff members from UHO Headquarters and a consultant.

Wo* done. The above meeting took place in the WHO building in New Delhi from 8 to 15 October 1963. It was attended by 6 participants and 3 observers from India, 1 each from Ceylon, the Unlon of South Africa and the USSR, and 1 representative of the International Uhion against Cancer. In addition to the two staff members from WHO Headquarters and a consultant, the UHO visiting professor of dentistry assigned to a project in India and a UHO medical officer engaged in an epidemiological study on oropharyngeal tumours in India took part in the meeting.

Reoommendations were made as to the design of a study to be. carried out to investigate these cancers, in view of their relatively high frequency in several countries of the Region and a possible relationship to smoking and chevtng habits. ANNEXES 3EA/RCl7/2 ORQIWIZATIONAL CHART Annex 1 1 Auyst 1964

OFFICE OF THE REGIONAL DIRECTOR PUBLIC INFORMATION REGI9NAL COMMITTEE Regional Director Public Inf ormatian Offficer I Dr C. Mani Mr J.G. MIlwertz I I Information Officer MALARIA ERADICATION UNIT Regional Adviser Dr H. Richards I Dr G. Sambasivan ASSISTANT DIRECTORS, HEALTH SERVICES Malariologists OFFICE OF ADMINISTRATION AND FINANCE Dr J.J. Alcccer - Dr D.R. Mehta - Chief, Office of Admin. and Ffna?ce Dr J.B. Petrle Dr V. Parisi Mr B.J. Edwards Dr A. Zahra Dr F.R.S. Kellrtt Admin. and Finance Officer - Mr T. V~R I - I Entomologist REGIONAL ADVISERS Tuber~culosis - Dr K.L. Hltze Communicable Diseases - Dr J.A. M~ntoya Sanitary Engineer (Malarla) Personnel Officer Communicable Diseases - (Vacant) Community Health Services - Dr D.H.S. Griffith Community Health Serviccs aff icur - Dr Rajasingham P. FZLLOVSHIPS 'UNIT Public Health Officer Dr M. Doraisingham - Budget and Finance Officer Health Laborat-ry Services Dr R. Modica - I I (Vacant ) Health Statistics Dr H.F. Helweg-Larsen - Finance Officer - Mr J.E. Morgan Health Statistician (Vacant) - Reports Officer Nursing - Mrs L.H. Hclslnger Nursing - Mlss D.C. Hall Health Education - Mrs A.R. Ncore Maternal and Child Health - Dr A.M. Gade Nutrition - Dr G.J. Stott WHO REPRESENTATIVES Environmental Health - Mr L.R. Mantilla Afghanistan - (Vacant) Sanitary Engineering - Dr V.M. Witt - Dr Lopez de Nava Hedical Education - Dr Sutarman Ceylon - Dr F. Loven India - Dr E.A. Gillis Indonesia - Dr H. mller Nepal - Dr A. Malaterre iThailand - (Vacant) SEA/RC~7/2 Annex 2 Qeographical Distribution of International Staff Assigned to the Soutn-East Asia RercLon.as of 30 June 1964 - Regional Field Country Advisers Total Office Staff wgnanistan - - 2 2 Argentina - - 2 2 Australia 2 - 2 4 Belgium - - 2 2 Bolivia - - 1 1 Brazil - 1 1 2 British Honduras - - 1 1 6ulgaria - - 1 1 Canada 1 1 3 5 ceylon - 1 2 3 columbia - 1 - 1 Cuba - - 1 1 Czechoslovakia - - 3 3 Denmark 2 2 7 11 Ecuador - 1 - 1 France 2 - 1 3 W-Y - 1 7 8 Qreece - - 1 1 Indla 3 2 10 15 Indonesia - 1 - 1 Ireland - - 5 5 Israel - 1 1 Italy - 2 1 3 Japan - - 2 2 Korea - - 1 1 Lebanon - - 1 1 Malaysia - 1 - 1 nexico 1 1 - 2 Nepal - - 1 1 Netherlands 1 - 5 6 New Zealand - - 2 2 Norway 1 - 2 J Pakistan - - 1 1 Peru - 1 - 1 Philippines - - 3 3 Poland - - 1 1 spain - - 1 1 Sweden 1 - 1 2 Union of Soviet Socialist Republl cs - - 4 4 Unlted Arab Republic - - 4 4 united ~hgdorn 2 5 46 53 United States of America 2 2 20 24 Yugoslavia - - 6 6

Total 18 23 155 196 a SEA/R c17/2 Annex 3

Canf~rencesand Meetings in the South-East Asia Region Called by the United Nations and Specialized Agencies at Which WO Was Representud

(1 August 1963 - 1 August 1964)

21-51 August ECAFE: Workshop cn Development of Local Leadership Bangkok in Community Develupment (in co-operation with the Bureau of Technical Assistance Op*ratfons)

27 August to FAO: Technical Meeting on Food Consumption Surveys Colombo 4 September

21 October to ECAFE(and Eastern Rcgional Organization for Public New Delhi 6 November Admin1stration):Seminar on Central Services to Lucal Authorities

25-30 November United Nations and ECAFE: Second "Editors' Round Bangkok Table Conference"

5-7 December UNESCO, Research Centre on Social and Economic New Delhj Development in Southern Asla: Third Meeting of the Steering Committee

10-20 December ECAFE: Asian Population Conference New Delhl -1964 13-24 January UNICEF: Session of the Executive Board Bangkok

10-15 February UNESCO, National Commission far UNESCO in Asia: Bangkok Fourth Reeional Conference

5-6 May ECAFE: Sixth Regional Inter-agency Meeting on Bangkok Rural and Community Development in Asia

12-25 May United Nations: Seminar on Human Rights in Kabul Developing Countries SEA/Rc17/2 Annex 4

Conferences and Meetings of Governmental, Non-Oovenunental and Other Organizations Held in the South-East Asia Region at Which WHO Was Represented*

(1 August 1963 - 1 ~ugust1964)

11 August Baroda Medical College: Symposium on the Objectives Baroda of Medical Education

16 nugust New Delhi Voluntary Blood Transfusion Association: New Delhi Inaugural Meeting

20-21 August Government of India: Meetlng of the Central Advisory New Delhi Committee on Venereal ise eases

22 August Government of Madras: Meet.ing of the Advisory Board Madras on the Pilot Health Project, Gandhigram

28 August Government of India, Ministry of Health: Meeting to New Delhi Review the Government's Requests to the UNICEF Executive Board

30 August Indian Council of Medical Research: Meeting on New Delhi Cholera Vaccine Studies in Calcutta

30-31 August Government of India: Meeting of the Central Advisory New Delhi Committee on Leprosy

31 August Indian Public Health Association. Delhi Branch, and New Delhi Indian Association of Alumni of Schools of Social Work, Delhi Chapter: Seminar on the Concept and Practice of Medico-social Work

16 September Government of India, Minlstry of Community Develop- New Delhi ment: All-India Applied Nutrition Seminar

22-26 September Government of India, Planning Commission: Seminar on New Delhi Social Welfare In a Developing Economy

25 September Government of India, Ministry of Health: Meeting of New Delhi the Central Advisory Committee on Leprosy

25 September All-India Institute of Medical Sciences: Seventh New Delhi Annual Observance of the "~nstitute~ay"

*This list does not include meetings of project conunittees in connection with projects to which WHO is providing staff. and which mybe regarded as normal work in connection with the projects. or meetings sponsored by WHO. SEAfRc17/2 hex4 Page 2

30 September Government of India, Directorate General of Health New Delhi Services: Meeting on Primary Health Centres

5 October Government of India: Inter-State Meeting on Plague Bangalore

16 October CARE: Meeting of CARE Representatives in Far Eastern New Delhi Countries

17-23 October Government of India: All-India Orientation Training Seminar on Applied Nutrition

28 October Meeting of the Nursing Council of Maharashtra Statc Bombay

30 October Government of India: Meeting of the Indian Ewpert New Delhl Committee on Leprosy

5-7 November Government of India: Meeting of the Central Council Madras of Health

9 November Meals for Millions Association of India: General New Delhi Body Meeting

11-12 November Trained Nurses Association of India: Council New Delhi Meeting

18 November to Indian Council of Medical Research: Annual Meetings New Delhi 12 December of the Advisory Committ?e's Expert Groups

18-20 November Government of India: Annual Meeting of the Nutrition New Delhi Advisory Committee

21 November Indian Nursing Council: First Meeting of the New Delhi Co-ordinating Committee

26-28 November Indian Council of Medical Research: Seminar on New Delhi Cholera

1.2 December Nepal Tuberculosis Association: International Kathmandu Conference on Tuberculosis

8 December Indian Academy of Medical Sciences: First New Delhi Convocation

21 December Government of India: Meeting of the Officers in New Delhi Charge of Planning and Execution of Tuberculosis CGntrol Programmes

21 December Government of India: Meeting of the Smallpox New Delhi Advisory Committee SEA/R C17/2 Annex 4 Page 3

22-25 December United Schools Organization of India: Thirteenth New Delhl * Annual Conference

2 January Government of India: Meeting on the Training of New Delhl Elementary Teachers in Health Nutrition

2-5 January Cancer Society of India: Second All-India Cancer Madras Conference

4-6 January All-India Dental Associatian: @ual Conference Bangalore

6 January Government of India: Inauguration of the National New Delhl Institute: of Public Healtt. Administration and Education

10-12 January Indian Academy of Paedlatrics: First National Poona Conference

16-19 January Conference of Tutors and Superintendents from hivandrum Schools of Nursing in Kerala State

23-25 January Government of India: Second Meeting of All-India Bhopal State Leprosy Medical Officers

27-28 January Indian Association for Ghest Diseases: Fourth New Delhi Annual Conference

27 January to Pugwash: Twelfth Conference on Science and World Udaipur 1 February Mfairs

5-7 February 1.11-India Ophthalm~!logical Society: Ophthalm3loglcal Jaipur Ccnference

8 February Goverment ~f India: Scc-lnd Inter-State flnye Hosur (India) Co-ordinating Committee Xeeting

6-10 February Indian Fublic Health ;.ssoclotion: Annual C~~nfercnce New Delhi

8-12 February Institution of Engineers of India: 44th Annual Hyderabad C:nvcntion

10-12 February Indian Association for the Advancement of Medical Madras Education: Annual Conference

11-15 February Government of India, Central Education Bureau: Third New Delhi Conference of Health Educators SEA/RC~~/~ Annex 4 Page 4

12-15 February Indian Council for Child Welfare: Fourteenth Hyderabad Annual General Meeting and Seminar on National Policy for Children

16-23 February World Confederation of Organizations of the Teaching Bangkok Profession: Asian Regional Conference on Increasing International Understanding Through Teaching About the United Nations

17-26 February National Institute of Public Health Administration New Delhi and Education: Seminar on Planning

18-20 February Government of India: Meeting of Smallpox Workers in New Delhi India

20-21 February Government of India: Meeting of the Superintendents New Delhi of Nursing Services

24-28 February Rural Health Research Project, Narangwal (Punjab): Narangual Second Annual Conference on Orientation to Rural Services

10 March Indian Standards Institution: Meeting of the Ad Hoc New Delhi Sub-Committee on Antedotes for Pesticides

16 March (iovernment of India: Meeting of the Committee on New Delhi Co-ordination of Bilateral and International Agencies Working in Health with the National Authority

16-21 March India International Centre: Seminar on Social New Delhi Administration in Developing Countries

1 April Government of India: Meeting on Applied Nutrition New Delhi Programme

3 April Government of India, Applied Nutrition Programme New Delhi Co-ordination Committee: Meeting of the Sub- committee on Training

5-7 April Tuberculosis Association of India: Nineteenth New Delhi Conference of Tuberculosis and Chest Disease Workers

22-30 April Government of India: Fifth conference' of Public New Delhi Health Engineers and Seminar on Water and Sewage Works Financing and Management 4- May Indian Nursing Council: Meeting on Standardization Calcutta of Post-graduate Certificate Courses in Public Health Nursing

11 May ~overnmentof Indonesia: Fourth Asiar. Conference on ~jakarta Occupational Health

18-21 May Government of India: Annual Meeting of Malaria and Bhopal Pilarla Workers

21 May Government of India: Meeting of the Sub-cornittee on New Delhi Assistance to Medical Education

22 May Government of Nepal: Annual Conference of Malaria Kathmandu and Filaria Workers

3-5 July Srl Gowtami Jcevakarunya Sangham: First Leprosy RF. j ahmundhry Workers' Conference (India)

USAID: Regional Seminar on Rural Community Water Bangkok Supply Development SEA/RC17/2 Annex 5

Fellowships Awarded by WHO

(1 August 1963 - 1 ~ugust1964)

Table I:_Source of Funds and meof Fellowship SEA/Rc17/2 Annex 5 Table 11: Fellowship awards: Distribution Page 2 by Subject of Study and by Country

5 * m ", rl m a i YI rl SubJect Srn$0"3"m 4 5 5 rl bOm.,m .,zoo C1 CGgEgg %::r Health Ormization and Services ~ublichealth administration/health planning -2- -2-22 8 Maternal and child health 1 ------1 Health education 1 - -11- - - 3 Environmental sanitation - -21- - - 1 4 Industrial hygiene - - -2- - - 2 Nursing 1 - -1- -1- 3 Epidemiology - -14-1- - 6 Vital and health statistics 21112-3111 Nutrition 112-1- - 1 6 Communicable Diseases Malaria eradication 93-14-4829 Tuberculosis control 11-3- - - 2 7 Leprosy control -1------1 Enteric diseases - -1-1- - - 2 Venereal-disease oontrol ------1 1 Filariasis control -1- - - - - 2 3 Quarantine administration and yellow-fever control - - -2- - - - 2 Medical Sciences and Education Preventive and social medicine -1- - - - - 2 3 Medical education 2 ------2 Physiology - - - -1- - - 1 Anatomy - -111- - - 3 Bacteriology -1------1 Human genetics - -1- - - - 1 2 Clinical biochemistry - -12- - - 3 Paediatrics - - -1- - - - 1 Dermatology and vcnereology - - - - -1- - 1 Application of basic sciences in surgery - - -2- - - - 2 Anaesthesiology ------2 2 Public health aspects of radiation and isotopes ------1 1 Medical radiology 2 ------2 Sera and vaccine manufacture (including manufacture and control of polio vaccine) - - -611- - 8 Clinical pathology 1 ------1 cardiology/cardio-vascular diseases - - - - -3- - 3 Other Subjects Physical therapy - -21- - - 1 4 Electro-medical engineering - -1- - - - - 1 Insect physiology - - -1- - - - 1 Medical laboratory techniques -11- - -1- 3 Food analysis 1 - - - - -1- 2 Total 22 13 14 30 14 6 12 25 136 - List of Re~ortsand Papers by the Tuberculosis ChemotheraDy Centre. Madras (I z~uwst1963 - 1 ~ugust1964*)

Authors Reference

A. Reoorts and Papers Published

1. A comparison of the virulence in the A.L. Bhatia, Bulletin of the World guinea-pig of tubercle bacilli from Thai C.V. Jacob, Health Organization and British patients K.L. Hitze, (1963). 2. 483 K. Ramachandran and J.B. Selkon

2. The prevention and treatment of isoniazid Tuberculosis Bulletin of the World toxiclty in the therapy of pulmonary Chemotherapy Health Organization tuberculosis. 11. An assessment of the Centre. Madras (1963). 3. 457 prophylactic effectiveness of pyridoxine in low dosage

A controlled comparison of cycloserine J.H. Angel, Tubercle (1963), plus ethionanide with cycloserine plus A.L. Bhatia, -44, 215 thiacetazone in patients S. Devadatta. Wallace Rox, B. Janardhanam, S. Radhakrishna, C.V. Ramakrishnan. J.B. Selkon and S. Velu

B. Reaorts and PaDers with the Publisher

1. Emergence of isoniazid-resistant J.B. Selkan, Bulletin of the World cultures in patients with pulmonary S. Devadatta, Health Organization tuberculosis during treatment with K.G. Kulkarni, isoniazid alone or isoniazid plus PAS D.A. Mitchison, C. Narayanan Nair, K. Ramachandran and C.V. Ramakrishnan

2, A concurrent comparison of intermittcnt Tuberculosis Bulletin of the World (twice-weekly) isoniazid plus strepto- Chemotherapy Health Or&rinization mycin and daily isoniazid plus PAS in Centre, Madras the domiciliary treatment of pulmonary tuberculosis

*A complete list of the reports and papers which had been published, were with the publisher or were under preparationn up to 1 August 1963 was given in last year's Annual Report. The information glven here brings this list up to date. SA/RCl7/2 Annex 6 pagr; 2

Authors Reference .&A -Title

5 A controlled comparison of streptomycin S. Velu, Tubercle with either PAS or pyrazinamlde in the 9. Devadatta, treatment of patients with active Wallace Pox. tuberculosis after treatment with K.@. Kulkarni, isoniazid alone K. Mohan and C.V. Ramakrishnan

C. Redorts and Papers In Pre~aration

1. The diet of patients yith persisting quiescent pulmonary tuberculosis in a poor South Indian community

2. A comparison of supervised spot specimens and collection specimens of sputum

3. An investigation into the contamination rate of cultures set up for the isolati~n of tubercle bacilli from patients with pulmonary tuber?ulosis in South India

4. Cycloserine and ethlonamide (TH 1314) in the treatment of chronic drug-resistant pulmonary tuberculosis in South India

5. A clmparison of smear results with culture results in the assessment of quiescence

6. Rate of elimination of sensitive organisms . . 7. Post-treatment virulence: methodology

8. The guinea-pig virulence, catalase-activity and peroxide susceptibility of isoniazid resistant cultures which emerged during treatment

9. Association between virulence, peroxide susceptibility, catalase and degree of isoniazid resistance

la Virulence in the guinealpig and susceptibility to hydrogen pyroxide of isoniazid- sensitive tubercle bacilli from South Indian patients

11. Five-year follow-up of hohle and sanatorium patients

12. Pive-year follow-up of home and sanatorium contacts

1% Virulence in the guinea-pig and sensitivity to PAS and thlacetazone of tubercle bacilli from South Indian patients in pulmonary tuberculosis List of Papers Published by the National Tuberculosis Institute. Banwlore (from 1959 to 1963)

1. Bordia, N.L. Drug prophglaxis in the control of tuberculosis in India Indian J. Tuberc., 1960, 1, 83

2. Bordla, N.L. . . The training programme of the Institute Ministry of Health G)overnment of India Bulletin Devoted to the Prevention of Tuberculosis, 1960, VII, -3

3. KulBhushan Assessment of BCG vaccination in India Indian J. Med. Res., 1960. ffj, 407

4. Bordia. N.L., (ieser, A.. McLary, J., Mdt. I. & Kul Bhushan Tuberculin sensitivity in young children (0 - 4 years old) as an index Of tubtrculvsis in the cmimnity Indian J. Tuberc., 1960, 8. 25

5. Mahler, H.T. The WHO and ideas behind the Institute Ministry uf Kealth,Gcvernment of India Bulletin Devsted to the Prevention of Tuberculosis, 1960, VII, 2

6. Bordia, N.L. Z1-aining of auxiliary personnel for the control of tuberculosis in India Bombay Hosp. J., 1961, 2. 122

7. Raj Narain, Kul Bhushan & Subramanian, M. Allergy-producing capacity of the Madras and Danish BCG vaccines as seen among school-children in Bangalme Indian J. Tuberc., 1961, 2, 15

ti. Banerji. D. The medical sciences and the Indlan society Journ.of IMA.. VII. &

9. Raj Narain Size and extent of tuberculosis problem in urban and rural India Indian J. Tuberc., 1962, 2, 147

10. Plot. M. Outline of a district tuberculosis programme Indian J. Tuberc., 1962, 2. 151 SEA/RC~~/~ Annex 7 Page 2

Andersen, S. Some aspects of the economics of tuberculosis in India Indian J. Tuberc., 1962, 2, 176

Waaler, H.T., Geser, A. & Andersen, S. The use of mathematical models in the study of epidemiology of tuberculosis Amer. J. Publ. Hlth. 1962, z,1002

Raj Narain, & Subramanian. M. Limitations of single-picture interpretation in mass radiography pberculosis Association of India. Proceedings of the Eighteenth Tuberculosis and Chest Diseases Workers' Conference, held in BanRalore New Delhi, 1962, 64

Raj Narain. Jambunathan, M.V., & Subramanian, M. Resurvey of 15 villages from the Madanapalle Zone of National Sample Survey on Tuberculosis Tuberculosis Association of India. ProceedinRs of the Eiphteenth Tuberculosis and Chest Diseases Workers' Conference, held in BanRalOre, New Delhi, 1962, 34

Baily, C.V.J. Doorto-door BCG vaccination Tuberculosis Association of India. ProceedinRs of the EiRhteenth Tuberculosis and Chest Diseases Workers' Conference, held in BanRalore, New Delhl, 1962, 304

Andersen, S. & Plot. M.A. The operations research approach Souvenir - Eighteenth Tuberculosis and Chest Diseases Workers' Conference held in Bangalore, New Delhi. 1962, 18

Bordia, N.L. Ideas on the district tuberculusis clinic Souvenir - Eighteenth Tuberculosis and Chest Diseases Workers' Conferenc$, held in Bangalore, New Delhi, 1962, 6

RaJ Narain Tuberculosis control (an approach to villages) Souvenir - Eighteenth Tuberculosis and Chest Diseases Workers' Conference, held in Banplalore, New Delhl, 1962, 13

Kul Bhushan Trials on experimental batches of freeze-dried BCG vaccine produced at Guindy Laboratory Ministry of Health Government of India mlletin Devoted to the Prevention of Tuberculosis, 1962, VIII, 9,IX, 1 SEA/FiC17/2 Annex 7 Page 3

Andersen. S. & Banerji, D. Report on a study of migration in four taluks of Bangalore District Population Review, 1962, 6, 69

Kul Wushan Allergy after BCG vaccination Tuberculosis Association of India, Proceediws of the Eighteenth Tuberculosis & Chest Diseases blorkers' Conference, held in BanRalOre New Delhi. 1962, 286

Andersen, S. Five Mlllion Tuberculous in India: BCG t INH 18~rt Ma Razine of the IUAT. 1962, 111, 6

Fmerji, D. Medical practice in India: its sociological implications Antiseptic. 1962

Andersen, S. CQerations research in public health Indian J. Fubl. Hlth, 1963. VII.5 141

Raj Narain, Geser, A., Jambunathan. M.V. & Subramanian, M. Tuberculosis prevalence survey in WurDistrict Indian J. Tuberc.. 1961, 10. 85

Andersen, S. & Banerji, D. A sociological enquiry into an urban tuberculosis progrmme in India BUU. wid ~lthOra., 1963, 3

Banerji, D & Andersen, S. A sociological study of the awareness of symptoms suggestive of pulmonary tuberculosis ~ull.~ld ~lth Org., 1963, 3 SEA/RC17/2 Annex 8

Ust of Technical Reports Issued by the ReRional Office from 1 Aunust 1963 to 1 Aunust 1964

Document No. a7d Date -Title -Author

*SEA/Bilharz/6 Assignment report on schistosomlasis in Dr Yoshitaka Komlya 26 ~uly1963 Thalland (malland 61). 12-25 June 1963

Communicable Diseases

SEA/CD/~ 0 Report on a visit to the Infectious-Disease Professor T. Andersen 22 November 1963 Hospital, Kathmandu, 20-23 October 1963

SEA/CD/~~ Field visit report on communicable diseases. Dr A. Zahra 4 December 1963 Afghanistan. 9-16 November 1963

SEA/CD/~~ Field visit report on epidemiological and Dr K. Raska and 28 April 1964 and laboratory services and communicable Dr A. Zahra Corr.1 diseases in Mongolia, 4-11 April 1964 21 My 1964

Dental fieaLth

SEA/DH/5 Report on a visit to Luchow. Uttar' Pradesh. Dr J.J. Plndborg 14 January 1964 Indla, in connection with assistance to schools of dentistry (India 186). 20 October - 8 December 1963

SEA/DH/~ Assignment report on assistance to schools Dr J.J. Plndborg 17 ~uly1964 of dentistry in India (India 186), October 1963 - July 1964

Environmental Sanitation

*SEA/Env.San./Zq Report on an interim water supply and Professor Harvey F. 29 ~uly1963 sanitation scheme for Wtropolitan Calcutta, Ludwig 3-16 ~uiy1963

SZ:./Env.San./>O liotes on s prsposed "pnckaaa" ;~rogrammefor Proffss3r Harvey F. 19 ).upst 1963 watcr supp!? systems for' smaller c,~mmunities ~uduil: in davcl:,piny areas

SEA/Env.San./'Jl Assignment report on environmental sanitation Mr H. Street 25 Novembqr 1963 aspects of public health programme, Madhya and Pradesh (India 149). January 1959 - Mr K. Achutan Decenber. 1962

*Report not included in last year's list SEA/~c17/2 hex 8 Page 2

Document No. and Date -Author

SEA/Env. San./32 Assignment report on water fluoridation, Dr Mlchael J. Flynn 21 February 1964 Ceylon (Ceylon 70). December 1963 - January 1964

Assignment report on public health Professor F.E. Bruce engineering education in India (India 176). October - November 1963

Assignment report on assistance to Central Mr W.J. Younker Public Health Engineering Research Institute, Nagpur (instrumentation aspects) (India 176) 30 June - 30 September 1963

SEA/Env. San. /35 Assignment report on community water supplies Dr H.T. Shenefield 11 June 1964 (water and sewerage works: financing and management) (India 209). 20 March - 21 May 1964 s~n/Env.san./36 Assignment report on community water supplies Mr Norman J. Pugh 17 June 1964 (water and sewerage works: financing and management) (India 209). 22 April - 22 May 1964

SE~iEpid/7 Assignment report on strengthening of health Professor R. Cmickshank 28 November 1963 services (epidemiology) (India 1821, 17 September - 31 October 1963

Final report on strengthening of health Dr D. Sovrlich services (epidemiology). Indonesia (Indonesia 29). February 1961 - March 1964

Filariasis s~A/Pil/6 Assignment report on filariasis control, Dr J.F.B. Edeson 6 December 1963 Ceylon (Ceylon 56). 12 August - 19 September 1963 . . HaemorrhaRlc Fever

Assig~nentreport on establishment of an Dr F.R.S. Kellett . Aedes aeplmti pilot project in Thailand, 4-18 June 1963

Assiwent report on dengue-like disease Dr W. McD. Haon in Rangoon, Burma (SEAR0 99). 16 - 18 January 1964 SEA/RC17/2 Annex 8 Page 3

Document No. and Date -Title -Author

S~~/Haem.Fever/3 Assignment report on haemorrhagic fever Dr w. qc~.Hammon 26 March 1964 and dengue-like disease in Calcutta. India (SEARO 99). July-December 1965

SEA/Haem.&ver/U Assipnent report on haemorrhagic fever Dr W. McD. Hamon 26 March 1964 and dengue-like disease in Thailand. 1958-1963 (SEARO 99). 11-15 January 1964

~~~/Haem.~ever/5 Report on haemorrhagic fever and dengue-like Dr W. McD. Hammon 10 April 1964 disease in the Philippines and South-East Asia, January 1964

Health Education

SEAmP/19 Report on a field visit to Uttar Pradesh, Mrs A.R. Moore 11 November 1963 27 June - 2 July 1963

Health Laboratory Methods

SEA^ Report on a visit to mma, Dr R.E. Modica 12 Pebruary 1964 1-13 December 1963

*SEA/Lep/l5 Field visit report on leprosy control Mr A.M. Subramanian 8 ~uly1963 in Nepal (Nepal 13). 16-23 January 1963

SEA/Lep/l6 Assipment report on leprosy control project, Dr M.V.J. Blanc 22 ~ugust1963 Indonesia (Indonesia 9), September 1956 - nugust 1963

SEA/Lep/l7 Assignment report on leprosy control Dr M.J.Mallac 26 March 1964 Project, Srikakulam, Andhra Pradesh. India . . (India 81.2). January 1962 - February 1964

Malaria

SEA/Ma1/35 Assipment report on malaria eradication Dr J. Rahman 27 August 1963 in Afghanistan (Afghanistan 11). 22 June 1961 - 29 Deccmber 1962

SEA/Hal/36 Asslpnent report on entomological aspects Dr A.M. Shalaby 4 November 1963 of malaria eradication programme, Baroda, India (India 1531 August 1958 - Xay 1962

"Report not included in last year's list SEA/RC~7/2 Annex 8 Page 4

Document No. and Date -Title -Author

SEAbl/37 Report on assessment of malaria eradication Dr B.A. Rao 24 March 1964 progrme in Ceylon, by WHO Regional Mr D.A. Muir Assessment Team (SEARO7) MT W. Rooney

SE~bl/38 Report on a visit to West Irian (Indonesia Dr 0. Sambasivan 26 mrch 1964 2 30 December 1963 - 3 January 1964

Maternal and Child Health

SEA/McH/23 Assignment report on paediatric training ~r Cicely D. ~illiams 31 October 1963 and services, Ceylon (Ceylon 69), July - September 1963

SEA/MCH/24 ~ssignmentreport on maternal and child ~r 1. J. van ~i jk 21 January 1964 health. Ceylon (ceylon 4). March 1959 - November 1963

SEA/moH/25 Assignment report on paediatric education Dr I. Seginer 21 May 1964 project (biochemistry aspects), Madhya Pradesh India (India 114.2) Wcember 1963 - January 1964

SEA/MCH/26 Assipent report on paediatric education. Dr N.O. Zemov 27 May 1964 Uttar Pradesh, India [India 114). October 1962 - March 1964

SEA/MCH/27 Final report on paediatric education, Dr P. Robinson 5 June 1964 Mysore State a 4 September 1961 - . . my 1964

SEA/MCH/27 Add. 1 Assignment report on nursing aspects of Mss M. Brown and 8 June 1964 paediatric education, Mysore State (India Miss K. Joshi 114). February 1962 - May 1964

SEA/MCH/Z~ Assi-ent report on assessment of maternal Dr W.B. MacDonald 1 ~uly1964 and child health services in rural areas of and Thailand (SEAR0 95). December 1963 - Miss Marie S. Lochore March 1964

Medical Education

SEA/W~.E~UC./36 Assignment report on assistance to Paculty Professor Brian Maegraith- 25 October 1963 of Tropical Wdicine and Endemic Diseases, Thalland (Thailand 57). June - August 1963 Document No. and Date -Title -Author

SEA/M~~.~duc. /37 Assignment report on assistance to medical Dr Robert Cruickshank 24 December 1963 education, Gujarat (India 183). 3 August - 11 September 1963

SEA/Med.Educ ./38 Assiwment report on medical education, 13 January 1964 Gujarat (India 183). August - December 1963

SEA/Med.Educ ./39 Report on a visit to Gujarat, India, Dr D.P. Nath 14 January 1964 17-24 November 1963

SEA/Med.Educ.DO Assignment report on assistance to medical Professor J.H.F. 12 February 1964 education, Oujarat (India 183), Brotherston 2-26 January 1964

SEA/M~~.E~UC.Dl Assignment report on assistance to the Dr B.F. Matthews 28 Aprll 1964 Department of Physiology, Second Medical School, Psradeniya, University of Ceylon (Ceylon 47), 9 November 1963 - 9 April 1964

SEA/Med.Educ./42 Assignment report on assistance to tile Dr K.V. Krishnan 11 May 1964 Faculty of Medicine (preventive and social medicine), University of Kabul (Afghanistan 13). 1957-1963

SEA/Med.Educ./llj Report on medical education study tour Dr J. Chandy 13 May 1964 (Deans and Principals of Medical Colleges) 1964, 26 January -23 February 1964

SEA/W~.E~UC Assiflent report on assistance to medical Dr E.G. Walsh 4 June 1964 education, Gujarat State (Baroda Medical WHO Visiting Professor Of College) (India 183). July 1963 - June 1964 PhySi OlOgy

SEA/Med.Educ./45 Assignment report on assistance to medical Dr A.R. Mills 12 June 1964 education, Gujarat State (Baroda Medical WHO Visiting Professor of College) (India 183), May 1963 - April 1964 Preventive and Social Medicine

SEA/Med .Educ ./46 Assignment report on assistance to medical Dr J. Gerald Collee 17 June 1964 education, Gujarat State (Baroda Medical WHO Visiting Professor of College) (India 183). July 1763 - June 1964 Bacteriology

SEA/W~.E~UC./47 Assignment report on assistance to medical Dr O.S. Boyd 25 June 1964 education, Gujarat State (Baroda Medical WHO Consultant in College) (India 183). 5 August - Bi ochemlstry 5 October 1963 SEA/RC17/2 Annex 8 Page 6

Document No. and Date -Title Author

SEA/Med .Educ ./llB Assiwent report on assistance to medical Dr I.W. Delamore 1 ~uly1964 education, aujarat State (Baroda Medical WHO Visiting Professor of College) (India 183). June 1963 - May 1964 Internal Medicine and Therapeutics

SEA/Med.Educ ./49 Assignment report on assistance to Medical Dr A.J.M. Reese 2 3uly 1964 College, Mandalay. Burma (Burma 591, August 1963 - June 1964

~~~/Med.~duc./SO Assiwent report on assistance to medical Dr P.R. Myerscoush 15 ~uly1964 education, aujarat State (Bsroda Medical WHO Visiting Professor of college) (India IBJ), June 1963 - May 1964 Obstetrics and aynaecology

SEA/Med.Educ./51 Assignment report on medical education, Dr G.Q. Hadley 17 July 1964 Afghanistan (Faculty of Medicine, Kabul University) (Afghanistan 13). March 1963 - JULY 1964

Mental Health

SEA/Ment/l2 Assignment report on mental health situation Dr A. Stoller 30 August 1963 in Thailand (Thailand 17). 31 May - 4 June 1963 s~A/Ment/l3 Assig~lentreport on mental health Dr A. Stoller 17 December 1963 situation in Indonesia (Indonesia 43). March - May 1963

SEA/Ment/l4 Assignment report on mental health services Dr Tsung-Yi Lln 27 May 1964 in Thailand (Thailand 17), December 1963 - February 1964

~~~fiurs/Tl Final report on nursing education (public Miss M.I. Tabbanor 10 October 1963 and health integration), Kimachal Pradesh, India and corr. 1 (India 99.4). August 1961 - August 1963 Mrs S. Solanky 2 March 1964

SEAfiurs/72 Information on the first all-India Refresher Hss Mary 0. Abbott 11 October 1963 course for nurses to teach in the emergency * nursing aide programme 1963, held at the Lady Hardinge Medical College Hospital. New Delhi (India 98). 18 April - 17 May 1963 SEA/RCI~/~ Annex 8 Page 7

pocument No. and Date -Title -Author

SEA/Nurs/73 Infomation on the second all-India refresher Miss Mary 0. Abbott 11 October 1963 course for nurses to teach in the emergency nursing aide programmes 1963, held at the Victoria Hospital. Bangalore, Mysore State (India 98). 5 June - 2 July 1963

SEA/Nurs/74 Assignment report on nursing advisory Miss Barbara Darbyshire 12 November 1963 services, Afghanistan (Afghanistan 35). November 1959 - August 1963

SEA/Nurs/75 Assigunent report on nursing aspects of Miss C. Walsh 21 November 1963 public health programme, Bihar (India 145). January 1962 - August 1963

SEA/Nurs/76 Information on all-Indla hospital tutors' Miss I.M. Lovedee 21 November 1963 refresher course, held at the Civil Hospital, Ahmedabad (India 98). 19 August - 12 October 1963 sE~fiur~/77 Infamation on all-India refresher course EIiss M.I. ~abbanor 12 December 1963 for nursing superintendents, held at the Post-Graduate Institute Hospital, Chandigarh (India 98). 7 October - 2 November 1963

SEA/Nurs/78 Information on short-term course in paediatric Miss L.E. Stapleton 3 January 1964 nursing, held at the Sarojini Naidu Hospital, Agra, Uttar Pradesh (India 114), 1 Octaber - 30 November 1963

SEA/Nurs/79 Information on short-term refresher course 19 February 1964 in paediatric nursing, held in Bangalore, Mysore State (India 114.3). 1 Octsber - 30 November 1963

SEA/Nurs/80 Conclusions and recommendations of the 16 June 1964 Conference of WHO nurses stationed in India, held at the WHO Regiunal Office for South East Asia, New Delhi, from 24 to 27 February 1964

SE~/Nurs/81 Infomation on short-term refresher course Miss M. Brown 26 June 1964 in paediatric nursing, held at the Vanivilas Hospital, 15 March - 15 May 1964 SEA/RC17/2 Annex 8 Page 8

Documont No. and Date -Title Nutrition

~~~/lrut/l6 Field visit report on goitre control. Dr GIJ~Stott 19 August 1963 Prae, Thailand, 2-6 June 1963

SEA/lt~t/l7 Field visit report on the expanded nutrition Dr G.J. Stott 11 September 1963 programme, Uttar Pradesh, 1-6 April 1963

sEA/Nut/l8 Field visit report on expanded nutrition Dr G.J. Stott 19 November 1963 programme, Orissa, India, 7-11 October 1963

QcuDational Health

Assignment report on manganese poisoning Dr Donald Hunter in India (India 196). November-December 1963

Organization of Medical Care

SEA/OMC/2 Assi@ment report on infect1ous-disease Professor T. Andersen 1 April 1964 and hospitals in Delhi, Bombay, Hyderabad, . . Ccrr.1 Madras and Calcutta (India 182). October 18 May 1964 December 1963

Public Health Administration

SEA/PHA/~~Aild .1 Final report on public health progralmne, MISS E. Hazel1 12 September 1963 Mysore State (India 148). December 1958 - ~uly1963

Field visit report on training of health Dr D.H.S. Griffith assistants and related subjects, Nepal, 15-29 May 1963

SEA/PHA/34 Final report on public health programme, Dr J. Alvarez Zamora 21 January 1964 and Bihar (India 145). January 1962 - Corr. 1 December 1963 27 Kay 1964

SEA/PHA/35 Assigment report on Institute of Public Dr K.V. Krishnan 11 March 1964 Health, KaDUl (Afghanistan 31). Febmary 1963 - January 1964

SEA/PHA/~~ Assignment report on drug oontrol in Professor W.E. KcConnell 9 April 1964 Afghanistan. 25 January - 10 February 1964 SEA/RC~7/2 hex8 Page 9

Document No. and Date -Titli -Author

SEA/PHA/~~ Field visit report on yaws control and Dr D.H.S. Griffith 22 June 1964 integration (strengthening of health services), Thailand (Thailand 21, 12-23 January 1964

Radiation

SEA/Rad/lZ Rev. 1 Revised version of the assignment report on Dr E. Eric Pochln 5 September 1963 the development of the radiation centre, Bombay (India 192). 31 January - 17 February 1963

SEA/Rad/l4 Field visit report on a visit to Ceylon Dr H.J. am 16 August 1963 (SEARO 42), 17-25 June 1963 . .

SEA/flad/l5 Field visit report on a visit to Madras Dr H.J. Ham 10 September 1963 (SEARO 42). 12-17 June 1963

Assiwent report on radiation protection Dr H.J. bll India (SEARO 42). February-November 1963

Radiation and protection - report on visits Dr H.J. am to Hyderabad, Bangalore, Mysore, Vellore and Trivandrun (SEARO 42). 22 September - 7 October 1963

SE~/Rad/l8 Radiation and protection - report on a visit Dr H.J. Ham 8 January 1964 to Uttar Pradesh (SEARO 42). 16-26 August 1963

Assignment repart on course on radiological Mr T.N. Swindon physics, held at thc Atomic Energy Establishment, Trombay (India 195). 1-25 February 1964

Rehabilitation

SEA/Rehab/2 Assiment report on poliomyelitis control Dr Knud Jansen 8 April 1964 and rehabilitation, Ceylon (Ceylon 63). 14-23 December 1963

~~~/Rehab/3 Assignment report on medical rehabilitation Dr F.K. Safford 15 April 1964 in India (India 194), November 1963 - and February 1964 Dr Knud Jansen SEA/RC17/2 Annex 8 Page 10

Document, No. and Date -Title

Rural Health

SEA/RH/~~ Assierment report on rural health project, Dr D. Penman 31 July 1964 Afghanistan (Afghanistan 26). June 1963- my 1964

Tetanus

SEA/Tet/l Rev. 1 Assignment report on tetanus control, Punjab Dr D. Bytchenko 18 December 1963 (India 193). April-June 1963

Tuberculosis

Assiment report on laboratory aspects Mr H.W. Cotton of the national tuberculosis project, Thailand (Thailand 42). December 1959 - December 1962

SEA/TB/~~ Recommendation for tuberculosis control Dr K.L. Hltze 27 August 1963 in Nepal

Field vlsitreport on tuberculosis control Dr K.L. Kitze in Burma, 21-26 April 1963

SEA/TB/~~ Case-finding and domiciliary treatment in --- 7 October 1963 tuberculosis control - conclusions and recommendations arising out of the technical discussions held during the sixteenth session of the Regional Committee for South-East Asia, September 1963

SEA/TB/49 Assiqment report on the National Tuberculosis Mr Stig Imdersen 21 November 1963 Institute, Bangalore, India (India 103), 1 January 1959 - 30 September 1963

SEA/TB/~ 0 Assigment report on the National Tuberculosis Dr M. Piut 9 January 1964 Institute, Bangalore, India (India 103). July 1959 - February 1963

SEA/TB/~I Asslpment report on the National Tuberculosis Mr C. Cobbold 14 January 1964 Institute, Bangalore (Bacteriology Section), India (India 103). October 1960 - December 1963 SEA/RC17/2 Annex 8 Page 11

Document No. and Date -Title -Author

SEA/TB~2 Assipment report on the National Tuberculosis Mr C.W. Kroezen 12 February 1964 Institute, Bangalore (X-ray Section) and (India 103). September 1960 - December 1963 Mr V.A. Menon

SEA/TB/5 3 Assignment report on the work of the labora- Mr P.M. Hinchliffe 12 February 1964 tory of the Tuberculosis Chemotherapy Centre, Madras (India 53). February 1962 - February 1964

SEA/TB/5'f Assignment report on the Tuberculosis Dr J.J.Y. Dawson g April 1964 Chemotherapy Centre, Madras (India 53). April 1961 - March 1964

Vaccines

SEA/Vaccine/l3 Assimment report on production of freeze- Dr Colin Kaplan 22 April 1964 dried smallpox vaccine in Buma (SEARO 38). February 1964

SEA/Vaccine/l4 Assignment report on production of freeze- Dr Colin Kaplan 22 April 1964 dried smallpox vaccine in Indonesia (SEARO 38). March 1964

SEA/Vaccine/l5 Assipment report on production of freeze- Dr Colin Kaplan 22 April 1964 dried smallpox vaccine in India (SEARO 38). March 1964

Venereal Diseases and Trenonematoses

SEA/V-DT/~ Assignment report on yaws ciintrol in Thailand Dr J. Orassioulet 31 March 1964 (Thailand 2). 3 June 1960 - 31 December 1963

Vital and Health Statistics

SEA/VHS/55 Report on Regional Seminar on Health 15 October 1963 Statistics (Hospital Statistics), Bangkok. 11-22 December 1962

SEA/VHS~~ Report on a visit to Ceylon, 24-29 February Dr H.P. Helweg-Larsen 14 April 1964 1964 Trainlng Activities Carried Out by Governments with the Assistance of WHO Staff (1 August 1963 - 1 August ig64p

No. of Total No. Subject Type of course or training Duration and location Categories of trainees courses if trainees:

AFOHANISTAN

Mal aria Basic training in malaria 1 - 8 weeks Malaria inspectors 10 142 eradication techniques, Malaria Institute, Kabul entomology and parasitology Regl~nalDirectorates, Kunduz and Kandahar, and Malaria Units

Etfreshrr training in 3 - 4 wseks Assistant entomologists 3 18 entcmoiogy Malaria Insti'~ute,Kabul, and Regional Directirates Kunduz and Kandahar

Smallpox Refresher course 4 weeks Vaccinators and sanitarian- 1 47 eradication Ministry of Public Health supervisurs Kabul

Vaccinaticn techniques 2 - 3 months Vaccinators 5 148 Vaccine Centre, Kabul

Rural health Orientation training in ruraI Repeated course; sf Medical undergraduates, 5 51 health 1 month graduates, nurse and Rural health project midwifery students

*The figures in this table have been obtained from WHO field staff in respect of their training activities. Because of possible omissions in or duplication of reporting, they Cannot be regarded as being completely accurate. They do, however, represent a fairly reliable record of training activities during the year. SEA/RC~~/Z Annex 9 Page 2

No. of Total No. subject Type of course or training Duration and location Categories of trainees courses of trainees

Health Basic training 1 academic year Teachers 2 220 education and Faculty of Mucation, school health Kabul, and Teachers Training Institute, Kabul

2 - 5 months Headmasters and teachers 3 100 Faculty of Education, Kabul, and Teachers Training Institute, Kabul

Nursing/ Basic nursing and midwifery 3 - 4 years Student nurses and midwives Continuous 63 midwifery Mastoorat. Shararah and education Avlcenna Hospitals,Kabul

First aid Lectures and practical work 1 week Village-level workers 1 40 Gulzar Training Centre 1 Baslc 2- years Sanitarian students 3 Environmental 2 73 sanitation School for Sanitarians, Kabul

I, In-service field training 2 - 16 weeks Sanitarian students and 2 24 Gulzar,Shswoki, Nuristan. sanitarians working in Parwan, Jaji Maidan Rural Development Depart- ment

Preventive and Academic undergraduate course Continuous Medical students and 1 250 social Medical Faculty, interns medicine University of Kabul SEA/RC~~/~ Annex 9 Page 3

NO. of Total No. Subject Type of course or training Duration and location Categories of trainees courses of trainees

BURMA

Leprosy Basic training 3 months Junior leprosy workers 1 43 Mandalay

Refresher course 1 mcnth Medical offic2rs and 3 72 Htaukkyant (Rangoon) leprosy inspectors

Pathology Basic training Continuous Medical students 2 122 Medical College, Mandllay

Midwif cry Refresher course 6 weeks Midwives 2 42 Pegu and Tuungoo

! Bhsic training le months Student midwives 16 583 Midwifery Schools -CEYLON Hospital Orientation 3 months Senior hospital administra- 1 12 administration General Hospital, Colomb3 tors

Nursing Psst.bssic technical and 9 mcnths Graduate nurses 2 59 education practical training Colombo, Mulleriyawa and Angoda

" In-service training in 3 months Graduate staff nurses 1 1 6 psychiatric nursing Angoda Mental Hospital

- sEn/Rc17/2 Annex 4 Page 4

N0.0f subject Type of course or training Duration and location Categories of trainees TotalNo. Courses of trainees

Nursing APf iliat ion in psychiatric 1 month Student nurses 1 26 cduaation nur sins Angoda and Mulleriyawa Hospitals

Current Refresher Course 1 week Medical officers and a 2 4 laboratory Angoda Fever Hospital medical laboratory methods of technologist identification of entero- bactarincsaz -INDIA Tuberculosis Training in organization 9 months Medical officers 3 V0 control National Tuberculosis Institute, Bangalore

n Training in treatment and -do. Health visitors. x-ray and 3 132 case-finding laboratory technicians

11 Training in statistical -do. Statistical assistants 3 27 aspects

'I Orientation seminar 2 weeks Senior tuberculosis 1 25 National Tuberculosis administrative officers Institute, Bangalore

n Home visiting 12 months Newly recruited health 1 10 Tubersulosis Demonstra- visitors tion and Training Centre, re No.of TotalNo. Subject Type of course or training Duration and location Categories of trainees Courses of trainees

Tuberculosis Home visiting 1 month Health visitor trainees 1 2 3 control Health Visiting School, Madras

BCG vaccina. Training In laboratory 1 week - 6 months Laboratorj technicians and - 4 tion techniques and bacteriology Tuberculosis Chemotherapy doctors of tuberculosis Centre, Madras

!I BCG programme training 6-12 weeks BCG team leaders and 3 40 National Tuberculosis supervisors Institute, Bangalore

Leprosy Basic course 9 months Leprosy workers 1 25 Danish Centre, Pogiri (Srikakulam District)

Trachoma Basic training 2 weeks Medical officers and 2 52 control md Jaipur and Naila supervisors other communicable eye diseases

I Demonstration field training 5 days Medical offlcers 1 7 Jaipur and Sikar 1 Nursing BasIc nursing 3- years Student nurses Continuous 233 2 Simla and Cuttack S~P./Rc17/2 Annex 9 Page 6

No. of Total No. Subject Type of caursc 3r training Duration and locatiln Categories of trainees caurses of trainees

Nursing Short-term courses in 1 - 2 months Nursing superintendents, 4 84 nursing administration, Chandigarh, Ahmedabad and sister tutors and nurse- nursing education and Bangalare midwives paediatric nursing

I Simple nursing procedures 7 - 8 weeks Nursing orderlies and 2 19 and first aid Cuttack and Quilon lay workers

Post-basic training in 3 months Public health students 1 14 rural health Neendakara from Trivandrum

(8 Public health integration 1- 4 weeks Student nurse .midwives 5 45 Neendakara

Supplementary course in 1 month Student nurses 1 80 nur sin& Ribander (03a)

I Post.basic course in public 10 months Graduate nurse-midwives 1 12 health nursing Ahmedabad

Paediatric Refresher course 8 weeks Post-basic nursing students 1 25 nursing S.A.T. Hospital, Trivandrum

I Basic training 1 year Auxiliary nurse-midwife 1 20 Trivandrum students

II In-service training 3 months Staff nurses 1 9 Trivandrum

sm/Rc17/2 Annex 9 Page 9

No. of Subject Type of course or training Duration and location Categories of trainees courses

Leprosy Bnaic training 1 manth Medical undergraduates 20 Central Institute, Djakarta

,I I 3 weeks Leprosy nurses 12 Leprosy Training Scho~l, Tangerang

Fhysiotherapy Basic academic course 3 years Student assistant physio- 2 Rehabilitation Centre, therapists Solo

1 year Student physiotherapy- 1 Rehabilitation Centre, aides Solo

II Past-graduate training in Graduate teachers of 1 cedical and physizthera- physical education peutlc aspects cf physical education

Environmental Pre-service field training 4 weeks Student "Kor~trolir 1 sanitation Rural Health Training Kesehatan" (sanltarian. Centre, Bekasi public health administra. tors)

Physiology Undergraduate course 3 years Medical undergraduates Continut University of Jogjakarta sEA/Ac17/2 Annex 9 Page 10

No. of Total No. Duration and location Categories of trainees subject Type of course or training courses of trainees

MALDIVE ISLANDS

Rural health Basic training 2 years Health assistants 1 15 Male

Nursing Basic training 1 year Nurse-aides 1 10 Male

MONGOLIA

Bruccllosls Short course in diagnostic 1 week Medical officer 1 1 procedures Ulan Bator -NEPAL Malaria Basic training in malario- 1 - 8 weeks Superintendents, inspectors 7 139 logy, entomology, parasito- Kathmandu, Biratnagar. and microscopists logy and microscopy Nepalganj and Birganj

n Basic training in 1 - 4 weeks Superintendents, inspectors 4 216 geographical rec0nnais;ance Biratnagar and Nepalganj foremen and other field workers

tt Basic training in 2 - 6 weeks surveillance superintendents, 8 677 surveillance activities Kathmandu and Birganj inspectors, supervisors and visitors

I Basic training in spraying 1 - 2 weeks Superintendents,inspectors, 3 832 Birat~garand Nepalganj foremen, spraymen and others I SEA/RC~~/Z Annex 9 Page 11 J NO. of Total No. Subject Type of course or training Duration and location Categories of trainees courses of trainees

Malaria Basic training in 2 weeks Cartographers 2 20 cartography Kathmandu

,I Basic training in 8 weeks Evaluation inspectors and 1 10 Surveillance and Biratnagar supervisors epidemiollgy

I Refresher course in 3 weeks Entomological field 1 10 entomology Biratnagar assistants and technicians

Smallpox Vaccination technique and 1 month Vaccinators 1 30 control associated basic training Kathmandu

Rural health Basic training 2 years Auxiliary health workers 2 96 Auxiliary Health Workers' School, Kathmandu 1 Nursing Basic nursing 3- years Student nurses Continucus 52 2 School of Nursing, Kathmandu

THAILAND

Malaria Basic training in malaria 1 year Squad chiefs 2 4a eradication, entomology, Malaria Training Centre, parasitology and public Prabuddhabat and Chiengmal health SEA/RC~~/Z Annex 9 Page 12

NO. Of Total No, Subject Type of course or training Duration and location Categlries of trainees courses of trainees

Malaria Basic training in 2 months Microscopists laboratory work and Prabuddhabhat , Chiengmai, laboratory diagnosis of' Konkaen, Songkla and malaria Bangkok

Refresher training ?n 7 days Zone and sector chiefs and 5 geographical recocais 2nce ?I;ztucli.z.h--u..dt, Chiengxai, assistant chiefs; province spraying and surveilla ce Kcnkaen, Song!rla and and district health operations, c.aluation End Sriracha (Cholburi) officers; representatives surveillacce, health Omhe : 1!3vy and education and a4ninist1 .- ! en.! ne6icai tion f pzivincinl hi;cpit:iiicerf

Health education coursc 1 month I Health educators (school 1 Bangkok teachers and journalists)

Training in active case- 7 days House visitors (surveil- detection Prabuddhabhat , Chiengmai, lance workers) Konkaen, Songkla and Sriracha

Training in surveillance 7 days Zone and sector chiefs operations National Malaria Eradica- tion Programme Head- quarters, Bmgkck

Training in Entomology 7 days Entomological assistants NMEP Headquarters, and insect collectors 1 I Bangkolc SEA/RC~~/Z Annsx 9 Page 13

NO. Of Subject Type of course or tralnlng Duration and location Categories of trainees I courses Leprosy Practical training in 6 weeks Auxiliary leprosy workers 3 leprosy control Phra Pra Daeng

B3sic training 1 year Secondary schssl students 1 Bangrak Central Laboratory

3'-:'rduct-c!: to laborat Jry 1 month Laboratory assistants 1 techniques Centrzl Chest Clinic, Banglcok

Lectures and field 3 weeks Field supervisors 1 demonstration in technljues Provincial Health Office, of health education and Korat therapy

Aczdelnic undergraduate 1 academic year Undergraduate pharmacy 2 course in drug evaluation, School of Pharmacy, students etc. Bangkok

Basic training 4 years Student nurses Continuo Bangkok, Pltsanuloke and Korat

Post-basic training 1 year Graduate nurses 1 post-basic school of Nursing. Bangkok SEA/Rc17/2 Annex 9 Page 14

No. of Total No. Subject Type of course or training Duration and location Categories of trainees courses of trainees

Preventive and Academic undergraduate Continuous Medical students 2 8 50 social course Siriraj and hulalongkorn medicine Medical Schools, Bangkok

Social and Orientation 1 reek Resident paediatricians 1 15 preventive Siriraj Hospital, Bangkok paediatrics

Rural health Multi-purpose training for 2 weeks Doctors, nurse supervisors 2 70 rural health workers Pitsanuloke sanitarians. nurses and midwives