P a R T 111 Activities Undertaken By

PART 111

ACTIVITIES UNDERTAKEN BY GOVERNMENTS

WITH THE HELP OF WHO SEA(RC30/2 Page 89

PROJECT LIST

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

In the first column (under "Project Number - codes in parenthesis denote old numbers - Source of Funds, Co-operating Agencies") "R" means the Regular budget; "UNDP" the United Nations Development Programme; "KSFPA" the United Nations Fund for Population Activities; "FUNDWI" the Fund of the United Nations for the Development of West Irian; "UNICEF" the United Nations Children's Fund, and "US AID" the United States Agency for Inter- nati~ndlDevelopment. Names of LO-operating agencies, except for UNICEF, whether or not they have contributed funds, are given in parenthesis. In the second column, under the title of the project, the starting and, where relevant, finishing dates are shown within brackets. The projects are listed in accordance with the programme classification.

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

Projects entitled "Fellowships" list those fellowships which do not form part of assistance to a larger project; other fellowships are shown under the projects concerned. SEA/RCU)/2 Page 91

1. BANGLADESH

Agencies Title

BAN PPS 001 (SHS 001) Organization of Health Semices. Planning R and Hospital Administration (Jan. 1973 - ) Aim of the project. To establish and strengthen a sound organization for health planning in the Ministry of Health, to train personnel in health planning, to develop a health information system, including evaluation, to plan efficient integrated rural health services, including the development of a referral system, and plan health and manpower studies with the aim of improving the delivery of medical care, especially to rural areas.

Assistance provided by WHO during the year. (a) A public health administrator, a statistician and a secretarial assistant; (b) a twelve-month fellowship for study in the United States of America; (c) supplies and equipment.

Probable duration of assistance. A nlrmber of years.

Work done during the year. Under this project, a WHO task force on primary health care was constituted to develop a project document in close co-operation with various government departments as well as other United Nations agencies. Assistance was provided in collecting health and family planning data from the field for the preparation of a UNICEF report with particular reference to the setting of priorities and the allocation of resources for the Ministry of Health. A working paper on "Proposals for UNICEF assistance to the health sector during the Second Five- Year Plan period" was prepared in connexion with the formulation of detailed proposals for UNICEF assistance. Another paper entitled "Primary Health Care - Bangladesh" was prepared for an ESCAP-IRDP Workshop on Integrated Rural Development. A scheme for the establishment of a central indexing system for nurses was developed and sample vital registration areas were established. The preliminary collection of available information and data was undertaken in connexion with the country health programming exercise, which started in April 1977. The thana health complex scheme was finally approved by the National Economic Council and plans for the training of statistical assistants were formulated and their training initiated. A plan of action to undertake a survey of selected health problems was drawn up. In collaboration with a national team of civil and assistant civil surgeons,a scheme for the development of a health information system and a training programe, vas developed.

BAN HSD 001 (SHS 002) Development of Health Services and Training R of Auxiliaries (Oct. 1972 - ) Aim of the project. To develop further and strengthen integrated health programmes for rural areas (thana health centre, etc.), by planning, implementing and evaluating training and re-orientation prograrmnes for professional staff and auxiliary health and allied workers.

Assistance provided by WHO during the year. (a) A medical officer, an auxiliary health training officer and a public health nurse educator; (b) three fellowships - two for six months for studies in India. Nepal, Sri Lanka and Thailand and one for twelve months for studies in the United Kingdom and India; (c) supplies and equipment. SEAlRC3012 Page 92

Probable duration of assistance. A number of years.

Work done during the year. A public health nurse educator joined the project in December 1976 and is stationed in Rajshahi. She will be collaborating in the development of the nursing-midwifery component of the rural health services and in the educational prograrmne. In particular, she will co-ordinate the activities of nursing and midwifery personnel with those of other members of rural health teams.

The WHO medical officer and the WHO auxiliary training officer continued to collaborate in the training of various categories of auxiliary health personnel and, in addition, in progrmes for the refresher or field training of field supervisors, family welfare workers, sanitary inspectors and laboratory technicians. Assistance was also given in the teaching of cornunity medicine in field practice areas to medical students, and in the training of pharmacists-B.

BAN HSD 002 (SHS 005) Development of Health Laboratories and R Allied Laboratory Services (July 1975; Sept. 1975; Dec. 1975 - April 1976;

Aim of the project. To organize a network of public health laboratories throughout the country at district and sub-divisional levels attached to the existing hospitals for both clinical as well as public health, including sanitary laboratory work; also to strengthen further the Institute of Public Health to function as a central laboratory and produce and control the following vaccines: smallpox, TAB and beta-propio- lactone inactivated rabies and DPT.

haistance provided by WHO during the year. (a) A microbiologist and a consultant; (b) a onewnth fellowship for study in Switzerland.

Work done during the year. A microbiologist was assigned to the project in December 1976. He revieved the state of laboratories at different levels and is helping with plane to extend laboratory services. Towards this end the Institute of Public Health in Dacca is being vested with greater responsibility for developing laboratories at divisional and district levels, for meeting the requirements of laboratories at the thana health complexes for surveillance work, and for providing references for typhoid, cholera, polio and dysentery. Laboratories at thana complexes are being strengthened for use as practice areas in community medicine by graduates and undergraduates. In order to improve the efficiency of peripheral laboratories, manuals are being drafted in clinical pathology, bacteriology and clinical chemistry.

The production of vaccines was streamlined at the Institute of Public Health. The quality of the production has considerably improved since the establishment of a separate unit for testing the vaccines. Plans are in hand to manufacture the D and T components of DPT vaccine. The Institute should acquire consistency in quality before the D and T vaccine could be used in Bangladesh.

The laboratory facilities were surveyed by the microbiologist and his counterpart from the Institute of Public Health. With a view to improving the efficiency of the services, they suggested (i) laying emphasis on manpower training, particularly of doctor trainees and technicians; (ii) better utilization of staff and equipment, and (iii) streamlining of procedures for the procurement of laboratory supplies.

A consultant reviewed the clinical and research activities at the Institute of Diabetes Research and Rehabilitation, Dacca, assessed the research potential of the Institute, and advised on formulating plans for enhancing its role as a national institute for training, services and research. He also advised on the training of health and paraprofessional groups, the strengthening of clinical and laboratory services and the organization of research on problems related to diabetes prevention SEAlRC3012 Page 93

and rehabilitation. He identified the problems and assisted in developing research projects in order to mobilize external resources for these activities.

With the termination of WHOIUNICEF assistance to the production of rehydration fluid, the responsibility for the project "Production of Rehydration Fluid" (BAN ISB 001) has been taken over by the Institute of Public Health and that project has been merged with this project. The staff trained through WHO fellowships in the production of intravenous fluid as well as in control and maintenance engineering is in position.

The Government has plans to expand the premises and the plant in order to double its present capacity to 1000 000 bags a year.

BAN MCH 001 Development of Family and Child Health Services R (Jan. 1973; Apr. - Aug. 1973; Oct. 1973 - )

Aim of the project. To develop maternal and child health services in a phased manner, with special emphasis on the retraining of health personnel in maternal and child care and the training of specialist manpower for maternal and child health work, and to establish a referral system for maternal and child care in support of rural health services.

Assistance provided by WHO during the year. A consultant.

Work done during the year. A consultant took up a six-month assignment in January 1977 to help with the training programme in undergraduate paediatric education in a selected medical college. He is also assisting with the training of junior staff and in setting up a national committee on undergraduate paediatric education with a view to developing a suitable undergraduate paediatric curriculum. Assistance was given in the conduct of two national seminars - one for paediatric teachers and the other on maternal and child health.

A medical officer is under recruitment to assist in developing maternal and child health services in Bangladesh.

The activities of this project were closely co-ordinated with those of BAN MCH 003.

BAN MCH 002 Training of Health Personnel in Family Planning UNFPA (March 1975 - )

Aim of the project. To develop and implement a training programme for a new category of multipurpose health worker, tentatively called the family welfare visitor, who will vork in rural areas.

Assistance provided by WHO during the year. (a) A nurse-midwife educator; (b) five two-week fellowships for study in Sri Lanka; (c) supplies and equipment.

Probable duration of assistance. Until 1980.

Work done during the year. A programme for the training of family welfare visitors (ms) was prepared; 292 Wscompleted their training in February 1977 and 397 students were admitted in seven training institutes. The new curriculum was approved by the Bangladesh Nursing Council and the principals and trainers held discussions on its implementation. At the sub-centre level, a new categoly of worker was developed - 3043 family welfare assistants (female) and 1472 family planning assistants were trained; they now work in 145 thanas. Fifteen senior lady health visitors completed their training as thana health supervisors. The WHO nurse- midwife educator assisted the Government in preparing teaching aids and in drawing up the list of equipment essential for family planning activities. SEAlRC3012 Page 94

BAN MCH 003 Strengthening of the Family Planninz Clinical UNFPA Programme with Special Emphasis on Maternal and Child Health-based Family Planning (July 1974 - )

Aim of the project. To develop the clinical progranrme in family health in a phased manner with special emphasis on family planning based on maternal and child health.

Assistance provided by WHO during the year. (a) A maternal and child health officer; (b) supplies and equipment.

Work done during the year. The project document was signed by the Government, UNFPA and WHO.

The medical officer assigned to the project left in December 1976; a replacement is under recruitment.

The medical officer assisted the national authorities in preparing the first draft of the maternal and child health programme for the Second Five-Year Plan.

Tne first group of doctors visited Indonesia to observe maternal and child health- based family planning activities.

The Tripartite Review was held in April 1977, when it was agreed to extend the project beyond 1977. Steps are being taken to prepare the necessary project document.

The activities under this project were closely co-ordinated with those of BAN MCH 001 and other UNFPA-supported projects in Bangladesh.

BAN HRP 001 Teaching of Human Reproduction. Population UNFPA Dynamics and Family Planning, including Maternal and Child Health-based Family Plannina in Medical Colleges with Establishment of Field Practice Areas (Jan. - April 1975; - )

Aim of the project. To provide a comprehensive training programme in integral family planning and health care (family health) for medical undergraduates to enable them to function in rural and urban areas effectively and with the competence necessary to achieve national aspirations.

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

BAN HRP 002 Mobile Sterilization Teams UNFPA (Jan. 1977; - )

Aim of the project. To equip mobile sterilization teams to provide sterilization services to the rural areas and train staff in peripheral institutions.

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

BAN HED 002 Health Education R (Jan. - March 1974; June 1976 - )

Aim of the project. To develop health education, including services, manpower training, studies, methods, materials and media and other components of the programme such as school health and family life education. SEAlRC3012 Page 95

Assistance provided by WHO during the year. (a) A health education specialist; (b) a twelve-month fellowship for study in India; (c) supplies and equipment.

Probable duration of assistance. Until 1983. Work done during the year. The health education specialist who was assigned to the project in June 1976 has been assisting the Government in reviewing, reorganizing, strengthening and expanding health education services. He carried out a survey of the health education services in the country and made recommendations for improvement. Assistance was also given in idqntifying the educational components of health services and in planning, implementing and evaluating these aspects. The in-service training of health workers received assistance, and plans were made for a national health education conference, to be held later in 1977.

BAN HMD 001 Nursing Advisory Services and Training (Aug. 1972 - ) Aim of the project. To develop the nursing component of national health care delivery services and the programmes in nursing and midwifery essential to the preparation of the necessary nursing personnel.

Assistance provided by WHO during the year. (a) A senior nurse educator, a public health nurse educator, a nurse consultant and a secretarial assistant; (b) four fellowships - one for twenty-four months for study in India and three for four weeks for studies in Thailand, Yugoslavia and the United Kingdom; (c) supplies and equipment.

Probable duration of assistance. Until 1980.

Work done during the year. Through the assistance of this project to the post-basic nursing programe enough tutors have been trained to provide qualified nurse tutors to each nurse training centre in Bangladesh. The training centre has expanded its programme to include the preparation of public health nurses who will help provide health services to the rural population. Of the 52 students now enrolled, ten are in the public health nursing specialty programne.

The post-basic training centre has also trained 50 nurses and lady health visitors as trainers of family welfare workers; 27 more will complete their training by June 1977.

The library of the post-basic training centre has been fully organized through the assistance of a consultant. Another consultant taught two courses in paediatric nursing in Rangpur and Sylhet early in 1977.

The project staff is assisting the Director of Nursing in compiling an index of all nursing personnel in the country.

BAN ESD 001 Strengthening of Epidemiological Services R (Aug. 1972; Feb. 1973; July 1973 - Dec. 1974; UNDP Aug. 1975; Jan. 1976; Aug. 1976 - ) Aim of the project. To improve and strengthen the surveillance and control of communicable diseases in the integrated health services.

Assistance provided by WHO during the year. (a) An epidemiologist; (b) supplies and equipment. Work done during the year. Epidemiological control and surveillance of communicable diseases continue to be major activities. A WHO epidemiologist was assigned to the SEA/RC30/2 Page 96

project in mid-August 1976 and concurrently under project BAN ESD 002 - Epidemiology and Disease Control. He has also been assisting the Institute of Epidemiology and Vector Control. Useful baseline data have been compiled and a nucleus created for disease surveillance. A survey of selected health problems was planned and tested in the field, and is being conducted to determine the disease patterns (see also BAN ESD 002). The drafting of legislation to support disease-control programmes is under study.

BAN ESD 002 Epidemiology and Disease Control UNDP (Jan. 1975 - )

Aim of the project. To review, plan and prepare a programme for organizing an epidemiological service in the country; to organize the Institute of Epidemiology and Vector Control Research, which will train technical personnel and give consultations on technical matters, and improve the organization of surveillance and control of communicable diseases in integrated health services.

Assistance provided by WHO during the year. (a) Temporary assistance from the epidemiologist assigned under project BAN ESD 001; (b) supplies and equipment.

Work done during the year. The project document was signed by the Government, WHO and UNDP in August 1976. The WHO epidemiologist assigned to project BAN ESD 001 has concurrently been working under this project and assisting in the further development of a central epidemiology unit at the Institute of Epidemiology and Vector Control.

In order to determine the disease patterns, a survey of selected health problems is being carried out. For this purpose, a national statistician was appointed on a contractual basis to assist with the statistical aspects.

The first number of the newsletter on epidemiology and disease control was issued in February 1977, and was widely distributed among the health institutions down to the thana level. The newsletter is intended to disseminate information on epidemiology and disease control to all public health workers.

Cases of tetanus admitted to the Infectious Diseases Hospital during 1976 were studied and the data were being analysed. About 900 cases of tetanus were admitted, of whom one third died in hospital. Among the deaths from tetanus about 60% were found to be of the neonatal type.

A team from the Institute of Epidemiology, Disease Control and Research spent about 20 days in the field during February and March 1977, studying the epidemiology of filariasis in Dinajpur District.

A WHO parasitologist, a WHO virologist and a WHO entomologist are under recruitment.

BAN MPD 001 Malaria Eradication R (Nov. 1972; July 1973; Sept. 1973 - Jan. 1974; March 1974; Feb.-March 1975; Dec. 1975; Aug. 1976 - )

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 vear. (a) A malariologist, two consultants and temporary assistance from a sanitary engineer and a public health administrator assigned to other projects: (b) a six-month fellowship for study in Thailand; (c) supplies and equipment.

Probable duration of assistance. A number of years. SEA/RC30/2 Page 97

Work done during the year. According to the mid-year estimates for 1977, out of a total population of 76.4 million in Bangladesh, 37.7 million are in the pre- maintenance phase, 33.5 million under discovery and treatment of cases, including the consolidation phase, and 5.2 million under extensive mosquito control, including the attack phase. A WHO malariologist was assigned to the programme during the year. In addition, a public health administrator, an epidemiologist, an entomologist and a sanitary engineer were provided by WHO to participate in a 'situation analysis' conducted jointly by a Government/WHO/USAID team at the end of 1976. The team endorsed the Gwernment's policy to change the strategy from an autonomous, time-limited eradication programme to one of realistic malaria control within the general health services. It recommended, among other things, strengthening of the thana health complexes in high malaria-risk zones, field investigations in areas with technical problems, and the orientation and training of medical and health personnel in malaria control. The 400 tons of DDT being supplied by the Government of the Netherlands will be available only towards the end of the period under review. Pre-monsoon spraying will therefore have to be restricted to selected high-risk areas, and will be carried out with the available DDT (150 tons) manufactured locally. The shortage of DDT is severely hampering the programme and there is an urgent need for securing adequate supplies.

During 1976, a training course for 28 newly recruited microscopists was held at the Malaria Eradication Training Centre, Dacca. In addition, 24 microscopists underwent an eight-week course in laboratory techniques at the Para-medical Medical Institute, Dacca. A one-week orientation course in malaria for civil and additional civil surgeons was held at MEP Headquarters, Dacca, in which both national and international malariologists participated as lecturers. Five medical officers of the MEP are undergoing a one-year DPH course at the Institute of Post-graduate Medicine, Dacca. The epidemiological information for 1976 shows that 44 645 slides were found positive for malaria in the examination of 3 506 597 blood smears, giving a slide positivity rate of 1.27% (as compared to 31 247 positives detected out of 2 929 935 examinations, resulting in a slide positivity rate of 1.07%, during 1975). A further improvement - 19.7% in slide examinations - over the 1975 level was noticed, but the increase (18.7%) in the slide positivity rate indicated a further deterioration in the epidemiological situation. The increase in examinations (26.0%) was this year again from areas in consolidation and maintenance; in attack areas there was a further 5% fall in examinations, compared to the 1975 level. The increase in detected cases in 1976 over the.previous year in consolidation and maintenance areas was again high - 115% - whereas that in attack areas was 25%. The slippage in non-attack areas, thus, continued. P. faZciparnun infections further dropped by about 5% as a proportion of total positives, while in absolute nrnnbers they registered a 32% increase in 1976 over 1975.

In vivo studies on the resistance of P. faleiparnun to the 4-aminoquinolines are being continued. In vitro tests are also planned, depending on the availability of test kits.

A study on the bionomics of vector A.b. balabacensis is being conducted along with one on the effectiveness of DDT and Malathion in respect of the number of cycles and dosages. Studies are also under way regarding the re-appearance of malaria vectors A. phiZippinensis and A. sundaicus after the withdrawal of DDT spraying. The effects of intensive irrigation and of the Farakka Barrage on vector distribution are also under study. SEA/RC30/2 Page 98

BAN SPI 001 Smallpox Eradication R (March 1972 - )

Aim of the project. To achieve total eradication of smallpox in the country by 1977.

Assistance provided by WHO during the year. (a) Two medical officers, two administrative officers and a secretarial assistant; (b) supplies and equipment.

Work done during the year. During the year, surveillance for cases of smallpox has been maintained at a high level. Three searches were carried out all over the country in which all villages were visited during a limited period in a search f~r cases of smallpox, chickenpox and fever with rash cases; no case of smallpox was discovered. An assessment at the end of the year showed that 99% of all villages had been searched and that over 85% of households were aware of the reward of TK 500 for reporting cases of smallpox.

In doubtful cases, specimens for laboratory examination were collected and duplicate samples sent to WHO reference laboratories. Following the reporting of specimens from a case of buffalopox, an intensive search was conducted for other human patients and for a wildlife reservoir of the virus. A film was made of these activities.

Sixty-two surveillance teams continued to operate in both rural and urban areas.

WHO has maintained an average of nine staff members in the country and has trained groups of national epidemiologists each month.

Project staff assisted in surveys of health utilization, natalitylmortality, lathyrism, awareness of family planning and the incidence of disease.

BAN BVD 001 (MBD 003) Mycobacterial Disease Control R (Jan. 1975 - )

Aim of the project. To develop, organize, implement and assess the surveillance and control of mycobacterial diseases.

Assistance provided by WHO during the year. (a) A leprologist, a medical officer and a technical officer (laboratory operations); (b) Two fellowships - one for twelve months for study in India and one for six months for studies in India, Sri tanka, Malaysia and Burma; (c) supplies and equipment.

Work done during the year. A draft plan of action for the project was prepared. A leprosy manual for the thana health complex and the WHO-supported Mycobacterial Disease Control Project was printed and distributed in the field. The manual primarily focuses on case-finding and case-holding activities in the field, with the support of the general health services.

Passive case-finding in thana health complexes was continued.

Model areas are being set up in four thanas. Ten additional thanas were selected as "crash areas" for leprosy control. These thanas are located in leprosy endemic areas. As a preparation for the baseline survey, basic information was collected from these thanas.

The intensified BCG vaccination programme proceeded according to plan. Reorienta- tion training of BCG technicians was arranged with a view to preparing them to serve as trainers of family welfare workers. In 1976, 609 025 BCG vaccinations were perf ormed. SEA/RC30/2 Page 99

According to a preliminary report on the leprosy drugs trial, the trial covered 54 cases, besides the control group. Among them DDS treatment was initiated with 600 mgmlweek for 15 patients and with 350 mgmlweek for 39. The results are being analysed further, but it is clear that DDS at the initial dose of 350 mgmlweek is well tolerated by the lepromatous patients. The final data on the analysis are expected to be available shortly.

BAN PBA 001 (SQP 001) Phamceutical and Biological Quality Control R (Aug. 1972 - Feb. 1973; Aug.-Sept. 1973; Jan.- April 1974; March 1975 - Jan. 1976; Aug. 1976 - )

Aim of the project. To strengthen drug quality control laboratories at central and zonal level and to train technical staff.

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

Work done during the year. The WHO scientist (pharmacist) assigned to the project in September 1976 has been assisting in assessing the existing situation as well as in formulating a drug policy, strengthening drug legislation, organizing a system of laboratories for pharmaceutical analysis and quality control, and training personnel.

Lists of various categories of staff required for the new manufacturing unit attached to the Central Medical Stores (CMS) at Tejgaon, Dacca, have been prepared. WHO will provide the necessary machinery and other equipment for this unit.

The WHO scientist advised on the improvement of the facilities for drug quality control at Mahakhali Medical Complex and demonstrated new methods to the technical staff. This unit is also to receive equipment from WHO.

A programme was drawn up to train the staff of the drug laboratories in new methods of analysis and drug inspectors and final-year students of the School of Pharmacy in manufacturing practices and quality control. Assistance was provided in conducting training courses for the directors of production and quality control of a number of pharmaceutical companies. These courses were held in Chittagong from 15 to 27 November 1976. Curricula for three pharmacy courses were re pared - a crash three-month programme for all existing drug stores, a two-year "pharmacy B" for drug store operation, and a course for modernization of the curriculum of the School of Pharmacy.

The WHO scientist served on various professional pharmaceutical committees.

BAN BSM 001 Cornunity Water Supply and Sanitation R (Dec. 1972 - ) UNICEF

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

Assistance provided by WHO during the year. (a) A sanitary engineer and a sanitarian; (b) six three-week fellowships for studies in India and Thailand; (c) supplies and equipment.

Work done during the year. Assistance continued to be given in developing water supply and sanitation activities. In order to implement the second plan of operation for 155 000 shallow tubewells and 5 000 deep tubewells, which was signed in August 1976 by the Government, UNICEF and WHO, national engineers were trained and subsequently posted at the thana level. SEA/RC30/2 Page 100

A sanitary scheme for 12 CARE villages was revised in order to recommend the sale of latrine components at subsidized rates. Out of 700 demonstration school latrines, 31 have been completed. Another primary school demonstration latrine programme with UNICEF assistance was launched in October 1976 to cover 40 schools, and the construction work began in November 1976.

Early in 1977, the Government embarked on a programme to establish under-five-clinics at rural health centres throughout the country. The project actively contributed to the development and implementation of a demonstration latrine progranrme for under- five-clinics. It also developed amicable working relationships with voltmtary agencies providing assistance in the field of environmental sanitation. It is hoped that this would greatly accelerate the implementation of the programme in the future.

The WHO sanitary engineer, together with the WHO sanitarian, continued to give technical guidance and assistance in providing water supply and sanitation facilities throughout the country, including the development of a project funded by UNDP for extending engineering and financial management assistance to the Dacca and Chittagong Water and Sewerage Authorities, which was approved in November 1976.

The project was visited by consultants and fellows interested in various subjects such as rural water supply, sanitation, and surface and groundwater quality.

UNICEF continued to provide assistance to the project.

BAN PBL 001 Prevention of Blindness (Nov. 1976 - Feb. 1977; - ) Aim of the project . To (i) formulate and implement a comprehensive national strategy for the orevention and control of blindness and visual impairment; (ii) organize community-oriented ophthalmic services as part of the existing public health delivery system; (iii) strengthen the training of health and allied manpower, including specialists, for this purpose, and (iv) promote epidemiological investigations for the prevention and control of visual impairment and blindness.

Probable duration of assistance. Until 1980. Work done during the year. A consultant assigned during November 1976 - February 1977 evaluated the available ophthalmic facilities, studied the operation of mass eye camps organized in rural areas and discussed with the national authorities and the Preeident of the International Agency for the Prevention of Blindness a plan of action for training and services in community-oriented public health ophthalmology. Supplies and equipment were made available from the Royal Commonwealth Society for conducting 50 mass eye camps in rural areas. Efforts were made to provide another consultant to review the state of public health ophthalmology and assist in formulating a national programme for the establishment of community-oriented public health ophthalrmlogy as an integral part of the existing medical care system. He will also advise on the training of health and allied personnel for providing an integrated comprehensive community-oriented eye health service.

BAN CVD 001 Cardiovascular Diseases R (April-June 1977; - ) Aim of the project. To assess the morbidity and mortality due to cardiovascular diseases and train specialized health and allied manpower required for a prevention, control and rehabilitation programme; to establish epidemiological, educational and therapeutic services against cardiovascular diseases.

Assistance provided by WHO during the year. (a) A consultant; (b) supplies and equipment. SEA/RC30/2 Page 101

Probable duration of assistance. Until 1980.

Work done during the year. A consultant was assigned during April-June 1977 to evaluate the facilities for training, services and research for the prevention and control of cardiovascular diseases. He conducted a workshop for the representatives of public health services and members of medical faculties and developed community- oriented strategies for the prevention and control of rheumatic heart disease, hypertension, myocardial infarction and peripheral vascular occlusive disorders.

BAN HWP 001 Occupational Health R (0ct.-Nov. 1973; April 1975; April 1976; Dec. 1976 - March 1977; - ) Aim of the project. To control health hazards in industry.

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

Probable duration of assistance. Until 1983.

Work done during the year. A consultant in occupational health was assigned to Bangladesh from December 1976 to March 1977 to study the occupational health problems in the country and to make broad-based recommendations for the development of services. He made a number of visits to various departments, institutions and establishments and held discussions with the officials concerned. He also assisted in the conduct of two national seminars on: (1) Making Work More Human, and (2) Social Security and National Development. Assistance was provided in reviewing the existing labour laws and in revising the draft of the Tea Labour Rules, 1976. Lectures on some important aspects of occupational health were given. An important activity was the "First Training Course on Occupational Health for Doctors and Related Personnel in Industries". Thirty-two occupational experts took part in this course; many lectures were given and field visits were organized for the participants.

The recommendations of the consultant were submitted to the Government. SEA/RC 30 / 2 Page 103

2. BHUTAN

Project Number Source of Funds Co-operating _Agencies Title

BHU HSD 001 (SHS 001) Development of Health Services UNDP (Jan. 1975 - ) UNICEF (WFP)

Aim of the project. To establish basic health units, provide integrated curative and preventive health services with special emphasis on maternal and child health and the control of tuberculosis, train health manpower for the basic health units, ensure quality control of drinking water, and improve the nutritional state of the population.

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

Probable duration of assistance. Until 1979.

Work doneduring the year. A programme to train health assistants, auxiliary nurse midwives and basic health workers was introduced at the Health School established at the General Hospital, Thimphu. The job descriptions and job responsibilities for the three grades were developed. Similarly, the curricula and syllabi for these three grades of trainees were finalized. Refresher, conversion and rc-orientation courses were organized for compounders, nursing auxiliaries and vaccinators. Assistance was given in the systematic conversion of existing dispensaries into basic health units; the nmber of such dispensaries was increased from 46 in 1974 to 61 during 1976. Sixteen basic health units had been established by 1976. Maternal child health, family planning and nutrition were introduced at most zonal and district hospitals, but the quality and quantity of the services varied, depending upon the personnel, their number and state of training. Diagnostic facilities for tuberculosis were strengthened by the teaching of tuberculosis microscopy to health assistants and the supply of microscopes and reagents to all basic health units. The organizational sections of a draft operational manual for the basic health unit organization, including a revised draft model of a basic health unit, were completed.

Technical co-operation was extended in finalizing a World Food Programme project to provide food supplements to hospital in-patients, infants and feeding mothers in the development and resettlement areas. Proposals for a UNICEF project for inclu- sion in the 1977-1981 UNICEF planning period were also formulated with WHO'S assistance. Two public health laboratories were set up, and a standardized list of drugs, supplies and equipment for basic health units and dispensaries vas developed, and is being implemented. A basis was provided for the collection of health statistics and records by designing records and returns in respect of the general activities as well as the family planning and tuberculosis work of basic health units.

The WHO project staff completed their assignments at the end of December 1976. The project will henceforth be implemented by the Government of Bhutan through a national project co-ordinator. In line with these developments,the project document is being reviewed for reprogramming purposes. SEAlRC3012 Page 105

3. BURMA

Agencies Title

BUR PPS 001 (SB 002) Planning and Strengthening of Health Services R (May-Aug. 1969; Jan.-March 1970; Nov. 1970; May 1972; UNICEF Oct. 1972; Oct. 1973 - March 1974; Aug.-Nov. 1974; Aug.-Sept. 1975; Jan. 1976 - )

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

Assistance provided by WHO during the year. (a) A consultant in operational studies; (b) six fellowships - one for nine months for study in the USSR, four for welve months for studies in Thailand and India. and one for five months for studies in the United Kingdom and Egypt; (c) supplies and equipment.

Work done during the year. An extensive country health programming exercise was undertaken which resulted in project formulation on primary health care, family health, expanded programme of immnization,environmental sanitation, vector-borne disease control and medical care. In addition to these service programmes, six support projects were formulated, i.e., supplies system, repair and maintenance of health equipment; staff and procedure development; promotion of health laboratory technology; health services and other biomedical research in support of country health programing; health information development, and the development of production and quality cmtrol of biological and pharmaceutical products. Assistance was provided in reviewing the existing operational research studies and health services research and advice was given on the development of studies relevant to the health care delivery system to be carried out in future.

BUR HSD 001 (SHS 001) Rehabilitation of the Handicapped R (0ct.-Nov. 1969; July 1970; July 1971; 0ct.-Nov.1971; May 1972: Sept.1972 - Feb. 1974: May. 1974: July 1974: M.aich-~p;il i975; March 1976 - j

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

Assistance provided by WHO during the year. (a) A physiotherapist, an occupational therapy tutor and a consultant; (b) five six-month fellowships for study in the United Kingdom; (c) supplies and equipment.

Work done during the year. The occupational therapy tutor provided to the project in March 1976 completed her assignment in August. She visited a number of hospitals and institutions to obtain first-hand knowledge about the services related to occupational therapy. Assistance was given in hand-splinting by using inexpensive material and in training national staff in the techniques of occupational therapy. She also helped in organizing a Department of Occupational Therapy at the ~ospital for the Disabled and in drawing up a curriculum for the proposed School for Occupational Therapy. Her recommendations have been sent to the Government.

A specialist in orthopaedics and rehabilitation assisted the Kernmendine Orthopaedic Hospital in reviewing its problems and needs and advised on the further planning and development of the Hospital. SEA/RC30/2 Page 106

In addition, a physiotherapist was deputed early in January 1977 for about six weeks to help the Government in holding an "intensive course of practical exercise therapy in rehabilitation". organized for physiotherapists in order to train than in conducting similar courses in the country.

BUR HSD 002 (5HS 003) Maintenance and Repair Workshop for Health Equipment R (Sept. 1971 - Feb. 1975; Nov. 1975; June 1976 - ) UNICEF

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

Assistance provided by WHO during the year. (a) A consultant; (b) three fellowships - me for nine months for study in Lndia, one for twelve months for study in Australia-- - and one for studies in the Federal Republic of Germany, the United Kingdom and Czechoslovakia.

Probable duration of assistance. Until 1979.

Work done durina the year. The WHO electro-mdical engineer provided to the project in June 1976 canpleted his assignment in September. During this period, practical training was given to technicians from varioua hospitals and, as a result, several hundred items of equipment were repaired and put into operation. In addition to the expansion of the workshop at the Rangoon General Hoapital, 12 first-line maintenance workshops were set up at various hospitals for day-to-day repairs. In pursuance of the policy to extend the maintenance and repair facilities to hospitals throughout the country, seven divisional hospital workshops were established to service the equipment in their own and other hospitals within each division. A simple system of stores and workshop administration. designed to collect information and establish records of equipment, was introduced. The report of the engineer was forwarded to the Government.

BUR HSD 003 (SHS 004) Hospital Services Management R (Feb.-May 1975; Jan.-Feb. 1977; April 1977; - )

Aim of the project. To promote hospital administration and management, including the planning and development of facilities for the diagnosis, treatment, care and rehabilitation of the sick.

Assistance provided bv WHO during the year. (a) Five fellowships - one for ten months for study in the United Kingdom, two for four months for study in India, one for four months for studies in Australia and Singapore, and one for six months for study in the United Kingdom; (b) supplies and equipment.

BUR PHC 001 Primary Health Care and Basic Health Services R (Feb. 1977 - )

Aim of the project. To develop the primary health care programe, including the training of trainers of primary health workers and primary health workers themselves, and strengthen basic health services aimed at providing effective support to and supervision of the primary health care programe, including assistance in dealing with the problems of tuberculosis and leprosy in the cormrmnity.

Assistance provided by WHO during the year. (a) A statistician and two consultants; (h) supplies and equipment.

Probable duration of assistance. Until 1979 SEA/RC30/2 Page 107

Work done during the year. A consultant was assigned to the project in February to evaluate the former leprosy/BCG trial and study the evaluation of leprosy cases from the indeterminate to the lepromatous form among the cases in the trial programme. The long-term statistician continued his activities in following up the BCG trial in Mandalay. Together with a consultant he was involved in the planning of the rifampicin trial to be implemented in the near future. Another consultant reviewed the progress of the trachoma control project and advised on the strengthening of training and services in the field of trachoma control and the prevention of blindness. Assistance was also given in developing a national programme for the promotion of eye health.

BUR MCH 003 Development of Family and Child Health R (June 1975; Aug. 1975; March 1976; July 1976; Sept. 1976; Nov.-Dec. 1976)

Aim of the project. To plan, implement and evaluate a family health program@ with emphasis on maternal and child health and nutrition activities; to develop staff for the family health program.

Assistance provided by WHO during the year. (a) Seven fellowships - two for three months for studies in India and Thailand, two for three months, one for four nonths and two weeks, one for five months and two weeks and one for twelve months for study in the United Kingdom; (b) supplies and equipment.

Work done. Emphasis was laid on adequate training and orientation of health workers in maternal and child health (including school health) under the fellowship programme. Supplies and equipment were provided to improve the quality of maternal and child health services at the peripheral maternal and child health outlets and in supporting referral services. From 1977 the activities of this project are being continued under BUR MCH 004.

BUR MCH 004 Family Health R (March 1977 - )

Aim of the project. To plan, implement and evaluate a family health programno, with emphasis on maternal and child health and nutrition activities; to develop the staff for the programme.

Assistance provided by WHO during the year. (a) A medical officer (maternal and child health); (b) three twelve-week fellowships for studies in India, Sri Lmka, Malaysia and Indonesia.

Probable duration of assistance. Until 1979.

Work done during the year. A medical officer joined the project in March to assist the national authorities in reviewing, planning and implementing the maternal and child health services with a view to strengthening these services within the context of total family health.

BUR NUT 001 Nutrition Services R (May 1972; Oct. 1972; May-June 1974; Nov. 1974; June 1975; Oct. 1975 - Jan. 1976; June 1976; bug. 1976; Nov. 1976; - )

Aim of the project. To strengthen nutrition activities of the health services by assisting the nutrition unit of the Directorate General of Health in developing models and in its programme of in-service orientation courses for medical personnel. SEA/RC30/2 Page 108

Assistance provided by WHO during the year. (a) Four fellowships - one for nine months for study in the United Kingdom, one for eleven months for study in India and two for three months for studies in India and Thailand; (b) supplies and equipment.

BUR HE0 001 Health Education (Nov. 1966; May 1968; Aun. 1971; Nov. 1971 - Jan. 1972: ~une-~ug.1972; oct. 1953 - an. 1974; ~ug.1974 - Jan. 1975; Sept.-Oct. 1975; June 1976; March 1977)

Aim of the project. To develop health education services and to provide training in health education to teachers and those holding key posts in the school organization and in the general health services; to develop health education manpower and educational materials required for health education services and training programmes.

Assistance provided by WO during the year. (a) Five fellowships - three for three months for study in India, one for six months for study in the United Kingdom, and one for three months for study in Thailand; (b) supplies and equipment.

Work done. This project, which started in 1966, provided assistance in organizing training courses for various categories of teachers and health educators during the two years 1966 and 1968. Subsequently, consultants helped with the training and in reviewing health education activities in 1971 and 1972. Three training courses were held in 1973 for tovnship medical officers and for the staffs of the Medical Institute and the Teacher Training College. During 1974-1975 a consultant reviewed the state of health education services and helped in formulating plans for further strengthening these services.

Evaluation

Burma had already established health education services when WHO'S assistance in health education began. The project provided assistance in reviewing these services and in identifying the areas in which strengthening or expansion was required. In addition, help was given in formulating plans for such strengthening or expansion. Further, besides training key personnel of the Ministries of Health and Education in health education within the corntry, assistance was given to enable selected health education specialists to receive additional training abroad. The project has thus helped the health education services of the comtry in organizing themselves so as to provide better support to health programmes.

BUR HMD 001 Nursing Advisory Services R (March 1959 - April 1966; June 1969; Oct. 1970 - Jan. 1971; May 1971 - Dec. 1976)

Aim of the project. To assist in the development of nursing and midwifery education and services.

Assistance provided by WHO during the year. (a) Seven fellowships - one for two months, one for five months (extensions),one for six months and one for fourteen months - for study in the United Kingdom; one for nine months for studies in India and Thailand, one for thirteen months for studies in India and Indonesia and one for twenty-four months for study in India; (b) supplies and equipment.

Work done. WHO assistance through this project started in 1959. Earlier, beginning in 1951, assistance had already been given to nursing with a series of proJects through which refresher courses for nurses were given, individual schools of nursing strengthened and an adviser provided to the Department of Nursing of the Health Directorate. SEAlRC3012 Page 109

The objectives of the project were to: (i) expand and upgrade the undergraduate and midwifery training programmes, (ii) co-ordinate undergraduate and post-graduate training, and (iii) improve nursing services in those institutions which were used for teaching students.

From 1959 to 1962, two long-term nurse educators were assigned to help meet the above objectives. Assistance was given particularly in paediatric nursing.

From 1962 onwards, assistance was given primarily through the assignment of consultants who carried out short courses. In addition, fellwships were awarded and supplies provided. Toelve fellowships ranging from one month to 12 months in duration have been awarded between 1961 and 1977. From 1968 to 1975. 11 inter- country and 14 country-level short courses were taught, the topics ranging from ward administration and clinical teaching to a variety of clinical nursing subjects. The activities of project ICP HMD 001 "Continuing Education for Nurses" (SEAR0 0139) were co-ordinated closely with those of this project. With the assignment in 1973 of a long-term nursing staff member to project BUR HMD 005, the activities of these two projects were also closely co-ordinated.

Evaluation

The project has, through the provision of both long-term staff and short-term consultants, fellowships and supplies and equipment, assisted the Government in upgrading nursing education and services. Schools of nursing and midwifery and the post-basic school now have at least a minimum of teaching materfals,and their tutors are better prepared through short courses in clinical teaching. The value of short courses in clinical subjects is particularly evident in the orthopaedic and neonatal wards. All nurses who have been awarded fellowships have returned to Burma and are actively engaged in nursing.

BUR HMD 004 Sanitary Engineerinp. Education and Training, UNDP Institute of Technology, Rangoon (May 1969 - )

Aim of the project. To strengthen the teaching programme in sanitary engineering For undergraduate civil engineering students and to develop a post-graduate programme in sanitary engineering.

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

Prabable duration of assistance. Until 1978.

Fork done during the year. A WHO professor of sanitary engineering was assigned to the Institute of Technology, Rangoon, in January 1977 to assist in conducting courses in sanitary engineering, including demonstration, practical field work and research, at the Department of Civil Engineering. He will also help in promoting and Strengthening the environmental hygiene aspects of the post-graduate training programme of the School of Preventive and Tropical Medicine.

The proposal to institute a post-graduate programme in sanitary engineering is awaiting Government approval.

BUR HMD 005 Education and Training of Health Manpower WDP (Nov. 1972 - )

Aim of the prolect. To strengthen undergraduate and post-graduate education in the three existing medical institutes in Burma, the education and training of nurses, midwives and lady health visitors, the education and training of various categories of auxiliary health personnel, and to expand and strengthen the Hlegu Rural Health Demonstration Area as the common training field for all members of the health team. SEAIRC30IZ Page 110

Assistance provided by WHO during the year. (a) A project manager, a nurse educator, a paediatric nurse and four consultants; (b) twenty-four fellowships - fifteen for study in the United Kingdom (one for twelve months, tw for six months, one for four months and two weeks, six for four months, one for two months and two weeks (extension), two for two months (extension), one for six weeks (extension) and one for two weeks); two for four months for study in India; three for six wnths - one for study in Australia, one for study in Canada and one for study in the United Kingdom and India; one for four months and two weeks for studies in India and Singapore; one for four months for studies in the United Kingdom and Malaysia; one for four months for studies in the United Kingdom and Denmark, and one for four months for study in Japan; (c) supplies and equipment.

Probable duration of assistance. Until 1978.

Work done during the year. The project manager completed his assignment in October 1976 and his replacement joined the project in January 1977.

During the period under review four consultants were assigned to the project - one in clinical biochemistry, one in operational research in medical education, one in radiology and one in hwn genetics. The reports containing the recommendations of these consultants were sent to the Government. Arrangements are being mde for the assignment of two more consultants - one in health msnpwer planning and the other in forensic medicine.

The nurse educator who had been with the project since October 1973 leff in March 1977.

A paediatric nurse educator was assigned for three months from March 1977 to assist in the development oE a certificate course in paediatric nursing.

A number of group and in-service courses for various categories of health personnel were conducted during the year. In addition, two workshops on educational science for teachers of health professionals were organized in Rangoon and Mandalay in July 1976.

BUR ESD 001 Strengthening of Health Services (Epidemiology) UNDP (Feb. - May 1968; Jan. 1969 - )

Aim of the project. To establish epidemiological units in all the administrative divisions by converting the existing disease

Assistance provided by WHO during the year. (a) Two fellowships - one for five months for studies in the USSR, Czechoslovakia, Switzerland (WHO Headquarters), Egypt, India and Sri Lanka, and one for three months for study in Yugoslavia; (b) supplies and equipment.

BUR ESD 002 Prevention, Control and Surveillance of Communicable R Diseases (Feb.- April 1975; Aug.- Nov. 1975; Jan. 1976; Aug. 1976; 0ct.- Dec. 1976; March 1977)

Aim of the project. To prevent, control and undertake measures for the surveillance of communicable diseases. SEAlRC3012 Page 111

Assistance provided by WHO during the year. (a) A consultant; (b) six fellowships - two for five months for studies in the USSR, Czechoslovakia, Switzerland (WHO Headquarters), Egypt, India and Sri Lanka, one for three months in the USSR and Iran, two for two months in the USSR and one for twelve rmnths in the United Kingdom (extension); (c) supplies and equipment.

Work done. This project, which began in 1975, was the result of the merger of six projects for improved co-ordination and management in the field of (1) Trachoma Control (Burm 0069); (2) Epidemiology and Control of Cholera and hteric Infections (Burma 104); (3) Filariasis Control (Burma 0087); (4) Virus Disease Control (Burm 0098); (5) Plague Control (Burma 0078), and (6) Venereal Diseases and Treponematoses Control (Burma 0105).

A consultant was assigned during October-December 1976 to review the vector control activities. His recommendations relating to f ilariasis, dengue haemorrhagic fever and the consolidation of vector control services have been sent to the Government. The assignment was considered useful; however, the effectiveness and input could not be measured.

The activities of this project will continue under projects BUR PHC 001 and BUR VBC 001.

BUR ESD 003 Expansion of Epidemiolo~icalSurveillance in UNDP Cowunity Health Services (Jan. 1976; - )

Aim of the project. To improve the effectiveness of the health services through the application of epidemiological methods in the prevention and control of communicable and non-communicable diseases.

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

BUR MPD 001 Malaria Control (May 1954 - )

Aim of the project. To control malaria in certain areas, with the ultimate goal of malaria eradication from the entire country and to prevent the re-establishment of endemicity.

Assistance provided by WHO during the year. (a) Three fellowships - two for sixteen weeks for studies in Thailand, Malaysia, Indonesia and Sri Lanka, and one for fourteen weeks for studies in Iran, India, Malaysia, Indonesia and Thailand; (b) supplies and equipment.

Work dme during the year. At the end of the reporting period, out of the country's total population of 31.3 million, of which 29.1 million was in mlarious areas, 5.1 million was in areas covered by vigilance activities, including passive case- detection, treatment and remedial measures by the integrated health services, 9.6 million in areas under discovery of cases, including active case-detection, treatment and focal spraying, 6.6 million under mosquito control measures with residual spraying of DDT combined with casedetection, and 7.8 million under drug- administration and prophylaxis.

Case-detection activities during 1976 revealed 7881 malaria positive cases from a total of 210 909 blood examinations, resulting in a slide positivity rate of 3.7%. The actual dynamicity and extent of the parasite reservoir is not, however, reflected by these figures, which are the outcome of a very limited case-detection work. The morbidity and mortality statistics for the last few years, however, SEA/KC31)/2 Page 112

bring the situation into a clearer perspective. The available information from 1972 to 1975 on the clinically suspected in-patients and out-patients in hospitals, primary health centres and dispensaries of 126 towns reveals that morbidity due to malaria increased from 323 250 cases in 1972 to 480 384 in 1975. In the context of populations covered by these health institutions the malaria morbidity based on these statistics increased from 14.07%0 of the population in 1972 to 20.1liio in 1975. The mortality due to malaria, expressed as a proportion of the deaths due to all causes, increased from 6.11% in 1972 to 9.55% in 1975, which is consistent with a high proportion of P. faZciparm infections revealed by the limited case- detection data. There is no particular reason to believe that the situation in 1976 may have improved in any way as compared to the previous years.

During 1976, training courses in the control of malaria and other vector-borne diseases were held for 21 medical officers for six weeks and for 20 health assistants for four weeks at the Malaria Institute of Burm.

The malaria project has been merged with a comprehensive vector control project, BUR VBC 001,from 1 January 1977.

BUR SPI 001 Expanded Programme on Immunization R (Feb. 1977; - )

Aim of the project. To plan, implement and evaluate the expanded programme of immunization and train the staff engaged in the programme.

Assistance provided by WHO during the year. Supplies and equipment

Probable duration of assistance. Some years.

BUR BVD 001 (MBD 002) Tuberculosis Control UN DP (Jan. 1964 - )

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

Assistance provided by WHO during the year. (a) A consultant; (b) four fellowships - two for four months for studies in India and Sri Lanka and tm for two weeks for studies in the Republic of Korea and India.

Probable duration of assistance. Until 1978.

Work done during the year. The project is continuing satisfactorily. Direct BCG vaccination is gradually increasing. With the assistance of a consultant the project has constructed an epidemetric mdel to study the trend of tuberculosis in Bumduring the next decade.

BUR BVD 002 (MBD 003) Mycobacterial Diseases R (Jan. 1976 - )

Aim of the project. To strengthen the leprosy and tuberculosis control programmes integrated into the general health services.

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

Work done during the year. A WHO consultant was assigned to Burm in July 1976 to assist in evolving a scientific design and in drafting a protocol for drug trials in the treatment of leprosy with special reference to the use of rifampicin. SEAlRC3012 Page 113

Following on the draft protocol the same consultant is being assigned again to help in the establishment of a clinical baseline for a field drug trial in the Rifampicin Trial Area under provisions made by the Sasakawa Forndation of Japan.

The activities are being continued under project BUR PHC 001.

BUR VBC 001 Vector-Borne Disease Cmtrol R (March 1977 - )

Aim of the project. To plan, implement and evaluate comprehensive control activities against malaria, denguelhaemorrhagic fever, filariasis, Japanese encephalitis and plague, by developing one coherent vector-borne disease control programe by mobilizing existing resources available in individual projects related to vector- borne disease control; to develop staff required for a comprehensive vector-borne disease control prograwe.

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

Probable duration of assistance. Until 1982.

Work done during the year. A plm of action for this comprehensive disease-control programme, in which activities against malaria, denguelhaemorrhagic fever, filariasis, Japanese encephalitis and plague have been merged, has been drawn up. A staff member from WHO Headquarters (vector specialist) has been initially assigned for a period of three months to help the national authorities in developing a coherent vector-borne disease control programme and evaluate the existing control measures for effective implementation.

The Government has reorganized the Disease Control bit and established a Vector- Borne Diseases Control Division under a project manager assisted by a deputy project nanager. Separate sections dealing with malaria, arbovirus diseases, f ilariasis, plague, research and training have also been created at the central level. Similar services are being organized at state, divisional, tarnship and village levels.

Malaria

The malaria control project (BUR MPD 001) has been merged with this new project effective 1977, and the Malaria Section, as newly reorganized, will aim at the reduction of mrbidity and mortality, especially in infants. Selective DDT residual spraying will be carried out in developmental areas where an aggregation of labour needs protection and in special areas where epidemics have occurred. Mechanical measures, source reduction, larvivorous fish and reaf forestation will be undertaken with community participation at township and peripheral levels (see also BUR MPD 001).

Dmgue and Dengue Haemorrhagic Fever

The control of Aedes aegypti in relation to dengue and dengue hemorrhagic fever will be based primarily on the elimination of breeding sources by commrnity action, supplemented by ultra-low volume spraying in areas of high endemicity. Insecticides for emergency control during epidemics are being procured.

Filariasis

Filariasis control and elimination of C.p. fatigans breeding by mechanical measures and sanitation will be given priority. Case-finding and management and treatment with diethylcarbamazine (DEC) will be carried out at state, divisional and peripheral levels. SEA/KC30/2 Page 114

Japanese Encephalitis

A comprehensive approach will be adopted to control Japanese encephalitis through surwillance in areas where epidemic outbreaks have been reported, serological surveys, case monitoring at hospitals and entomological surveillance in areas with a possibility of outbreaks.

In the control of plague in the known foci of transmission in Bum, the WHO/RCDU staff stationed in Rangoon assisted the Government in taking effective measures to check the outbreak.

BUR ORH 001 (DNH 001) Dental Health Services R (Aug.-Oct. 1971; Feb. 1972; Sept. 1974; Jan. 1975; July 1975; Dec. 1975 - )

Aim of the project. To strengthen and expand training facilities for dental auxiliary personnel; plan the gradual expansion of existing and new dental health services,and establish and ensure gradual implementation of programmes to provide preventive and curative dental services.

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

Work done during the year. The WHO dental tutor continued to assist the project. Procedures in regard to oral hygiene for primary school children were explained, the importance of instructions on oral hygiene was stressed and the usefulness of a regular massage of the gums was underlined. After a series of meetings with the teaching staff, an improved curriculum for the Dental Nurse Training Scl~oal was evolved.

A dental equipment engineer was assigned to Bum in mid-December 1976 for three months. He advised the national staff on the maintenance of equipment and also on th organization of such workshops in the country. He also gave training on dental equipment.

The report on a two-week visit in April 1976 made by a dental officer from WHO Headquarters was sent to the Government. The Government received assistance in (i) planning a national oral health survey; (ii) developing a national plan for the prevention of oral diseases, and (iii) providing guidelines for napping the country for the fluoride content of drinking water supplies and other water reservoirs.

BUR MNH 001 Mental Health Training and Services R (March 1973; July 1973; Oct. 1973; Dec. 1973 - Feb. 1974; Sept.-Oct. 1974; Jan. 1975; July 1975; Nov. 1976 - Jan. 1977)

Aim of the project. To train psychiatrists and health workers in mental health, including the prevention and control of drug abuse; to undertake epidemiological investigations into the problem of drug dependence, and to strengthen facilities for psychiatric services, including rehabilitation.

Assistance provided by WHO during the year. A consultant.

Work done. A cmsultant spent six weeks during November 1976 - January 1977 evaluating the curriculum being developed for a two-year M.Sc. (psychiatry) course at Institute of Medicine I in Rangoon. The aim of this course is to provide local SEAIRC3012 Page 115

training for psychiatrists which will be appropriate to the needs of the country and which will enable those who complete the course to practise and teach the subject in Bum.

The curriculum review was conducted with full and thorough local consultation and subsequently recanmendations for various rmdifications were made to enhance the objectives for training in psychiatry appropriate to the needs of the country.

In addition, advice was given on teaching methods and on teaching equipment and its use.

The report of the consultant was forwarded to the Government.

This project has helped to lay che base for a national training programme at post- graduate level in psychiatry with suitable emphasis on comnunity practice. The course is flexible enough to provide suitable training for both teachers and practitioners in the psychiatric specialties of the country.

BUR RAD 001 Radiation Health (June 1970; Jan. 1971; Dec. 1971; June-Sept. 1972; May 1973; Aug.-Sept. 1973; July 1974; Sept. 1974; July 1975; Jan. 1976;

Aim of the project. To strengthen the radiation protection services in Rangoon and Mandalay; establish facilities for the training of personnel for radiological services, including physics, and strengthen services in radiation, radiotherapy and nuclear medicine.

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

Work done during the year. The Medical Physics Department at the Rangom General Hospital has been organized to provide radiation protection services in Burw. In addition, the Department assists in planning radiotherapy treatment for patients in the hospital and is involved in the training of radiographers and technicians.

With assistance from WHO through fellowships and the provision of supplies and equipment, the Department has acquired adequate expertise and developed satisfactorily the service and training activities to protect health personnel and patients against the hazards of ionizing radiation.

BUR HWP 001 Occupational Health R (Jan.-April 1975; June 1975; Aug. 1975; Feb. 1976; Aug. 1976; Oec. 1976; - )

Aim of the project. To strengthen occupational health services, revise legislation and train personnel.

Assistance provided by WHO during the year. (a) Two fellowships - me for six wnths and two weeks and one for twelve mnths - for study in the United Kingdom; (b) supplies and equipment.

BUR BIG 002 (SQP 002) Development of Production and Quality Control of R Biological and Pharmaceutical Products (April 1975; Nov.-Dec. 1976; Feb.-April 1977; - 1

Aim of the project. To enact legislation and evolve procedures to control the quality of biological and pharmaceutical preparations, to modernize methods for the production and assay of bacterial and viral vaccines and anti-sera preparations as well as to develop new vaccines. SEA/RC30/2 Page 116

Assistance provided by WHO during the year. (a) Three consultants; (b) five fellowships - three for study in India (two for six months and me for twelve months), one for six months for study in Yugoslavia, and one for five months and two weeks for studies in tne United Kingdom and Denmark; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. At the request of the Government, a WHO mission visited Burm late in 1976 to study the feasibility of expanding the production of D, T and P vaccines at the Burma Pharmaceutical Industry (BPI) to meet the requirements of an eqanded programme of immunization. The mission, which ccnsisted of a vaccine expert (plant manager), a specialist in the standardization of vaccines and an economist, reported that the BPI has the technical and financial capacity to implement a project aimed at making Bur- self-reliant and self-sufficient in DPT and DT as well as T vaccines by 1981. The project will spread over a period of five years and will cost one million dollars by way of capital investment for equipment to be imported from abroad and a recurring expenditure ranging from $30 000 to $90 000 annually over the same period. The report of the Mission is being considered by the Government for possible bilateral assistance.

In the meantime WHO continued to provide support to the BPI with the award of fellowships in the fields of pharmaceuticals, instrumentation technology and standardization.

In the field of phamceuticals, as the Government is interested in expanding BPI'S capacity to meet the increasing demand for medicines, steps are being taken, after ascertaining the Government's priority, to seek assistance from the Asian Development Bank in this regard. Technical assistance was provided for the preparation of the necessary documentation.

BUR IS001 Strengthening of Laboratory Services R (May-June 1967; April 1968; June 1968; Aug.-Oct . 1968; LINICEF April 1969; April 1970; Jan. 1971; Dec. 1971 - )

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

Assistance provided by WHO during the year. (a) Two consultants; (b) three fellowships - me for six months for studies in the United Kingdom and India, one for four months for studies in India, Czechoslovakia and the United Kingdom and one for two mnths for study in the United Kingdom (extension); (c) supplies and equipment .

Work done during the year. A WHO consultant visited BUM towards the end of December to help the mycologist at the National Health Laboratory (who had returned after training in the United Kingdom) to establish the laboratory at the NHL and develop a programme of work. Working relations were established between the clinicians, the epidemiologist, the chest specialists and the mycology laboratory at the NHL. In a seminar attended by clinicians and pathologists the importance of chronic diseases of fungus etiology was highlighted and the need for identifying patterns of deep mycotic infections as well as chracterizing the fungus associated with such conditions was stressed. The laboratory started operating with material assistance from WHO, and basic technology was introduced for the isolation and identification of fungi. In the absence of a suitable animal house, the work would be confined to culture and histopatholagy. For the next few years the laboratory will concentrate mainly on clinical material, as it is too early for mycology to be involved in food (mycotoxins) and in occupational health (pneumopathies) . SEAlRC3012 Page 117

The brucellosis section at the NHL received assistance from a consultant, who helped to put the bacteriology and serology of brucella in routine practice. The animal and human populations were examined and from hospitals cases of fever of unknown origin were also scrutinized for brucella. Brucella exists in Burma but its prevalence does not seem to he alarming.

BUR LAB 003 Pranotim of Health Laboratory Technology R (March 1977; - )

Aim of the project. To adapt and to practise advanced technology with a view to providing comprehensive and high quality laboratory support to the health and disease surveillance prograwe.

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

BUR PHA 001 (SQP 002) Development of Production and Quality Control of R Pharmaceutical Products (April 1975; Nov. 1976; - )

Assistance provided by WHO during the year. A five-month fellwship for study in India.

Probable duration of assistance. A number of years.

BUR BSM 002 Environmental Sanitation R (Jan. 1977 - )

Aim of the project. To plan, implement and evaluate the cmmmity water supply and sanitation programe, and to develop staff for the programme in urban and rural areas.

Assistance provided by XHO during ttr ywr. (a) A sanitary engineer; (b) two two-month felluwahips iar studies in India. Bangladesh and Thailand; (c) supplies and equipment.

Work done during the year. The provision of safe water supply to the population was identified as the major activity to be carried out in the field of environmental health. Assistance was therefore given in the preparation of definite proposals to construct 1000 deep tubewells; these were subsequently revised to include 1700 such tubewells in 1600 villages in the dry zone. UNICEF has confirmed its decision to assist, and the Australian Government expressed keen interest in assisting the programme with technical inputs as well as supplies and equipment.

Meanwhile, WHO initiated and assisted in the preparation of an investigation-cum- demonstration programme, specially designed to assess the water supply and sanitation situation for the preparation of further package proposals for the implementation and overall development of the rural water and sanitation sector.

A WHO sanitary engineer was assigned to the project in January. Efforts continued for the provision of short-term consultants in the fields of water supply design, wastewater treatment (including bio-gas design) and health education in 1977. SEA/RC30/2 I'age 118

BLlR DHS 002 Department of Medical Research R (Jan. 1972; Nov. 1972-Feb.1973; May 1974; Oct. 1974-Jan.1975; May-Aug.1975; Feb.1976; Aug.1976; Oct. 1976-Feb.1977; - )

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

Assistance provided by WHO during the year. (a) Two ccnsultants; (b) five fellowships - two for six months, one for nine months and one for twelve months - for study in the United Kingdom and one far twelve-months far studies in Switzerland and the United Kingdom; (c) supplies and equipment.

Probable duration of assistance. Until 1979.

Work done during the year. A consultant was assigned in December 1976 for a period of six weeks to review the progress of the nation-wide studies on growth and development which are under way and to advise on future directions far the programmes.

Another consultant visited Bum in December to help the Government to plan and initiate research prograormes m tropical sprue, sub-clinical and overt malabsorption in relation to malnutrition, and disacharidase deficiency. He could not complete his three-month assignment as the electron microscope was out of order and clinical studies could not be undertaken. It was, therefore, agreed that he would visit the country again for a period of six weeks later in 1977 for the same purpose.

BUR WS 003 Development of Health Information Services R (Dec. 1975-Feb.1976; July 1976; Feb. 1977; - )

Aim of the project. To build up co-ordinated health information services.

Assistance provided by WHO during the year. (a) Two fellovships - one for twelve mnths for study in India and one for thirteen months for studies in New Zealand and the United Kingdom; (b) supplies and equipment.

Probable duration of assistance. A number of years. SEA/RC30/2 Page 119

4. DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA

Project Number

Agencies Title

KRD HSD 001 (SHS 001) Strengthening of Medical Care Services R (Jan. 1976; April 1977; - )

Aim of the project. To strengthen, in general, health services and, in particular, specialized medical care in county hospitals, as well as train health personnel in the planning and administration of hospital services and various medical specialties.

Assistance provided by WHO during the vear. A twelve-month fellowship for study in the USSR.

KRD HMD 001 Strengthening of Health Manpower Development R (April 1977; - )

Aim of the project. To provide training and continuing education to health manpower needed by the country.

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

KRD ESD 001 Epidemiological Surveillance R (April 1977; - )

Aim of the project. To train staff in recent developments related to epidemiological surveillance and control methods in selected countries.

Assistance provided by WHO during the year. Two six-month fellowships for studies in Bulgaria and Czechoslovakia.

KRD IMM 001 General 1mmunolog)l R (April 1977; - )

Aim of the project. To develop and improve facilities in immunology.

Assistance provided by WHO during the year. Two four-month fellowships for study in Poland.

Probable duration of assistance. Until the end of 1977.

KRD CAN 001 Cancer Control R (Feb. 1975; Feb. 1976; April 1977; - )

Aim of the project. To (i) establish a system of registration, (if) strengthen and train services for early detection, diagnosis and treatment, (iii) strengthen comprehensive cancer prevention and control measures, and (iv) promote epidemiological investigations and stimulate biomedical research in cancer.

Assistance provided by WHO during the year. (a) Four twelve-month fellowships for study in the USSR; (b) supplies and equipment.

Probable duration of assistance. Until 1980 SEA/RC30/2 Page 120

KRD PHA 001 Drug Quality Control R (April 1977; - )

Aim of the proiect. To strengthen laboratories and train health and allied personnel for the quality control of drugs produced locally or imported.

Assistance provided by WHO during the year. Two six-month fellowships for study in the USSR.

KRD CEP 001 Environmental Health R (April 1977; - )

Aim of the project. To train staff for the study of problems related to environmental pollution.

Assistance provided by WHO during the year. Two twelve-month fellowships for study in Bulgaria.

KRD FSP 001 Food Hygiene R (April 1977; - )

Aim of the project. To strengthen the National Food Control Administration and train staff.

Assistance provided by WHO during the year. Two twelve-month fellowships for study in Romania. SEAIRC3012 Page 121

5. INDIA Project Number Source of Funds Co-operating Agencies Title IND HSD 001 (SHS 002) Medical Rehabilitation R (Nov. 1963 - Peb. 1964; April-June 1967; Feb.-June 1969; Oct. 1969; June 1970 - 1 Aim of the project. To expand medical rehabilitation services and establish training schools in the various disciplines.

Assistance provided by Wlicduring the year. Supplies and equipent. IND HSD 002 (SHS 005) National Institute of Health Administration R and Education (NIHAE) (Sept. 1965 - May 1967; March 1968; kc. 1968 - Jan. 1971; Nov. 1971; Jan. 1973 - ) Aim of the project. To assist in the conduct of studies in district health .d.inis- tration as well as in the promotion and planning of comprehensive health care services at the district level; to formulate research and teaching progr- pertaining to health administration, and to undertake teaching progrees, studies md research in the field of hospital administration.

Assistance provided by WHO during the year. (a) A public health officer; (b) two fellowships - one for six months for study in the United Kingdom and one for five months and two weeks for study in the United States of America. Probable duration of assistance. Until the end of 1977.

Work done during the year. The research project entitled "Study on Multi-purpose Health Workers Strategy" continued to make steady progress, and plans for its inple- mentation were finalized. In the States of Maharashtra, Andhra Pradesh and Uttar Pradesh the observational study schedule and interview check-list developed by the central research team were pre-tested and finalized. In accordance with the protocol of the Study, an expert group was constituted in Maharashtra to assess the quality of the services rendered by multi-purpose health workers and middle-level supervisors to the rural population in the field practice demonstration area. Assistance continued to be provided for meeting the cost of research investigators. The National Institute of Health Administration and Education was merged with the National Institute of Family Planning to form the National Institute of Health and Family Planning. Prom 1978, the project will merge into a new project, "Health Economics and Manage-t" (IND PPS 001).

The title of this project has been changed to "Study on Multi-purpose Health Workers Strategy". IND HSD 003 (SHS 006) Nursing in Clinical Specialties* R

IND HSD 003.4 (SHS 006.4) Nursing in Clinical Specialties, Karnataka and Bihar R (Jan. 1973 - )

Aim of the project. To improve clinical practice in selected specialties.

*This project started in January 1972 and is expected to continue until the end of 1977. During the period under review, two twelve-month fellowships were awarded - one for studies in New Zealand, Fiji and Malaysia and one for study in Australia. SEA/RC30/2 Page 122

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

Probable duration of assistance. Until the end of 1977.

Work done during the year. In Bangalore, Karnataka State, a WHO nurse educator worked with the staff of the National Institute of Mental Health and Neurosciences on the development of psychiatric nursing services. The first class of students admitted under the revised eleven-month diploma course in psychiatric nursing (DPN) completed the course, and a short refresher course was held for the former graduates of the DPN programme. In-service education for nurses and attendants continued with marked improvement in ward management and patient care. A draft of the "Guide- lines for teaching Psychiatric Nursing in Basic Schools of Nursing" was completed. The WHO nurse educator completed her three-year assignment in December 1976.

In Bihar State, a WHO nurse educator was assigned to the Hospital for Mental Diseases in Ranchi in February 1977. The activities of the project include the improvement of nursing services, in-service education and development of community mental health services. Plans for the future include a diploma course in psychiatric nursing, similar to the one in Bangalore.

From January 1978, this project will be amalgamated with a new project "Nursing Development" (IND HMD 013).

IND HSD 003.6 (SHS 006.6) Nursina in Clinical Specialties, Pondicherry R (Jan. 1974 - ) Aim of the project. To improve clinical practice in selected specialties.

Assistance provided by WHO during the year. (a) A nurse educator and a consultant; (b) supplies and equipment. Probable duration of assistance. Until the end of 1977.

Work done during the year. In Pondicherry, the WHO maternal and child health nurse educator based at JIPMER Hospital continued to work with national staff on planning and teaching the three-month refresher course in paediatric nursing. Six courses have been completed since the beginning of the project in January 1974,asd follow-up evaluations reveal positive results. A procedure manual and an immunization guide for nurses are under preparation. The popular booklet "Guide for Care of the Low Birth-weight Infant" is under revision, and is expected to be published by the end of 1977.

A WHO nurse consultant was assigned to Pondicherry for three months and to Lucknow in Uttar Pradesh for a similar period to conduct short courses in orthopaedic nursing and rehabilitation.

This project will be merged with "Nursing ~evelopment" (IND HMD 013) from 1978.

IND HSO 004 (SHS 007) Development of Community Health Nursing Services R (April 1975 - ) Aim of the project. To strengthen the provision and development of patterns of public health nursing services in selected States in India.

Assistance provided by WHO during the year. (a) Two public health nurses; (b) a six-month fellowship for studies in Malaysia, Philippines and Australia; (c) supplies SEA/RC30/2 Page 123

Probable duration of assistance. Until the end of 1977.

Work done during the year. This project is operational in two States.

In Maharashtra State, a WHO public health nurse worked with nacional staff on the further development of community health services, with major activities centred in five districts of Aurangabad Division as the demonstration area. In-service education for nursing personnel continued. An improvized kit for home visiting, supplied with locally available materials,was introduced on a trial basis. There were some staffing problems.

In West Bengal, the WHO public health nurse and national staff have conducted activities from a primary health centre, with the focus on community health assessment as a basis for planning nursing services. An advisory committee was established to review and guide the total operations. Over 300 family health profiles were collected by a sample household survey in villages served by the health centre. These are being analysed and additional data collected for amalgamation into village health profiles. Health service needs identified from the profiles will form the basis for planning staffing patterns and priorities in nursing services. Other activities included in-service education and the improvement of clinical services offered by the health centre.

IND PHC 001 strengthen in^ of Health Administration (Rural), R including Pla~ingand Evaluation (Oct. 1976; - )

Aim of the project. To assist the health administration in the planning, implementation and evaluation, including the development and strengthening, of a health information system, and in the strengthening of rural health services.

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

IND MCH 001 Strengthening of Departments of Paediatrics, R Obstetrics and Preventive and Social Medicine UNICEF in Indian Medical Colleges (Aug. 1958 - ) Aim of the project. To expand and improve undergraduate and post-graduate teaching of paediatrics in medical colleges and to develop courses for various categories of personnel in paediatric departments.

Assistance provided by WHO during the year. (a) Three temporary advisers; (b) eleven fellowships - two for twelve months for studies in the United Kingdom, Sudan, Egypt, Iran, Thailand, Singapore and India; two for six months and one for three months for study in the United Kingdom,three for three montns, two for two monchs and one for one month for study in India; (c) cost of attendance of participants; (d) supplies and equipment.

Probable duration of assistance. Until the end of 1977.

Work done during the year. A revised plan of operation was signed by the Government of India and WHO for providing assistance to this project up to the end of 1977. A handbook on maternal and child health for medical undergraduates and physicians of primary health centres is being drafted. Two WHO temporary advisers visited medical colleges at Ahmedabad, Jabalpur and Trivandrum to help promote the demonstration of delivery patterns of maternal and child health/family planning services in the field practice areas, in preparation for the introduction of an experimental curriculum in maternal and child health at undergraduate and internship levels. Subsequently, on 1 and 2 March 1977, a meeting of the Task Forces on maternal and child health/ SEAIRC3UI2 Page 124

family planning curriculum from the three medical colleges was held in the Regional Office to discuss problems arising from preparations for the pre-testing of the curriculum and evaluate the progress and development of the programme. The report of this meeting, which was assisted by a temporary adviser, has been sent to the Government.

IND MCH 002 Integration of Maternal and Child Health UNFPA Services, including Family Planning Services, into the General Health Services (May 1971 - Dec. 1976)

Aim of the project. To integrate family health services through strengthening in- service training, service, delivery and operational research.

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

Work done. A project committee consisting of senior government officials was conveoed in May 1971 and its recommendations were embodied into a draft plan of operation, the signing of which was, however, eventually deferred. Further work was carried out on the basis of exchanges of letters. Assistance under this project consisted of four group educational activities, provision of supplies and equipment, award of fellowships and the assignment of consultants.

The opportunity afforded by the series of meetings which took place between 1971 and 1974, at a time when the integration approach and the multi-purpose concept were being evolved, served as a forum where technical experts and senior health planners could work out some of the training and service implications of these innovations. The reconnnendations emanating from the meetings played a catalytic role in implementing 6ome of the major policy changes which occurred during the formation period affecting the development of health services in India.

This project concluded at the end of 1976.

IND NUT 001 Applied Nutrition Programme R (Oct. 1964 - ) UNICEF (FAO)

Aim of the project. To improve the health component of the Applied Nutrition Programme assisted by FA0 and UNICEF.

Assistance provided by WHO during the year. (a) A twelve-week fellowship for studies in the Philippines, the United Kingdom and Thailand; (b) supplies and equipment; (c) grant.

Probable duration of assistance. Until the end of 1977.

Work done during the year. A two-day Seminar on the Role of the State Nutrition Officers in the National Nutrition Programme was held in New Delhi on 8 and 9 December 1976 in which 37 persons took part. In addition to State Nutrition Officers from some States, representatives of various Central Ministries (such as Health, Food and Agriculture and Social Welfare), international organizations (WHO, UNICEF, WFP) and voluntary agencies (CARE) took part in this meeting.

WHO provided assistance in the form of a grant for meeting the expenses on guest lecturers,the publication of technical reports and other miscellaneous items. SEAlRC3012 Page 125

IND NUT 003 Nutrition Training R (Dec. 1970; May 1971; July-Sept. 1973; Jan-Feb. 1974; Sept. 1974; Dec. 1974 - Jan. 1975; - ) Aim of the project. To support nutrition courses conducted at the National Insti- tute of Nutrition, Hyderabad; to train the teaching staff of the National Institute of Nutrition, Hyderabad, in particular, and other institutions in general.

Assistance provided by WHO during the year. (a) Two guest lecturers; (b) four fellowships - one for twelve months for studies in Sweden, the Federal Republic of Germany and Switzerland, one for three months for studies in the United Kingdom, Sweden, Switzerland and Egypt, and two for twelve weeks (one for studies in the United Kingdom, France, Switzerland (WHO Headquarters), the Federal Republic of Germany and Sweden, and one for studies in Thailand, the Philippines, Indonesia, Malaysia and Sri Lanka); (c) supplies and equipment.

Probable duration of assistance. Until the end of 1977.

Work done during the year. Two guest lecturers assisted the National Institute of Nutrition, Hyderabad, for a period of two weeks each in January 1977. They delivered lectures at the two nutrition courses - the one-year degree course and the three- month certificate course - and suggested measures for the improvement of these courses.

IND HED 001 Training in Health Education R (Sept. 1968; June 1969; April 1970; July 1970; Nov. 1970; ~~i'i1-m~1971; Aug. 1971; Nov.-Dec. 1971; Dec. 1972 - March 1973: Dec. 1973 - March 1974; May-June 1974; Aug. 1974; 0ct.'1974; Feb. 1975; April 1976; July 1976; ~ai. 1977; - )

Aim of the project. To establish and develop three post-graduate health education training centres with rural and urban field practice areas.

Assistance ~rovidedby WHO during the year. (a) A ten-month fellowship for study in the United Kingdom; (b) subsistence allowance for participants.

Probable duration of assistance. Until the end of 1977.

Work done during the year. A national workshop to strengthen health education in support of health programmes was held at the Gandhigram Institute of Rural Health and Family Planning, Madurai, in January 1977. It is proposed to hold a similar workshop to consider manpower training in health education in the light of the present health problems and needs of the country.

IND HED 003 Health Education UNDP (Oct. 1971 - Jan. 1972: Julv 1972:. Aup.-Nov.- 1972: an. 1973; March 19731 ~uly1973; Aug, 1974 - ) . Aim of the project. To establish and develop State Health Education Bureaux; to integrate and co-ordinate health education activities of the general health services further with those of the family planning programme at different levels of the health administration, and to develop health education in primary and secondary schools and teachers colleges.

Assistance provided by WHO during the year. Two health education specialists Probable duration of assistance. Until 1978. SEA/RC30/2 Page 126

Work done during the year. One of the two long-term health education specialists assigned to the project left on reassignment in mid-October 1976 and the other completed his assignment at the end of March 1977.

An All-India workshop to develop the strategy for health education at primary health centres was held from 19 to 25 August 1976. Prior to this workshop the participants had undertaken a series of pilot projects in health education at selected primary health centres. A similar national workshop on health education in hospitals was held in Chandigarh during the first quarter of 1977. Prior to this workshop, pilot hospital health education projects had been conducted in 30 hospitals in the country. Following these activities preparations are under way for holding workshops on the health education component of undergraduate medical programmes and the nursing undergraduate programme.

Considerable progress was made in the area of school health education. At the request of the Central Board of Secondary Education, a textbook on school health was prepared and printed and is being used by the schools of the Central Board of Secondary Education. Action is also being taken to prepare learning resource materials and guides for teachers for the school health textbook already prepared.

IND HED 004 Health Education in Schools, including UNFPA Family Life Education UNICEF (July-Aug. 1971; Nov. 1972 - July 1974)

Aim of the project. To integrate family life education in school, college and teacher-training curricula, establish and develop a health education programme in the educational system, prepare teachers in health education and develop teaching aids required for primary, secondary, collegiate and teacher-training institutions.

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

IND HMD 001 Medical Education R (Dec. 1958 - Sept. 1961; Nov.-Dec. 1965; Aug. 1966 - ) Aim of the project. To assist medical colleges in developing a curriculum based on educational objectives and in improving student evaluation; to assist with research methods and to train national staff in various medical and public health fields.

Assistance provided by WHO during the year. Seventeen fellowships - one for four months for study in the United Kingdom, fourteen for three months (eight for study in the United Kingdom, one for study in the USA, two for study in the United Kingdom and Sweden, one for studies in the United Kingdom and Belgium, one for studies in the United Kingdom, Ireland and the Netherlands and one for studies in Switzerland, the United Kingdom and the Netherlands), one for seven weeks for studies in the USA and Canada and one for six weeks for study in the USA.

IND HMD 002 Post-basic Nursing Education: Assistance to States

IND HMD 002.1 Post-basic Nursing Education, Uttar Pradesh R (Jan.-Nov. 1962; March 1972 - )

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

Assistance provided by WHO during the year. (a) A consultant; (b) supplies and equipment . Probable duration of assistance. Until the end of 1977. SEA/RC30/2 Page 127

Work done during the year. In Uttar Pradesh, a WHO nurse educator was assigned for six months to work with the faculty of the College of Nursing, Kanpur University, on the development of the medical-surgical component of the curriculum. In addition to curriculum revision, the work accomplished included the introduction of newer methods for examinations, preliminary plans for a Master of Science in Medical- surgical Nursing, preparation of a three-week course for theatre supervisors, and the initial phase of detenination of supplies, equipment and staffing requirements for medical-surgical units used for clinical teaching.

From January 1978, this project will be amalgamated with a new project, IND HMD 013, "Nursing Development".

IND HMD 002.4 Post-basic Nursing Education, Karnataka R (July 1973 - Jan. 1974; Jan. 1975 - )

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

Assistance provided by WHO during the year. (a) A nurse educator; (b) supplies and equipment; (c) grant.

Probable duration of assistance. Until the end of 1977.

Work done during the year. In Karnataka State, a WHO nurse educator collaborated with the faculty of the College of Nursing, Bangalore, on the revision of curricula, strengthening of clinical teaching in the areas of public health and psychiatric nursing, a staff development progrme for faculty and plans for expansion of the building. The basic degree programme was revised with emphasis on community health. A workshop on "Continuing Education", was held, resulting in plans for the establishment of a Department of Continuing Education within the College of Nursing as a regional centre for educational activities serving all categories of nursing personnel. A second workshop, on "Population Dynamics and Family Planning", was held for 18 senior nurse leaders. WHO provided a grant to help meet the expenses of these activities.

From January 1978, this project will be amalgamated with a new project, "Nursing Development" (IND HMD 013), with the aim of establishing regional centres for continuing education and the development of educational materials, and of developing research in nursing.

IND HMD 002.7 Post-basic Nursing Education, New Delhi R (Nov. 1969 - ) Aim of the project. To expand post-basic nursing education, with initial emphasis on post-basic degree programmes usually offering professional specialization in teaching, administration, public health or one of the clinical specialties.

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

Probable duration of assistance. Until the end of 1977. Work done during the year. Two workshops were held during the period under review - one in Ahmedabad (Gujarat State) at the College of Nursing in August 1976 for 16 participants representing nursing education, hospital nursing services, and community health positions and coming from mid-India; the other in New Delhi in December 1976 for 17 participants representing north and north-east India. These participants represented different types of programmes in nursing education, i.e., basic diploma SEA/RC30/2 Page 128

programmes, university programmes including basic, post-basic, and masters programmes, and a health visitors school. A WHO fellow from Burma at the WK College of Nursing for two months attended as an observer.

Six short courses were also conducted for State and local participants (total participation was 73) during January-March 1977 at the WU( College of Nursing, New Delhi, under the government plan scheme. The WHO nurse educator was actively involved in the conduct of these courses, the themes of whicn included nursing education patterns, community health nursing, Craining and utilization of village level health workers and five specialty nursing courses.

A post of Senior Lecturer in Continuing Education at the RAK College of Nursing in New Delhi, was created and the WHO nurse's national counterpart was appointed to this position on 17 July 1976.

The WHO nurse educator presented a paper on "Nursing Services and Education in India" at the Eighth National Conference on Continuing Education in Nursing held from 11 to 14 October 1976 in Austin, Texas, (USA).

From January 1978, this project will be amalgamated wit11 a new project "Nursing Development" (IND HMD 013).

IND HMD 005 Physical Therapy School, Baroda R (May 1968; March 1969; April 1972; July 1972 - ) Aim of the project. To train physiotherapists to degree standard, "Bachelor of Science (Physiotherapy)", at the Physical Therapy School in S.S.G. Hospital, Barada, over a three-year period. Assistance provided by WHO during the year. Two fellowships - one for twelve months for study in the United Kingdom and one for three weeks for studies in the Republic of Korea and India.

IND HMD 006 Training Programme for Medical Officers and R Trainers of Basic Health Workers (Jan. 1974 - ) Aim of the Drolect. To strengthen the rural health services by training health staff, particularly doctors and trainers of basic health warkers, auxiliary nurse- midwives, health assistants (F.P.) and other monovalent health workers to be converted into multi-purpose health workers.

Assistance provided by WHO during the year. (a) A public health officer and a senior nurse educator:. (b).. a two-week fellows hi^ for studies in Japan and Indonesia: (c) supplies and equipment. Probable duration of assistance. Until 1979.

Work done during the year. The project staff continued to give support to the training prograume, with a shift in the emphasis from the training of trainers to the training of health workers and their supervisors. The training programme to be conducted at selected primary health centres has been drawn up. The manual for health worker (male) was published in January 1977 and the manual for health worker (female) is with the printers and is scheduled to be published later in the year. Meanwhile, the draft of the teaching manual for the medical officer (PHC) is nearing completion, while work has started on the drafts of the manuals for health assistants (male and female). SEA/RC30/2 Page 129

A prototype of the kit to be used by health workers has been prepared and approved by the Government. This activity was a collaborative effort among the Government, WHO and UNICEF, which is supplying a large number of the kits.

Teaching aids for the 70 health and family planning training centres have been provided by WHO. These teaching kits will be used in the training of health workers at PHC level. Also, a number of teaching slides have been prepared locally from originals obtained on loan from WHO Headquarters. Sets of library reference books have been provided to the 70 health and family planning training centres, as well as a portable locally-manufactured slide projector to be used in the training at the peripheral level.

The strategy of holding an annual conference of trainers and administrators to review the progress of the training programne has been changed to that of holding zonal meetings in different parts of the country. The first such meeting was held at Jhansi in March for the States of Uttar Pradesh and Madhya Pradesh. Subsequent zonal meetings have been held at Chandigarh, Hyderabad and Calcutta, and others are planned for Bombay and Gandhigram.

IND HMD 007 Research in Nursing R (June 1975: June 1976 - )

Aim of the project. To assist colleges of nursing and institutions in the design and conduct of operationallaction studies in the broad areas of nursing education and clinical nursing practice, including community health nursing, and to conduct workshops/seminars on nursing methods for the faculties of various colleges of nursing and senior nurses working in clinical areas of community health centres.

Assistance provided by WHO during the year. (a) A nurse researcher; (b) supplies and equipment; (c) grant.

Probable duration of assistance. Until the end of 1977.

Work done during the year. This project is based at the Rajkumari Amrit Kaur College of Nursing, New Delhi, but serves the whole of India. Two workshops were held, one in New Delhi for faculty members of colleges of nursing, and one in Yercaud, Tamil Nadu, for district public health nurses. The participants worked in small groups to prepare research designs for studies to be carried out in their respective areas; the research projects are in various stages of progress, with continued support and guidance from the WHO nurse researcher and her national counterpart. Consultation on a continuing basis is provided for faculty members, other nursing personnel and Master's students. Work has started on a book on "Research in Development Countries", to be serialized in the Journal of the Trained Igurses Association of India.

From January 1978, this project will be amalgamated with a new project, "Nursing Development" (IND HMD 013).

IND HMD 008 Seminars and Workshops on Medical Education R (Dec. 1965 - May 1966; Jan. 1967 - Dec. 1976) Aim of the project. To strengthen further, in collaboration with the Indian Academy of Medical Sciences, medical teaching through seminars and workshops in specialized fields.

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

Work done. During the past ten years, the Organization has collaborated with the Indian Academy of Medical Sciences in holding seminars and workshops on various SEA/RC30/2 Page 130

aspects of health and on specialized fields of medical education. Each of these workshops dealt with a particular problem and formulated plans and programmes for its solution.

In July 1975, a seminar on epilepsy was held in Bangalore. WHO provided assistance by assigning consultants and by making a grant to meet the expenditure of participants and national advisers. Some supplies were also provided. At the request of the Government, a seminar on paediatric surgery was organized in November 1976 jointly by WHO and the Indian Academy of Medical Sciences. A WHO consultant assisted with this activity, and a grant and some supplies were also given.

An evaluation of the group educational activities organized under this project as well as the follow-up action taken has indicated that the objectives of the project have been realized to a large extent.

IND HMD 009 Training of Medical Educators UNDP (May 1968; July 1968; Sept. 1968; Nov. 1971; Dec. 1971; Sept. 1972; Jan. 1973; May 1973; Dec. 1975; Aug. 1976; - ) Aim of the project. To provide further training to national medical educators. Assistance provided by WHO during the year. A nine-month fellowship for study in the United States of America.

Probable duration of assistance. Until the end of 1977.

IND HMD 010 Strenxtheninx of the Teaching of Human Reproduction UNFPA Population Dynamics and Family Planning in Nursing and Midwifery Education (March 1972 - Jan. 1973: March 1973 - Jan. 1974: June 1974 - Feb. 1975;.~u~.1976; - ) Aim of the project. To improve the maternal and child health and family planning components of auxiliary nurse-midwife training and to strengthen the domiciliary midwifery and public health nursing experience of nursing students in hospital schools of nursing; to strengthen the teaching of human reproduction, family plan- ningand population dynamics at teaching institutions for nursing personnel.

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

IND HMD 011 Medical Librarianship R (Aug. 1976; - ) Aim of the project. To train medical librarians.

Assistance provided by WHO during the year. A five-month fellowship for studies in the United Kingdom and the United States of America.

IND ESD 001 Assistance to National Institute of Communicable R Diseases (Feb. 1972; Sept.-Dec. 1972; Feb. 1977; - )

Afm of the project. To assist the National Institute of Comunicable Diseases in the cosduct of the Inter-regional Training Course in the Epidemiology and Control of SEA/RC30/2 Page 131

Connnunicable Diseases, held partly in Prague and partly in Delhi; to assist the Institute in strengthening its faculty in order to improve further the field training of epidemiologists.

Assistance provided by WHO during the year. (a) Two two-month fellowships for studies in Sri Lanka and Burma; (b) subsidy.

Work done during the year. A memorandum of agreement was concluded between the Government of India and WHO for providing financial assistance to the National Institute of Communicable Diseases for the period from November 1976 to October 1977, in conducting the Delhi Chapter (two weeks) of the Inter-Regional Training Course on the Epidemiology and Control of Communicable Diseases and in organizing and conducting a new three-month regional training course on the subject. The latter course was started keeping in view the training needs of this region, and the first group of four fellows (one from Bangladesh and three from India) were trained during December 1976 - February 1977.

IND MPD 001 Malaria Eradication R (Aug. 1958 - ) Aim of the project. Effective control of malaria to protect areas of economic and health priority, prevention of mortality, and eventual eradication frcm the entire country.

Assistance provided by WHO during the year. (a) Seven fellowships - two for five months (one for studies in the USSR, Czechoslovakia, Egypt, India and Sri Lanka and one for studies in the USSR, Czechoslovakia, Egypt, Switzerland, India and Sri Lanka) and five for two weeks for studies in Indonesia, Malaysia and Thailand; (b) supplies and equipment.

Probable duration of assistance. Some years.

Work done during the year. Based on the mid-year population estimates for 1977, a population of 362 million is living in the erstwhile maintenance areas, out of a total of 602 million at malaria risk; a population of 32 million lives in malaria- free areas.

The availability of anti-malaria drugs throughout the country has resulted in a reduced pressure of the disease, and the rate of increase in incidence has been considerably checked. Whereas, in 1974 and 1975, the increase in incidence recorded over the respective previous years was more than 60%, in 1976 this increase is likely to he in the neighbourhood of only 15%. No significant increase in the slide positivity rate (11.0%) has been noticed either. P. fazcipam infections, which constituted over 13% of the total incidence in 1975, are likely to remain below 10% in 1976.

A modified plan of operation for malaria control has been evolved, aimed at prevent- ing malaria mortality, protecting with intensive anti-malaria measures areas of economic importance industrially and agriculturally, and maintaining the gains of the programme achieved so far. The budget of the anti-malaria programme has been almst doubled, and stands at Rs. 650 million.

The Government's efforts aim at the free supply of anti-malarials to all fever cases and of insecticides to all sections with an annual parasite incidence of 2 per thousand and above. In addition, the intention is to fulfil the existing commitment of supplying five tons of DDT 75% to maintenance units and help with the re-organization of malaria units to conform to the district administrative machinery; decentralization of laboratory technicians and augmentation of surveillance staff; redistribution of the staff of the 72 existing zonal medical officers to provide effective epidemiological and entomological support to the programme, and providing quick service to the population by undertaking surveillance and vigilance activities every fortnight. SEAIRC3UlZ Page 132

It is also planned to secure the active participation of the people in the programme. Panchayats and school teachers are already being involved in the distribution of anti- malarials in the remote areas. Publicity through the mass media is to he extensively used for encouraging people's participation.

IND MPD 002 Filaria Control R (July 1975; July 1976; - ) Aim of the project. To train senior medical and paramedical staff in methods of controlling filariasis.

Assistance provided by WHO during the year. Four two-month fellowships for studies in Burma, Thailand and Sri Lanka.

IND SPI 001 (SME 001) Smallpox Eradication R (Oct. 1967 - May 1977)

Aim of the project. To achieve total eradication of smallpox in the country by 1977.

Assistance provided by WHO during the year. (a) Eight smallpox co-ordinators; (b) supplies and equipment.

Work done. This project, which started in October 1967, came to a close in May 1977 with the declaration of India's smallpox-free status by the WHO International Commission in April. The highlights of the eradication programme are given below in a chronological order:

October 1960 Smallpox pilot projects were started in one district in each State and in Delhi.

January 1962 The Ministry of Health sanctioned a sum of Rs. 68 900 000 for launching the nation-wide programme.

March 1963 The programme was subjected to an independent assessment and evaluation by a special committee. WHO staff were associated with the work of this Central Expert Committee.

May 1966 The Nineteenth World Health Assembly adopted a resolution proposing intensification of the programme to eradicate smallpox, with the hope that the disease would be eliminated from the world within ten years. Smallpox was considered to be endemic in 33 countries. India was one of these and accounted for 65 per cent of the global smallpox incidence.

OctoberINovember 1967 A Government/WHO assessment of the programme was undertaken. The assessment team noted, inter alia, that "on the basis of the findings it is concluded that the National Smallpox Eradication Programme (NSEP) is still, in most areas, far from achieving its objective of smallpox eradication".

September 1970 On the basis of the recommendations of the assessment team, a plan of operation for the NSEP was signed by the Government of India and WHO. The first k110 field staff - four medical officers - arrived in India in 1971.

While the problems of vaccine and vaccination were being resolved, a new eradication strategy was gradually implemented throughout the country. This strategy was based on an active SEA/RC30/2 Page 133

surveillance system to detect outbreaks of smallpox as quickly as possible on the epidemiological investigation of these outbreaks and on their rapid containment.

October 1972 A WHO-sponsored inter-country Seminar on Surveillance was held in Delhi which dealt with the key elements of surveillance and containment.

November 1972 The final phase of the Global Smallpox Eradication Programme was announced with the target of reducing the incidence of smallpox in India to zero.

July 1973 Intensified Smallpox Eradication Campaign

In June 1973, at a meeting of smallpox programe officers, attended also by officials of the Central Government and WHO staff, it was decided to launch a special intensified campaign. The first phase was to take place in July-August 1973 in the urban areas and the second phase, from September to December, throughout the country.

Epidemiologists from the Centre, from non-endemic States and from other countries were assigned to specific geographic areas to assist the operation further.

January 1974 The Director-General of WHO agreed to make available another US $900 000 (Rs. 7 200 000) to augment existing resources. Additional funds provided by the Swedish International Development Authority (SIDA) permitted programme activities to be further increased. More epidemiologists were deployed in the States. During 1974, at any given time, approximately 100 national and international epidemiologists were working in the field, primarily in the heavily-affected areas.

May 1974 The number of smallpox outbreaks reached a peak of 8 403 in May, with 11 000 cases being reported in a single week. April 1975 World Health Day on 7 April carried the theme "Smallpox - Point of No Return", which coincided with an all-India search operation, carried out from 7 to 14 April.

May 1975 On 24 May 1975, India's last known smallpox patient, Saiban Bibi, a 30-year old female, developed fever and rash while living on the platform of Karimganj railway station in Cachar District of Assam. She had become infected in the village of Thauri, Sylhet District, Bangladesh.

July 1975 India was proclaimed a non-endemic country on 5 July 1975.

November 1975 The Public Accounts Committee of the Lok Sabha (Parliament) recommended that an independent assessment be made of the progress of the NSEP. A committee for this assessment visited 11 States and two Corporations. The report, presented in November 1975, stated that it could find no evidence of any foci of smallpox having occurred after 5 July 1975.

January 1976 Fever and Rash Outbreak Surveillance was introduced throughout India. SEA/RC30/2 Page 134

January 1976 All-India Active Search Operations were carried out in which March and 110 million households, in more than half a million villages November 1976 and in 2 600 urban areas of the country, were searched for smallpox cases. In August 1976, all urban areas were searched by municipal and district health staff.

December 1976 A National Comission consisting of Central, State and WHO epidemiologists visited all States and Union Territories (except the Andaman and Nicobar Islands) and scrutinized programme activities.

April 1977 An International Commission was convened to assess smallpox eradication in India. On 23 April 1977 it expressed its agreement that transmission appeared to have been interrupted in May 1975, and that smallpox had been eradicated from the country.

The success of the smallpox eradication programe in India was the result of out- standing co-nperation between the Government, WHO and the governments and agencies who conttibuted funds, personnel and materials. From the time the Government of India decided to intensify the programme, the pace of progress has been dramatic. This momentum may be attributed, in the main, to a proven, simple but effective technique implemented through intensive training and supervised and assessed by committed, enthusiastic and skilled field staff, both governmental and WHO. The flexibility adopted in the recruitment and transfers of personnel, and the rapid availability and deployment of resources and funds in areas where they were most needed, played a major part in the success of the campaign.

INTI BM 001 Leprosy Control R (Jan. 1961 - ) UNICEF

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

Assistance provided by WHO durin~the year. Five fellowships - three for six months for studies in India, Burma, Thailand and Malaysla, one for twenty-four weeks for studies in Nepal, Bum, Malaysia and Indonesia, and one for five months for studies in the USSR, Czechoslovakia, Egypt, India and Sri Lanka.

Work done during the year. The national leprosy control programme intensified its activities in.some hyperendemic areas, and plans are being made for further extension of the control operations. Fellowships were awarded to national officers for training in control operations. One of the Regional Advisers on Communicable Diseases attended the Tenth All-India Leprosy Officers Conference, which was held in Wardha in July 1976.

INTI BVD 002 (MBD 002) Tuberculosis Chemotherapy Centre, Madras UNDP (Dec. 1955 - ) (EMRC)

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

Assistance provided by WHO during the year. Supplies and equipment. SEA/RC30/2 Page 135

Work done during the year. The WHO-associated studies continued at the Tuberculosis Chemotherapy Centre, Madras. The Director of the Centre visited Tokyo in August 1976 to deliver lectures at the WHOIJapan Course on Tuberculosis Control.

IND BVD 004 (MBD 004) Tuberculosis Research Centre, Madras R (Jan. 1975; March 1975; - ) Aim of the project. To carry out research on tuberculosis.

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

Probable duration of assistance. Until the end of 1977.

Work done during the year. The research activities of the Centre continued according to plan. A slow-release preparation of isoniazid has been specially developed which, if given even only once a week, is expected to compensate the isoniazid inadequacy in rapid inactivators (while avoiding toxicity in the slow inactivators). This trial is still in progress. The Centre is also conducting research on short- course chemotherapy with various drug regimens. The pilot study on tuherculo~isof the spine is making very good progress and can now be regarded as the start of the main study. The study of chemoprophylaxis has also been continuing. Also in progress are two relapse studies in which streptomycin plus isoniazid once a week for 12 months for patients with residual cavitation at one year, or for six months in patients with residual cavitation, would be used.

A consultant is under recruitment for a three-week assignment to review the current studies and to assist in planning for future studies.

IND VPH 001 Training in Veterinary Public Health R (Aug. 1969; March 1970; May-July 1971; Oct. 1972; March 1973; June 1973; Sept. 1973; Feb. 1974; July 1974; Sept.-Oct. 1974; July-Aug. 1975; - ) Aim of the project. To develop further a post-graduate (Master's degree) course in veterinary public health at the All-India Institute of Hygiene and Public Health, Calcutta, and the Indian Veterinary Research Institute, Izatnagar.

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

Work done during the year. A consultant recruited under an inter-country project visited veterinary public health institutions in India to review the programmes in order to define future areas for WHO assistance (see also ICP VPH 001).

IND PBL 001 Prevention of Visual Impairment and Control R of Blindness (April 1977; - )

Aim of the project. To train ophthalmologists in community eye health services and health and allied personnel in the delivery of basic eye health services in the peri- phery and comprehensive referral ophthalmic services at the intermediate and central levels.

Assistance provided by WHO during the year. A two-month fellowship for studies in the United Kingdom and the USSR.

Probable duration of assistance. Until 1980. SEA/RC3U/Z Page 136

Work done during the year. A DANIDA delegation visited India to observe the national activities against blindness and discuss with the authorities details of bilateral assistance for the prevention and control of blindness and visual impairment.

IND CAN 001 Cancer Control Pilot Project, Tamil Nadu (July 1968 - ) Aim of the project. To start and develop a pilot project for the early diagnosis and control of oropharyngeal and cervical cancer and to establish a training centre in Kancheepuram (Tamil Nadu).

Assistance provided by WHO during the year. (a) A consultant; (b) a twelve-month fellowship for study in the Philippines; (c) supplies and equipment. Probable duration of assistance. Until the end of 1977.

Work done during the year. A consultant assigned for four weeks during December 1976 - January 1977 reviewed the progress of cancer epidemiological investigations at the Arignar Anna Memorial Cancer Institute, Kancheepuram, and advised on simpli- fying recording procedures and analysis and on organizing training in epidemiology for health personnel.

The 250-bed cancer hospital is nearing completion and action was taken for supplying radiotherapy equipment to this institution.

INTI CAN 002 Establishment of Cancer Centres in States R (March-May 1976; Sept. 1976; Dec. 1976; - ) Aim of the project. To organize regional cancer control progrmes, through the strengthening of training, service and epidemiological investigations, and to co- ordinate training and epidemiological research in the regional cancer centres.

Assistance provided by WHO during the year. (a) Two six-month fellowships - one for studies in Noway, the Federal Republic of Germany, Denmark, Sweden, the USSR and the United Kingdom and one for studies in the United Kingdom, the Federal Republic of Germany, Sweden and the USSR; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1977.

Work done during the year. A national seminar on cancer control was organized at which participants from different States of India reviewed the existing facilities and formulated a national plan for comprehensive cancer control activities. Supplies and equipment were provided to some selected centres to support training in cancer control.

IND CVD 002 Cardiovascular Diseases Control R (Feb. 1976; June 1976; Nov. 1976; Jan.-March 1977; - ) Aim of the project. To develop cardiac resuscitation and rehabilitation services integrated into the existing health services, and train health and allied workers in the management of cardiac emergencies and in the organization of health education for the prevention and control of cardiovascular diseases. Assistance provided by WHO during the year. Five fellowships - one for twelve months for studies in the United Kingdom, Sweden and elsewhere, one for six months fo~... studv in the United Kinndom. one for four months for studies in the United ----,- -~ ~ ~ -. Kingdom, Sweden, Denmark and the Netherlands, and two for three months (one for SEA/RC30/2 Page 137

study in the United Kingdom and one for studies in the United Kingdom and Sweden). Probable duration of assistance. Until 1983. Work done during the year. In collaboration with the American Heart Association, the services of specialists in cardiology were made available to Sree Chitra Tirunal Medical Centre, Trivandrum, for training and research in the prevention and control of cardiovascular diseases. Fellowships were awarded for training and specialization in different aspects of cardiology and cardiovascular surgery.

IND MNH 002 Mental Health R (June 1975; March 1976 - Jan. 1977; - ) Aim of the project. To assist the National Institute of Mental Health and Neuro- sciences, Bangalore, in the planning and delivery of socio-culturally relevant training programmes for psychiatric educators and clinical specialists in psychiatric medicine, nursing and allied fields and in the development of ambulatory field training centres.

Assistance provided by WHO during the year. (a) A consultant; (b) three fellowships - one for six months for study in the United Kingdom, one for fifteen weeks and one for three months for study in Denmark, the United Kingdom, Czechoslovakia, Switzer- land and India; (c) supplies and equipment.

Probable duration of assistance. Until 1983.

Work done during the year. A consultant was assigned for nine months during 1976 to assist the Director and staff of the National Institute of Mental Health and Neurosciences, Bangalore, with improvements in specialist psychiatric training for all categories of mental health personnel. She also advised on the development of advanced psychiatric practice in the hospital and in the community. The consultant's recommendations have been sent to the Government.

IND MNH 003 Mental Health (Drug Addiction) R (Dec. 1975; July 1976; Nov. 1976; - Aim of the project. To give training in epidemiology, prevention, treatment and rehabilitation of drug abuse. Assistance provided by WHO during the year. Two fellowships - one for three months for studies in the United Kingdom, Sweden, Finland and Switzerland (WHO HQ) and one for two months and two weeks for study in the United Kingdom.

IND RAD 002 Radiation Medicine Centre, Bombay R (Jan.-Feb. 1963; March 1967 - ) Aim of the project. To organize the training of nuclear medicine specialists, strengthen services and research and also radio-pharmaceutical production activities of the Radiation Medicine Centre, Bombay.

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

Probable duration of assistance. Until 1983. Work done during the year. The Radiation Medicine Centre, Bombay, organized a national seminar on nuclear medicine from 27 to 30 December 1976, vith support from SEA/RC30/2 Page 138

WHO. Participants from different States of India attended the seminar. They reviewed existing facilities and formulated a plan for the further development of nuclear medicine departments at different levels of health care. In collaboration with IAEA, the feasibility of a project to study the cost-effectiveness of the application of nuclear medicine in public health epidemiology, in the diagnosis and treatment of commonly occurring tropical diseases, and in biomedical research was explored.

IND RAD 004 Advanced Course in Radiological Physics R (Dec. 1975 - March 1976; Dec. 1976-Jan. 1977; - )

Aim of the prolect. To conduct the M.Sc. course in radiological physics at the Division of Radiological Protection, Bhabha Atomic Research Centre, Bombay, and develop radiological protection services.

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

Probable duration of assistance. Until the end of 1977.

Work done during the year. A consultant assisted in the conduct of a training course far radiation physicists, reviewed the progress made in organizing the advanced course in radiological physics and advised on current research projects at the Division of Radiation Physics,Bhabha Atomic Research Centre, Trombay.

Two national seminars were sponsored at the Bhabha Atomic Research Centre to review current practices in radiology and radiation protection. Radiologists, physicists and public health administrators from different States of India took part in these seminars, which discussed the existing situation and formulated plans and guidelines for the standardization of techniques, protection of personnel against ionizing radiation and the training of personnel in radiological and radiation protection services.

IND HWP 001 Occupational Health R (April-Sept. 1964; Aug. 1970; Nov. 1970 - Jan. 1971; July 1972; Aug. 1973; Dec. 1973; March 1975; Dec. 1975; July-Sept. 1976; - )

Aim of the project. To conduct courses in occupational health related to specific hazards found in industries, and to undertake studies on specific hazards.

Assistance provided bv WHO durinz the vear. Four fellowships - one for twelve months for study in the United Kingdom, one for ten months for studies in the Netherlands, the Federal Republic of Germany and Poland, one for three months for studies in the United Kingdom and the Netherlands, and one for five weeks for studies in the United States of America and Japan; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1977.

IND PHA 001 (SQP 001) Dng Laboratory Techniques and Biological R Standardization (June 1967; 0ct.-Dec. 1967; Aug. 1968; July-Aug. 1969; Nov. 1969 - Jan. 1970; Sept. 1970 - Feb. 1971; Dec. 1971; 0ct.-Dec. 1972; Feb. 1973; Aug. 1973; Jan. 1974; Sept.-Dec. 1974; April 1975; July-Sept. 1975; Feb.-March 1977; - )

Aim of the project. To develop services concerned with the quality control of pharmaceutical and biological preparations, and to train staff. SEAlRC3012 Page 139

Assistance provided by WHO during the year. (a) Five fellowships - one for six months for study in the United Kingdom and two for three months and two for one month for study in the United States of America; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1977.

ItJn BLG 001 (ISB 001) Production of Freeze-dried Smallpox Vaccine R (Sept.-OCL. 1964; June 1965 - March 1966; Feb. 1967 - UNICEF Jan. 1970; Aug.-Sept. 1972; July-Aug. 1973; April 1974; Aug. 1974; Nov. 1974; May 1976; - )

Aim of the project. To become self-sufficient in the production of freeze-dried smallpox vaccine of standard quality.

Assistance provided by WHO durinp, the year. (a) A three-month fellowship for study in the United Kingdom; (b) supplies and equipment.

Work done during the year. The production of freeze-dried smallpox vaccine continues at Patwadangar and Belgaum, whereas it was stopped at the institutes in Hyderabad and Madras. Altogether less than 50% of the installed capacity is being produced annually to meet the various requirements of the health services under the Government's policy to continue to vaccinate newborns for two more years after the eradication of smallpox. During the year WHO provided source materials such as peptone and arcton, which are not available locally, in order to keep the production going.

IND BLG 002 (ISB 002) Production of Freeze-dried BCG Vaccine R (May-June 1968; June-Sept. 1970; Dec. 1973 - Feh. 1974; Dec. 1974 - Jan. 1975; - )

Aim of the project. To produce freeze-dried BCG vaccine of standard quality.

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

Probable duration of assistance. Until 1983.

IND BU: 003 (BAC 001) Production of Diphtheria, Pertussis and Tetanus R Vaccine, Kasauli UNICEF (Jan.-March 1961; Sept. 1961; March 1965; Dec. 1966; Aug. 1967; 0ct.-Nov. 1968; May-June 1970; Sept. 1970; Nov.-Dec. 1970; April-May 1976; Jan. 1977; March 1977; - )

Aim of the project. To follow up on the WHO-assisted capacity developed at the Central Research Institute, Kasauli, for the production of DPT vaccine and its individual components.

Assistance provided by WHO during the year. Five fellowships - one for two months for studies in the Netherlands, Yugoslavia, Italy, the Federal Republic of Germany, Hungary and the United Kingdom, two for one month for study in the Netherlands, one for eight weeks for studies in Hungary and the Netherlands, and one for four weeks for studies in the Netherlands and the Federal Republic of Germany.

Work done during the year. At the Central Research Institute, Kasauli, the main services for power, steam and air are being laid down in the plant in accordance with the blueprint provided by the consultant engineers late last year. After the completion of the work in May, an engineer from the manufacturers will proceed with the installation of the heavy industrial equipment (super peljas fernentors) from the SEA/RC30/2 Page 140

Netherlands supplied by UNICEF. Both the production manager and the engineer in charge of maintenance and operation of the plant were trained at Rijks Institut, Netherlands, and at the manufacturers' plant under a WHO fellowship. Two other scientists were also trained in Rijks Institut in vaccine production, using the submerged technique for the production of the D, T and P components.

At the request of the Government of India, a mission is studying the feasibility of setting up a plant in Coonoor similar to that in Kasauli. When this plant goes into operation, the production of the vaccine at both institutes will total 40 million doses - double the present quantity.

IND LAB 002 Promotion of Health Laboratory Services R and Health Laboratory Technology (Feb. 1965 - )

Aim of the project. To strengthen health laboratory services in India.

Assistance provided by WHO during the year. (a) A microbiologist; (b) under project IND LAB 001, two fellowships - one for six months for studies in Czechoslovakia and the United Kingdom and one for three months for studies in the United Kinedom:-. under IND LAB 002, two fellowships - one for eight months and three weeks for study in the United Kingdom and one for five months and two weeks for study in Thailand; (c) supplies and equipment.

Probable duration of assistance. Until 1983.

Work done during the year. The WHO microbiologist took up position in Poona (Maharashtra), early in October 1976, after going through a comprehensive programme of familiarization with the laboratory services in India. A plan covering all laboratory projects in India was prepared, in order to provide assistance in strengthening the services in 20 States.

An inventory of laboratories at all levels in the States has been prepared, covering both manpower and supplies. Four hundred microscopists from the malaria programme are being trained in four regional training centres in tuberculosis, leprosy and malaria; they will be posted to primary health centres in order to undertake surveillance work. Manuals and notes for peripheral laboratories have been distributed to the trainees. The methodology of isolating and typing enteropathogens has been standardized in most district hospital laboratories and regional public health laboratories. The bacteriological culture of cholera is being done at many regional and district laboratories outside Poona. A reference service for typhoid and cholera as well as shigella operates between the peripheral laboratories and the State laboratory and between the latter and the National Reference Laboratories at Calcutta, Delhi and Lucknow.

The project has evolved a minimum programme for the standardization of microbiology in the health laboratories in Maharashtra. To this effect a senior technician was placed in charge of control activities in the State laboratory in Poona. Two seminars were held, and quality control in media and antisera became effective in April 1977. The practice of quality control is being introduced in medical colleges and consideration is being given to the question of involving district health laboratories in this programme.

A national seminar on quality control in clinical chemistry was organized during the year, attended by the directors of the 18 collaborating laboratories in India which participate in an external control scheme. This seminar, which was held in April, took place at the All-India Institute of Medical Sciences, New Delhi. A seminar on hospital sepsis control is being organized later in 1977.

Project IND LAB 001 has been merged with this project since January 1977. SEA/RC30/2 Page 141

IND LAB 005 (VIR 001) Virological Techniques R (Sept. 1968; Nov. 1969; Aug. 1971; 0ct.-Nov. 1972; Julv-Aue. 1973: Oct. 1973: March 1974: Aun.-Oct. 197i; Feb.-~arch 1975; ~aich1976; .June 1976; Oct. 1976; Jan. 1977; March-April 1977; - )

Aim of the project. To develop the laboratory capacity for the diagnosis and surveillance of virus diseases; to establish competence in the production and testing of live poliomyelitis vaccine and its neurovirulence testing at the National Institute of Communicable Diseases, Delhi.

Assistance provided by WHO during the year. (a) A consultant; (b) four fellowships - two for six months (one for study in the United Kingdom and one for studies in the USSR and Yugoslavia); one for five months for study in the United States of America and one for study in the United Kingdom; (c) supplies and equipment.

Work done during the year. The rickettsial laboratory established in 1974 with technical assistance from WHO is doing useful work; apart from research on experimental transmission in mites, the unit at the Virus Research Centre, Poona, was involved in population studies as well as in investigating certain outbreaks. It is also involved in the teaching of rickettsiology to post-graduate students attend- ing the course an virology. In March-April 1977, a consultant helped the unit in acauirina- the technoloev-. and skill to .ureuare . the various rickettsia1 antigens;- advanced methods in isolation and experimental transmission were also introduced in Poona. The consultant introduced the microagglutination-- (MA) test and discussed the method of preparing CF and MA antigens from the different rickettsiae. He has supplied antigens and antisera to the Virus Research Centre and has offered to have the antigens prepared by the Centre tested independently in his laboratory in Czechoslovakia. Action has been taken to obtain from a laboratory in Japan the three representative strains of R. tsutsuganushi, as well as a few other strains of different rickettsiae from the consultant's laboratory. This will enable the Virus Research Centre to become self-reliant in preparing the diagnostic reagents needed in serological surveillance work. The main constraint is the inadequacy of facilities to undertake isolation work from laboratory animals. An essential pre- requisite is the reallocation of space to keep experimentally inoculated animals in a temperature-controlled environment.

For the first time, the unit offered a two-week advanced course in the breeding and care of mice. The course was attended by veterinarians from various parts of India and by a WHO fellow from Sri Lanka.

Supplies were provided to facilitate the work of the serology department and the film laboratory. A WHO fellowship was also awarded.

IND BSM 001 Groundwater Training Course R (Feb.-Mav 1970: Julv 1970: June 1971: Dec. 1973: 'Feb. 19j4; .July 19j4; NO". 1974 - ~eb.1975; Nov. 1975; Jan.-Feb. 1977; - ) Aim of the project. To train staff in the development and utilization of groundwater for community water supplies. Assistance provided by WHO during the year. Two fellowships - one for six months for study in the United States of America and one for three months for studies in Sweden and Czechoslovakia. SEA/RC30/2 Page 142

IND BSM 002 Village Water Suvvlv R (May 1971 - ) UNICEF

Aim of the project. To plan and ca-ordinate the development of community water supplies in rural areas, including the well-drilling programme in areas where hard rocks present special problems and in those where water is scarce; to train professional and drilling staff.

Assistance provided by WHO during the year. (a) A hydrogeologist and a consultant; (b) sixteen fellowships - fifteen for three months (thirteen for studies in the Philippines, Australia and Thailand, one in the United Kingdom, the Netherlands and the Federal Republic of Gennany and one in Sweden and Czechoslovakia) and one fur eleven weeks for studies in Japan,Hong Kong,Australia and Singapore; (c) supplies and equipment. Probable duration of assistance. Until the end of 1977

Work done during the year. The WHO sanitary engineer assigned under the inter-country project "~ommunityWater Supply and Sanitation" (ICP BSM 001) and stationed in the UNICEF Regional Office in New Delhi, continued to provide technical advice and guidance to the village water supply programme in India. Close collaboration was maintained with UNICEF.

The consultant hydrogeologist provided under this project in February 1976 to advise the Central Public Health and Environmental Engineering Organization, the Ministry of Works and Housing, and some of the State governments on the hydrogeological aspects of rural water supply, completed his assignment in July 1976. He is expected to take up a long-term assignment as WHO hydrogeologist during the second half of 1977. Efforts were made to recruit two national drilling engineers to assist him in his work.

IND BSM 003 Solid Wastes Disposal R (Feb.-March 1973; June-Aug. 1974; Nov.-Dec. 1974; Sept.-Dec. 1975; Aug. 1976 - Feb. 1977)

Aim of the project. To study the problems of solid wastes in urban communities and plan the management of solid wastes.

Assistance provided by WHO during the year. (a) A consultant; (b) seventeen

fellowshi~s- eiaht- for three months (six for studies in the United Kinedom.u. the Federal Republic of Germany and Switzerland, one for studies in the United Kingdom, the Netherlands and Switzerland and one for studies in the United Kingdom, the Netherlands, Switzerland and the Federal Republic of Germany), one for eleven weeks for studies in the United Kingdom, the Netherlands and the Federal Republic of Genany, and eight for three weeks for study in India; (c) supplies and equipment.

Work done. The project started in 1972 and concluded successfully at the end of 1976. During this period consultant services and a number of fellowships for higher study abroad were provided. In 1974, an assessment of the solid waste problems in Bangalore City and the measures in force for their solution, and a study of the wastes disposal system in the city of Delhi were carried out by a consultant.

In 1975, the same consultant advised the authorities in Madras, Bangalore, Hyderabad, Delhi, Lucknow, Kanpur and Calcutta, on solid wastes management, with particular emphasis on the need far reviewing plans for the development of composting plants. The consultant also helped with a national seminar on solid wastes management held in Ahmedabad, Gujarat.

In 1976, again, the same consultant took up a further assignment and paid follow-up visits to Delhi and Bangalore. As part of this assignment he prepared, for the Government of India, a draft Manual on Solid Wastes Management in Developing Countries. SEA/RC30/2 Page 143

From 1978, the activities of this project will be absorbed in a more broad-based project on environmental pollution control.

IND PIP 001 Tamil Nadu Water Supply and Sewerage Pre-investment UNDP Studies - Madras Metropolitan Area* (Jan. 1976 - ) Aim of the project. To prepare a master plan, covering all aspects of water supply, drainage and sewerage, for the Madras Metropolitan Area.

Assistance provided by WHO during the year. (a) A project manager, three consultants, an administrative assistant and a clerk-stenographer; (b) supplies and equipment

Probable duration of assistance. Until 1978.

Work done during the year. In September 1976, the agreement for consulting services for engineering and feasibility studies was completed with the engineering firm, Engineering-Science, Inc., of California, U.S.A. A similar agreement with A.F. Ferguson & Co., Bombay, for consulting services for organization, management and finance (OMF) studies, was completed in October 1976. The two sub-contractors started their work at the site in November.

An interim report on organization prepared by the OMF firm on organization and a draft immediate works report prepared by the engineering firm were accepted by WHO.

An IBN) mission visited Madras in April 1977 to review the progress of the project.

Three consultants in the fields of water supply and sewerage, and organization, management and finance studies were assigned to the project, during the month of June 1977 to assist in reviewing the project documents, reports and the progress made so far.

IND CEP 001 Prevention and Control of Water Pollution R (0ct.-Nov. 1969; April 1971; 0ct.-Dec. 1971; July 1972; Dec. 1972 - Feb. 1973; July 1973; Dec. 1973; March 1974; Aug. 1974; Oct. 1974 - Feb. 1975; May-Dec. 1975: March 1976; June-Aug. 1976; Oct. 1976 - ~eb.1977; - ) Aim of the project. To provide technical advice on organizational and other matters related to the abatement and control of water pollution.

Assistance provided by WHO during the year. (a) A consultant; (b) twelve fellowships - eleven for three months (eight for studies in the United Kingdom, the Netherlands and the Federal Republic of Germany, two for studies in the United Kingdom, the Netherlands, the Federal Republic of Germany and Hungary, and one for studies in the United Kingdom, the Netherlands and Denmark) and one for six weeks for study in the United States of America; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1977.

Work done during the year. A consultant in water pollution control was assigned to the project from November 1976 for a period of three months. He visited the Central Water Pollution Control Board and similar boards in several States as well as their laboratories, and assisted them in the administration of the Water (Prevention and Control of Pollution) Act, 1974. He also helped with the planning and conduct of a

*Previous title: Water Supply and Sewerage, Madras. SEA/RC30/2 Page 144

national seminar in Bombay in January 1977 on the administration and implementation of the Act. This seminar was attended by the chairmen and member-secretaries of Water Pollution Control Boards from almost all the States as well as by prominent scientists from universities and research institutes. WHO stafl also took part in the seminar.

IND CEP 002 Control of Air Pollution R (Feb.-March 1971; March 1973; Dec. 1973 - llarch 1974; Sept.-Oct. 1974; Dec. 1974; 0ct.-Nov. 1975; Sept. 1976; - ) Aim of the project. To study the problems of air pollution connected with industrial development and to promote a control programme.

Assistance provided by WHO during the year. (a) A consultant; (b) two eleven-week fellowships for studies in the United Kingdom, the Netherlands and the Federal Republic of Germany; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1977.

Work done during the year. A WHO consultant was assigned in September 1976 to assist the Government in preparing and finalizing the rules and regulations in connexion with the legislation on air pollution control now being considered by the Government.

IND CEP 003 Medical Toxicology Unit R (Oct.-Dec. 1972: Dec. 1973 - A~ril1974: July 1975: ‘act.-~ec. 19755 Jan. 1977; - j Aim of the project. To undertake studies on the effect of air pollutants and organocholorine pesticides in man.

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

Probable duration of assistance. Until the end of 1977.

IND CEP 005 Pollution Investigation and Control, Maharashtra UNDP (Sept.-Nov. 1976; - ) Aim of the project. To investigate and control water pollution in the State of Maharashtra. Assistance provided by WHO during the year. (a) A consultant; (b) two fellowships -

one --.for sixteen ~ weeks far-- studies- ~ in the United Kingdom,-. the Federal Re~ublicof Gemany and Hungary, and one for nine weeks for studies in the United Kingdom, the Netherlands and the Federal Republic of Germany; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1977.

Work done during the year. During October-November 1976, a consultant on water pollution control assisted the Government of Maharashtra State in the implementation and enforcement of water pollution laws and administrative regulations. He advised the Maharashtra Water Pollution Prevention Board on the activities to be undertaken with regard to the treatment and discharge of industrial and municipal wastes. SEA/RC30/2 Page 145

IND SES 001 Assistance to the National Environmental R Engineering Research Institute (Feb. 1961 - ) Aim of the project. To develop the Institute as a major research and training centre for environmental sanitation problems; to co-ordinate research programmes.

Assistance provided by WHO during the year. (a) Four consultants; (b) three fellowships for three months - one for studies in the United Kingdom, the Federal Republic of Germany and Switzerland, one for study in the United Kingdom and one for study in the United States of America; (c) supplies and equipment.

Probable duration of assistance. Until 1980.

Work done during the year. Four consultants were assigned to the National Environ- mental Engineering Research Institute (NEERI), Nagpur, during the year. One of them advised the Institute on the use of recently acquired analytical equipmentin the monitoring of organic and other pollutants in air, water and wastes. He also assisted in conducting seminars for the scientists at NEERI on the use of this equipment.

The second consultant provided assistance in the planning, organization, Fmplementa- tion and evaluation of a course for chairmentmember-secretaries of the Central and State Water Pollution Control Boards on the operation and management of these boards.

The third consultant advised the Institute on research in water treatment with particular attention to coagulation and filtration.

A fourth consultant gave advice on the measurement of air pollution with particular reference to the development of techniques to suit conditions in India.

IND SES 003 Public Health Engineering Education UNDP (0ct.-Dec. 1967; March-April 1968; Nov. 1968; Nov. 1972; July 1973; Oct. 1973; Aug. 1974; June 1975; June 1976; Oct. 1976; - )

Aim of the project. To assist with the education and training of sanitary engineers and the development of advanced courses in design for community water supply programmes.

Assistance provided by WHO during the year. Two fellowships for three months - one for study in the United Kingdom and one for studies in the United Kingdom and the Netherlands.

IND DHS 001 Indian Council of Medical Research (Statistics) R (Aug. 1962 - Feb. 1963; Dec. 1963 - June 1965; Aug.

1966 - Julv 1967: Sevt. 1967 - Mav 1968: Oct. 1968-~~ ~ - Jan. 1969;.~ug.-~ec.'1969; NOV.-D~C.19j0; July 1971; Sept. 1971; Nov.-Dec. 1971; Nov. 1972 - Jan. 1973; July 1973; Nov. 1973; June 1974; Jan.-Feb. 1975; Aug. 1976; Dec. 1976; - )

Aim of the project. To help in the improvement of statistical procedures for the planning, conduct and evaluation of research studies in medicine and public health.

Assistance provided by WHO during the year. Two fellowships - one for six months for studies in the United Kingdom, Italy and Switzerland and one for twelve weeks for study in the United States of America. SEAIRC3012 Page 146

IND DHS 002 Strengthening of Health Statistical Services R (Julv-Oct.. . 1970: Julv 1972: Julv 1973: Oct. 1973 - Feb. 1974; ~ul;1975; Sep;.-~o;. 1975; Dec. 1976 - Feb. 1977; - )

Aim of the project. To develop a health statistics system; to review and improve hospital statistics and medical records; to plan curricula for the training of medical records personnel; and to organize and conduct training programmes for statistical staff.

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

Probable duration of assistance. A number of years.

Work done during the year. During the period from December 1976 to February I977 a consultant assisted in developing hospital statistics, with special reference to hospital morbidity, and in evaluating the state of medical record departments. SEA/RC30/2 Page 147

Agencies Title

IN0 HSD 001 (SHS 001) Strengthening of National Health Services R (Feb.-March 1969; May 1969 - ) UNICEF

Aim of the project. To plan, programme, monitor and evaluate health services; to establish a research and development programme concerning health care delivery; to co-ordinate and integrate health services and improve their effectiveness and efficiency; to standardize and intensify training activities for health staff, and to promote reviews of public health practices and organization intended to lead to the optimal delivery of health care.

Assistance provided by WHO during the year.. (a) A public health administrator, two systems ana1ysts.a statistician, a health planner and a consultant; (b) seven fellowships - one for twelve months for study in the Philippines and six for three weeks (four for studies in India, Thailand and Malaysia and two for studies in India, Sri Lanka and Malaysia); (c) supplies and equipment.

Probable duration of assistance. Several years.

Work done during the year. A senior public health administrator joined the project during the year to assist with the health planning cmponent. The team was involved in the preparation of the health plan for the formulation for Repelita 111, including the drawing up of terms of reference, establishment of a working group, conduct of a workshop, development of an approach and a basic pattern for national and regional programme formulation, and the continued development of approaches to health planning. A consultant assisted in conducting the workshop on health planning, in preparing a learning module and in evaluating the progress made under this component.

A "task force" on primary health care was established to take follow-up action emanating from the "maxi" seminar on primary health care held earlier. Assistance was provided to the task force in preparing a progress report for presentation at the National Conference on Primary Health Care. A survey of primary health care was undertaken to identify viable approaches, to study their arrangement and to develop means for the promotion of community health. Arrangements were made for a high-level multi-disciplinary mission to visit selected countries to acquaint itself with the concept of primary health care as practised in those countries and to exchange views.

At a meeting of the joint WHOlIndonesia Co-ordination Committee held in November 1976, the core project, Strengthening of National Health Services (IN0 SHS 001) was reviewed. The meeting discussed the future role of other international and bilateral agencies and reviewed the progress of implementation of primary health care. Subsequently, a revised schedule for primary health care activities was drawn up for the remaining period of Repelita 11. Action was taken to formulate and give a final shape to the plans of action for the three components of the project, viz., health planning, research and development and health care delivery system, in line with the evaluation report.

The project staff provided assistance in drafting proposals for a training course m conputer-based information systems,and helped with the course. They also helped in conducting a number of other training activities, such as (i) a one-week workshop in health planning to prepare for the planning of Repelita 111, (ii) a course on health survey research methodology, (iii) a course on operational SEAlRC3012 Page 148

researchlsystems analysis, and (iv) a workshop on health insurance. In addition, a symposium on field operations research in maternal and child health and family planning services was held with support from WHO; it was attended by participants also from other countries of the Region. The printing of the Fnglish version of the Health Centre Reference Manual, prepared jointly hy national and WHO staff, was undertaken. Short-term consultants were provided to assist in editing the maternal and child health "package" and in testing it in the field.

IN0 HSD 002 Medical Rehabilitation R (July 1976; - )

Aim of the project. To develop cmunityariented medical rehabilitation services and train the necessary health and allied personnel.

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

Probable duration of assistance. Until the end of 1977.

School Health (Jan. 1974: Dec. 1974 - March 1975: Dec. 1975: .~pril1977; - )

Aim of the project. To develop school health services.

Assistance provided by WHO during the year. (a) An eight-month fellowship for studies in Egypt, Sudan and Iran; (b) supplies and equipment.

Probable duration of assistance. Until 1979.

Medical Services for Family Health (Nov. 1976; - )

Aim of the project. To strengthen the development of an integrated approach to the delivery of family health services, with special reference to the provinces outside Java and Bali.

Assistance provided by WHO during the year. (a) Six one-month fellmships for studies in Indonesia, Malaysia, Thailand and Singapore; (b) grant.

Probable duration of assistance. Ultil 1979.

Work done during the year. Six inter-regional fellowships were awarded for a study tour of centres in Malaysia, Thailand, Singapore and Jakarta where the delivery Of family planning services is duly integrated with maternal and child health care. On their return, the fellows conducted a workshop in Surabaya for 20 senior health administrators in which they discussed and shared their ohsewations and experience with their colleagues. A grant of $1600 was given for this workshop.

IN0 NUT 003 Nutrition Training R (May 1975; - )

Aim of the project. To develop effective control programmes and strengthen and expand the nutrition aspects of health services and train staff.

Assistance provided by WHO during the year. Supplies and equipment. SEAIRC3012 Page 149

IN0 HED 003 Development of Health Education in Family Health WFPA (Aug.-Nov. 1971; Jan. 1973 - )

Aim of the project. To develop health education in family health, including services, rranpower development, training, studies, media and methods and other components such as school health and family life education.

Assistance provided by WHO during the year. (a) A health education specialist; (b) an eignteen-month fellowship for study in the United States of America.

Probable duration of assistance. Until the end of 1977.

Work done during the year. All hut one of the national health education specialists who had been sent abroad for specialized training returned to the country and are being assigned to the health education services at the Ministry of Health, the provincial directorates of health services, the Faculty of Public Aealth, University of Indonesia, and ather institutions. The WHO health education specialist assigned to the project assisted in establishing and staffing provincial health education bureaux,in identifying the functions of the staff, and in carrying out these functions properly in support of health education. He also helped in the joint WICEF/WHO Study of the Process of Community Motivation and Cmtinued Participation.

IN0 HMD 001 Medical Education R (May 1964 - ) Aim of the project. To develop the teaching programmes of the medical faculties in keeping with national needs and the progress of the educational sciences.

Assistance provided by WHO during the year. (a) Two medical officers; (b) four fellowships - one for nineteen months and me for three months (extension) - for study in Thailand.one for twelve months for study in the Netherlands and one for six months for st"dy in India; (c) supplies and-equipment.

Probable duration of assistance. A number of years.

Work done during the year. 'ho long-term staff members continued to provide assistance to the project. One of them,attached to the Consortium of Medical Sciences, has been involved in the establishment of medical education units in the medical schools and in the training of staff for these units. The other medical officer has collaborated in the development of a cmunity-oriented curriculum in the Medical School in Surahaya.

IN0 HMD 002 Nursing Education and Services R (June 1967; Aug. 1967; Jan.-Dec. 1969; April 1970 - 1

Aim of the project. To reorganize the total nursing system of the country within the context of national health plans in order that equitable distribution and utilization of adequately trained nursing manpower may be effected.

Assistance provided by WHO during the year. (a) A senior nurse educator and a nurse educator; (b) a three-month fellowship for study in Malaysia.

Probable duration of assistance. Until 1980.

Work done during the year. This project has undertaken a wide range of activities. In the past, nursing education developed in response to various specialized needs, resulting in at least 24 categories of nursing personnel. The present task is to change the system through the introduction of two levels of nursing, the primary health nurse (PK), prepared to carry out basic nursing flmctions in the hospital SEA/RC30/2 Page 150

and to render primary health care in the cmmunity, and the university-level nurse, trained in supervision, administration, teaching and other leadership functions. During the year under review, the activities have focused on the development of the PK programme. Continued assistance has been given to the ten schools opened in 1976 and to the re-training programe for converting nurse-midwife personnel to the PK nursing qualifications. Intensive work has been dme on curricula, various guidelines, evaluation pro fom and the development of the four teacher training centres. Many activities have been carried out in collaboration and cmsultation with other WHO-assisted projects as well as with international agencies. The WHO nurse educator and national staff have worked together on the preparation of reports and proposals inwlving bilateral aid agreemmts. They were also involved in the preparation of a research proposal for the "Evaluation of a Community-Based Nursing Education Programe", in collaboration with a WHO nurse researcher cmsultant and a consultant from the International Development Research Centre, Ottawa. Work was started m a registration system and job specifications for nursing personnel and for the development of staffing patterns and in-service education for the improvement of hospital nursing services.

Post-graduate Education in Public Health (Jan.-Feb. 1972; July-Aug. 1972; March 1973; July 1973; Feb. 1974; July 1974; Dec. 1974 - March 1975; May 1976; Jan. 1977; - )

Aim of the project. To develop further the teaching and training programmes conducted by the School of Public Health, University of Indonesia.

Assistance provided by WHO during the year. Twelve fellowships - one for fourteen months for study in the United Kingdm, ten for ten months for study in Indonesia and one for six veeks for study in the United Kingdom (extenaim).

Probable duration of assistance. A number of years.

IN0 HMD 008 Resources for Family Health DNPPA (July-Sept. 1971; Sept. 1972-Dec. 1974)

Aim of the project. To take a census of health manpower, to make an inventory of health and training facilities, and to develop and bring up to date a records system.

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

IN0 ESD 002 Research in Cornmicable Diseases Ecolopy* R (Jme 1972; Aug. 1972; Nov. 1972; Jan. 1973; July-Oct. 1973; Dec. 1973; Feb. 1974 - )

Aim of the project. To assist in the design, organization and analyais of biomedical studies.

Assistance provided by WHO during the year. (a) An ecologist and a statistician; (b) Five fellovships - two for twenty-four months for study in Indonesia, one for three months for study in the United States of America; one for eleven weeks for studies in Singapore,.~alaysia, Sri Lanka, Switzerland, Sweden, Nomy and Italy, and one for seven weeks for studies in the United Kingdom, the Federal Republic of Germany, Sweden, Dennark, France and Switzerland; (c) supplies and equipment.

Probable duration of assistance. btil 1979.

*~revioustitle: National Institute of Medical Research SEAlRC3012 Page 151

Work done during the year. A WHO sanitary engineer was deputed to the project at the request of the Government instead of a consultant for whom provision existed. His assistance was sought in the development of water supply schemes for rural areas and the identification of environmental pollution problems and the types of research needed. The staff, particularly the statistician, assisted and participated in related research activities of the National Institute of Medical Research other than biomedical studies.

Other important activities were lectureltraining courses on health survey research methodology at the Institute of Health Research and Development, Jakarta, and assistance and guidance to national staff in the analysis and interpretation of data from various projects undertaken by the Institute. Studies on schistosomiasis control in the pilot area in Mndu Valley and on soil-transmitted helminthic infections are progressing.

IN0 ESD 003 Strengthening of Epidemiological Surveillance R and Control (June 1975 - )

Aim of the project. To strengthen further epidemiological surveillance in the country at both central and intermediate levels, and to train staff.

Assistance provided by WHO during the year. (a) Three consultants; (b) two six- month fellowships - one for study in India and one for study in Thailand; (c) supplies and equipment.

Probable duration of assistance. Until 1979.

Work dme during the year. Three consultants were assigned to this project during the year. One of them studied the situation on the use of penicillin and the surveillance of the sensitivity of gonococci to the drug. The second evaluated the control programme and the epidemiological situation of taeniasis in Irian Jaya and other places, and also reviewed the epidemiological situation of filariasis. The third consultant assisted in strengthening the epidemiological surveillance programme in the country; he also studied the epidemiological situation of cholera in West Java.

IN0 MPD 001 Malaria Eradication K (May 1955 - ) US AID

Aim of the project. To control malaria in the entire country and eventually eradicate it, with special emphasis on Java and Bali and on the socio-economic areas of the other islands, as an integrated activity.

Assistance provided by WHO during the year. (a) A senior malariologist; two mlariologists; tm entomologists and a typist-translator; (b) seven fellowships - me for six months for study in Thailand and six for twelve weeks for studies in India and Sri Lanka; (c) supplies and equipment; (d) subsidy.

Probable duratim of assistance. A number of years.

Work done during the year. At the end of the period under review, the malaria control programme covered a population of 84.9 million in Java and Bali under extensive mosquito control measures; in the other islands, with a population of 46.9 millim, insecticide spraying was undertaken in areas selected m the basis of their socio-economic importance, covering a very small population. A population of 4.6 million in Jakarta is considered malaria-free. SEA/RCU)IZ Page 152

A joint GovernrnentlWOI~SAID team undertook a 'situation analysis' of the programme in relation to the long-tern US AID loan of USS24.7 million to support the programme. The first Kelimantan-Sarawak Malaria Border Meeting, as a sequel to the Indonesia- Malaysia-Singapore Malaria Border Co-ordination Meeting, was held during the period under review.

Owing to delay in the arrival of supplies and consequently in starting spraying in 1975-76, only 27% of the coverage targeted in Java and Bali could be achieved. Against this, with timely supplies available now, a coverage of 97% was recorded duringthe first round of spraying in 1976-77. In the other islands, too, the coverage in the last two years has been better. Supplementary measures such as the reforestation of some lagoons and the lamiciding of A. slmdaicu.9 in breeding places, in addition to intermittent irrigation, are also being practised.

Six senior staff of the malaria control programme underwent training in malariology at the National Institute of Communicable Diseases, Delhi, under WHO fellowships; me medical officer attended an MPH course in Iran. During 1976, 31 regency medical officers and 22 assistant entomologists received training in two courses at the Ciloto Training Centre in addition to 6809 programme personnel trained in 187 courses held in provincial training centres.

Case-detection data for 1976 show a further improvement in the epidemiological situation. The downward epidemiological trend, which was first witnessed in 1974, has continued. The slide positivity rate, 1.51% in 1975, which was half that of the 1974 level, has further come down to 1.16% in 1976. The proportion of P. faZcipmm also has stabilized at about 35%. heepidemiological prospects in Java and Bali are thus encouraging. In the other islands blood examinations from areas covered by the programme show a slight decrease in the slide positivity rate as compared to the previous years.

The monitoring of parasite and vector resistance in various parts of the country continued. A stage V re-trial with Malathion was conducted in Central Java, as the results of the earlier trial were inconclusive. An ultra-low volume application of fenitrothion to assess its effectiveness is also being undertaken. Longitudinal entomological observations at several sites in Central Java were begun in order to provide baseline data for a fenitrothion fogging trial in an area where malaria transmission continues in spite of DDT application.

Malaria Control (Province of Irian Jaya) (Jan. 19 70 - Dec. 19 76) UNDP

Aim of the project. To control malaria in Irian Jaya.

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

Work done. This project, earlier financed by FUNDWI, was supported in 1974 by LNDP funds. The activities were stepped up in 1975 with an increase in the number a£ houses targetted for spraying. The parasite rate in 1975 was, however, higher than in the previous years. Progress has not been satisfactory because of local constraints such as difficult communications. The departure of the technical officer in the latter part of 1976 resulted in the termination of the project at the end of 1976 before its expiry period.

IN0 SPI 001 (ESD 004) Immunization Services (including Smallpox) R (May 1975 - )

Aim of the project. To initiate and develop gradually imunization services against diphtheria, tetanus, pertussie and poliomyelitis according to national priorities in addition to the existing programmes against smllpox and tuberculosis. SEA/RC30/2 Page 153

Assistance provided by WHO during the year. (a) Tvo three-month fellowships for studies in Iran and Ghana; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1977.

IN0 BVD 001 (MBD 001) Tuberculosis Control R (July 1961 - ) UNICEF

Aim of the project. To integrate BCG vaccination without prior tuberculin testing into the work of the maternal and child health clinics and regency polyclinics; to train staff engaged in case-finding by microscopic examination of sputum, and to provide ambulatory treatment.

Assistance provided by WHO during the year. A consultant.

Probable duration of assistance. Until the end of 1977.

Work done during the year. A consultant was assigned for four weeks during October- November 1976 to review the progress of the national tuberculosis control programme with reference to the BCG vaccination component. He has given recommendations for the future development of (a) BCG immunization activities, (b) case-finding and treatment, and (c) integration of the project into the basic health services. he of the Regional Advisers on Communicable Diseases also visited Indonesia during the year and discussed the problem of tuberculosis and its control with the national authorities.

IN0 BVD 002 (MBD 002) Leprosy Cmtrol R (July-Sept. 1955; Sept. 1956 - Dec. 1967; Feb.-May 1969; Feb. 1970; April 1974 - )

Aim of the project. To assist the leprosy control programme through the development of a training-cum-demonstration area in leprosy control.

Assistance provided by WHO during the year. A leprologist.

Probable duration of assistance. Until the end of 1979.

Work done during the year. The WHO leprologist cmtinued to assist the project.

The main development has been on the training of health personnel at all levels for leprosy surveillance and treatment of cases. Leprosy control is now integrated into the general health services. Training courses for leprosy supervisors and medical officers from the various parts of Indonesia who have responsibility for leprosy control activities continued to be given at the National Leprosy Training Centre in Ujmg Pandang. Random surveys in South Sulawesi and Bali Provinces, and trial case-finding,case-holding and technical screening of leprosy-affected villages in South Sulawesi continued to make progress.

IN0 ORH 001 (tNH 001) Dental Health R (Jan.-April 1968; July 1969; Aug. 1970 - Feb. 1971; ZW DP Aug. 1971 - Jan. 1972; Nov. 1972 - April 1973; May-Oct. 1973; 0ct.-Nov. 1974; April 1975; March-April 1976; May 1976; - )

Aim of the project. To plan further dental activities and strengthen dental health services within the framwork of health services, and to promote research in dental health. SEA/RC30/2 Page 154

Assistance provided by WHO during the year. Temporary assistance from a staff member from WHO Headquarters.

Work done during the year. A dental officer from WHO Headquarters visited Indonesia for two weeks in May 1976, when he participated as an adviser in the Workshop on the Plwning of Dental Health Services for Repelita 111. He also helped in designing a curriculum for an in-service training course in dental public health and in the planning and evaluation of a national oral disease preventive programme. The report on his visit has been sent to the Government.

IN0 MNH 001 Mental Health R (Aug. 1974; Nov. 1974; Dec. 1975; Feb. 1976; Dec. 1976; April 1977; - )

Aim of the project. To train medical, nursing and allied health personnel for community-oriented mental health services within the framework of comprehensive health services, to strengthen psychiatric services, including rehabilitation, and undertake epidemiological investigations of mental illness.

Assistance provided by WHO during the year. (a) A consultant; (b) two fellowships - one for three months for study in the Netherlands and me for two months for studies in Denmark, the United Kingdan and Switzerland.

Probable duration of assistance. A number of years.

Work done during the year. A consultant on assignment for one mnth assisted the Directorate of Mental Health, Department of Health, in the planning and conduct of a workshop on the treatment of drug abuse and the training of health personnel in dealing with the problem. The consultant further helped with an evaluation of current facilities in the country for training, services and research.

The recommendations of the consultant have been sent to the Government.

Training of X-ray and Electro-medical Technicians (March 1966 - ) UNDP

Aim of the project. To train radiographers; to train electro-medical technicians in the installation, use, maintenance and repair of electro-medical equipment.

Assistance provided by WHO during the year. An electro-medical engineer (specialist in elect ro-medical techniques).

Probable duration of assistance. Until 1978.

Work done during the year. UNDP assistance to this project had to be suspended in mid-1976 wing to the liquidity crisis. WHO continued the operation of the project under its Regular budget till the departure of the WHO staff member towards the end of 1976. 1MDP's support was not available in 1977 and is dependent on Government priorities in 1978. During the operation of the project, the training programme at the Academy for the Training of Radiographers in Jakarta was well established and the faculty was strengthened through the award oE fellowships for training the staff members in teaching radiographers. Action was initiated for establishing a second Academy in Surabaya. The standard of radiographic services in hospitals is improving with the appointment of technicians trained in this academy. SEA/RC30/2 Page 155

With bilateral assistance from the Federal Republic of Germany a hospital mrkshop has been established in Semarang.

IN0 PHA 001 (SQP 001) Quality Control of Food and Drugs R (Dec. 1973 - March 1974; Oct. 1974; Jan. 1975; March-May 1975; July 1975; Feb. 1976; May-Sept. 1976; - )

Aim of the project. To draft legislation to cover the qmlity control of food and drugs; to improve the central quality control laboratory, and to train personnel.

Assistance provided by WHO during the year. (a) A consultant (food technologist); (b) three six-month fellowships for study in Thailand.

Probable duration of assistance. &ti1 the end of 1979.

Work done during the year. A consultant was assigned in June 1976 for a period of three months to evaluate the work of the e~dstingfood control laboratories and make recommendations for their improvement concerning equipment, personnel and procedures. He was also to prepare training programes for the upgrading of laboratory technicians and deliver lectures.

The consultant visited various food cmtrol laboratories, reviewed the available equipment, procedures and personnel required for the central laboratories, delivered lectures on fwd and drug legislation, and assisted in the preparation of the Drug and Food Control Act and curricula for a two-year food science course proposed by the Institute of Food Science Association.

IN0 BLG 001 (LAB 002) Vaccine and Sera Production UNDP (Dec. 1968: Jan. 1969; March 1970; 0ct.-Dec. 1970; Nov. 1971; UNICEF Feb. 1973; Sept. -0ct. 1973; Nov.-Dec. 1974; March-April 1975; Sept. 1976; - )

Aim of the project. To improve methods of producing bacterial and viral vaccines, anti-toxins and toxoids; also to develop capability for the quality control of vaccines md sera.

Assistance provided by WHO during the year. Temporary assistance from the Regional Adviser on Health Laboratory Services.

Work done during the year. Because of WDP's financial difficulties, the consultant planned to be provided to this project could not be recruited, and the final evaluation was done by the Regional Adviser m Health Iaboratory Services, who visited BIOPHARMA in September 1976. BIOPHARMA has been able to co-ordinate international assistance from different sources and has made considerable efforts in modernizing vaccine production in Indonesia. In order to meet the future requirements of the expanded programme of immmization for DPT vaccine, BIOPHARNA needs support in expanding its present capacity five fold. ?he supply of large units for submerged culture and the procurement of a large-capacity centrifuge and an automatic bottling and filling unit will be necessary for this purpose.

IN0 LAB 001 Laboratory Services R (June 1967: June-Aug. 1968; June 1969; June 1970 - ) UNICEF

Aim of the project. To strengthen health laboratory services. SEA/RC30/2 Page 156

Assistance provided by WHO during the year. (a) A technical officer and a typist- clerk; (b) four fellowships - one for sixteen months for study in the United Kingdom, two for six months (me for study in the Netherlands and one for studies in India and Thailand) and one for four months for study in Thailand; (c) supplies and equipment.

Probable duration of assistance. Some years.

Work done durinp the year. Considerable improvement was reported in many laboratories as a result of the strengthening of the staff, premises and water and electricity facilities. In view of the efforts made by kabupaten administrations several kabupaten laboratories in Sumatra and Sulawesi were recommended for assistance by UNICEF.

From 1971 to 1976 a total of 395 laboratory workers have been trained - 312 from kabupaten laboratories; 25 from provincial laboratories; directors of provincial laboratories, 45, and tutor technicians, 13. The course for kabupaten workers was reorganized and made job-oriented, and also strengthened by using teaching aids and audio visuals and the manual issued by WHO Headquarters. Fran 1973 to 1976, 56 workers were trained.

A recent evaluation of these courses indicates that they should be repeated every three years, and the courses expanded to include other additional subjects such as water and food and the collection and transport of specimens. Provincial laboratories where such courses are held would like to be provided with sets of slides and transparencies. The need for all material to be translated into Indonesian was emphasized by several laboratories. The role of the technical officer was an important one, as he was responsible for conducting the course and training the core of senior technicians from the provincial laboratories who trained the workers from the kabupatens.

Chapter 12 of the manual for primary health centres, which has been published, deals with the laboratories in these centres. It is a handy manual containing useful notes on laboratory procedures in day-to-day clinical work.

Improvement of the curricula of the various courses in order to make them more relevant to the future work of the trainees was the subject of discussions between the Directorate of Laboratories and bodies such as the Academy of Analysts.

IN0 BSM 001 National Community Water Supply and Sanitation R (March 1969; June 1969 - ) UNICEF

Aim of the project. To plan community water supply and sanitation facilities in rural and urban areas and to train personnel.

Assistance provided by WHO during the year. (a) Two sanitary engineers, a sanitarian and two cmsultants; (b) five twelve-week fellowships for studies in Thailand, Bangladesh, India and Malaysia; (c) supplies and equipment.

Probable duration of assistance. Some years.

Work done durinp, the year. During the year under review, the activities of the project continued to record satisfactory progress. A third WHO sanitary engineer will be assigned in July 1977 to help with the planning and implementation of the water supply and sanitation programme in the province of South Sulawesi.

Two consultants assigned to the project, one for six months to assist in reviewing and improving existing standard designs of rural water supply, and the other for three months to advise on the development of a programme for the improvement of food sanitation, completed their assignments in October and December 1976 respectively. SEA/RC30/2 Page 157

hder the national rural water supply prograwe of Repelita I. 83% of the piped water supply schemes and 100% of the handpmp systems have been cwpleted. The INF'RES rural water supply programe, which receives UNICEF assistance, ccntinued to make progress.

In July 1976, activities were initiated on the rural water supply project for West Java with Dutch assistance. The Government has allocated Rupiahs 20 million to this project. In addition, the Government sanctioned Rupiahs 8 million for the Central Java rural water supply project, for which assistance from West Germany is expected in 1977. A loan agreement was signed in October 1976 between US AID and the Government for assistance in the developmmt of manpower for rural sanitation. US AID approved a loan of USS6.8 million and the Government has allocated Rupiahs 300 million.

The WHO sanitarian participated in the preparation of a workshop on hygiene and sanitation of public places and food sanitation and pesticides, which was held in August 1976. A short course on designing simple piped water systems for rural cowunities was held in April 1977, and was attended by 14 health controllers and 6 sanitarians from 16 provinces. The WHO sanitary engineer assisted with this course.

The national survey of community water supply and sanitation was cwpleted in 19 000 villages with financial and technical assistance frw WICEF and WHO respectively.

Eio PIP 002 Jakarta Sewerage Master Plan* UNDP (June 1974; Aug. 1974 - )

Aim of the project. To prepare a plan for the development of sewerage and sanitation facilities in Jakarta and to train personnel.

Assistance provided by WHO during the year. A sanitary engineer.

Work done during the year. The project continued to make sufficiently good progress. All the necessary reports were submitted by the sub-cmtractor either in draft or in revised form, with the exception of the Summary Master Plan Report,

During the year, the activities were concentrated on the preparation and submission of three pending draft reports, viz., Evaluation of Investment Required of First- stage Programne, the Master Plan Report, and Preliminary Engineering and Feasibility Studies. An external consultant and the WHO project manager visited the sub- contractor's office in Japan and reviewed reports pending for submission prior to the meeting of the WHO Review and Guidance Mission.

In January 1977, the WHO Review and Guidance Mission made an on-site evaluation of the basic sanitation measures, sewerage and stom drainage works proposed by the sub-contractor within the Master Plan, and the first-stage developrent prograwe for Jakarta. The mission also discussed the findings and recommendations of the sub-contractor's draft reports with national officials and representatives of UNDP and IBRD. The Mission's report was submitted to the subsontractor, who will proceed with the finalization of the reports in accordance with the agreed plan.

IN0 PIP 003 Rural Water Supply Project, East Java Province UNDP (Feb. 1975 - )

Aim of the project. To develop and implement a planned rural water supply programme for East Java Province.

*Previous title: Jakarta Sewerage and Sanitation Project. SEAIRC3012 Page 158

Assistance provided by WHO during the year. (a) A project manager and a sanitary engineer; (b) supplies and equipment.

Work done during the year. During the period under review, the main activities of the project related to the preparation of the rural water supply report for eleven regencies and of the water supply manual, the completion of final designs for five small water supply projects in the regencies of Bangkalan, Jombang, Blitar, Madiun and Sampang, and the construction of the Jombang water supply project.

The preparatory assistance to the project was extended until December 1977 following the submission of the project extension document to UNDP.

The draft of the full-scale project document was re-written in the new UNDP format and submitted to MDP for review and comment.

lko vehicles were provided to the project in addition to other supplies necessary for carrying out the activities. The project received adequate support from the Government, in additim to technical guidance from the WHO project manager and the WHO sanitary engineer.

IN0 SES 001 Training in Sanitary Engineerin R (Feb.-March 1968; Sept. 1968; Mfy 1969; Aug.-Sept . 1969; July 1970 - )

Aim of the project. To train sanitary engineers at the Institute of Technology, Bandung, and other institutions.

Assistance provided by WHO during the year. Three fellowships - one for sixteen wnths for studies in the Netherlands. the United Kinedam. the Federal Reoublic of Germany, Switzerland and India and two for three montis (ke for studies India, Turkey, Switzerland, the Federal Republic of Germany, the United Kingdw and the Netherlands and me for studies in India, Singapore, the Philippines, Japan and Thailand); (b) supplies and equipment.

Work done during the year. The Department of Sanitary Engineering at the Institute of Technology, Bandtmg, which now has seventeen faculty members, eleven of whom have attended post-graduate educational programmes with WHO assistance, is now firmly established. A second faculty member has been pursuing a doctoral programme under a WHO fellowship and is expected to graduate in 1977. Additional equipment, books and laboratory supplies were provided to assist teaching and research activities.

Under a contractual agreement with WHO, the University of Oklahoma, USA, provided three visiting professors in 1976-77 m short-term consultancies in environmental planning, air pollution assessment and control, water quality management, and water pollution control. An arrangement is being worked out for similar consultancy assistance in 1977-78 in the fields of industrial waste treatment, solid wastes management and the assessment of environmental impact. SEA/RC30/2 Page 159

Project Number Source of Pmds Co-operating Agencies Title

MAV HSD 001 (SXS 001) Public Health Administratirn R (Oct. 1959 - )

Aim of the project. To develop comprehensive health services, promote manpower development and strengthen medical care services, with particular emphasis on the control of endemic diseases of social and economic importance.

Assistance provided by WHO during the year. (a) A laboratory technician, a sanitarian, seven consultants and a secretarial assistant; (b) four six-month fellowships for study in India; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. Surveillance activities in respect of mlaria, filariasis. tuberculosis and leprosy were continued. Regular and systemtic surveys of leprosy and tuberculosis were undertaken, and a cwplete coverage of five atolls had been achieved by the end of 1976. It is hoped to complete these surveys in the remaining 14 atolls during 1977.

BCG vaccination as well as immunizations against smallpox, diphtheria, pertussis, tetanus, polio and typhoid were carried out in Male and outside.

Chlorination of a number of mosque wells, tanks and schools was done. Cross checking of water samples from wells was carried out.

A number of experts in various fields of health were assigned with a view to further strengthening the health services. A team of general surgeon-anaesthesio- logist performed 160 operations and also organized an ia-service training programme for hospital staff. The same team took up a further assignment in June 1977. A health education specialist cmducted three health workshops for dcmiciliary workers, health assistants and nurse-aide students. An ENT apecialist made a sample survey of the incidence of these diseases, held clinics, performed operations, organized a training course for health personnel and assisted in setting up ENT units in health centres; 1633 patients were examined. A pathologist helped in the planning, organization, development, operation and evaluation of hospital laboratory services. Visits by a paediatrician were arranged for providing assistance in running child health clinics and in training counterparts.

me assignment reports of these consultants were submitted to the Government.

MAV HUD 001 Training of Auxiliary Health Personnel MDP (Nov. 1971; Sept. 1972 - )

Aim of the project. To establish a school for the training of auxiliary health personnel.

Assistance provided by WHO during the year. (a) A medical officer and a public health nurse; (b) aupplies and equipment.

Probable duration of assistance. A number of years. SEA/RC30/2 Page 160

Work done during the year. The WHO public health officer and the WHO nurse educator continued to assist with all training, organizational and co-ordination aspects of project activities. The WHO public health officer, in addition, co-ordinated the work of all WHO-assisted projects in the Maldives.

In January 1977 a new combined training course for conmunity health workers and nurse aides was started. A new group of trainees joined the course in March 1977.

MAV HMD 003 Fellowships (Medical Education - Non-Communicable UNDP Disease Prevention and Control) (July 1976, - )

Aim of the project. To build up a national corps of health personnel.

Assistance provided by WHO during the year. A twelve-month fellarship for study in India.

MAV MPD 001 Malaria Control R (Jan. 1972 - ) Aim of the project. To control malaria in the entire country, leading to ire eventual eradication. Assistance ~rovidedby WHO during the year. (a) A scientist-technical officer; (b) two three-month fellowships for study in India; (c) supplies and equipment. Probable duration of assistance. Some years.

Work done during the year. The entire population of the Maldives, totalling 137 thousand at the end of the period under review, has already received protection at least once through DDT spraying along with five-day mass drug administration.

With the provlaion of health centres and/or hospitals in 18 out of the 19 atolls by 1976, the general health services improved further. Health centres are providing support to the malaria programme by undertaking passive case-detection.

During 1976, there was a resumption of the transmission of malaria in many islands of the northern atolls due to the reappearance of A. sdpictus. Follow-up spraying on a total coverage basis was, therefore, carried out in 28 inhabited and 49 uninhabited islands. in addition to five-day mass drug administration. In three islands of Noon Atoll, where transmission could not be interrupted, a second round of follou-up spraying was undertaken.

No changes were introduced in the pattern of surveillance activities during the year. Case-detection continued to be carrid out, as before, by health centres, island chiefs, hospitals and the malaria office, as well as active searches by house visits in Male.

The examination of 74 631 blood slides during 1976, reflecting the improved collaboration of passive case-detection agmcies and intensified epidemiological investigations in the malaria foci, revealed 580 malaria positives, giving a slide positivity rate of 0.78% (compared with 61 908 examinations resulting in 1105 positives with a slide positivity rate of 1.78% in 1975). This indicated an encouraging trend towards malaria control. The pattern of malaria incidence in the country b the recent past my seem erratic, but a closer and detailed examination of the data for 1975 and 1976 shows that the incidence was not generalized in all atolls and malaria outbreaks in some northern atolls were msinly responsible for its comparatively high level. Indigenous malaria was altmst non- existent in the central atolls and at a very low level in the southern atolls. P. faZciprum malarla, which accounted for a high proportion in earlier years and had achieved a predominant status during 1973, decreased drastically, reaching a very low - 1.4% - level during 1975 and was not detected at all during 1976. SEA/RC30/2 Page 161

Successful operational trials were carried out cn a five-dose regime of the radical treatment of P. vivaz using 45 mg primaquine every fourth day to prevent intra- vascular haemolysis. It is felt that further studies should be conducted m the bionomics of A. subpictus and the use of Nipa frutimns or Caemrina equisitifolia as permanent larval control measures in saltwater swamps.

MAV BVD 001 (MBD 0011 Leprosy and Tuberculosis Cmtrol Programme R (Oct. 1975 - ) Special Account

Aim of the project. To control the spread of tuberculosis and leprosy by means of reducing sources of infection and increasing imunity among persons susceptible to these diseases.

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

Probable duration of assistance. Some years.

Work done during the year. The first phase of the plan initiated by a WHO consultant in October 1975, who had organized an efficient survey team, continued. The plan of operation for the project consists of two phases, viz., (1) survey of leprosy and tuberculosis in the country and immunization, and (2) integration of leprosy and tuberculosis into the basic health care and primary health care programmes, and iwunization.

It is proposed to assign the same consultant again for providing further assistance. A comprehensive health plan as a basis for a pilot project of comprehensive health service by the integration of leprosy and tuberculosis control and immunization services is being drawn up. DANIDA has expressed interest in supporting such a pilot project and the second phase of the programme.

MAV BSM 001 Water Supply and Sanitation R (April 1971; Aug. 1973; March-June 1974; Aug. 1974 - ) UNICEF

Aim of the project. To develop water supply and sanitation systems in Male and other atolls; to train personnel.

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

Probable duration of assistance. Until 1981.

Work done during the year. The WHO sanitary engineer assigned to this project since August 1974 left at the end of July 1976.

The WHO consultant-sanitary engineer assigned to the project in early October 1976 for a period of eleven months continued to provide technical advice and guidance to the Maldives Water and Sanitation Authority (MUSA) m the development of a water supply and sanitation programme in the country. The progrmme of chlorination of wells continued. The construction of the marine drive sewer project was completed in November 1976.

Another consultant was assigned to the project in October 1976 for a period of two mcnths, to advise the MWSA on planning water supplies and waste disposal projects for Male and other islands of the Republic. He also helped in the preparation of a plan of action for the next three years. SEA/RC30/2 Page 163

8. MONGOLIA

Title

MOG PPS 001 (SHS 0051 Management of Health Services R (Jan.-March 1975; Aug.-Nov. 1975; Jan.-Feb. 1976; April 1976; June-Oct. 1976; - )

Aim of the project. To develop integrated health services and train health personnel in all aspects of comnity health services; to develop a health information system and train health statistical personnel; to develop health services management and operational research.

Assistance provided by WHO during the year. (a) Two consultants; (b) thirteen fellowships - five for ten months for study in the USSR; one for three months and three weeks for study in the German Democratic Republic; three for three months for study in Czechoslovakia and four for two months (three for studies in the USSR and the German Democratic Republic and one in the USSR); (c) supplies and equipment.

Probable duration of assistance. Several years.

Work done during the year. The plan of operation for this project was finalized and concluded with the Government. Under this plan an innovative approach was adopted,in that a national project manager was appointed to co-ordinate the activities of the project. Two short-term consultants were provided during the year. One of them advised the Government on the uses of a computer in the health information system, on developing a computer programme and on training national staff in computer programming. The second consultant conducted national courses and sminars in modern health services management techniques and provided consultations to research workers in public health practice. He also demonstrated the practical application of some modern managerial techniques in health services administration and made recormendations for improving health development work. A one-month national course in health economics was held for health economists from the aimaks. A hospital utilization study was designed and work on the establishment of new health manpower planning norms and staffing patterns was initiated.

MOG HSD 001 (SHS 003) Rehabilitation Services R (June-July 1973; July 1974; Oct. 1974 - Peb. 1975; Oct. 1975 - May 1976; Nov. 1976; April 1977; - )

Aim of the project. To develop medical rehabilitation services and train necessary personnel.

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

Probable duration of assistance. Until the end of 1977.

Work done during the year. The assignment reports of the three rehabilitation consultants (in physical medicine, orthotics and prosthetics and physiotherapy), assigned to Mongolia from December 1975 to May 1976 (mentioned last year) were submitted to the Government.

Steps were taken to provide the services of a temporary adviser and a consultant. The temporary adviser will help the national authorities in the treatment of patients SEA/RC30/2 Page 164

by demonstrating new surgical and rehabilitative techniques and will also make recommendations for further improvements in this regard. The consultant will carry out an evaluation of the work done under the project.

MOG HSD 002 (SHS 004) Strengthening of Emergency Health Services R (Nov.-Dec. 1974; May-June 1975; Aug. 1975; Jan.-April 1976; Oct. 1976; April 1977 - )

Aim of the ~roiect. To develop, plan and manage emergency health care services, and provide continuing education on new trends in emergency care.

Assistance provided by WHO during the year. (a) A consultant, (b) a five-month fellowship for study in the USSR.

Probable duration of assistance. Until 1980.

Work done during the year. A consultant on resuscitation was assigned under this project for two months from the last week of April 1977 to assess the resuscitation services in Mongolia, demonstrate modern resuscitation techniques, conduct a seminar and advise on research.

MOG MCH 002 Maternal and Child Health R (July 1975 - ) UNICEF

Aim of the project. To improve maternal and child care further, including nutrition, with emphasis on the development of specialized services for the care of mothers and children.

Assistance provided by WHO durin~the year. (a) A social paediatrician and two consultants; (b) three fellowships - one for six months and two for five months - for study in the USSR; (c) supplies and equipment.

Work done during the year. Following the signing of the plans of operation for the project by the Government, UNICEF and WHO, a meeting was held with UNICEF to discuss further UNICEF assistance to Mongolia. The Government is particularly interested in equipping the creches and kindergartens with educational toys and nursery furniture with assistance from UNICEF. A suitable plan of action for this activity was under preparation in consultation with the national authorities. UNICEF officials also visited Mongolia in this connexion.

A consultant in infant and child nutrition visited Mongolia during April-July 1976 and made recommendations concerning the production and supply of baby food, the improvement of advisory services and the management of child nutritional services. Recommendations were also made on the training of medical personnel in child nutrition, identification of areas of nutritional research in the country and fields of international collaboration.

A consultant in paediatrics (ENT) also visited Mongolia for a period of two months during November 1976 - January 1977 to advise the Government on the further development of ear, nose and throat services for children.

A social paediatrician joined the project in June 1977. SWRC30/2 Page 165

MOG HED 001 Health Education R (Nov. 1970 - March 1971; Sept. 1971 - Jan. 1972: Sept. 1972; Feb.-May 1973;.Aug. 1973; June 197i; Oct. 1974; Sept. 1975; June-kg. 1976; Dec. 1976; - )

Aim of the project. To reorganize and develop health education services; to develop, implement and evaluate health education as an integral part of each health programme; to train the manpower needed for key positions in health education.

Assistance provided by LMO durinn the year. (a) Two consultants; (b) a five-nth fellowship for study in the USSR; (c) supplies and equipsnt.

Probable duration of assistaqce. Until the end of 1977.

Work done during the year. A consultant was aasigned for two and a half mnths from the middle of June 1976 to review the actions taken by the Government in implementing the recommendations made by UUO consultants provided in 1971 and 1973, and to make further suggestions for the reorganization or expamion of current health education services in Mongolia. In continuation of this assistance mother consultant for two months uaa assigned in June 1977.

MOG HM) 003 Assistance to the State nedical Institute. U1.n Bator R (April-May 1970; Sept. 1970; Dec. 1970 - Jan. 1971; UNDP May 1971; July 1971; Dec. 1971; Aug.-Nov. 1972; Jan. 1973 - )

Aim of the project. To develop further and improve the medical education system by improving admission procedures, by revising the curricula, teaching and evaluation practices, and by developing a corps of teachers competent in differat bratches of medicine and able to apply &ern teaching technology.

Assistance provided by WHO during the year. (a) Two medical officers and a secretarial assistant; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1978.

Work done durinn the year. The activities of the project have been wide ranging md have continued throughout the year. An educational unit was established at the Institute and a plan for its activities has been prepared. A substantial mount of educational supplies and equipment was provided.

The project manager's post is being fiwced fro. Pcgular funds from July 1976 up to the end of 1977. A tripartite review was held in November 1976.

Training of Health Manpover (Jan. 1976 - )

Ain af the project. To develop a comprehensive and nation-wide system of training an4 continuing education for all categories of middle-level health personnel.

Assistance pmviatd by WO during the year. (a) A nurse educator and a consultant; (b) eight felldips - one for twenty-four months and two for two months for study in Polad, two for eight months, ore for six months and one for four months for study in the USSR and one for four mths for studies in the USSR and Poland; (c) supplies Od equipment.

Probable duration of assistance. A nmber of years. SEA/RC30/2 Page 166

Work done during the year. The National Centre for the Post-basic Training of Niddle-level Health Personnel was established in December 1976.

A consultant in health manpower training, provided in September 1976, assisted in the organization and evaluation of an Educational Technology Seminar. The fourteen participants were teachers of middle-level health workers.

The WHO nurse educator conducted, through the post-basic students, a survey of middle-level health personnel in Ulan Bator. Much effort was spent in improving the practical tuition of both basic and post-basic students. The post-basic students assisted and aupemised some 13 local national courses for health auxiliaries.

National plans for post-basic and continuing education (1976-1980) were finalized.

An evaluation of the first post-basic courses was conducted.

One 12-month, two eight-month, one six-month, one four-month and two two-month fellowships were awarded.

Some supplies and equipment were provided.

The activities were cwordinated with those of project MOG HMD 003.

MOG ESD 001 Epidemioloaical Services and Surveillance R (Jan. 1972; Aun.-Nov. 1973; Julv 1974; Sept.-Nov. 1974;

Aim of the project. To develop further epidemiological surveillance of diseases representing uajor public health problems, and to strengthen further health laboratory services in the country.

Assistance provided by WHO during the year. (a) Two consultants; (b) five fellowships - one for six uonths for studies in the USSR and Czechoslovakia, one for four months for study in the USSR, and three for three months (two for study in the USSR and one in Czechoalavakia); (c) supplies and equipment.

Probable duration of aesistance. Some years.

Work done during the year. A consultant visited Mongolia for two weeks in August 1976 and made a review of brucella vaccine production, He also advised on the control of rabies and hydatidoais and acquainted the 'national workers with recent advances in the control of important zoonoses.

Another consultant, assigned to the project during August-September 1976, made an epidemiological analysis of viral hepatitis in the city of Ulan Bator. He assisted in conducting training seminars for the staff of the Institute of Hygiene, Epidemiology and Microbiology and of the hospitals in the field, and held discussions with the national health authorities. He recommended that (i) laboratory investigations of HBs AG be carried out in the whole country using a simple and inexpensive method, (ii) blood donors who once were HBs AG positive should never be registered for blood donation again; (iii) central sterilization in hospitals should be further improved; (iv) the effectiveness of measures against the spread of viral hepatitis B using the epidemiological evaluation of its frequency auong the hospitalized patients should be routinely checked, and (v) a group of clinicians be constituted for evaluating the treatment methods used and for selecting adequate medicaments. During the period under review, 70 000 doses (A+C - 50 000, A = 10 000 and C = 10 000) of vaccine against meningococcal meningitis were supplied to Mongolia on a reimburseable basis. SEA/RC30/2 Page 167

Recruitment of two consultants is in hand. One of them will advise on the development of health services in the field of bacteriology of intestinal infections, and the other will make an epidemiological analysis of the morbidity of intestinal bacterial infectious diseases. The consultants are expected to be in position in September.

MOG OCD 001 Control of Non-Communicable Diseases (Feb.-March 1975; May-Aug. 1975; April 1976 - )

Aim of the proiect. To identify health problems due to non-communicable diseases, undertake epidemiological investigations and health education for prevention and control, and train health and allied personnel for early detection, diagnosis, and treatment services, including biomedical research.

Assistance provided by WHO during the year. (a) Three consultants; (b) five fellowships - one for eight months, one for six months and one for five months for study in the USSR and two for six months for studies in the USSR and Czechoslovakia.

Probable duration of assistance. Until 1980.

Work done during the year. Three consultants were provided under this project during the year.

The first assisted in the conduct of training courses for health persomel in modern methods of therapeutic management of chronic and degenerative diseases.

A second consultant reviewed the existing facilities for the epidemiological surveillance of non-communicable diseases with special reference to the control of cardiovascular diseases, gave lectures on this topic to health personnel and identified areas for undertaking research in prevention and control.

A third consultant advised on the organization of services, the training of personnel and the management and treatment of cancer patients.

Two mental health dispensaries and a rehabilitation centre for mental patients have been opened.

MOG ORH 001 (DNH 001) Dental Health Services R (May-June 1970; Feb.-July 1972; Dec. 1972 - May 1973; Aue.-Oct. 1973: Mav 1974: Se~t.1974: Nov. 1974:

Aim of the project. To strengthen dental health services, particularly the paediatric stomatology services, train dental health personnel and study the feasibility of having a fluoridation program.

Assistance provided by WHO during the year. A consultant.

Work done durinp, the year. A dental health expert provided during April-June 1976 studied the dental health services in Ulan Bator and Moron (Hovsgol Aid). A statistical study of the state of dental health of the Mongolian population (Ulan Bator and Moron) was also carried out with the help of national staff,and 500 children and adults were examined. A detailed long-term programme for the development of prophylactics against dental caries was proposed. A number of lectures on important topics were delivered at the advanced post-graduate course for stomatologists- parodontologists in Ulan Bator and also for fourth-year students. In addition, advice Was given on research work and practical demonstrations. The assignment report of the consultant waa forwarded to the Governuent. SUlRC3OlZ Page 168

MOG RAD 001 Strengthening of Radiological Services and R Maintenance of Electro-medical Equipment (Nov. 1968 - Feb. 1969; April 1971 - Dec. 1974; Feb. 1975; Sept. 1975; Nov.-Dec. 1976; - )

Aim of the prolect. To train technicians in the repair and maintenance of electro- medical equipment; to strengthen repair and maintenance services for hospital equipmnt through the organization of a central and a series of satellite workshops; to promote radiation protection practices in health institutions.

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

Probable duration of assistance. Until 1980.

Work done during the year. During November-December 1976, a consultant assessed the state of radiological protection services in the country and advised on measures to protect health personnel and the population exposed to the hazards of ionizing radiation in health institutions. He conducted a training programme in radiation protection and advised on the organization of a radiation protection cell at the Institute of Hygiene.

HOG PHA 001 (SQP 001) Quality Control of Druns and Biologicals R (Feb. 1971:. Sept.-Oct.. 1971: June-Aua.- 1973: Oct. 1973; June-Sept. 1974; Nov. 1975; April- June 1976; Aug.-Sept. 1976; March-April 1977; - )

Aim of the project. To develop further the manufacture of pharmaceutical products and to upgrade services associated with their quality control; to train staff.

Assistance provided by WHO during the year. (a) A consultant; (b) two fellowships - one for six months and one for four months - for study in the USSR.

Work done during the year. A consultant assigned during March-April 1977 surveyed the existing facilities and the training of national staff in basic and advanced methods in phytochemistry such as the determination of alkaloids, flavonoids and glycosides, including chromatographic methods of separation of the above.

HOG HLG 001 (VPH 001) Brucella Vaccine Production K (May-July 1970, June-Aug. 1972, Feb. 1973, Sept. 1973 - ) LINLIP Aim of the project. To produce freeze-dried BruceZLa vaccine and establish laboratory facilities for its testing.

Assistance provided by WO durinz the year. (a) A projecr co-ordinator, a microbiologist, a consultant, and a secretarial assistant; (b) supplies and equipment.

Work done during the year. Following che sudden withdrawal of UNDP support in September 1976, assistance to the project was provided from the Regular budget. A tripartite - Government, UNDP and WHO - review carried out in November 1976 concluded that the project has met its objectives; it was also felt that the sustenance of an immunization campaign in 62 somons in 5 aimaks covering a total animal population of three million heads during the years 1975 and 1976 was no doubt evidence of the good work done. The aimaks covered so far are Baian Olgi. Dornod, Sukhebator, Bulgan and Selenga. The tripartite review recommended further extension of the immunization programme to all other aimaks and the continuation of the project until 1985. As UNDP was no longer in a position to maintain its support, the Government was urged to seek external assistance from FA0 orland SEA/RC30/2 Page 169

bilateral and multilateral agencies. The Government was also advised to take steps to achieve self-reliance so as to phase out the professional and managerial assistance that was being provided by WHO. For this purpose it would be necessary to take steps to allow the national counterpart to work full time with the project.

Since the review was held the project has pursued its work, preparing for the next vaccination programme in 1977 and implementing some of the recommendations made by the tripartite review. By the end of April 1977, 1.7 million doses of vaccine had been produced for the 1977 immunization programme. A tentative plan was drawn up for producing 3.3 million doses of Rev.1 for the vaccination of 3.1 million heads spread over eight aimaks (five old aimaks already covered in 1975 and 1976 and three new ones); the plan awaits approval by the Ministry of Agriculture. At Songino experiments are under way to produce the vaccine on alternative media. For the purpose of the sero-survey the antigens used for CF and SAT were produced locally at Songino. In the sheep and goats that have been assayed serologically before and after vaccination, the seroconversion was of the order of 93.32, indicating that the vaccine was of good antigenic quality. Attempts have been made to produce large batches of vaccine of the order of 80 to 120 thousand doses; there is, however, resistance to the change-over because of the absence of a homogeneous technique. Also, the immunogenic potency of the vaccine is being tried on guinea pigs at Songino. Preliminary results indicate that the breed is not as suitable far this test as the Hartley breed.

Training in advanced techniques of fluorescent microscopy was provided to a veteri- narian from the Veterinary Research Institute.

MOG SES 001 Strengthening of Environmental Health Services* R (April 1974; July-Nov. 1974; March 1975; Sept. 1975; July-Dec. 1976; Feb. 1977; - )

Aim of the project. To evaluate the sanitaiy control services and develop them further; to improve the training of personnel for the State sanitary inspection services; to strengthen the public health chemical laboratories.

Assistance provided by WHO during the year. (a) Three consultants; (b) four fellowships - two far six months and two for five months - for study in the USSR.

Probable duration of assistance. Until 1980.

Work done during the year. A consultant assigned to the project in August-September 1976 assisted in a review and colnpletion of engineering designs and specifications for Jaragalant water supply and sewerage schemes.

Two further consultants provided assistance in the field of air pollution protection.

A comprehensive national program for environmental protection (1976-1980) was drawn up; this included the construction of industrial air and water cleaning devices and research in environmental pollution.

In February, an exchange of letters was concluded covering assistance to the project during 1977-1979. Efforts were under way to assign a long-term sanitary engineer to assist in promoting and further strengthening the environmental health services in the country.

*Previous title: Strengthening of Health Services (Public Health Inspection) SEA/RC30/2 Page 171

9. NEPAL

Co-operating Agencies Title

NEP PPS 001 (SHS 005) Health Planning and Programming R (June-Aug. 1976; Dec. 1976 - )

Aim of the proiect. To undertake national health planning, programming and health administration on a broad basis, including the health information system and health management aspects, with emphasis on the phased integration of vertical health programnes, the system of administration, logistics and information, eventually leading to the development of basic integrated health services in the country and a strong national health service infrastructure.

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

Probable duration of assistance. A number of years.

Work done during the year. A consultant (statistician) was provided during June- August 1976 to assist in the formulation of a national health information service program and help the Health Planning Unit in developing the information base needed for the planning and evaluation of health development programmes. She also gave assistance in the preparation of a plan of operation for the project which was finalized and concluded with the Government.

A health planner was assigned to the project in December 1976. He was involved in the conduct of a country-level course in health planning and health systems management held in Kathmandu from 7 to 19 March 1977. The course, which was attended by 25 participants, was organized under the inter-country project, Strengthening of ~ealthServices ~dknistrationthrough Training in-Planning (ICP SHS 012).

NEP HSD 001 (SHS 001) Development of Health Services R (Sept.-Nov. 1968; Jan. 1970 - ) UNICEF Aim of the project. To strengthen the development of an integrated health service in conformity with the development plans of the Government; to conduct health surveys, health manpower surveys and relevant studies; to co-ordinate associated projects operating in the country.

Assistance provided by WHO during the year. (a) A public health officer, a medical records officer, an electromedical engineer, a medical stores management officer, a laboratory specialist, a public health nurse, wo secretarial assistants and a consultant; (b) eight fellowships - four for twelve months and one for twenty-four months for study in India; one for three months and one for ten weeks for study in the United Kingdom,and one for three months for studies in the United Kingdom, Sweden and Denmark; (c) supplies and equipment.

Probable duration of assistance. Several years.

Work done during the year. Activities under this project related to the general aspects of the development of health services,with special reference to the implementation of integrated basic health activities in the six fully-integrated districts and seven E-stage districts. The recomnendation arising out of the project SEA/RC30/2 Page 172

formulation carried out in 1975 concerning the evolutionary and balanced establishment of health posts was implemented. Four steps for the development of basic health services were instituted from the minimum to the maximum,the latter existing only in the six fully integrated districts. Thus, while previously integration was confined to six districts, it spread to 39 additional districts distributed throughout most zones of the country in keeping with the principle of regional balance.

Seventy-five new and 52 existing health posts were established or converted into the minimum integrated model and the necessary staff to man them given training. The necessary supervisory district health offices were also established.

Other significant achievements during the period were the accelerated take-over of family planning in both integrated and evolutionary districts and the formulation of plans for a full programme of expanded immunization with the inception of a limited pilot scheme in the integrated districts.

Assistance was given in the preparation of a supply and store manual, which was printed in Nepali, and in the reorganization of stores in four regional health offices, five district health offices and two hospitals; a training course for store-keepers and supervisors was organized, and steps were taken to improve storage facilities for vaccines and to draw up the construction plan for the western regional store.

The training of ayurvedic personnel engaged in drug manufacturing and equipment maintenance was arranged. Fourteen well known and tested ayurvedic drugs, which are comparatively cheap and easily available, were inclsded in the standard drug list in place of more expensive allopathic medicines. A new stock recordipg system is being introduced in more hospitals and medical stores in the comtry. UNICEF supplies for health posts and maternal and child health clinics were received. Project NEP SHS 002 was merged with this project during the year.

With assistance from WHO staff, an operational plan for the implementation of the immunization programme and an assistant nurse-midwife manual for the training of traditional birth attendants were drafted. A seminar on neonatology and a two-week course in the repair and maintenance of electro-medical equipment for seven artisans working in hospitals were conducted.

A consultant was assigned for two weeks in April 1977 to assess the nature of ionizing radiation sources and the risk to health from radiation, and advise on the safe handling and storage of radioactive material. He made suggestions for proper protection against ionizing radiation and advised on the training of health and allied personnel in radiotherapy for establishing a cancer treatment centre in Kathmandu Following the country health programming exercise, a national project for the long-term development of laboratory services was formulated. As the laboratory was to be a part of the basic health services in the integrated districts, project NEP LAB 001was merged into HSD 001 and work is in hand to formulate a plan for the next five years. ks for the development of laboratories during the year, work on extending the new central laboratory is progressing; the regional laboratory in Pokhara in the Western Region came into operation, and the laboratory at Dangarhi was provided with equipment. Also, visits were paid to the laboratories situated in the Far Western, Central and Eastern Regions with a view to ascertaining their eligibility for UNICEF assistance. Reagents prepared by the Central Laboratory were distributed to district laboratories. With the provision of greater facilities and accommodation, it was possible to train four leprosy microscopists; the first group of Family planning/maternal and child health microscopists also completed their training. SEAIRC3012 Page 173

NEP HED 001 Health Education R (May-Aug. 1967; Sept. 1968; Nov. 1968 - Feb. 1969; UNICEF Sept. 1969; April-May 1970; July 1970; Dec. 1970 - Jan. 1971; May 1971; July-Sept. 1971; July-Aug. 1972; Dec. 1972; June 1974 - June 1975; Jan.-June 1976; - )

Aim of the project. To develop health education services at the central and other levels of the health administration as an integral part of health programmes; to develop school health education in primary and secondary schools and teachers' colleges.

Assistance provided by WHO during the year. Two twelve-month fellowships for study in India.

Probable duration of assistance. Until 1983.

Work done during the year. The activities of the project are being carried out by national staff. A WHO health education specialist is being assigned to assist the Government in (i) identifying the educational components of each health programme; (ii) planning, developing and implementing relevant educational activities, and (iii) evaluating their effectiveness.

NEP HMD 001 Training of Health Manpower R (June 1975 -)

Aim of the project. To train health manpower needed for the comprehensive health care system.

Assistance provided by WHO during the year. (a) A nurse midwife educator. a radiography tutor, and three consultants; (b) two fellowships - one for twenty- four months and one for twelve months - for study in India; (c) supplies and equipment .

Probable duration of assistance. A number of years.

Work done during the year. The nurse-midwife educator has been assisting with the improwaent of the midwifery portions of the basic nursing and assistant nurse- midwife (ANM) programs. She also collaborated in the development of the one-year post-basic course for midwifery tutors and administrators and has been assisting with the implementation, which began in March 1977.

A radiography tutor was assigned to the project for six months from September 1976 to collaborate in the training of radiographers leading to a certificate in medical science in radiography given by Tribhuvan University. She also studied and gave recommendations on the utilization of the various radiological departments in Nepal with regard to the teaching and service aspects of radiology, including radiation protection. Her recommendations were sent to the Government.

Three consultants - one each in curriculum development, community medicine and clinical sciences - were also assigned to the project during the year. They advised on the development of the curriculum for the medical sciences diploma course in general and community medicine at the Institute of Medicine, Tribhuvan University. Their recommendations were sent to the Government.

A planning codttee meeting for educational programmes for medical sciences diploma in general and community medicine, proposed to be started with effect from February 1978, was held in the Regional Office in February 1977. The meeting worked out a detailed curriculum and other educational programmes for the diploma course. SEA/RC30/2 Page 174

NEP HMD 002 Fellowships R

Nursing. Four tvelve-month fellowships for study in India.

NEP HMD 003 Fellowships UNDP

Nursinn education. A twelve-month fellowship for study in the United States of America.

NEP MPD 001 Malaria Eradication R (June 1954 - )

Aim of the project. To eradicate malaria.

Assistance provided by WHO during the year. (a) A malariologist, an epidemiologist, a sanitarian, a transport assistant, a secretarial assistant and temporary assistance from an epidemiologist and a laboratory specialist assigned to other projects; (b) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. According to mid-1977 estimates, a population of 7.6 million, out of a total of 13.0 million, lives in areas at malaria risk; 7.0 million persons are covered by the malaria eradication programme, with 3.3 million under the attack phase and 3.7 million under consolidation, including 1.5 million in six districts under integrated heslth services. A population of 0.6 million is not covered by any anti-malaria operations.

A situation analysis by a joint Govecnment/WHO/US AID team was undertaken at the beginning of 1977 to evaluate the progress since the last year's analysis, to identify the management problems and their solution, to assess the efficacy of special measures taken in the problem areas of the Western Region, and to analyse the causes of rising incidence in the integrated districts so as to recooonend effective remedial measures. The report of the team is under consideration. The Ninth Indo-Nepal Border Malaria Meeting was held in Darjeeling,India, in April 1977

During 1976, malathion residual spraying was used for the first time in the problem areas of the We,stern Region. It proved effective in reducing the indigenous cases but not to the extent of interrupting transmission. As recornended by the situation analysis team, an additional early cycle of spraying was undertaken in February-March, besides the two already carried out.

The number of malaria positive cases detected in 1976 totalled 10 137 out of 1 455 615 blood examinations, giving a slide positivity rate (SPR) of 0.70X (as against 12 359 positives from 1482 327 examinations with an SPR of 0.83% in 1975). Of these, 765, including 69 P. faleipanun (975 including 73 P. faLciparwn during 1975), were from the six integrated districts, 2137, including 439 P. faZcipanun (2195, including 433 P. fazcipnrmm in 1975) from consolidation and case-detection areas, and 7235, including 1717 P. fazcipamun (9189, including 2474 P. faleipanun in 19751, from areas under attack. A further reduction in the nvmber of positive cases was observed in all areas, occurring mainly, once again, in attack areas. The proportion of P. falciparum came down slightly from 242 in 1975 to 23% in 1976. Also, a further reduction of 36.5% in indigenous cases in areas inthe case-detection, consolidation and integration phases was observed. The magnitude of cases imported from abroad, however, remained almost the same. The annual blood examination rate improved in both integrated and consolidation areas, where the annual parasite incidence fell in integrated areas and registered SEAlRC3012 Page 175

a very slight increase in consolidation areas. The continued trend of falling incidence augurs well for the programme.

Entomological investigations have been stepped up with the detection of two mosquitoes of A.b. baZabacensis in a far comer of the Eastern Region.

Field trials covering a population of 137 000 with Abate as a larvicide are still being carried out in areas where A. annuzaris is resistant to DDT and HCH. Investigations on the suspected resistance of P. falcipanun to the Caminoquino- lines in the Eastern Region are under way.

The ready flow of insecticides and anti-malarials ensures adequate supplies for 1977 and part of 1978.

NEP SPI 001 (SME 001) Smallpox Eradication R (Feb. 1962 - Dec. 1963; Aug. 1966 - Dec. 1976) UNICEF

Aim of the project. To eradicate smallpox.

Assistance provided by WHO during the year. (a) An operations officer and a consultant; (b) three fellowships - two for three months for studies in Bangladesh and India and one for two months for study in India; (c) supplies and equipment.

Work done. Prior to 1962, smallpox was endemic in Nepal. Systematic morbidity data did not exist. It was believed, however, that the non-immune population at risk was very large. An informal pock-mark survey conducted in 1964 indicated that between one-seventh and one-eighth of the population of Kathmandu Valley had contracted smallpox at one time or the other.

The first effort in Nepal against wallpox therefore began in 1962 with the signing of a plan of operations between WHO and His Majesty's Government for establishing a Smallpox Control Pilot Project. WHO'S contribution consisted of a small amount of supplies and equipment, vaccine and the services of a non-medical smallpox control officer. The Government contributed a staff of 45 and a small budget. The area of operations was confined to Kathmandu Valley. The emphasis was on mass vaccination with little attention being paid to surveillance and the containment of outbreaks. Consequently, in 1964, the results were fotmd to be unsatisfactory by a WHO consultant.

In 1966, in line with the World Health Assembly's resolution on global smallpox eradication, a revised plan of operations was signed; the project assumed its present title - "Smallpox Eradication project" - and became country-wide in scope. The area of operations was to be gradually expanded over an eight-year period. Disease surveillance and cmtainment measures became an intea~alpart, although not major components, of the programme. Mass vaccination, as elsewhere, was the major emphasis. A WHO public health officer joined the project and a cash subsidy became a part of the WHO effort, which gave an impetus to governmental efforts. The Government increased its staff and budget, and provided a full-time medical officer as project chief.

In 1968, the emphasis continued to be on mass vaccination and detailed recording of persons vaccinated; surveillance and containrent were peripheral activities. By this time the area of operations had expanded to include all but the most remote districts.

In 1970 both the Government and WHO increased their support to the project. An addendum to the plan of operations was issued, making refresher training of field supervisory staff an integral part of the programme, with financial assistance from WHO. SEA/RC30/2 Page 176

In 1971, the strategy of the programme was changed to the surveillance-containment nethod. At the same time the area of operations of the programme was expanded to include, for the first time, all 75 districts of the country.

There were massive importations of smallpox in 1973 and 1974 and all staff was heavily engaged in surveillance-containment operations. The efforts culminated in the achieveuent of zero outbreak in May 1975. During this period the national staff totalled approximately 600 and the annual budget approximately Rs 220 000.

The period 1976-1977 was one of continuous searches for possible hidden outbreaks, with assistance from the malaria progranrme, and for preparing documntation for the International Commission.

The International Commission to assess smallpox eradication in Nepal met from 4 to 13 April 1977. It declared that it found no evidence of smallpox transmission during the previous two years and declared itself satisfied that smallpox had been eradicated.

The smallpox eradication project was merged with project NEP SPL 001 on 1 January 1977.

NEP BW 001 (MBD 001) Leprosy Control R (March 1967; Dec. 1968; Sept. 1969; July 1970; May 1971; Oct. 1972 - Jan. 1973; May 1974 - )

Aim of the project. To develop and expand a leprosy control programme and train staff.

Assistance provided by WHO during the year. (a) A leprosy control officer; (b) a three-month fellowship for study in India; (c) supplies and equipment

Probable duration of assistance. Until 1979.

Work done during the year. The WHO leprosy control officer continued to provide assistance to the project.

The project has made satisfactory progress. It is being increasingly recognized that leprosy control should be integrated into the general health services and that leprosy treatment should be made an intensive part of developing basic health services.

NEP BVD 002 (MBD 002) Tuberculosis Control R (March 1965 - Sept. 1970; April-May 1971; Feb. 1972; UNICEF' June-Aug. 1972; Dec. 1972; Oct. 1973 - )

Aim of the project. To develop a tuberculosis control programme as part of the basic health services, and to train personnel.

Assistance provided by WHO during the year. (a) A medical officer; (b) eight three-month fellowships for study in India; (c) supplies and equipment.

Probable duration of assistance. Until 1979.

Work done durin~the year. The WHO medical officer who had been assisting the project since 1973 completed his assignment in September 1976.

The International Union Against Tuberculosis (IUAT) plans to hold a national Seminar on Tuberculosis in Nepal in 1977 jointly with the Government and the SEA/RC30/2 Page 177

Nepal Tuberculosis Association, a constituent member of the Union, As desired by the Executive Director of the IUAT, WHO is involved in the preparation and holding of the Seminar,and a WHO consultant being recruited under this project will provide WHO technical representation.

NEP VPH 001 Prevention of Rabies R (Nov. 1972 - Feb. 1973; Jan. 1974; - )

Aim of the project. To prevent rabies.

Assistance provided by WHO during the year. Supplies and equipment

Work done during the vear. Early in 1977, a consultant provided under an inter- country project (ICP WH 001) reviewed this project and reported on its progress.

After a considerable delay the project has picked up. The laboratories are beginning to function and the equipment supplied by WHO is being put in operation. Staff is being appointed and it is planned to commission the Central Health Laboratory to test the vaccine; this could provide a basis for the further development of this facility into a more elaborate unit that would meet the requirements of the expanded programme of immunization. A proposal for further technical assistance in the development and testing of BPL inactivated anti- rabies vaccine is being considered by the Government.

NEP BSM 001 Community Water Supply and Sanitation (Jan. 1971 - ) UNICEF

Aim of the vrolect. To plan, organize and implement a long-term comprehensive national programme of cnmrmnity wacer supply and waste disposal.

Assistance ~rovidedby WHO during the year. (a) Two sanitary engineers and a secretarial assistant; (b) five fellowships - two for twelve months for study in the Netherlands; one for six months for study in the United States of America and two for two months for studies in India, Sri Lanka and Malaysia; (c) supplies and equipment.

Probable duration of assistance. Until 1980.

Work done during the year. During the year under review, assistance was provided in the development of water supply and sanitation schemes in urban as well as rural areas.

In the Fifth Development Plan (1975-1980), the UNICEFIWHO-assisted "Regular" programme continued to make progress and the total number of schemes completed was 25, which is the highest number in any twelve-month period since the initiation of the project in 1971. In addition, a "~oted"programme supported by LNICEF/WHO and an "Integrated" programme funded by the World Bank were introduced in order to construct 250 and 100 rural water supply schemes respectively.

Local Consultants and national staff completed 36 final engineering designs and 18 feasibility studies for town water supplies. Design criteria were developed and circulated for adoption by the Department of Wacer Supply and Sewerage. Guidelines for carrying out surveys, investigations and designs are under preparation. Meanwhile, a physical survey was carried out to assess the state of maintenance of the scheues completed under the project so far.

Seven water supply projects were completed in July 1976. Sixteen carry-over prolects and 13 new projects were under construction and it is expected to SEAIRC30/2 Page 178 complete 11 projects by July 1977. Materials needed for the conatzuctim of 13 nw projects during the current tiscal year ara being procused.

A group of United States Peace Corps volrnteers completed a thrss-Wqtb tr:iipin& and re-orientation course and were assigned to specific water supply schemes. In addition, the first group of 36 overseers completed a three-year training course under the project. SEA/RC30/2 Page 179

10. SRI LANKA Project No. Source of Funds Co-operating Agencies Title

National Health Planning R (June-Aug. 1970; Sept.-Dec. 1971; June 1972 - Dec. 1973; March 1974: Julv 1974; Nov. 1974 - March 1975; July-Aug. 1975; Oct. -1975; March 1976; July 1976; March 1977; - ) Aim of the project. To establish and strengthen a health planning unit in the Ministry of Health and to train staff. Assistance provided by WHO during the year. Two fellowships - one for three months for study in the United Kingdom and one for ten months and two weeks for studies in the United Kingdom, Iran and India.

Probable duration of assistance. Some years.

SRL HSD 001 (SHS 001) Medical Rehabilitation R (Nov. 1968 - Feb. 1969; Feh.-June 1970; Jan.-March 1972; March 1973; July-Sept. 1973; Sept. 1974; Nov. 1974; April 1975; Sept.-Dec. 1975; Feb. 1976; Aug. 1976; Oct. 1976; - ) Aim of the project. To strengthen community-oriented medical rehabilitation services and to train staff. Assistance provided by WHO during the year. (a) Three fellowships - one for three months for study in the United Kingdom, one for three months for study in Indonesia and one for twenty-two months and two weeks for study in the United Kingdom; (b) supplies and equipment.

SRL HSD 002 (SHS 002) Port Health Services R (Sept. 1969; Sept. 1970; Aug. 1972; March 1973; Aug. 1973; 0ct.-Dec. 1973; July 1974; Sept. 1974; Aug. 1975; Aug.-Sept. 1976; April 1977; - ) Aim of the project. To strengthen port health services Assistance provided by WHO during the year. (a) Three fellowships - one for twelve months for studies in the United Kingdom and India, one for seven months for study in the United Kingdom and one for twelve weeks for studies in India, Bangladesh and Thailand; (h) supplies and equipment.

Probable duration of assistance. Until 1979.

SRL HSD 003 (SHS 004) Strengthening of Electro-medical Division R (June-Sept. 1972; Feb.-March 1973; March 1974; Aug. 1974; Oct. 1974 - ) Aim of the project. To train electro-medical repair technicians and improve maintenance workshops to undertake repairs to X-ray equipment and other types of electrical and electronic instruments found in health institutions. SEA/RC30/2 Page 180

Assistance provided by WHO during the year. (a) A consultant; (b) a six-month fellowship for studies in the United Kingdom, the Netherlands and Denmark.

Probable duration of assigtance. Until 1980.

Work done during the year. The WHO electr~medicalengineer continued to assist in the installation, maintenance and repair of health equipment. Training courses on electronics, semi-conductors, television chains, television monitors, universal pulse generators and image intensifiers were held. Several written and practical tests were also conducted and, as a result, a large quantity of deiective equipment in hospitals was repaired and put back in working condition. It is understood that the Government has decided to establish four provincial workshops at Kandy, Galle, Anuradhapura and Badulla in order to attend to all the maintenance and repair of electro-medical equipment in the country.

SRL HSD 004 (SHS 005) Training of Anaesthesiologists R (Aug. 1972; Aug. 1973; March 1974 - ) Aim of the project. TO establish a national training centre in anaesthesiology. Assistance provided by WHO during the year. (a) Two fellowships - one for six months and one for two months - for study in the United Kingdom; (b) supplies and equipment.

Probable duration of assistance. Until 1979.

Work done during the year. A consultant is under recruitment to provide assistance in the training of anaesthesiologists at the post-graduate level. Some supplies and equipment are being procured for the Institute of Post-graduate Medicine.

SRL HSD 005 Medical Stores Management R (July 1976; - ) Aim of the proiect. To strengthen and expand medical stores and supply services.

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

Probable duration of assistance. Until the end of 1980.

SRL MCH 001 Family Health UNFPA (Nov.-Dee. 1971; Feb.-June 1972; Aug. 1972 - ) UNICEP

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

Assistance provided by WHO during the year. (a) A medical officer, a nurse administrator and a consultant; (b) thirty-two fellowships - one for twenty-four months for study in India, one for twelve months for study in the United Kingdom, sixteen for one month for studies in India, Malaysia and Singapore, one for two weeks for studies in Thailand and Indonesia and thirteen for one week for study in Singapore; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1977.

Work done during the year. The project continued to make steady progress. Under the "Intensive Implementation District" programe activities have been started in SEA/RC30/2 Page 181

four districts. The WHO medical officer completed his assignment in September 1976 and a staff member from the Regional Office has been reassigned to the project as his replacement. A consultant (manual writer) provided from June to October 1976 completed the "Manual for Health Workers" for the use of field health personnel engaged in the national family health programme. The WHO nurse educator completed her assignment in January 1977.

SRL NUT 001 Public Health Nutrition R (Dec. 1969 - Jan. 1970; Dec. 1971 - Jan. 1972; Sept. 1972: Nov. 1973 - Jan. 1974: June-Oct. 1974: ~ec.1975 Jan. 1976; NOV.-~ec.i976; - ) Aim of the project. To strengthen the public health nutrition programmes and to train national staff in nutrition.

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

Work done during the year. A consultant was assigned to the project in mid- November 1976 for a period of one month to evaluate the public health nutrition programmes in collaboration with the Nutrition Unit of the Medical Research Department and to recornend measures to improve the training in public health nutrition. He has proposed strengthening of the Nutrition Department of the Medical Research Institute by the provision of the necessary personnel and laboratory equipment. The development of public health-oriented food and nutrition programmes has also been recmended.

SRL HED 001 Health Education R (Nov. 1966 - Feb. 1967: Feb.-Mav 1969:. Seot.~.~~ 1969: June 1970; Dec. 1970;'~an. 197i; March 1971; ~u1;- Sept. 1971; July 1972 - Dec. 1976; - ) Aim of the project. To strengthen health education services, including school health education, and to evaluate health education activities; to strengthen health education teaching in medical colleges, teacher training institutions and in other training centres.

Assistance provided by WHO during the year. A health education specialist.

Probable duration of assistance. Until 1983.

Work done during the year. The project has assisted in reorganizing and expanding the health education sewices at the national and provincial levels of the administration; this has made it possible to support educational activities in health programmes. The Health Education Bureau in the Department of Health Sewices now have units with responsibility for health education activities in the field, hospital health education, field study and demonstration, training in health education, dental health education, school health education, health education research, and mass communication and publications. Personnel in charge of these units have been trained with help from WHO.

The third and last in the series of health education seminars was held this year with the participation of 25 deputy administrators (health and hospital). A total of 84 such administrators have attended these seminars. In addition, three health educators obtained the certificate in health education awarded by the Central Health Education Bureau, India. A workshop on school health education for school teachers was also held with support from WHO. SEAIRC3012 Page 182

The WHO long-term health education specialist who has assisted with these developments completed his assignment at the end of 1976. The activities are now being carried on by national staff.

SRL HED 002 Health Education in Family Health UNFPA (July-Oct. 1971; March-June 1972; Nov.-Dec. 1972; (UNESCO) June 1973 - ) Aim of the project. To promote family health through health education; to support family health education activities with audio-visual and mass communication media; to train health professionals for health education responsibilities in the field of family health; to undertake research to provide directions for health education activities and to evaluate the effectiveness of such activities.

Assistance provided by WHO during the year. Three four-month fellowships for studies in India, Thailand, Indonesia and Singapore.

Probable duration of assistance. Until the end of 1977.

Work done during the year. The first tripartite review of this WHO/UNFPA project in Sri Lanka indicated considerable progress during the period January - June 1976. The review also brought out the need for greater emphasis on field programes, management, information system, and inter-project co-ordination. The Family PlanningtFamily Health Action Committee of Badulla, Ratnapura, Puttalam and Jaffna discussed the family health education action plan and took steps for its implementation. The Superintendents of Health Services (SHS) of Matale, Ratnapura, Badulla, Jaffna, Puttalam and Batticaloa also convened meetings of the medical officers of health in their respective areas and took steps for implementing the programme. The WHO health education specialist assigned to project SRL HED 001 was associated with the activities of this project.

SRL HMD 001 Medical Education R (June-Aua. 1959 : Nov. 1963 - A~ril1964; Oct. ~ec.1965; sep;. 1966; NO". 1967; ~ept. 1968 - ~ug. 1969; Jan.-March 1970; May 1970; Aug. 1970 - March 1971; May 1971; 0ct.-Dec. 1971; Feb.-April 1972; Aug. 1972 - March 1973; May 1973; Jan.-Feb. 1974; June-Dec. 1974; May-Nov. 1975; March-April 1976; Sept.-Oct. 1976; Dec. 1976 - March 1977; - ) Aim of the project. To develop undergraduate and post-graduate teaching programmes further and to assist teacher training at the two Faculties of Medicine in Sri Lanka. Assistance provided by WHO during the year. (a) A consultant; (b) six fellowships - three for three months (one for study in Thailand, one for studies in India and Thailand and one for studies in India, Nepal. Thailand and Singapore), one for two months for study in the United States of America and two for one montn for study in Bulgaria, (c) supplies and equipment. Probable duration of assistance. Until 1979.

Work done during the year. A consultant was assigned from January to March 1977 to assist in the teaching of neurology to medical and dental students and to study the feasibility of setting up a neurological centre at Kandy Teaching Hospital. is recommendations were sent to the Government. SEAIRC3012 Page 183

SRL HMD 002 Nursing Advisory Services R (July 1960 - Feb. 1966; AUK.-Oct. 1966: Sept.-Dec. 1967; Dec. 1969; Feb.1976; May 1970;JuiY 1970; Sept. 1970; Feb.-June 1971; Feb.-July 1972; Sept.- Dec. 1972; Feb.-March 1973; Sept.-Nov. 1973; Sept.-Nov. 1974; July-Nov. 1975; June-July 1976; Oct. 1976; Jan.-Peb. 1977; April 1977 - ) Aim of the project. To develop nursing and midwifery education and services.

Assistance provided by WHO during the year. (a) Two consultants; (b) thirteen

fellowshios - one for twentv-four months. one for eleven months and two for five~ - months - for study in India; one for twelve months for studies in India and Thailand; one for six months (extension) for studies in the United Kingdom, Belgium and India; five for three months for studies in India, Thailand and Singapore,and two for three months for studies in India, Thailand and Malaysia; (c) supplies and equipment.

Probable duration of assistance. Until 1979.

Work done during the year. A consultant was assigned for two months early in 1977 to conduct a four-week course on clinical teaching for 24 staff nurses. A second consultant began a six-month assignment in April 1977 as a continuation of a four month assignment with project SRL HMD 006. She is to advise on the strengthening of the Post-basic School of Nursing, Colombo.

A nurse educator from the inter-country project "Continuing Education for Nurses" (ICP HMD 001) taught two courses on 'Management of Nursing Care and In-service Education" in Colombo. She also worked with national nurses in collecting resource material on in-service education.

SRL HMD 006 Strengthening of NursingfMidwifery Education UNFPA (Feb. 1972; July 1973 - ) Aim of the project. To strengthen the nursinglmidwifery education offered in the eight schools of nursing, the Mulleriyawa affiliation school and the Post-basic School of Nursing, Colombo,with emphasis on public health, midwifery and child care; to produce nursing and midwifery texts and other reference material in the local languages.

Assistance provided by WHO during the year. (a) Two consultants; (b) five fellowships - one for thirty months for study in India, two for twelve months for study in the United Kingdom, one for twelve months for study in Australia and one for one month for studies in India, Thailand and Singapore.

Probable duration of assistance. Until the end of 1978.

Work done during the year. A consultant completed her four-month assignment in July 1976,having taught four courses in tests and measurements to 100 nurse participants.

Another consultant took up a four-month assignment in December 1976 to advise on the strengthening of post-basic nursing education. Consideration is being given to upgrading the post-basic school to a university programme. Meetings have been held to discuss higher education for nurses, and a series of workshops on curriculum design have been conducted.

The project continues to give support to nursing through fellowships to prepare nurse educators. SEAIRC3012 Page 184

SRL HMD 007 Teaching of Human Reproduction, Family Planning UNFPA and Population Dynamics to Medical Students* (Aug. 1974; Oct. 1974; Dec. 1974 - March 1975; July 1975 - ) Aim of the project. To strengthen the teaching of human reproduction, family planning and population dynamics in medical schools.

Assistance provided by WHO during the year. (a) Three consultants; (b) five fellowships - one for six months for studies in the United Kingdom and Sweden, three for three months for study in the United Kingdom and one for three months for studies in Singapore and Malaysia; (c) supplies and equipment. Probable duration of assistance. Until the end of 1977.

Work done during the year. The year 1976 saw an overall strengthening of the teaching of human reproduction, family planning and population dynamics in the medical schools of Sri Lanka. The University is working on plans to take over a district hospital (300 beds) to administer a community health service to a population of 50 000 in the area.

The first National Seminar on the Teaching of Human Reproduction, Family Planning and Population Dynamics was held in Peradeniya in November 1976. Three WHO consultants assisted in the preparation and conduct of the seminar.

SRL HMD 008 Post-graduate Teaching of Comunity Medicine R (Dec. 1975; March-April 1976; Sept. 1976; Dec. 1976 - May 1977; - ) Aim of the project. To initiate and strengthen a post-graduate course in community medicine.

Assistance provided by WHO during the year. (a) A consultant; (b) six fellowships - four for three months (one for study in Singapore, one for study in the United Kingdom, one for studies in Thailand and India and one for studies in India, Thailand and Indonesia),one for eleven weeks and one for nine weeks for studies in the United Kingdom and Denmark; (c) supplies and equipment.

Probable duration of assistance. Until 1979.

Work done during the year. A consultant was assigned at the end of December 1976 for a period of six months to take part in the teaching of epidemiology to undergraduate and post-graduate students and to advise on epidemiological studies to be carried out by the Department of Conrmunity Medicine. During the assignment, which was completed in May 1977, he also introduced modern methods of pedagogy and medical technology in the teaching of epidemiology.

SRL ESD 002 Strengthening of Surveillance and Control of R Comunicable Diseases (May 1975 - ) Aim of the Project. To strengthen the surveillance and control of communicable diseases.

Assistance provided by WHO during the year. (a) A consultant; (b) a twelve-month fellowship for study in the United Kingdom; (c) supplies and equipment; (d) grant. "Previous title: Teaching of Human Reproduction, Family Planning and Population Dynamics in Medical Schools. SEA/RC30/2 Page 185

Probable duration of assistance. Until 1980.

Work done during the year. A consultant was assigned for three months during the period under review to assess the epidemiological situation and epidemiological services in Sri Lanka. He also helped in revising the curriculum on epidemiology for health personnel.

A grant was provided for the conduct of a national seminar on the strengthening of surveillance and control of comunicable diseases.

SRL MPD 001 Malaria Control R (Aug. 1960 - ) Aim of the project. To control malaria, with the ultimate objective of eradicating the disease.

Assistance provided by WHO during the year. (a) A parasitologist, a technical officer, an entomologist, and a secretarial assistant; (b) four fellowships - one for ten months and one for nine months and two weeks for study in the United Kingdom; one for twelve weeks for studies in the United Kingdom and France, and one for three weeks for study in Yugoslavia; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. At the end of the period under review, the Anti-Malaria Campaign continued to extend protection to a population of 5.4 million with extensive mosquito control measures and to a population of 5.2 million with passive case- detection, treatment of cases and focal spraying. A population of 3.7 million was living in the relatively malaria-free areas.

The National Malaria Eradication Training Centre in Colombo continues to conduct regular training, refresher and orientation courses for different categories of health personnel. During 1976, a total of 370 personnel of various categories received training both at the Training Centre and in peripheral institutions. Two medical officers were sent abroad for training. Health education received special attention during the year.

In the beginning of 1976, a population of 5.5 million was protected through spraying. The highly malarious parts covering the health areas of Puttalam, Anuradhapura, ~ahatagasdigili~a,Kekirawa, ~rincomalee,Bibile, ?Loneragala and parts of ~ambantota, Atkalampanna and Balagoda and involving a population of nearly 1.5 million, were sprayed-withmalathion at 2 gm/m2 in three~mintblycycles. 1i November 1976, several other foci in the health areas of Dambulla, Naula, Amparai, Maho, Gakarella, Galgomuwa, Kilinochchi and Vavuniya were also included in the malathion spraying programme, increasing the population under malathion to 2.5 million. Nearly four million people were living in areas under DDT spray coverage at the beginning of the year. Gwing to vector resistance, DDT spraying was discontinued in July in all parts of the country. The areas where malathion spraying was not carried out had to go without insecticide protection on account of the non-availability of sufficient quantities of malathion.

As a result of the intensified control operations, including malathion spraying and treatment in the worst affected areas during 1975 and 1976, a considerable improvement in the situation was observed in 1976. The total number of positive cases detected in 1975 was 301 946 (24.7% less than 1975), with 283 263 P. vivax (16% less than 1975) and 18 683 P. faZcipamun (70% less than 1975). Of the total, 126 956 positives were detected during the first half of the year and 174 990 during the second half, registering a 38% increase during the second half. SEAIRC3OI2 Page 186

A rapid decline in P. falcip~infections occurred in the health areas of Moneragala (77.74%), Bibile (65.6%). Hambantota (51.6%), Anuradhapura (86.6%), Kekirawa (87.3%), Kahatagasdigiliya (71.4%), and Trincomalee (71.4%). and a general reduction in incidence was noticed in almost all highly malarious health areas, especially during the first part of the year. This decline is partly attributed to an extremely dry weather during that period. The incidence picked up rapidly with the onset of the north-west monsoon in the later part of the year. Malaria mortality remained low and only two deaths were confirmed during 1976, both due to cerebral malaria.

Immuno-fluorescent tests are being carried out in limited areas to study the usefulness of this method in assessing anti-malaria activities. Surveys of the cholinesterase level among workers of the Anti-malaria Campaign and among people under risk of malathion poisoning continued. Studies on anti-larval operations by intermittent flushing of the downstreams of river dams, on the introduction of larvivorous fish and chemical larvicides, and on river flow patterns were started.

SRL VPH 001 Veterinary Public Health - Control of Rabies R in Sri Lanka* (March 1972; Oct. 1973 - Aug. 1974; Dec. 1974; Nov. 1976; - ) Aim of the project. To develop services for the control of rabies.

Assistance provided by WHO during the year. (a) A three-month fellowship for study in India: (b) supplies and equipment. Work done during the year. Under inter-country project ICP VPH 001, a consultant reviewed the control of rabies in Sri Lanka and reported on its progress and difficulties. Laboratory equipment was supplied to the Veterinary Research Institute, where the fleury vaccine is to be manufactured. Field equipment and six vehicles were provided to the Department of Health for operational activities (dog vaccination and elimination of stray dogs) as well as communication equipment for the education of the community. Though the project has been in operation since mid-1976 and field activities have been taking place in two divisional areas, progress has been behind echedule. At Peradeniya vaccine was not produced and the Government has to depend for its operations on vaccine imported from abroad. Other setbacks related to delay in the delivery of the vehicles, the absence of the virologist on a fellowship abroad, and the loss of the mice colony and seed material at the Veterinary Research Institute. In order to suggest measures to improve the situation, a specialist in vaccine production is being assigned to the Institute. An epidemiologist is also to be provided to help establish better co-ordination between the Veterinary Research Institute and the Department of Health, which is responsible for rabies control.

SRL VBC 001 Vector Control rnP (Dec. 1972 - Jan. 1974; Jan. 1975 - ) Aim of the protect. To control insect vectors of communicable diseases of public health importance. Assistance provided by WHO during the year. (a) An epidemiologist and an entomologist; (b) supplies and equipment.

Probable duration of assistance. Until 1978.

*Previous title: Veterinary Public Health Services (Zoonoses Control). SEA/RC30/2 Page 187

Work done duringthe year. Vector and parasite investigations, control measures against C.p. fatigans in relation to filariasis and the treatment of detected cases with diethylcarbamazine are progressing, and the average microfilaria rate for the endemic belt has shown a downward trend, from 0.28% to 0.23%.

Larviciding using Fenthion, fogging with Folithion, health education and community participation in source reduction and sanitation are being pursued in spite of financial constraints.

Parasite investigation and control measures are being reorganized in areas where higher microfilaria rates are recorded, and more sensitive techniques for the detection of scanty microfilaraemia are being implemented.

Initial steps have been taken for the establishment of a serology and virology laboratory for arbovirus disease investigations in collaboration with the Medical Research Institute, Colombo. The necessary equipment is under procurement.

A nine-month study at Galle, Beruwela and Negombo on the ecology, distribution and density of the Aedes species in relation to dengue, dengue haemorrhagic fever or pyrexia of unknown etiology, is being carried out and will be evaluated after completion. Biological control using larvivorous fish as a complementary measure for the control of C.p. fatigans is being tested.

A tripartite review of the project was carried out in February 1977 jointly by the Government, UNDP and WHO.

SRL CAN 001 Cancer Epidemiology and Research R (April 1977; - ) Aim of the project. To undertake the epidemiological investigation of cancer, establish cancer registration, train health personnel in early detection, diagnosis, treatment and rehabilitation, and develop health education in cancer.

Assistance provided by WHO during the year. A four-week fellowship for studies in the United Kingdom, the Federal Republic of Germany and Denmark.

Probable duration of assistance. Until 1980.

Work done during the year. A consultant was under recruitment to assist with investigations and train health personnel in cancer epidemiology. He will also conduct a workshop for formulating a national plan for cancer control.

SRL CVD 001 Cardiovascular Diseases R (June 1977 - ) Aim of the project. To undertake the epidemiological investigation of cardiovascular diseases, strengthen facilities for the prevention and control of cardiovascular diseases, train health personnel in diagnosis, treatment, rehabilitation and research in this specialty, and develop health education for the prevention of cardiovascular diseases.

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

Probable duration of assistance. Until 1980.

Work done during the year. A consultant was provided from June 1977 to help in evaluating existing facilities and advise on the organization of training, services and research in cardiovascular diseases. He will also organize a workshop SE?A/RC30/2 Page 188

for formulating a community-oriented national strategy for the prevention and control of rheumatism, iechaemic heart disease and hypertension.

SRL ORH 001 Dental Health R (April 1970 - Aug. 1972; May 1974; Sept. 1974; Nov. 1974 -May 1975; Dct. 1975; Dec. 1975; Sept. 1976; - ) Aim of the project. To develop further teaching and training programmes for dental personnel and to expand integrated dental health services as part of the general health services. Assistance provided by WHO during the year. (a) Two fellowships - one for ten months and one for twelve months - for study in the United Kingdom; (b) supplies and equipment.

SRL MNH 001 Mental Health R (Nov. 1955 - Jan. 1956; Aug. 1960; Nov.-Dec. 1961; Jan.-May 1963; June-July i966; March 1967; Sept. 1969; Nov. 1969; Aug. 1970; 0ct.-Dec. 1970; Feb. 1971; Dec. 1972 - March 1973; July 1973; Nov.-Dec. 1973; June 1974; Jan.-April 1975; Dec. 1975 - March 1976; Sept. 1976; Feb. 1977; - )

Aim of the project. To give training in psychiatry to undergraduates and post- graduates in medicine, to nurses and other health personnel; to develop community- oriented mental health care services integrated within the existing public health delivery system; to introduce innovative approaches in mental health care, and to undertake epidemiological investigations of mental illness.

Assistance provided by WHO during the year. (a) Two fellowships for twelve months - one for studies in India, Burma and Thailand and one for study in the United Kingdom; (b) supplies and equipment.

Probable duration of assistance. A number of years.

Radiation Health (Nov.-Dec. 1966; Aug.-Sept. 1969; Aug.-Sept. 1970; Aoril 1971: 0ct.-Nov. 1971: Nov.-Dec. 1972: Feb. 1973; Aug.-Sept. 1973; May 1974; Aug.-Sept. 1974; Jan.-March 1975; Sept. 1976; Nov.-Dec. 1976; - ) Aim of the project. To strengthen radiological health protection services, train radiologists,radiotherapists, radiographers, nuclear medicine specialists and medical physicists, and promote the development of radiological services and science, including nuclear medicine.

Assistance provided by WHO during the year. (a) A consultant; (b) a one-month fellowship for study in the United Kingdom; (b) supplies and equipment. Probable duration of assistance. Until the end of 1977.

Work done during the year. During November-December 1976, a consultant evaluated the facilities for radiation protection, monitoring surveillance and the calibration of radiological installations in institutions making use of ionizing radiation. He also advised on improving facilities for radiation protection, on strengthening personnel film badge services at the Maharagam Cancer Hospital and helped in conducting a training course in radiation protection. SEAIRC3012 Page 189

Another consultant is being recruited to assess the existing facilities for the radiotherapy of cancer, advise on long-term planning and assist in organizing a course for training health personnel in the radiotherapeutic management of cancer. The consultant is expected to be in position in August 1977.

SRL HWP 001 Occupational Health and Industrial Hygiene R (Aug. 1968; July 1969; Dec. 1969 - Feb. 1970; Julv 1972: June 1973: Am.-Seot.- * 1974:, Aue.- 1975: see;. 1976; March 19j7; - ) Aim of the project. To control health hazards in industry.

Assistance provided by WHO during the year. (a) A five-month fellowship for studies in the United Kingdom and India and a three-month fellowship for studies in the United Kingdom, Belgium and India; (b) supplies and equipment.

SRL PHA 001 Quality Control of Biological and Pharmaceutical R Products (March 1966; Sept. 1966; Dec. 1967; Jan.-April 1971; April 1972; Nov. 1973 - May 1974; Aug.-Sept. 1974; Jan.-Feb. 1975; July-Sept. 1975; - ) Aim of the project. To strengthen the quality control of pharmaceutical and biological preparations, and to train staff.

Assistance provided by WHO during the year. Supplies and equipment. Probable duration of assistance. Until 1979.

SRL BLG 001 (LAB 002) Production of Improved Vaccines R 7~ec.1969; Peb. 1970; Jan. 1974; Dec. 1974 - UNICEF Feb. 1975; Aug.-Sept. 1975; June-Oct. 1976; March 1977; - ) Aim of the project. To produce freeze-dried smallpox and other vaccines. Assistance provided by WHO during the year. (a) A consultant; (b) a four-week fellowship for studies in the United Kingdom, the Netherlands, the Federal Republic of Germany, Denmark, Hungary and Yugoslavia.

Work done during the year. A WHO consultant (vaccine specialist) was assigned to the project from June to October 1976 to follow-up his earlier assignment and also to commission the laboratory situated at the Medical Research Institute, Colombo, for the production and control of freeze-dried rabies and smallpox vaccines. The chilling plant had to be modified, and the two VIRTIS freeze-drying units procured by UNICEF had some teething trouble; after repairs by the national engineers, however, the units had successful trial runs. As the glassware was not of the size recommended by the consultant the lyophilization of BPL inactivated liquid rabies vaccine had to be postponed. The assignment of the consultant was extended by a further two months because of the above reasons. With the attainment of consistency in quality, production of the phenol-inactivated vaccine was stopped and the BPL inactivated rabies vaccine is now being produced.

In his report, which has been sent to the Government, the consultant has suggested that plans for future development in respect of other vaccines (DT and DTP) should be made after carrying out a cost analysis, as it may be more economical to have the vaccine procured from abroad rather than producing it locally. For this purpose the Director of the Institute was awarded a WHO fellowship to receive orientation in vaccine production. SEA/RC30/2 Page 190

SRL LAB 001 Strengthening of Laboratory Services R (Aun.- - 1966 - March 1969: Oct. 1969: Dec. 1969: ~ay1970; ~ug.-sept. 1970; NOV. 1970; ~prili971; July 1971; Oct. 1971; Dec. 1971; Feb. 1972; June 1972; Aug. 1972; March 1973; Aug.-Sept. 1973; Dec. 1973 - Feb. 1974; May 1974; July 1974; Sept. 1974; Nov. 1974 - March 1975; June-July 1975; Nov.-Dec. 1975; Aug. 1976; March-April 1977; - )

Aim of the project. To develop further specialized diagnostic and reference functions in support of communicable-disease control and prevention, and to train staff. Assistance provided by WHO during the year. (a) Five fellowships - one for twelve wntha and one for nine months (extension) for study in the United Kingdom, one for six months and six weeks and two for three months for studies in the United Kingdom and Denmark; (b) supplies and equipment.

Probable duration of assistance. Until 1979.

Work done during the year. Technical assistance was provided by way of information, supplies and reference materials as well as fellowships to strengthen the laboratories at the Medical Research Institute and their extension at Colombo South Hospital, the Dcpsrtment of Bacteriology and Virology in the Universities, the Municipal Laboratory in Colombo, Angoda Fever Hospital and ten district laboratories. The fellowships awarded are for training in food microbiology and the standardization of viral vaccines, and the supplies provided included special media and antisera for the isolation and typing of enteric bacteria, and reference strains.

SRL BSM 001 Community Water Supply and Sanitation R (Oct. 1963 - Dec. 1975; March 1977; - ) UNICEF

Aim of the project. To develop programmes of community water supply, sewage disposal, storm-water drainage and general sanitation, and to train personnel.

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

SRL BSM 002 Provision of Basic Sanitary Services R (Jan. 1976 - )

Ahof the proiect. To provide safe water supplies and excreta disposal in rural corrmunities throughout the country.

Assistance provided by WHO during the year. (a) A sanitary engineer; (b) four fellowahips - one for twelve months for study in the Netherlands, one for six months for studies in India, Singapore and Malaysia and two for three months (one for study in India and one for studies in India, Thailand and Indonesia); (c) supplies and equipment.

Probable duration of assistance. Until 1981.

Work done duria the year. The WBO sanitary engineer continued to provide assistance to the National Water Supply and Drainage Board in the planning and implementation of the piped c-nity water supply schemes in different parts of the country. The plan of operation and plans of action for the project were prepared for signature by the Government, IJNIC!ZF and WHO. SEAIUC3012 Page 191

SRL FSP 001 Food Hygiene R (May 1974; June 1975; Sept. 1975; Jan.-April 1976; Nov. 1976 - May 1977; - ) Aim of the project. To establish a national food control administration and train staff for various branches of food control.

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

Probable duration of assistance. Until the end of 1980.

Work done during the year. A consultant was assigned for a period of six months during November 1976 - May 1977 to assist in improving the food control unit in the Ministry of Health, in revising the existing legislation on food control and in training staff in food inspection, food hygiene and in the analysis of food samples.

He helped with the preparation of the syllabus and in the conduct of a training course for food inspectors which was organized by the Ministry of Health from 31 December 1976 to 13 January 1977. The course was attended by 20 participants. SEA/RC30/2 Page 193

11. THAILAND

Prolect Number Source of Funds Co-operating Agencies Title

'IRA PPS 001 (SHS 002) Planning, Mananement and Information System* R (Oct. 1970 - )

Aim of the prolect. To assist in national health planning and in health administration, including the health information system and health management aspects, with emphasis on the phased integration of disease-control and special health programmes, eventually leading to the development of a comprehensive health care service in the country.

Assistance provided by WHO during the year. (a) A public health officer and a management officer; (b) supplies and equipment.

Probable duration of assistance. A number of years.

Work done durin~the year. The project's major involvement had been in the comtry health programming and project formulation exercises, which contributed to the development of an acceptable national plan. In addition, a revised plan of operation for the project has been developed in order to bring it in line with the project formulatim, The revised plan of operation has been finalized with the Government.

The project cmtinued to have a great impact on national planning and management. A manual on provincial planning to serve ae a guide in preparing pravincial operational plans was completed. Assistance was provided in developing a design for a health information system and a management information system for use in preparing provincial operational plans. Financial assistance was given for the development and testing of recording and reporting forms and their translation into local languages.

The project was also involved in (i) the Regional Course for Trainers and Senior Planners which was attended by 15 participants, (ii) the National Workshop in Health Planning and Management attended by 33 participants, and (iii) the National Project Management Workshop for divisional directors and their deputies involved in the Provincial health care project. mA HSD 001 (SHS 0011 Medical Rehabilitation R (Oct. 1968 - )

Aim of the project. To develop rehabilitation services in selected hospitals in the provinces and in Bangkok, and to train staff.

Assistance provided by WHO during the year. A three-month fellowship for study in the United Kingdom. niA PHC 001 (SHS 006) Development of Provincial Health Care R (Nov. 1974; Jan. 1976 - )

Aim of the project. To strengthen integrated rural health services.

*Previous title: Health Planning and Management SU/RC30/2 Page 194

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

Probable duration of assistance. A nunber of years.

Work done durin~the vear. During the period under review the organization, functions and job descriptions Tor the project personnel were revised and were approved by the Ministry of Public Health. Guidelines for provincial planning were completed and a course on this subject was conducted. The project staff also assisted in preparing plans for the Rural Health Division for 1978 and in studying and modifying the reporting system for this division and the Public Health Division. Assistance was given in identifying the project's components to be monitored and in determining the monitoring requirements and the frequency of reporting. Manuals/instructions on operating procedures were drafted and training curricula were developed; these are to be tested in selected provinces. Other activities included the preparation of a protocol for studying the implementation of the facilities required, the preparation of a basic document on primary health care, drawing up of a plan and the necessary guidelines for the training of trainers at various levels, and the finalization of the monitoring system for priraary health care.

TEA MCH 001 Bangkok Municipality Family Planning Field UNFPA Workers Proiect UNICEF (Nov. 1973 - Jan. 1974; July-Sept. 1974; Jan.-March 1975; Oct. 1975; - )

Aim of the proiect. To improve and expand the family health services in the Bangkok-Thonburi Metropolis as an integral part of the general health care services provided at the health centres.

Work done during the year. The project continued to make good progress in providing increased coverage of family health services to the slum dwellers of Bangkok-Thonburi Metropolis.

The folloving activities were undertaken: A consumer satisfaction survey was completed in July 1976; refresher training of field workers was completed in April 1976, and a design and pre-test survey on the effectiveness of personnel was ccmpleted in November 1976. A meeting of the Tripartite Review Cornittee was held in March 1977.

THA MCH 002 Accelerated Development of Maternal and UNFPA Child Health and Family Plannine Services UNICEF (March 1974; - )

Urn of the project. To improve the maternal and child health/family planning services of the hospitals and rural health centres in the four north-eastern provinces, for the better delivery of these services.

Assistance provided by WHO durins the vear. Supplies and equipment

work done during the year. Favourable changes in both family planning and maternal and child health practices are taking place in the project area. The number of family planning acceptors has increased significantly and the integration of the services has been proceeding satisfactorily.

A regular production of maternal and child health service statistics was initiated The in September 1976. A tripartite review meeting was held in September 1976. 1976 field surveys, the formulation of a curriculum and detailed plans for the training of traditional birth attendants were completed in December 1976. SEA/RC30/? Page 195

THA HRP 001 Expanded Sterilization Project UNFPA (March 1974 - Dec. 1976)

Aim of the project. To make sterilization services more readily available within the family health services, as an integral part of the general health services.

Work done. This project, which commenced in December 1972.ended in December 1976. One of the main activities was the provision of financial assistance to hospitals and health centres in order to increase the availability of male and female sterilizations. The target was to reach approximately 265 000 sterilizations in 48 months of the operation of the project and to reirburse the cost of around 200 000 of these sterilizations. Under this project feasibility trials for mobile sterilization reams were undertsken. UNFPA support to mobile sterilization teams beyond December 1976 will be chsnnelled through a new project. Considerable emphasis is being laid on vasectomy through these mobile teams.

The Tripartite Review Meeting-cunrfinal evaluation of the project was carried out on 15 March 1977.

This project has been very successful, and some of the activities will continue to be partially supported by UNFPA under a new policy. As a result of the project's activities, the number of sterilization procedures increased from a total af 57 500 during the three years 1969-1971 to a total of 330 000 during the life of this project. The project exceeded its initial target of 265 000 procedures by 14.5 per cent.

THA HED 001 Development of Health Education R (Dec. 1966; Sept. 1969; Jan. 1971; June 1975 - )

Aim of the proiect. To assist ill the development of health education services in support of health programes in the regions and the provinces.

Assistance provided by WHO during the year. (a) A temporary adviser; (b) four fellwships - one for twelve months for study in India, one for eight weeks for study in the United States of America and two for six weeks for studies in the Philippines, Sri Lanka and Indonesia; (c) supplies and equipment.

Probable duration of assistance. Until 1983.

Work done during the year. A WHO temporary adviser was assigned to the project for two months from mid-December 1976 to assist the Health Education Division in designing and carrying out behavioural research. He also helped in selecting health communicators and village health volunteers and in studying their acceptance by the population and the inter-action between these primary health workers and the population and between primary health care workers and the peripheral health services. In addition, he served, on a part-time basis, as the principal investi- gator for the preparation of the plan for field work.

It is also proposed to provide assistance in designing health education activities in connexion with the major health problems. The Deputy Director of the Health Education Bureau and two senior health education specialists undertook observation visits to selected health education projects outside Thailand, and a health education specialist went to India to undertake post-graduate training in a university. SEA/RC30/ 2 Page 196

THA HMD 003 Faculty of Public Health (Dec. 1968 - Jan. 1969; 0ct.-Nov. 1969; Jan. 1970; Nov. 1970; Dec. 1971 - Jan. 1972: Harch-Mav 1972: Jan. 1974; Dec. 1974; Jan. 1975;-~pril1975; J&- Aug. 1975; Dec. 1975; March 1976; Sept. 1976 - )

Aim of the project. To assist the Faculty of Public Health, Mid01 University, in further developing its teaching and training programs for better co-ordination and effective support of the health services in health planning and management.

Assistance provided by WHO during the year. (a) An education specialist, a public health nurse, and a secratarial assistant; (b) six fellowships - three for two months for studies in Tanzania, Kenya, the USSR and Iran and three for one month for studies in Indonesia, Malaysia and India; (c) supplies and equip~nt.

Probable duration of assistance. A number of years.

Work done during the year. A long-term staff l~emberwas assigned to this project in Oct&er 1976 for collaborating with the Faculty of Public Health, Mahidol University, in the development and evaluation of the curriculum for the education of health personnel.

A public health nurse was provided in September 1976 to assist with the development and implementation of educational programmes for public health nurse practitioners and bachelors and masters degrees in public health nursing.

Medical Education and Training (Hay 1971 - )

Aim of the project. To develop further the teaching and training programs of the existing four medical faculties at Chiengmai. Chulalongkorn and Hahido1 Universities. including the Faculty of Post-graduate Studies of the latter, and to plan the Faculties of Medicine at Prince of Songkhla and Khon Kaen Universities.

Assistance provided by h7lO during the year. (a) A medical educator; (b) two fellowships - one for twelve months for study in the United Kingdom and one for six months for studies in the United States of America, the United Kingdom and Sri Lanka.

Work done during the year. A long-term medical educator was assigned to this project in September 1976 for collaborating with the Dean of the Faculty of Medicine, Khon Kaen University, in setting up a medical education mit, in training staff in modem educational methods and in developing the curriculum.

Health Manpower Development (Ministry of Public Health) (Jan. 1976 - )

Aim of the protect. To develop and implement the training programmes for health workers to prepare them Eor work in rural areas; to prepare teaching materials for prima- health workers.

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

Probable duration of assistance. A number of years.

Work done during the year. Early during the period under review, implementation of project activities was hampered by manpower shortage; the staff was too small SEA/RC3O/Z Page 197

to cope with the size and complexity of the project's work. Nevertheless, progress was noted in the following aspects: training of central and provincial-level trainers for primary health care workers; preparation of a manual for the training of primary health care workers; the revision of the basic nursing education curriculum and the planning of curricula for the in-service training of other categories of workers.

THA MPD 001 Malaria and Vector Control* R (Jan. 1962 - )

Aim of the project. To control malaria in the border and mountainous region and its ultimate eradication in the remaining areas.

Assistance provided by WHO during the year. (a) A senior malariologist, an epidemiologist, an entomologist, two sanitarians and a clerk-typist; (b) two fellowships for twelve months, one for study in the Philippines and one for study in the United Kingdom (extension); (c) supplies and equipment; (d) local costs subsidy.

Probable duration of assistance. A number of years.

Work done during the year. At the end of June 1977, a population of 33.0 million, out of a total of 40.1 million at malaria risk, was estimated to be living in areas under the consolidation phase. This figure included nearly 17 million in areas with low malaria risk, scattered over 239 districts of 51 provinces, already partially integrated into the general health services. A population of 7.1 million continued to be in the attack phase, and 3.7 million people living in urban areas under municipal administration were considered free from malaria risk.

The Ninth Malaysia-Thailand Border Health Conference was held in Penang, Malaysia, during the period under review. Also, a scientific group meeting on malaria in South-East Asia, organized by SEAMEO-TROPMED, was held in Bangkok during the year.

The infection reservoir seems to have deepened further, as indicated by the surveillance data for 1976. Some 285 342 malaria positives were detected out of 3 584 602 blood examinations, giving a slide positivity rate of 7.96% (against 267 534 positives from 3 589 238 examinations with a slide positivity rate of 7.45% during 1975). The number of P. fazciparwn, including mixed infections, was 162 174, constituting 56.8% of the total infections (against a proportion of 64.U in 1975). indicating the continued decline of P. fazciparum infections in the community.

A total of 5594 workers of different categories received pre-service training in malaria. In addition, 802 general health service personnel were given orientation in the integration of malaria work into the general health services, and 3132 trainees attended in-service refresher courses during 1976.

In collaboration with WHO, a three-week Workshop on Bio-environmental Measures of Control was conducted in February 1977 for senior operational field staff of the national malaria services.

As for operational research, plans have been made for long-term susceptibility studies on A. minimus to determine the longitudinal change in its susceptibility levels, its resistance status and the extent of distribution of the suspected resistant species in and around the area in Phaitan Canton. A further study of the distribution of P. fazciparum resistance to chloroquine in Thailand is also being planned. Studies to develop the most suitable and economical controlled release formulation of larvicide for the control of A. b. batabacensis in the man-made breeding places in the gem-mining pits in Chantaburi and Trad provinces are under way.

*previous title: Malaria Eradication SEA/RC30/2 Page 198

TtL4 0P.B 001 (DNH 001) Dental Health R (Jan. 1967; Nov. 1967 - April 1968; April 1969; Aug. 1969 - July 1970; Peb. 1971; April 1971; March 1972; Aug.-Sept. 1972; Feb.-March 1974; Sept.-Oct. 1974; April 1975; March 1977; - ) Aim of the project. To improve dental services and to train dental health personnel.

Assistance provided by WHO during the year. (a) Teqorary assistance from a staff me&er from !.O Headquarters; (b) tvo three-month fellowships for studies in Singapore and Malaysia.

Work done during the year. In April-May 1976, a dental officer from WHO Head- quarters paid a short visit to Thailand to aasist the Division of Dental Health in planning a national oral health survey. A number of recommendations were made by him in this cmnexim.

He paid a eecond visit during January 1977 to help the national authorities in the survey. The results of the survey are being analysed.

It is planned to conduct a research project on fluoride preventive measures. A proposal to establish a regional training centre in Thailand is also mder consideration. All the8e activitier are expected to go a long way in strengthening the national dental health progame.

Strengtheninn of Laboratory Technology (April-May 1968; March 1969; Sept. 1969; Dec. 1969; Harch 1970; 0ct.-Dec. 1970; Hay 1971; Aug. 1971; Oct. 1971; Hay-June 1972; Aug.-Sept. 1972; Peb.1973 - )

bin of the project. To organize national health laboratory services; to strengthen the teaching of laboratory sciences and the training in medical laboratory technology.

lusiatolu provided by WtU) durinn the vear. (a) A microbiologist; (b) three fellornhip. - one for Nelve mo~lthe. one for seven months and one for one month (extmsion) - for atuiy in the United Kingdom; (c) supplies and equipment.

PrQab'le duration of usistance. Until the end of 1979.

Work dme durinx the year. Two Important docmnts were prepared and finalized during the year - one to extend bill0 collaboration vith the project for the next five years, and the other, an agreement between the Departmot of Medical Sciences of Hahidol University and MI0 to provide local training to 15 technologists to qualify as clinical pathologists. An evaluation of the project lmderteken in September 1976 rsvealm that the major lileatonea have been implemented, some of them in advmce of the target date. A workshop on laboratory manpower development vsa organized, and a new category of laboratory staff, namely, laboratory aide, has been established. A rider of training activities were also carried out during the year. Twenty-four laboratory technicians are in service after receiving training in general laboratory technology, and 20 health centre workers from six selected provinces have coqleted their training in basic laboratory techniques. Training in haaatology, serology and mice analysis was given to all technicians in regional and provincial laboratories in their respective subjects. Workshops in the Australian antigen were conducted in six regionalhoapitals and a seminar on managennt vas organized for the chiefs of the public health laboratory services.

In the field of laboratoly technology, important activities included the organization of a course in the maintenance of laboratory equipment; drawing up of the syllabus in haematology for first and second-year courees in medical laboratory technology, SEA/RC30/2 Page 199

and the preparation of a manual in clinical serology for provincial and regional laboratories and of manuals on sampling and testing in venereal disease, tuberculosis and food.

Considerable atrentim was given to the management of laboratories and tbsi~personnel. A scheme was drafted to streamline the indenting and supply of laboratory mterials to regional and provincial laboratories from the centre; a draft schedule was also prepared for the tests to be performed at the various levels. New laboratories were established in hospitals in Rayong, Chainat, Singbeer, Pang-go, Sanucet Prakorn, Nakorn md Pathorn.

Progress was also made with regard to the quality control of laboratory methods: the committee on laboratory maupover discussed the subject of standardization in biochemistry, haematology and microbiology; the Division of Provincial laboratories of the Department of Medical Sciences was strengthened by the appointment of a technical supervisor and an assistant supervisor; ten volmteers from the.Eritish Coulcil and the United States Peace Corps are to assist in the implementation of the programme in provincial and regional laboratories, and a unified list of laboratory methods in haematology, blood bank, clinical chemistry, serology, parasitology, bacteriology and urine analysis was approved.

THA BSM 002 Co-ity Water Supply and Sanitation R (Jan. 1976 -)

Aim of the project. To plan and implement the national environmental health programe. and, in particular, to promote the development of provision of safe water supplies to smaller communities by exploitation of gromdvater sources or use of appropriate technology for vater treatment.

Assistance provided by WHO during the year. (a) A sanitary engineer and a hydrb- geologist; (b) supplies and equipment.

Probable duration of assistance. Until 1981.

Work done during the year. The WHO sanitary engineer (team leader) continued to provide assistance in planning and implementing the national environmental health program. The WHO hydrogeologist assisted the Division of Rural Water Supply of the Department of Health in compiling hydrogeological data and maps and in planning the gromdvater investigation and development programme. Until the end of 1976, the WHO sanitary engineer under the inter-country project "Comrmnity Water Supply and Sanitation" (ICP BSM 001). stationed in Thailand, also gave assistance to the Rural Water Supply Division.

The report on the sector study on water supply and sanitation carried out by the WHOIIBRD Co-operative Programme Mission was finalized and sent to the Government in August 1976.

The project document covering UNDP assistance for the period 1978-1981 was prepared and was under ccmsideration by the parties concerned.

TXA SES 001 Strengthening of the Depart~ntof R Sanitary Engineering, Chulalongkorn UNDP University (Nov. 1973 - Feb. 1974; May-Oct. 1974; Jan. 1975; May-June 1976; Nov.-Dec. 1976; March-April 1977; - )

Aim of the project. To strengthen the Department of Sanitary Engineering at Chulalongkorn University. SEA/RC30/2 Page 200

Assistance provided by WHO during the year. (a) A consultant; (b) three fellovshfps - two for three months (one for studies in India, Turkey, Switzerland, the Federal Republic of Germany, the United Kingdom and the Netherlands and one for studies in the Netherlands, Switzerland, the Federal Republic of Germany, the United Kingdom and India) and one for seven weeks for study in the United Kingdom; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1977.

Work done during the year. A WHO consultant assigned to this project made his first visit during the month of April 1977. He assisted the Departrent of Sanitary Engineering in surveying the existing organizations and activities in the country on air pollution, and advised on curricula development. The same consultant will pay a second visit to the project during August/Septenber 1977, for a period of about six weeks.

THA FSP 001 Food and Drug Control R (Aug.-Oct. 1964; Feb.-April 1971; Oct. 1971; Aug. 1972; Jan.-Nov. 1974; Dec. 1974 - March 1975; Dec. 1975; June 1976; Aug. 1976; Oct. 1976; March 1977; - )

Aim of the protect. To assist the Department of Medical Sciences, Ministry of Public Health, in establishing a national food and drug control administration and in training staff.

Assistance provided by WO during the year. Five fellowships - one for six months and two for one month for study in the United States of America, one for two months for studies in the United Kingdom and Sweden and one for three weeks for study in Yugoslavia.

Probable duration of assistance. A number of years.

Work done during the year. Action is in hand for the assignment of a consultant for a period of two months to assist the Governuent in analytical uethods and in setting up equipment for chemical analysis.

Training and Increased Mobility for Health Personnel in the National Family Planning Programue (March 1974: Dec. 1976)

Aim of the project. To meet the continuing need for training government health personnel, including doctors, nurses, auxiliary midwives, sanitarians, family planning clinic and field workers, for family health services, and to increase the coverage of the population receiving family health services from the health personnel.

Work done. The project's activities, which extended from November 1972 to December 1976, were aimed at increasing the mobility of nurses and midwives in service in the rural areas. For this purpose motorcycles and bicycles were provided by UNICEF. To meet the continuing need for training government health personnel, financial assistance and technical support were provided for initial or refresher training in family planning.

All the objectives of this project were achieved. Some 4495 motorcycles and 450 bicycles were procured by UNICEF and spot-checks on their utilization were made in five provinces. The vehicles were fornd to be properly utilized and to have enhanced the efficiency of the health personnel by an estimated forty per cent. SEAlRC3012 Page 201

With the support of WHO in curriculum development and the technical assistance of UNESCO's Development Support Comunication Service (DSCS) in teaching and canmunication methodology, a national master plan for training in family planning administration and methodology has been developed by the Family Health Division; the necessary manuals and teaching aids were developed. Much attention was given to the development of a competent corps of teachers in the field of family planning in addition to the training of staff at service level. The project has been successful in terms of the nvmber and adequacy of training of various categories of personne1,all having a vital role to play in the extension of the National Family Planning Programme in Thailand.

The provision of transport has greatly improved the supervisory process and allowed the nursinglmidwifery staff to apply effectively the knowledge and skills acquired in their training. SEA/RC30/2 Page 203

12. INTER-COUNTRY

Agencies -Title

ICP PPS 001 (SHS 0011 Asian Development Institute R (Jan. 1964 - Feb. 1977) ESCAP UNICEF

Aim of the protect. To assist the faculty of the Asian Development Institute with the health component of training courses and other allied activities of the Institute.

Assistance provided by WHO during the year. (a) A public health administrator and an economist; (b) cost of attendance of participants.

Work done. In response to a request from the Director of the Asian Institute for Economic Development and Planning, Bangkok, a medical consultant was seconded from WHO to strengthen the teaching faculty. Consequently the project started in January 1964 with the following objectives: "To train personnel of Member and Associate Member countries of the ECAFE region in planning and economic development; to undertake research and advisory services."

During the period 1964-October 1966, the WHO medical consultant did pioneering work, and assistance was provided to the Institute with its general and special courses as well as short courses on planning techniques, and also with manpower planning. and human resources development.

In October 1966, a WHO public health administrator was assigned on a long-term basis. From 1967 to 1968 assistance was also given to the ECAFE-sponsored Conference of Asian Planners, the WO-sponsored Inter-regional Seminar on Smallpox Eradication, and an orientation course on health planning.

In the second half of 1969, assistance to the Institute was strengthened by the assignment of a WHO technical officer (economist). In 1969, the WHO public health administrator, in addition to carrying on with his normal teaching of health subjects at the Institute, assisted in the organization, conduct and evaluation of the First Regional Course in Health Planning, which lasted three months. The second regional course was organized in 1970 and the third in 1971-1972. From 1970 to 1972, the two staff members were also involved in the organization and conduct of national courses in Member countries and helped with a Regional Course on Social Development and Planning. The project also assisted and participated in group educational activities organized by ESCAP and by other WHO Regional Offices, such as the 15ch International Conference on Social Welfare held in Manila, the fourth Regional Course on National Health Planning of the WHO Regional Office for the Western Pacific, an inter-country course in health and manpower planning organized by the WHO Regional Office for the Eastern Mediterranean, the ECAFE- sponsored Regional Seminar on Population Change and Development, the Conference of Asian Economic Planners, and the ECAFE-sponsored Expert Group Meeting on Socio- economic Returns of Family Planning Prograrmnes.

In 1973, the Public Health Faculty of Mahidol University and the Ramathibodi Hospital in Bangkok received assistance, respectively, with the health planning aspects of the university's MPH course and in conducting a seminar on the principles and techniques of health planning. Assistance was given to the Western Pacific Region and to WHO Headquarters as well as to the United Nations in conducting courses and workshops related ta health planning. SEA/RC3O/2 Page 204

In 1974-1975, the WHO staff assisted the Institute in (a) an expert group meeting on health projects and programme formulation. (b) a workshop for trainers and planners in health planning, and (c) an inter-regional seminar on health project analysis. They also helped in developing a "Draft Design of a Least Developed Country's Health Situation Assessment", with an in-depth assessment of the National Malaria Eradication Programme in Thailand, with long-term planning for the health field in Nepal, and with the costing of health care in the Trust Territories of the Pacific Islands.

The "Korat Field Study" waa conducted in Thailand with the main objective of improving and updating teaching material on the utilization of health services, on morbidity and mortality, on a provincial hospital's catchment area, and on health and economic changes. The study was completed and its report finalized in 1976.

The most important activity of the project during 1976-1977 was the assistance given in the planning, organization, conduct and evaluation of a three-month joint WHO/ADL Regional Course on Comprehensive Health Planning and Development (27 September - 22 December 1976) held at the Asian Development Institute.

In addition, the project staff assisted in the organization of a course on the environmental aspects of development, which took place at the Institute from 18 October to 19 November 1976, as well as with (i) the Consultative Meeting on Population Policies, (ii) a course on the delivery of social services, jointly sponsored by UNICEF and ADI, and (iii) a seminar on environmental education.

After a review of the activities in the light of the provisions of World Health Assembly resolution WHA29.48 on Programme Budget Policy, the project was terminated, after almost 13 years of existence, on 28 February 1977.

1CP PPS 002 (SHS 012) Strengthening of Health Services Administration UNDP through Training in Planning (March 1969: July-Sept. 1969; Nov. 1969 - Feb. 1970; June 1970 - )

Aim of the project. To develop and strengthen health planning as an integral part of health services adminiatration in the participating countries in order to meet more effectively and efficiently the health needs of the people within the framework of their social and economic development; to provide training in health planning methods and health systems management, including, where appropriate, practical field training; to develop a training capacity so as to provide national self-sufficiency in training as well as operations.

Assirtan~~cprovided by WHO during the year. (a) A publl,: I,ealrh administrator, a unaremenr oiiicer and two consultants; (b) cutlt of attendance of participants; (c) supplies and equipment.

Probable duration of assistance. Until 1979.

Work done during the year. During the period under review, the project undertook the planning, organization, conduct and evaluation of a number of country courses In health planning and health systems management in the Region. In Thailand, a course was held in Bangkok from 21 June to 2 July 1976 and was attended by 39 participants from the central and provincial levels. The participants were exposed to the principles and practices of health planning and health systems management. A course in health planning was held in Bangladesh from 23 August to 3 September 1976, and was attended by 15 participants. Seventeen participants attended a course in health planning and special care administration organized in Colombo from 28 December 1976 to 6 January 1977. A course in health planning and SEAlRC3012 Page 205

health systems management took place in Nepal from 7 to 19 March 1977, attended by 25 participants. In India, the project staff participated in a course on project implementation, monitoring and evaluation held at the National Institute of Health Administration and Education (now National Institute of Health and Family Planning), New Delhi, from 3 to 25 January 1977. A course in planning and management was organized in Rangoon from 7 to 11 February 1977 with help from this project. It was attended by 56 senior staff from the central, state and divisional levels. The participants laid emphasis on the implementation of primary health care and basic health services programmes.

Another important activity during the period was the Regional Seminar on Health Planning and Health Systems Management, held at the United Nations Asian Development Institute, Bangkok,from 7 to 16 December 1976 which was attended by twenty-two senior participants from seven countries of the Region. The main objective of the Seminar was to stimulate further the practice and teaching af health planning and management.

Teaching material for modules in health planning and health system management to serve as national instructional material was compiled.

ICP HSD 001 (SHS 006) Health Research and Development R (June 1970 - )

Aim of the project. To provide support to the Programme Support and Co-ordination Unit (PSC) in the delivery of its main functions: country health programming (CUP), project formulation and management (PF6M), medium-term programming (m),programre budgeting (PB), development of programme evaluation methodology (DPEV), programme/ project information system (PPIS), and consultation services to countries on their request.

Assistance provided by WHO during the year. (a) A programme management officer, an operational research specialist, a social scientist, an economist and a secretarial assistant; (b) supplies and equipment.

Work done during the year. The project team assisted in conducting project formulation in Burma following the programing phase of the country health programing exercise and with follow-up action emanating from the management workshop held in Thailand earlier. The team collaborated in completing the collection and analysis of information as the first step towards conducting the second cycle of country health programing and project formlation, immediately following the workshop.

The preparation of the medium-term programme for health manpower development for the Region was completed in accordance with a resolution of the World Health Assembly,and work on preparing a similar programme for other areas was being pursued.

The project contributed to the programme budgeting activities of the Regional Office and in an evaluative review of the programmes for improving their delivery and quality.

Work on the development of the WHO information system continued in close co-operation with Headquarters on the one hand and Member States on the other. All the project and programme profiles were completed and two country profiles, those for Indonesia and Thailand, were developed.

The project staff were actively involved in organizing the Inter-regional Seminar on Country Health Programing, held in the Regional Office in February 1977. The seminar was attended by a number of national participants and WHO staff from all the Regions. The recommendations made by the seminar are under study. SEA1 RC3O I:! Page 206

The project was involved in a number of studies to examine ways and means of improving community participation in health programmes, especially in India and Thailand.

The team leader and other members participated in a nunber of inter-country seminars and consultative meetings organized during the year.

ICP HSD 002 (SHS 009) Advisory Services R (March-July 1973; 0ct.-Dec. 1973; July-Aug. 1974; Jan.-March 1975; Sept.-Dec. 1975; act.-Nov.1976; - )

Aim of the project. To provide consultant services in various subjects upon specific requests of governments; also to provide support to activities currently financed under inter-regional projects and suitable for implementation in this region.

Assistance provided by WHO during the year. Temporary assistance from a consultant and a nurse researcher assigned to other projects.

Probable duration of assistance. Until 1980.

Work done during the year. A short-term project in nursing research was undertaken as a tripartite endeavour of the Government of Indonesia, WHO and the International Development Research Centre (IDRC), a Canadian agency. A WHO nurse researcher from project IND HND 007, a WHO nurse educator from project IN0 HEID 002 and a nurse consultant sponsored by IDRC assisted national staff in the preparation of a "Research Proposal for a Comunity-based Nursing Education Project". The aim was to provide a framework for the on-going evaluation of the primary nurse (PK) training programme. The report was under consideration by the Government.

ICP HSD 003 (SHS 0111 Medical Rehabilitation R (Feb. 1974 - )

Aim of the project. To study (i) the problem of rehabilitating the physically handicapped and (ii) facilities available; to advise on the integration of various components of rehabilitation semices into a unified program.

Assistance provided by WHO durin~the year. (a) A physiotherapist, a technical officer and a secretarial assistant; (b) supplies and equipment.

Probable duration of assistance. Some years.

Work done during the year. Under this project, which is based in Solol~emarangin Indoneaia, aasistance was provided to the Director of the Academy of Physical Therapy in Solo in carrying out an exhaustive management and curriculum survey. The final survey report, which advocated retention of many good aspects of the Academy's work, also made a number of recornendations for change. A detailed proposal for a new school of rehabilitation was submitted to the Ministry of Health, Jakarta. Frequent visits to project sites were made in order to observe the physical therapy programme. The in-service training of staff in both locatiuss was conducted regularly and frequent consultations were held with the persons in charge. Assistance was given in collecting curricular information on the proposed school of rehabilitation, on streamlining the existing physical therapy services at Dr Kariadi Hospital and on the clinical education of students from the Academy of Physiotherapy in Solo.

The WHO prosthetist/orthotist spent a number of days at Sitanalla Leprosarium and gave advice on the establishment of a prosthetic and orthotic laboratory. The program of investigation of pathology subsequent to the use of mechanical SEAIRC3OI 2 Page 207

apparatus as a means of treatment was continued. Lectures were given on the theoretical and technical problems of integrated treatment.

The WHO physical therapist and prosthetist/orthotist left the project in September 1976 and March 1977 respectively. Since then the proiect has continued without the services of the team members.

Steps were being taken to organize an inter-country seminar on medical rehabilitation in the Regional Office in August 1977.

ICP PHC 001 (SHS 002) Organization and Administration of R Primary Health Care* (Aun.-Oct.. - 1968: Dec. 1968: Feb. 1969: Julv 1970 - Jan. 1971; sepi.-~ec. 197i; Feb. 197i; ~a;-~ul~ 1972; Nov. 1972 - July 1973; Nov. 1973; June 1974 - ) Aim of the project. To promote the concept and practice of primary health care in order to expand the coverage and improve the quality of health care, especially in rural areas, within the context of overall rural development, and to promote and maximize the utilization of traditional systems in primary health care and baaic health services, especially in rural areas.

Assistance provided by WHO during the year. (a) A consultant; (b) cost of attendance of participants; (c) supplies and equipment.

Probable duration of assistance. A number of yearn.

Work done during the year. This project has dovetailed into project ICP SHS 002, "Organization and Administration of Hospital and Medical Care Services", which started in 1968. The aim of the latter project was, among other things, to assist in the development of regional health services, in the organization of systems of medical care, in hospital administration, in the development of uniform systems of record keeping and reporting, and to assist in training staff at various levels of operation.

Under the new project, a Regional Seminar on Traditional Medicine Program was organized in Colombo, Sri Lanka, from 1 to 5 April 1977. This seminar, which was the first of its kind, was organized in pursuance of a resolution of the Regional Committee and was attended by 17 participants from Bangladesh, Burma, India, Indonesia, Nepal, Sri Lanka and Thailand. A WHO consultant assisted with the conduct of the seminar, and the Regional Adviser on Medical Care also took part.

Preparatory arrangements for the conduct of a Regional Meeting on Primary Health Care, scheduled to be held in November 1977 in collaboration with UNICEF and the World Federation of Public Health Associations, are under way. This regional meeting is to serve as the basis for the regional contribution to the International Conference on Primary Health Care to be held in the USSR in 1978. Through this project, assistance was given in the conduct of primary health care conferences at national level in the countries of the Region so as to collect background docmnen- tation for the forthcoming regional meeting.

ICP MCH 002 Course for Senior Teachers in Child Health R (June-Oct. 1970; Dec 1973; Sept.-Oct. 1974; UNICEF Oct. 1975; Feb.-March 1976; Feb. 1977; - )

Aim of the project. To provide advanced training for senior teachers in child health in developing countries with the object of improving education in child health in these comtries.

*Previous title: Organization and Administration of Hospital and Medical Care Services. SEA/ KC30 / 2 Page 208

Assistance provided by WHO during the year. An eight-month-and-onelreek fellowship for a candidate from Indonesia for studies in the United Kingdom, Sudan, Tanzania, Kenya and India.

Work done during the vear. The participants in the 1976 Course for Senior Teachers in Child Health attended the Indian part of the course during the last quarter of 1976 and also took part in the Workshop on the Delivery of Maternal and Child Health/ Family Planning Services in the Context of Family Health Care, held in the Regional Office in September 1976 under project ICP MCH 011. Preparations were made for holding a "reunim" meeting of past fellows of the course in October 1977.

ICP MCH 010 Education and Studies in Child Health K (Feb.-March 1974: Dec. 1974 - March 1975:

Aim of the project. To assist in further developing the education and service programs, including special studies, in priority areaa in the field of child health.

Aasistance provided by WHO during the year. (a) Two consultants; (b) Cost of attendance of participants; (c) supplies and equipment.

Work done durinn the vear. The main study on pregoancy and its outcme,including perinatal morbidity and mortality and low birthreight, was started in Burma in November 1976. Assistance by way of supplies and equipment was given for this study. Technical and administrative procedures for the perinatal study in India were completed in February 1977 and work on the study started in B.J. Medical College, Poona.

A terminationfevaluation inter-comtry meeting on the teaching and practice of neonatology was held in October 1976 in Nepal. The draft "Guidelines for the Teaching and Practice of Neonatology" relevant to countries in this region were also finalized in this meeting, which was attended by participants from several countries in the Region. Two consultants were provided to assist with this meeting.

The activities of this project relating to the teaching and practice of neonatology are proceeding as planned.

ICP MCH 011 Regional Team on Family Health UNFPA (Aug. 1970 - )

Aim of the project. To support country and inter-country activities in family health with regard to services, training, evaluation and research embracing family health, including the maternity-centred approach.

Assistance provided by WHO during the year. (a) A medical officer, a statistician and three consultants; (b) cost of attendance of participants; (c) supplies and equipment.

Work done during the year. The team members have been assisting in the relevant technical and administrative components of family health projects, particularly those funded by LJNFPA. The team leader (senior medical officer) was reassigned to another project in June 1976 and a replacement was being recruited. The ~dical officer stationed in Bangkok, who joined the team in September 1976, ham been assisting the UNFPA-funded projects in Thailand and in other countries of the Region. The statistician has been involved in activities relating to the evaluation of UNFPA-funded projects and in an assessment of the preliminary phase of the study on "Pregnancy and its Outcome, including Perinatal Morbidity and Mortality and SEA/RC30/2 Page 209

Low Birth-Weight'' in Burma, India and Thailand. Assistance has also been rendered in connexion with the statistical component of activities in the field of family health in various corntries.

A Workshop on the Delivery of Maternal and Child Health/Family Planning Services in the Context of Family Health Care was held in September 1976 in the Regional Office attended by twenty-three participants from eight countries of the Region. In addition, the fellows of the UNICEF/WHO Course for Senior Teachers of Child Health took part in the workshop.

Assistance was provided for the Tripartite Review Meeting on health relating WHO/ ULtFPA projects in Bangladesh, which was held in August 1976 and again in April 1977.

An assessment of the pilot phase and the main study on "Pregnancy and its Outcome, including Perinatal Morbidity and Mortality and Low-Birth Weight" in Burma was completed. The technical and administrative formalities for the WHO collaborative study in perinatal mortality and morbidity in India and Thailand were being finalized.

Assistance was provided in collecting data in the field of child health for the preparation of a document entitled "Regional Programme in Child Health".

During October-December 1976 a consultant was assigned to Nepal under the intra- country training programme in surgical techniques. His recommendations have been sent to the Government.

The activities of the project were closely co-ordinated with those of ICP MCH 010.

ICP NUT 001 Nutrition Training and Advisory Services R (Dec. 1963 - ) UNICEF

Aim of the project. To assist with the training of health personnel in nutrition and to advise on public health measures in nutrition.

Assistance provided by WHO during the year. (a) A three-month fellowship for a candidate from Burma for study in India; (b) supplies and equipment.

ICP NUT 002 Nutrition Teaching in Educational Institutions R for Health Personnel (Dec. 1976 - Feb. 1977; - )

Aim of the project. To strengthen the teaching of nutrition to health personnel and assist in problem and service-oriented training.

Assistance provided by WHO during the year. A consultant

Probable duration of assistance. Some years.

Work done during the year. A consultant assigned for two months during December 1976 - February 1977 assisted in the preparation of background material for a one-week seminar on the "Organization and Delivery of Nutrition Activities in the Health Sector", scheduled to be held in New Delhi from 28 November to 2 December 1977. He collected detailed information on the nutritional activities in the health sector in Burma, India and Nepal. SEAlKC3012 Page 210

ICP BED 003 Development of Health Education in Family UNFPA Bealth Progr~s (Aug.-Nov. 1971; Oct. 1972 - Jan. 1973; 0ct.-Dec. 1973; Feb.-May 1974; Dec. 1974 - )

Mm of the project. To moist in developing, implementing and evaluating the effectiveness of the health education component of family health programmes; in improving the quality and utilization of information, educational and teaching materials used for family health education; in providing continuing education to staff of training institutions and key health education personnel in different aspects of family health education and in developing capabilities in family health education.

Assistance provided by W durinp the year. (a) Three consultants, three temporary advisers d eight guest lecturers; (b) cost of attendance of participants; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. A Workshop on the "Development and Pre-Testing of a Manual for Audio-Visual Techniques and Communication Strategies in Support of Family Health Education" was held in New Delhi from 25 to 29 October 1976. Eighteen participants from six countries of the Region attended the workshop, which was assisted by a consultant, three temporary advisers and eight guest lecturers.

Another workshop, on "Health Education Services in Family Health", was held in New Delhi from 13 to 23 December 1976, attended by 19 participants from eight corntries of the Region; a consultant assisted in conducting this workshop. The immediate postlrorkshop evaluation of the participants was favourable.

Preparations for two further workshops - one on "Strengthening of Frunily Health Education in the Pre-service Training of Health and Allied Personnel" and the other on "Planning and Developent of Textbooks and Other Learning Resource Materials for Training in Family Health Education" - to be held in Sri Lanka from 16 to 23 August and from 24 to 31 August 1977 respectively, were under way.

The long-term health education specialist assigned to the project resigned during the year. In her place a caaultant was recruited for five months to deal with specific activities of the project. A second health education consultant is being recruited to undertake a study of school health and population education in corntries of the Region. A long-term health education specialist is also under recruitment.

ICP HEa) 001 Continuing Education for Nurses R (Jan. 1967 - UNICEF

Aim of the urolect. To stimulate and encourage Member countries to develop continuing education programmes for nurses and assistant nurse-midwives; to assist institutims and health centres in Member countries in the planning and organization of continuing education for nurainglmidwifery personnel on the basis of local needs,and demands; to develop, compile and publish reference materials geared to the needs of nurses/pidwivea at the primary health care level, and to encourage and promote the collection, exchange and evaluation of information and studies in continuing education.

.Assistance provided by WHO durinp, the year. (a) Two nurse educators and two secretarial assistants; (b) supplies and equipment. SEA/RC30/2 Page 211

Probable duration of assistance. Until the end of 1977.

Work done during the year. One of the nurse educators spent three months at the Post-Basic School of Nursing in Colombo conducting two short courses for ward sisters on "Nursing Care Management and In-Service Education for Nursing Personnel". A post-course document on in-service education for nursing personnel in Sri Lanka was compiled for use as a reference for future courses in that country. Negotiations are under way for both nurse educators to make follow-up visits in mid-1977 to the continuing education programs for nurses which they helped to initiate in Thailand and Sri Lanka in 1976.

The country-level course on "Nursing Service Administration" planned to be held in Mongolia early in 1977 (under project MOG HMD 004) has been postponed by the Government of Mongolia until later in the year.

Work is under way on tabulating and analysing the data on the evaluation of the inter-country workshop on the "Improvement of Hospital Nursing Services" held in Jakarta in 1975. The absence of the team's statistician on sick leave has caused delay in completing the final analysis of the data until April 1977.

A consultant nurse educator is under recruitment for the Inter-country Workshop to be held in the Regional Office on "Comunity Health-oriented Nursing Education".

One post of nurse educator, deleted from the project for 1977, was reinstated.

ICP HMD 003 Education and Training in Community Health* R (March-April 1970; Oct. 1972; Nov.-Dec. 1974; Feb. 1976; Nov. 1976 - )

Aim of the project. To assist medical schools in developing inter-departmental teaching and training programmes in health care for the community.

Assistance provided by WHO during the year. (a) A consultant and four temporary advisers and assistance from Headquarters staff members; (b) cost of attendance of participants; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. A workshop on the primary role of doctors and other health personnel in community health care was held in the Regional Office from 31 January to 5 February 1977, attended by twenty participants from eight countries of the Region. The workshop, which was assisted by three temporary advisers and one staff member from WHO Headquarters, was organized to discuss and identify patterns of health teams and their role in health care delivery systems.

A consultation meeting on health manpower development was held in the Regional Office from 7 ta 11 February 1977. Altogether fourteen participants from seven countries of the Region attended this meeting, which was assisted by a temporary adviser and two staff members from WHO Headquarters. It was organized in order to obtain the views of governments in the Region on formlating long-term and medium-term programms for the general development of health manpower and drawing up specific programmes for each country.

A staff member from WHO Headquarters visited the Regional Office as well as Pondicherry (India) and Dacca to evaluate health manpower development projects.

A consultant provided for a period of three months from April 1977 visited different countries of the Region to verify the information on voluntary health workers and

*Previous title: Comunity Health Aspects of Medical Education. SEAIRC3OlZ Page 212

their training which had been collected earlier, review specific activities and gather additional data.

Preparations were under way for holding a consultation meeting on the training of voluntary health workers, to be held in the Regional Office from 27 June to 1 July 1977. The aim of this meeting is to obtain the views of governrents in the Region on the establishment of sound training programmes for voluntary health workers and their trainers by providing them with guidelines and manuals or other teaching aids.

ICP HMD 005 Participation in Meetings R (Aug.-Sept. 1973; May 1974; Sept. 1974; - )

Aim of the project. To provide for participation from the South-East Aaia Region in group educational activities in various disciplines organized outside the Region; to provide support to activities currently assisted under inter-regional projects and suitable for implementation in this region.

Assistance provided by WHO durin~the year. Supplies and equipment.

ICP HMD 006 Educational Technology R (Sept. - Nov. 1975; Nov. 1976 - Feb. 1977; April 1977; - )

Aim of the project. To protnte the establishment of educational technology centres in the countries of the Region for the local production of teaching materials for education and the training, initially, of medical teachers and later on of other levels of health workers; to provide support to the teacher training centres in different countries of the Region, and to help in the conduct of courses for national personnel concerned with the production of educational materials.

Assistance provided by WHO during the year. (a) A consultant; (b) a three-month fellowship for a candidate from India for study in Sri Lanka and a four-month fellowshio for a candidate from Burma for studies in India, Sri Lanka and Thailand; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. A consultant was provided under this project for a period of three months from November 1976 to visit three countries of the Region - Bangladesh, India and Nepal - to report on the development of facilities for teacher training and educational technology. His report is under study.

Preparations are under way for holding an inter-country course in educational science for teachers of health professionals, in Jakarta, from 31 October to 11 November 1977. Two consultants and two temporary advisers are under recruitment to plan and conduct the course.

Efforts are being made to organize a national couree in Nepal.

ICP HMD 008 Medical Education in Human Reproduction, UNFPA Family Planning and Population Dynamics (March 1972 - )

Aim of the project. To assist in the planning, preparation, conduct and evaluation of short training courses for senior medical teachers in order to improve further the teaching of human reproduction, family planning and population dynamics in medical schools of the Region. SEA/RC30/2 Page 213

Assistance provided by WHO during the year. (a) Three consultants; (b) cost of attendance of participants; (c) supplies and equipment.

Work done during the year. The fifth Training Course in the Teaching of Human Reproduction, Family Planning and Population Dynamics in Medical Schools was held in the Regional Office from 29 November to 10 December 1976. It was attended by 29 participants from Bangladesh (5), India (6), Indonesia (5), Nepal (2), Sri Lanka (6) and Thailand (5) representing 22 medical schools of the Region. The course was conducted by the Regional Adviser on Health Manpower Development with the assistance of three consultants in the disciplines of obstetrics and gynaecology and maternal and child health. Ten guest speakers from different faculties in India were invited to address the participants on different aspects of human reproduction, family planning and population dynamics. Two field trips were also arranged.

A consultant visited five countries of the Region, viz., Bangladesh, India, Indonesia, Sri Lanka and Thailand, to ascertain the state of the teaching of human reproduction, family planning and population dynamics in the medical schools of these countries. He presented his report to the training course highlighting visits to 14 medical schools. The consultant also met a large number of participants who had attended one or more training courses held an this subject earlier.

Plans have been finalized for organizing the next Seminar on Training in the Teaching of Human Reproduction, Family Planning and Population Dynamics in Medical Schools, in Colombo from 10 to 15 October 1977.

A national course on this subject is being organized in Bangladesh and two national workshops are being planned in India and Indonesia.

ICP HMD 009 Medical Teachers' Training and Continuing UNDP Education (March 1969 - July 1976)

Aim of the project. To increase the regional capacity to train teachers of health professionals in all aspects of medical pedagogy and to assist in introducing a method of continuing education of health personnel already in service.

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

Work done. Two national courses in educational science for teachers of health professionals were held in Burma - one in Rangoon from 5 to 13 July and the other in Mandalay from 16 to 24 July 1976. WHO provided two consultants for five weeks each for this activity.

One of the consultants assisted in writing up the project's Agency Terminal Report, which was sent to the Government. The project terminated in July 1976.

ICP ESD 001 Dengue Haemorrhagic Fever R Surveillance and Control

Aim of the project. To assist in the national as well as regional surveillance and control programmes against dengue haemorrhagic fever (UHF).

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

Probable duration of assistance. Until 1979. SEAIRC.3012 Page 214

Work done during the year. A consultant visited Burma in November 1976 to review the dengue haemorrhagic fever situation in that country. His recormendations have been sent to the Government.

ICP ESD 003 Epidemiological Surveillance and National R Health Intelligence Systems Development (June 1976 - ) Aim of the project. To assist in the development and strengthening of national health information systems at all levels of the health services for efficient and effective planning, management and evaluation of health service6 with emphasis on sub-systema directed at epidemiological surveillance of priority diseases.

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

Probable duration of assistance. A number of years.

Work done during the year. A consultant was assigned to assist with the surveillance of rickettsia1 diseases in Bum and Thailand. Another helped with the surveillance of tuberculoeis in Burma. India, Sri Lanka and Thailand.

A consultant was provided under this project to assist with the meeting of the "Working Group on Lay Reporting of Morbidity and Mortality Statistics", held in the Regional Office in November 1976 (see under ICP HSM 001).

The technical officer completed the preparation of guidelines for the evaluation of training programmes for multi-purpose health workers. Data collected for evaluating the impact of an inter-country course on "Improvement of Hospital Nursing Services" were analysed and a final report prepared.

ICP MPD 001 Advisory Team on Anti-malaria Activities* R (May 1959 - Dec. 1961; Nov. 1963 - )

Aim of the project. To provide technical assistance in the fields related to a multi-disciplinary approach to the control of malaria and other parasitic diseases.

Assistance provided by WHO during the year. (a) A sanitary engineer and a laboratory specialist; (b) supplies and equipment.

Probable duration of assistance. A number of years.

Work dme during the year. During the period under review, the sanitary engineer of this project, who is atationed in the Regional Office, assisted the programw in Sri Lanka in selecting areas for pilot work on bio-environmental interventions by water management activities; he helped the Indian programme with the implementation of suitable anti-larval measures in the rural areas of Tamil Nadu and in a study of continuing bio-environmental interventions in Maharashtra. Assistance was also given to the programme in the Maldives in carrying out an epidemiological survey of A. subpictus areas in the northern atolls. He took part in the joint Government/WHO/ US AID assessment of malaria operations in Bangladesh, and in a three-week workshop on bio-environmental methods of malaria control, held in Prabudhabat, Thailand.

A laboratory specialist was assigned to the project effective 1 January 1977 with duty station in Jakarta. He assisted the malaria control programme in Indonesia for two months with the training of microscopists and also helped with cross-checking activities. From 1 March to 15 June he assisted the Nepal Malaria Eradication Organization in running refresher courses for laboratory technicians and in evaluating the NMeO's laboratory services.

*Previous title: Assessment Team on Malaria Eradication SEA/RC30/2 Page 215

Smallpox Eradication and Epidemiological R Advisory Team (Oct. 1962 - )

Aim of the project. To assist the countries of the Region in achieving total eradication of smallpox by 1977.

Assistance provided by WHO during the year. (a) Three medical officers and three administrative officers; (b) supplies and equipment.

Work done during the year. During the year, the project staff prepared documntation for the International Commission to assess smallpox eradication in India and Nepal. Preparations were also made for the visit of the Codssion itself.

Regular visits were made to the countries with active smallpox eradication programs. In India, the project staff participated in review meetings at the State level. All-India review meetings were held in September 1976 and January 1977. Assistance was also given in arranging the visits of a national commission in India, and the staff of this project served as members of the Commission. Supplies and equipment continued to be procured and arrangements made for the independent checking of vaccine samples for potency and samples from patients for laboratory diagnosis.

ICP SPI 002 Expanded Programme on Immunization R (June 1976 - )

Aim of the project. To reduce morbidity and mortality to the lowest possible level for diseases preventable by inmnization, i.e., diphtheria, pertusis, tetanus, tuberculosis, poliomyelitis and measles; to assist countries in planning, implementing and evaluating their national expanded programmes on imnization.

Assistance provided by WHO during the year. (a) A medical officer and assistance from headquarters and Regional Office staff; (b) cost of attendance of participants.

Work done during the year. A medical officer was assigned under this project in June 1976 to assist in implementing immunization programmes in the countries of the Region. This assignment preceded the connnencemen; or project ICP SPI 002,which is scheduled for 1978.

A regional workshop on the management and evaluation of the expanded programme of immunization was held in the Regional Office from 17 to 20 November 1976. Participants from all the ten countries of the Region attended the workshop.

The following aspects of the programme were discussed at this workshop: the organization and structure of a national programme on immunization, project formulation, feasibility studies, operational research, procurement of vaccines, cold chain, community participation, resources, and international assistance.

Staff members from WHO Headquarters and the Regional Office took part in the formulation of national programmes in Burma, Nepal and Sri Lanka. They were also associated in evaluating feasibility studies and in conducting a national seminar on the expanded programme of immunization, bath held in Indonesia.

Assistance is being given to several countries under this project. Vaccines were provided to Mongolia for its immunization programme, and fellowships were awarded and a subsidy given to Nepal, where an operations officer is to be assigned later in 1977. Further, an epidemiologist and an operations officer are to be provided to Indonesia in the third quarter of 1977. A consultant from WHO Headquarters visited Indonesia in March 1977 and advised on the expansion of the vaccine production capacity at Bio Farma, Bandung. A consultant-operations officer was also assigned to that country from October 1976 to January 1977. SEAIRC30/2 Page 216

train in^ in Veterinary Public Health (AUK.-Sept. 1968; March-June 1969: March-Mav 1970: ~eb.-Maich 1972; May 1972; arch-~pril 197:; Oct. 1973; Oct. 1974; Dec. 1976 - Feb. 1977; - )

Aim of the project. To assist in training veterinary public health officers.

Assistance provided by WHO during the year. A consultant.

Probable duration of assistance. Until 1979.

Work dme durinn the year. A consultant provided under this project for three months during December 1976 - February 1977 visited veterinary public health institutions in Bangladesh. Burma, India, Nepal, Sri Lanka and Thailand to review the regional programme in this field in order to define future areas for WHO assistance.

ICP PBL 001 (OCD 002) Prevention of Blindness and Visual Impairment R (March 1976; Aug. 1976; - )

Aim of the project. To promote community-oriented programues for the prevention and control of blindness and visual impairment through tne establishment of regional and national training centres in public health ophthalmology in selected medical colleges in the countries of the Region; to establish pilot-cum-demonstration centres for training in community-oriented basic eye health care as an integral part of the existing public health delivery system and organize compreheneive ophthalmic referral services at the intermediate level.

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

Probable duration of assistance. Until 1980.

Work done during the year. Increasing collaboration was maintained with intdr- national agencies and man-governmental organizations such as the International Agency for the Prevention of Blindness and the Royal Commonwealth Society for the Blind in promoting co-ordinated national activities and mobilizing resources for the prevention and control of visual impairment and blindness in the countries of the Region.

A staff member fro@ the WHO Begional Office for Europe represented the Organization at the Sixth Congrese of the Asia Pacific Academy of Ophthalmology, which was held in Bali, Indonesia,in August 1976. He visited Thailand and Burma and reviewed the progresa of the national plans for the prevention and control of visual impairment and blindness in these countries. A visit was also paid to Nepal, where the comultant revieved the existing activities and advised on organizing the training of health personnel in community-oriented public health ophthalmology.

ICP IMM 001 Training in I~mnunolony P. P. (0ct.-Dec. 1969; Nov. 1970; Feb.-March 1972; Aug.-Sept. 1972; Nov.-Dec. 1975; - )

Aim of the project. To review the progress in immunology, particularly as related to commuaicable diseases, and to contribute towards increasing the competence of national im~~unologists.

Assistance provided by WHO during the year. Supplies and equipment. SEAlRC3012 Page 217

ICP LAB 004 Strengthening of Diagnostic Material and R Laboratory Practice (Feb. 1977; - )

Aim of the project. To help develop national standards for biological preparations (vaccines), chemical agents and diagnostic material as well as to develop related aspects of laboratory methods; also to promote and support the co-ordination of research, service and information between national laboratories and regional and inter-regional collaborating laboratories concerned with standards and quality control.

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

ICP BSM 001 Community Water Supply and Sanitation K (April 1965 - ) UNICEF

Aim of the project. To assist in developing community water supplies and sanitation facilities and in planning and managing environmental health services.

Assistance provided by hNO during the year. (3) Fuur sanitary engineers, three secretarial assistants and two consultants; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1980.

Work done during the year. The project continues to fulfil its objective of providing supportive assistance in the development of programmes in the countries of the Region. One of the two sanitary engineers stationed in New Delhi made a follow-up on the environmental health manpower study in Indonesia which had been conducted in 1975. During the visit he also reviewed the need for further assistance to the Institute of Technology, Bandung, and discussed a proposal for UNDP assistance to the Institute. In Thailand, he held further discussions on the proposal of having an environmental health manpower study carried out in that country, and, in Burma, he helped with the project formulation in environmental sanitation. He assisted in the planning of the IBRD-assisted project on the measurement of health benefits of water supplies in Uttar Pradesh, India. The other sanitary engineer took part in the discussions between the Government of Burma and UNICEF on the immediate programme for rural water supply and on the investigation-cum-demonstration project which had been prepared by WHO in consultation with the national engineers. He was associated with a guidance mission on the UNDP-funded sewerage and sanitation project for Jakarta, Indonesia, and a pre-appraisal mission and sector study on water supply and sewerage in the State of Punjab, India, under the WHOIIBRD Co-operative Programme.

The WHO sanitary engineer stationed in Bangkok continued to provide assistance in the development of rural water supplies in the country until the end of December 1976, when he was reassigned to a project in Burma. The WHO sanitary engineer stationed at the UNICEF Regional Office, New Delhi, helped in the ~lanninaand implementation of the village water supply and sanitatibn in different States of India.

With the help of a consultant, a regional report on community water supply and excreta disposal (mid-decade Review) has been prepared, and the data received from the countries through field staff for the country reports on urban water supply and excreta disposal and on rural sanitation have been reviewed and analysed. Also, steps have been taken to update the country reports on rural water supply, prepared in 1974, by adding information on developments in this field up to the end of 1975. Another consultant assisted in the preparation of typical designs for engineering components of rural water supply on the basis of information collected from the countries. These documents are being ~rocessedand finalized for publication for use by governments of the Region. SEA/RC30/2 Page 218

ICP CEP 002 Environmental Pollution Control R (Septa-Nov. 1973; Sept.-Nov. 1974; April 1975; Nov. 1975; July-Aug. 1976; Dec. 1976 - Feb.1977; - )

Aim of the project. To assist the countries of the Region in the control and abatement of environmental pollution and hazards.

Assistance provided by WZlO during the year. Two consultants.

Probable duration of assistance. Until the end of 1980.

Work done during the year. Work on the collection of information on major potential polluting sources in the Region continued. Two consultants were engaged for two months each to assess and analyse the data received from some countries and also from some of the States in India. Efforts continued for collecting information from other countries of the Region. Inventories have so far been prepared for Bangladesh, Burma, Sri Lanka, the States of Andhra Pradesh, Gujarat, Kerala and Madhya Pradesh in India, and the metropolitan city of Kathmandu in Nepal.

ICP HLT 003 Reuional Centre for Documentation on Human UNFPA Reproduction. Family Planning and Population Dynamics (Jan. 1971 - )

Aim of the project. To set up, in the Regional Office, a regional centre to reproduce annotated bibliographies and documentation on various aspects of human reproduction, family planning and population dynamics.

Assistance provided by WHO during the year. (a) Three consultants and a consultant- documentation officer; (b) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. Consultants recruited during the year assisted in the production of annotated bibliographies. Four issues were published and special supplements covering the Eollowing specialty topics were also brought out:

(1) Demographic, Behavioural and Social Aspects of Family Planning; (2) Immunology in the Field of Contraception; (3) Management of Mother and Child during Post-partum Period, and (4) Morbidity and Mortality due to Pregnancy and Child Birth.

In order to evaluate the use made of the bibliographies, a questionnaire was sent to their recipients. The replies indicate that the publications of the Centre have been very well used.

Action has been initiated for appointing "Correspondents" in the countries of the Region, who will serve as focal points for the collection of information and material for the Regional Documentation Centre.

A consultant-documentation officer joined the project in May 1977.

ICP HSM 001 Health Statistics me tho do log^ R (Jan. 1972 - Dec. 1976)

Aim of the project. To assist in the development of knowledge and skills necessary for the application of statistical methods to problems in the health field in the Region. SEAIRC3012 Page 219

Assistance provided by WHO during the year. (a) A consultant and two temporary advisers; (b) cost of attendance of participants; (c) supplies and equipment.

Work don:. Prior to 1973 this project dealt with developing a uniform system of record keeping in and reporting from health centres and hospitals. In 1973 the objectives of the project were reformulated as above in order to cope with the increasing demands for advice and help in the application of statistical methods. A statistician joined the project in August 1974 and was providing assistance until June 1976, when he was reassigned to another inter-country project (ID ESD 003).

A meeting of the Working Group on Lay Reporting of Morbidity and Mortality Statistics took place in the Regional Office from 22 to 27 November 1976. Participants from seven countries of the Region and a representative from the Western Pacific Region attended the meeting. The deliberations of the Working Group resulted in two short lists, one for lay recording of mortality and the other for recording the reasons for contact with health services. Both lists are currently being tried out under field conditions. If the outcome of these trials is positive the lists will be brought out as a supplement to the Inter- national Classification of Diseases (ICD), Ninth Revision, for use in those countries where their adoption is applicable. The project terminated in December 1976, and some of its functions such as ICD training courses will be carried on under praject ICP ESD 003. SEA/RC30/2 Page 221

13. INTER-REGIONAL (PROJECTS WITHIN THE REGION)

Project Number Source of Funds Co-operating Agencies -Title

Inter-regional 0033 Study Tour on Medical Termination of Pregnancy UNFP A (March 1975; May 1975; Aug. 1975; Dec. 1975 - Jan. 1976; April 1976; Dec. 1976)

Assistance provided by WHO during the year. (a) A consultant and a temporary adviser; (b) grant-in-aid for workshop (see below).

Work done. Under this inter-regional project, 60 fellowships have been awarded to senior obstetricians and gynaecologists to study the organization and management of abortion services in India, United Kingdom, Sweden, Yugoslavia and Singapore. In addition, 20 fellowships were awarded to health administrators to study the organization and implementation of abortion care services in the United Kingdom, Yugoslavia and Singapore. A Workshop on an Implementation Programme on Medical Termination of Pregnancy at District Hospital and Block Level was held in the Regional Office from 1 to 3 July 1975. Forty-four senior obstetricians and health administrators from India attended this workshop, which was assisted by a WHO consultant. Another Workshop on the Implementation of the Programme of Medical Termination of Pregnancy (MTP) was held at the National Institute of Family Plan- ning, New Delhi, from 7 to 9 December 1976 to review the state of the MTP programme with regard to the training, service, research and administrative aspects, as well as to assess the progress achieved since the first workshop held in 1975. A WHO consultant and a WHO temporary adviser assisted with this workshop.

Inter-regional 0188 Liaison with the Economic and Social Commission R for Asia and the Pacific (July 1970 - ) Aim of the project. To carry out liaison funcrions with ESCAP.

Assistance provided by WHO during the year. A liaison officer, a secretary and a driver.

Work done during the year. The WHO Liaison Officer to ESCAP represented WHO at various meetings called by ESCAP. Assistance and advice were provided in respect of projects and proposals of mutual interest.

Effective January 1977, the administrative responsibility for this project has been transferred to the Regional Office.

LW HKP 016 (11129) Research Team on Evaluation of Fertilit~ UNFPA Control Methods (April 1972 - ) Aim of the project. To evaluate the health impact of fertility control methods by direct field studies, by assisring in national clinical trials, and by short-term training programmes in the methods of organizing clinical trials.

Assistance provided by WHO during the year. An epidemiologist. SEA/KC30/2 Page 222

Work done during the year. The project continued to make good progress.

The clearance of the Government of Thailand was obtained for WHO consultants to provide assistance to the WHO Research Team for the Evaluation of Fertility Regulating Agents.

The medical officer of the team visited Chiang Mai to discuss with investigators the progress in the study on the return of fertility following discontinuation of Depo-6lPA (medroxy-progesterone acetate).

IKP VUC U25 Vector and Rodent Control Research Unit. Jakarta K (April 1966 - )

Aim of the project. To study (i) the ecology, biology and distribution of insect vectors of disease; (ii) the distribution, ecology and population dynamics of urban and commensal rodents, and (iii) techniques for the control of insect vectors and animal reservoirs of disease.

Assistance provided by WHO during the year. A vector specialist (project leader), six entomologists and a sanitarian.

Probable duration of assistance. A number of years.

Work done during the year. The Unit was strengthened by the addition of two entomologists, one of whom is financed by a grant from the Government of the Netherlands. The research activities are progressing satisfactorily and operational studies in relation to malaria using Malathion residual spraying for a second round will be carried out in July 1977. Fenitrothion ultra-low volume sequential application has been carried out by the VBC Sub-unit in Semarang, and its impact on malaria transmission is being evaluated.

Insect growth regulators applied at 1 ppm to C.p. fatigans larvae in relation to the control of filariasis were highly effective up to five weeks after one application.

Entomological surveillance of Ae.aegypti in relation to dengue and dengue haemorrhagic fever in Jakarta and other provinces is being developed according to the guidelines provided by the Unit. Emergency control measures are available to deal with outbreaks of DHF.

As for plague control, surveillance activities are being maintained in the dormant foci of Boyolali in Java, and an effective alternative insecticide (Malathion 5X WDP) is being tried for flea control.

The project staff in Jakarta and Semarang are also actively engaged in providing complementary expertise for the development of a self-sufficient national cadre of vector specialists/entomologists.

A review meeting of inter-regional activities in the field of vector biology and control was held in Jakarta in December 1976 and was attended by the Director of the Division of Vector Biology and Control from WHO Headquarters and the Regional Advisers from this region and the Western Pacific.

IRP VBC 043 Rodent Control Demonstration Study Unit, DANIDA Rangoon, Burma (0ct.-Nov. 1974; May 1975 - )

Aim of the project. To develop and demonstrate efficient and economical methods of controlling rodent populations under conditions obtaining in a large urban centre SEAlRC3012 Page 223 in South-East Asia and reduce and hold these rodent populations at a level where no threat to public health will exist.

Assistance provided by WHO during the year. A project leader (scientist) and a specialist in rodent control.

Probable duration of assistance. Until 1980.

Work done during the year. A general survey of rodents in all townships in the Rangoon urban area has been completed. Bandicote bengazensis, Rattus emZans, R. mttus and Suncus murines are the rodents being trapped in abundant numbers. Seasonal changes and reproductive activity for timely control intervention are being studied. The flea index of XempsyZZa cheopsis and X. astia, the main fleas involved in plague transmission, is being monitored and susceptibility tests for several insecticides have been carried out. The use of 5% DDT for flea control cannot be expected to kill more than approximately 70% of the rodent fleas, and therefore DDT at 10% has been reconrmended for control. Malathion, Propoxur and Carbaryl are being investigated as effective replacements for DDT. Several insecticides are being studied and Pyriminyl and Difenacoum are showing signs of being effective anticoagulants.

Sera collected from trapped rodents are being examined for antibodies to Yersinia pestis; 15.35% were found positive, the highest rate of 21.54% being observed in B. bengazensis. Blood taken on filter paper from the same rodents shows 17.73% positive for antibodies against R. rnooseri.

Assistance was provided to the national health authorities in taking effective control measures during outbreaks of plague in and around Rangoon.

The project has also been training national workers and WHOIDANIDA fellows in rodent control. A nucleus of trained workers for field studies is now available.

The Director of the Division of Vector Biology and Control in Headquarters and the Regional Adviser on Vector Biology and Control visited the project during the period to review its activities. SEA/RC30/2 Page 225

14. INTER-REGIONAL (PROJECTS OUTSIDE THE REGION WITH PARTICIPANTS FROM THE SOUTH-EAST ASIA REGION) (1 May 1976 - 30 April 1977)

Project No. and Number of Source of Funds Title Participants

SRLIGEAI 76 Training Course in the Maintenance and 1 from Sri Lanka UNIDO Repair of Electronic and Biomedical Equipment, Budapest (5 September - 12 November 1976)

15/133/8(76) Inter-regional Training Course in 3 (1 from Indonesia 6 HQ Funds Immunology, Lausanne, Switzerland (1-21 2 from Thailand) September 1976)

IRP/ISB/001 Training Course on Biologicals, Zagreb 2 (1 from Sri Lanka 6 (SEA Regular budget) (Yugoslavia) (22 September - 6 October 1 from Thailand) 1976)

EU/ICP/~O/O2O/VK/76 Course on Production of Lyophilized BCG 1 from India DANIDA Vaccine, Copenhagen (1 May - 1 August 1976) IR/IRP/CEP/033/VK/76 Training Course on Coastal Pollution 5 (1 from India*, DANIDA Control, Denmark (18 July - 14 August 1976) 1 from Indonesia, 2 from Thailand 6 1 from Sri Lanka)

*f rom SEAR0 funds

IR/IRP/HMD/033/ Teacher Training Workshop on the 2 (1 from Sri Lanka & (FP)/76 - FP Development of Modular Curricula, 1 from Thailand) Manila, Philippines (5-16 August 1976)

SEA/INO/ESD/002/ Seminar on Epidemiological Methodology 3 (2 from Indonesia 6 RBI76 & SEA/SRL/ in the Study of Pesticide Poisoning and 1 from Sri Lanka) ESD/002lRB/76 Potential Long-term Effects, Geneva (4-8 October 1976)

IR/IRPIHMD1033I Inter-Regional Course in Fertility 6 (3 from Bangladesh 6 FPl76132.05 Management and Maternal and Child Health 3 from Indonesia) Care for Senior Teachers, Singapore (29 November 1976 - 7 January 1977) IR/IRP/NUT/O25/RB/76 Inter-Regional Consultation on Strategies 4 (1 from Bangladesh, of Nutrition at the Local Health Service 1 from India, Level, Teheran (8-11 November 1976) 1 from Indonesia 6 1 from Sri Lanka)

IR/IRP/VBC/045/VK/76 WHOIDANIDA Training Course in Rodent 4 (1 from Burma, Biology and Control and Rodent Resistance 2 from India, 6 ta Rodenticides (DenmarkIUnited Kingdom) 1 from Thailand) (27 September - 9 October 1976)