Regional Office for South-East Asia

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WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR SOUTH-EAST ASIA

SEVENTEENTH ANNUAL REPORT OF THE REGIONAL DIRECTOR TO THE REGIONAL COMMITTEE FOlZ SOUTH-EAST ASIA

1 AUGIIST 1964 - 1 AUGUST 1965

SEA/RC18/2 Page iii

TABLE OF CONTENTS 29% Introduction vii PART I - GENERAL REVIEW OF ACTIVITIES 1. Communicable Diseases 1.1 Malaria Eradication 1.2 Tuberculosis 1.3 Quarantinable Diseases 1.3.1 Smallpox 1.3.2 Cholera 1.3.3 Plague 1.3.4 Typhus 1.3.5 Yellow Fever 1.4 Other Endemo-epidemic Diseases 1.4.1 Bacterial Diseases 1.4.2 Virus Diseases 1.4.3 Parasitic Diseases 1.4.4 Veterinary Public Health

2. Epidemiology 2.1 Epidemiological Services and Training 2.2 Global Epidemiological Surveillance Programme

3. Health Laboratory Services

4. Vaccine Prcduction

5. Health Statistics Public Health Administration Community Health Services Maternal and Child Health Nursing Environmental Health Health Education Nutrition Mental Health Dental Health Social and Occupational Health Radiation and Isotopes Cancer

7. Education and Training 7.1 Direct Assistance to Medical Institutions 7.2 Fellowships s~~hic18/2 Page iv

Assistance to Research Malaria Insecticides Tuberculosis 8mallpox Cholera Leprosy Treponematoses Migratory Birds in their Role as Disseminators of Arthropod-Borne Dieearns Rabies Measles Vaccine Trials Diarrhoeal Diseases Haemorrhagic Fever Other Arboviruees Reepiratory Virums Filariasis Brucellosis Environmental Health Nutritional Anaemias Cancer

9. Reports, Technical Publications, Documents and Reference Services 9.1 Reports 0.2 Preparation and Mstribution of Other Documente 9.3 Sales end Sales Promotion 9.4 Library PART I1 - ORGANIZATIONAL AND ADbfINISTRATIVE MATTERS 1. Regional Committee Administration General Organizational Structure Personnel Staff Welfare Fiaance, Budget and Accounts Cultural Contributions to the Regional Office Building Conetitutional and Legal Matters

3. Procurement of SuppUes and Equipment

4. Collaboration with Other Agencies 4.1 United Nations 4.1.1 United Nations Technical Aesiatance Board (UNTAB) and Unlted Nation8 Special Fund (UNBF) 4.1.2 Economic Cornmiasion for Asia and the Far Ead(ECAFE) SEA/RC18/2 Page v

4.1.3 United Nations High Commission for Refugees 4.1.4 United Nations Children's F'und (UNICEF) 4.1.5 World Bank 4.2 Specialized Agencies 4.2.1 Food and Agriculture Organization of the United Nations (FAO) 4.2.2 United Nations Educational, Scientific and Cultural Organization (UNESCO) 4.3 Inter-governmental and Bilateral Agencies 4.3.1 United States Agency for International Development (US AD) 4.3.2 Colombo Plan 4.3.3 Other Bilateral Agencies 4.4 International Non-governmental Organizations 4.5 Other Organizatfons

5. Public Information PART m - ACTNITIES UNDERTAKEN BY GOVERNMENTS WITH THE HELP OF WHO

Project List Afghanistan Burma Ceylon India Indonesia Maldive Islands Mongolia Nepal Thailand Inter-Country Inter-Regional (Projects wlthh the Region) Inter-Regional (Projects outside the Region in which Candidates from the South-East Asia Region Participated) ANNEXES

1. Organizational Chart

2. Geographical Distribution of International Staff Assigned to the South-East Asia Region, as of 30 June 1965

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

4. Conference and Meetings of Governmental, Non-Governmental and Other Organbations Held in the South-East Asia Region at which WHO Was Represented SEA/RC18/2 Page vi

pas2 ANNEXES (continued)

5. Fellowahips Awarded by WHO 206

6. List of Reports and Papers Published or Under Preparation, Tuberculosis Chemotherapy Centre, Madras 208

7. List of Papers Published or Under Preparation, National Tuberculosis Institute, Bangalore 211

8. List of Technical Reports Issued by the Regional Office 213

9. Training Activities Carried out by Governmeats with the Assistawe of WHO Staff 224

GRAPHS

1. Expenditure on Projects by Brcad Subject Groups, 1964

2. Expenditure on Commmicable-Diseasa Projects by Main Subject Group, 1963 and 1964

3. Population at Malaria Risk in the Areas under Various Phaaes of Malaria Eradication, 1 August 1963, 1964, 1965

4. Followships Awarded by Number, Major Subjects and Year of Award, 1960 - 1964, and those Awarded to Candidates from South-East Asia for Study in Other Regions and Vice Versa, 1 A-t 1964 - 1 August 1965

5. Fellowships Awarded by Country hdNumber of Awards, 1960-1984 SEA/RCl8/2 Page vii

INTRODUCTION

ThL past year has shown once again that the difficulties which are impeding efforta to achieve an improvement in health conditions remain as formidable as ever. They etlll include insufficient funds, scarcity of nearly all categories of health staff and cumbersome administrative promsees. No serious breakthrough has been possible in aqy of these three sectors, and least of all in the administrative procedures. Although £tnancial difficulties haunt most programmes, the administrative procedures are such that they do not permit the best we being made of even those resources which are available. There is over-centralization, and even minor decisions are taken at the higher echelons. The technician on the spot either has no power to take decisions or is afraid to do so.

Undoubtedly the greatest achievement of the health services in this Region during recent years haa been the enormous reduction in the incidence of malaria as a result of national eradication programmee. Increasingly, wide areas are reaching entry into the maintenance phase of malaria eradication, Failure in this phase, however, will involve the loss of the whole investment in malaria eradication. I would therefore once again stress the urgent need to carry out effective plans for the proper maintenance of malaria eradication and to embark now on training programmes for surveillance staff. Equally I would advocate an immediate expansion of the current network of basic hdth services in order to absorb and integrate hemalaria eradication programmes.

Specialized campaigns for the eradication or control of other communicable diseases have a180 been undertaken in countries of the Region, with varying degrees of success. These are mentioned in some detail in Chapter 1 of thie Report.

However, specialized campaigns are exceedingly costly and also create serious problems of eventual integration into the bwic health services. Governments are now beginning to realize the high cost and limited impact of such programmes, but the specialists are still fond of pushing their pet subjecta as independent ventures. It te our constant endeavour, aa a rerrult of pet experience, to discourage new programmee of this nature and to promote any new activity unly as an integral part of the general health eervicee from the very beginning. We must all continue to resist the temptation to start new specialized programmes and, instead, look more and more towards the expension and consolidation of the basic services.

The urgent need to establieh an organization for the maintenance of malaria eradication offers an opportunity to integrate other mass campigne. SEA/RC18/2 Page viii

The basic health workers employed in malaria surveillance can, with a limited amount of additional training, detect and treat sporadic cases of yaws, carry out immunization against smallpox, follow up tuberculosis patients, distributing druge and collecting sputa, and undertake routine prophylactic treatment of trachoma,provided they are employed in sufficient numbers. Such workers can also provide a useful epidemiological intelligence and health educatloa network.

Far too little use haa so fBr been made of the basic health auxiliary with a minimum standard of training, to extend the peripheral coverage by health services. Given proper supervision, such staff can bring an acceptable standard of health care to the whole of the community and relieve more highly qualified staff of much of the heavy burden of routine care.

I have mentioned the burden of routine work,which absorbs much of the time and mergy of professional staff in rural health services, to the detriment of their technical duties. The following extract from a WHO consultant's report is most revealing: "Foljty-two routine returns and reports are required from primary health centres, twenty of which are monthly and the remainder quarterly or mual. From the dtstrict office, ninety-three returns are required by ibe Health Directorate, forty-five of which are monthly. The daily output alone of all correspondenae in one district office at which enquiries were made averaged 150, or something over 3 500 per month. "

As regards medical education, the quantitative and qualitative deficiency of teachers in medical collega is still far from being remedied. Suitable incentives must be offered to encourage the cream of the medical and scientific profemions to follow full-time academic careers, and, wherever appropriate, greater use must be made of personnel who are not medically qualified.

There has been a continued increase in the number of medical schools. The development of institutes for the basic medical sciences te also being promoted in some countries, However, the shortage of medical teachers ha8 induced a vicious circle and has inhibited the introduction of modern teaching methods. There ia far too much reliance on didactic lectures, and too little use of discussion, integrated teaching and practical instruction. Moreover, the axpansion in the number of medical colleges has not been accompanied by an improvement in the condition of teaching hospitals. Really eeriou.9 efforts should be directed to the betterment of environmental cditione and patient care in such hospitals.

I would request governments to take a hard look at their programmes in medical education and consider the way in which WHO can best assist them in this field. Long-term international staff are castly and in any case are just not available, because of the world-wide scarcity of experienced medical teachers. Duly qualified specialists are often unwilling or unable to leave their own poets for long periods. Moreover, the impact of assistance through the assignment of a single specialist to the department of a faculty is often circumscribed. It may be more realistic and useN to provide small WHO teams of two to three medical teachers in different disciplines who can visit individual medical colleges for short periods, demonstrate modern methods of teaching and advise on over-all improvement. If we can arrange this type of programme, governments should be prepared to bring in teaching staff from other medical colleges to the college at which the WHO team is working, to give them the benefit of co-operation with the visiting specialista.

We have maintained our fellowships programme, by which advanced training is made available to selected medical educators, while the vast majority of natfonal teaching staff continue to receive their higher education, in their own countries.

Little progress can be recorded in the matter of health departments of the Region being able to assume responsibility for the protectim of health against hazards of ionizing radiation. An exception is Thailand, where,witb assistance from WHO and the Government of New Zealand under the Colombo Plan, the Division of Radiation Protectioqwhich it was decided to establish over two years ago in the Department of Medical Sciences of the Ministry of Health, has made progress.

Control of the quality of pharmaceutical preparation8 has become the concern of all countries in the Region, both by reason of the increasing number of new products imported from many sources and the large number of prepam- tions, sometimes manufactured under unsatisfactory conditions, within the country itself. The quality control of drugs involves regular inspection of manufacturing plants at all stages of the process, together with adequate testing of the finished product. WHO is prepared to advise on programmes for controlling the quality of pharmaceutical prepsrations, on the training of laboratory staff and on equipment for national drug laboratories.

During the period covered by this report, the Regional Office has co- operated with governments in giving assistance -to149 projects (including 14 inter-country and 5 inter-regional programmee.) These were Ln the fields of malaria eradication (9), tuberculosis control (a), leprosy (7), other communicable diseases (12), health statistics (6), public health administration and rural health services (7), maternal and child health (7), nursing (20), environmental health (9), direct asaistance to medical institutions (lo), other special public health servicaa (21) and miecellaneous activities @3). Appmximately 171 WHO field staff members were assigned to these projects. A total of 150 fellowehips were awarded, 50 of which were for studies in countries of the Region. WHO etaff co-operated in some 260 training cour8ea of various kin& (see Annex 9).

Early in 1965, new WHO Representatives were accredited to Afghanistan and Thailand.

The pattern of WHO collaboration with international and bilateral agenciee in the health fleM ha8 been well maintained. Frequent informal diecussione have helped to co-ordinate assistance provided from various sources. We have again provided a staff member to take care of health teaching in the UNSF/ECAFE- asstated Asian Institute of Ecmomic Development and Planning in Wgkdk, aad have contributed to a number of meetings and seminars sponsored by ECAFE. Many of the United Nations Resident Representatives have visited the Re@-1 Office to diecuss subjects of mutual interest. Resident Representstives have been kept informed of WHO activities, and have helped in the promotion of our work under the wedProgramme of Technical Assistance and the United Natlone Special Fund.

Our relations with UNICEF, WHO1s main collaborator in the United Nation0 bmily, have been as close harmonious and important as ever. During the year 37 joint project8 were in operation.

WHO has continued to participate in the health aspects of education projecte asslated by UNESCO and ha6 co-operated with FA0 ta a number of nutritioo projects. We have discussed the development of occupational health services with ILO, with special reference to rehabilitation projecte in Jndia.

We have also been active in the promotion of negotiations leading to the generoue provieion of freeze-dried smallpox vaccine from bilateral eources.

There has been close co-operation with the Colombo Plan in nursing education, radtation protection and maintenance of electronic equipment. There has also been co-operation with the Ford Foundation in the development of public health adminiatration and education and in the Calcutta watsr supply and town platmiug poject. Jointly with US AID, WHO has cmUnued to assist programme6 to eradicate malaria and to help in the assesslnent of progress towards that goaL

I must admowledge the assistance given by voluntary organizations to our work in the Regioa Notable contributions have been received fsom the Emmaue SWe, the 0rde.r of Malta and the DeutEIchas Wfmverk Nr Auseateigen SEA/RC18/2 Page xi

in the leprosy programme in Burma. Our collaboration with the Danish Save the Children Organization and with the Indo-Norwegian health project hfu continued during the year.

Some policy changes in the biLatera1 and multilateral aid programmes in public health have taken place. It seems that a number of governmental and non-governmental agencies are drastically curtailing the routine type of technical assistance to this Region in favour of more intensive aid to family planuing programmes. This will result in increased requests for WHO assistance to fill some of the gaps.

Throughout the year we have received the closest co-operation from the governments of the Region and from our colleagues in the national health services. On behalf of the Regional Office staff, I acknowledge with much gratitude their generous support and unfailing understanding so characteristic of this Region.

Regional Director GRAPH 1 -EXPENDITURE ON PROJECTS BY BROAD SUBJECT GROUPS, 1964

WHO SOUTH-EAST ASIA REGION

COMMUNICABLE -

PROJECTS

Expenditure. 1964.

~~ ~~ -- Subject group Amount (US %) Per cent I-- - Communicable-direare projects 46'32 Other projects : ::: ::: 53.68 All projects 4 611 696 1OO.W GRAPH 2-EXPENDITURE ON COMMUNICABLE-DISEASE PROJECTS BY MAIN SUBJECT GROUPS. 1963 AND 1964 WHO SOUTH-EAST ASIA REGION

Expendirure

~~ - ~ Code Subject 1963 1964 - Amount (US S) Per cent ; Amount (USS) I per cent i ~ MAL Malaria 1 032 758 5?96 ! 941 012 4905 I TB Tuberculorir 494 200 25.82 466 527 21.84

VDT Venereal diseases and treponernatorer 39 510 2.06 I 51 820 243

EE Endemo-epidemic disease, including virus diseases 181 W8 : 9.47 i 492 897 23'07 L Leprosy 166 323 8.69 183 920 861

,411 communicable direares 1 913 799 2 136 176 IWOO PART I

GENERAL REVIEW OF ACTIVITIES SEA/RC18/2 Page 3

1. COMMUNICABLE DISEASES

Specialized mass campaigns for the control of communicable diseases have of necessity been a prominent feature of the early development of health scrvices in countries of the Region. However, it is increasingly realized that such campaigns cannot in themselves lead to a satisfactory end-point. The continued effort necessary to maintain initial gains is too expensive, in terms of multiplication of staff and facilities, particularly when most countries have been simultaneously engaged upon more than one mass campaign. The further development and rapid expansion of permanent and fully participating basic health services capable of providing adequate health coverage to the total population are now our primary aims, and the bulk of available resources must now be concentrated on them. This has been underlined consistently during the year in the preparation of future national health plans, which have taken into consideration the fact that the burden of specialized disease-control programmes is absorbing approximately 50% of the total financial resources available for health services.

Many countries are today committed to as many as eight specialized mass campaigns, against malaria, smallpox, yaws, tubcrculosis (including mass BCG vaccination), leprosy, trachoma and venereal diseases. In addition, there is often the mobilization of specialized personnel to deal with epidemics of diseascs such as cholera, or to tackle other serious though localized problems such as filariasis, plague or mosquito-borne haemorrhagic fever. It is evident that a serious reckoning is needed on how to develop effective co- ordination of activities as between mass campaigns and basic health services, so as to avoid multiplication of effort and personnel and excessive recurrent expenditure.

Recent advances include an increasing acknowledgement of such a need, and three methods of integration of specialized campaigns into the general health services are being used, which may be referred to as the sequential approach, the approach in the late stage of an eradication programme, and the approach which is integration from the start.

The "sequential approach", implying integration disease by disease, has already been adopted successfully in Indonesia (Java) and in Thailand. In Indonesia, yaws workers have been gradually trained to become multi-purpose workers, able to diagnose and treat leprosy and communicable eye-diseases (trachoma, conjunctivitis), to immunize against smallpox, cholera and typhoid and to treat minor ailments - all these activities being carried out in areas not adequately covered by pcrmanont health serviccs but in co-operation with those services that do exist. In Thailand, it has been possible to follow this pattern because the health workers were initially trained as health assistants or sanitarians and therefore have a suitnble background. With this approach, with the gradual acceptance of direct BCG vaccination without prior tuberculin testing, and with the availability of a potent, stable BCG vaccine, it is not unreal- istic to foresee that in the immediate futurc both BCG vaccinators and all general health staff will be able to undertake BCG and smallpox vaccinations simultaneously in all countries of the Region.

The second approach is one by which the specialized workers in the late stages of the specialized campaign are taken into the general health services, thw strengthening these services and enabling them to carry out the surveillance necessary to prevent resurgence of the special dieease. This method is being followed in many countries in respect of the malaria eradication programme, in which, in the last phase of the programme, the aim is to develop such basic health services concurrently with a national malaria service. The means to achieve this end will be the topic of the technical discussions to be held during this year's session of the WHO Regionkl Committee for South- East Asia. Worthy of mention in this connection also is the Government of India's plan to integrate trachoma control into the existing and developing health services strengthened to deal with surveillance of malaria. It is estimated that the present specialized trachoma control programme to cover a population of 122 million, if continued as such, will cost nearly five million dollars over a five-year period,with no assurance of eliminating the disease. The present plan is to integrate this programme, particularly in those endemic arena which have entered the maintenance phase of malaria eradication. The peripheral basic health workers required for malaria surveillance as well as other health duties will also be trained to undertake trachoma controL

The approach which is integration from the start of the campaign is exemplified by the efforts being made to develop national tuberculosis control programmes (see Section 1.2 below), by placing the diagnostic, treatment and prevention services within the existing peripheral general health services from the outset and ilrqiting the work of the specialized tuberculosis services to consultation, training, co-ordinatiorl and assessment of the programme.

It is apparent that the present somewhat meagre specialized venereal- disease control services, with separate clinics and laboratories, are making little or no impression on tho problem of venereal diseases. It is the experience in many parts of the world that people will seek diagnosis and treatment of venereal diseases more readily in general health units than in specialized clinics which give undue publicity to the disease. It is gratifying to note that in Thailaml special venereal-disease laboratories are gradually being converted into health laboratories to form a framework for a future health laboratory service. Sufferers from venereal diseases are encouraged to seek treatment in general hospitals, health centres and maternal and child health centres.

It is also difficult to justify the establishment of separate and specialized cholera control programmes, with special cholera workers and special mobile units. Cholera control should be integrated into the existing health services and hospitals rather than being based on mobile field units; it should be the responsibility of the communicable disease/epidemiological unit in health directorates and be dealt with through the permanent health services, including envirom8ntd SEA/RC18/2 Page 5 sanitation services, throughout the health organization. For this work all hospitals and health centres should be equipped with readily utilizable rehydration sets for combined replacement regimen and antibiotic therapy, which have brought case fatality rates down to the minimum (see WHO Bulletin 1963, 28, 297- 305).

The consensus among health authorities now seems to be that the only practical approach to communicable-disease control in developing countries is to consider mass campaigns as only temporary expedients within long-range plans for development of basic health services. Such campaigns can only be absorbed by carefully preparing realistic, over-dl national henlth plims, aimed at building permanent, workable, referral systems and at eventually covering the total population. This implies that future plans for the development of health, including rural health, should be phased as one plan, integrating maternal and child health, community water supply and communicable-disease control services, the training of health personnel, etc. The integration of mass campaigns against specific diseases into the general health services was reviewed by a WHO study gMup in 1964 (see WHO Technical Report Series, 1965, 294).

To provide a proper basis for the control of communicable diseases, the major objective and long-term task must be the satisfactory development of effective epidemiological services within a framework of health administration at different levels and should include health laboratory and statistical services. Unfortunately,of all the kinds of public health services in countries of this region, the laboratory and statistical services are the weakest, and the least exploited. Their improvement is proving both difficult and slow.

Efforts made towards strengthening the epidemiological, laboratory and statistical services are described in the respective sections of this report.

As will be seen from the general review of activities described in subse- quent chapters,priority has continued to he given to the following categories of communicable-disease control programmes:

(1) Programmes either being carried out on a nation-wide scale (malaria, yaws, smallpox) or gradually being extended to larger areas from the pilot-control stage (tuberculosis, leprosy, trachoma).

(2) Those concerned with conditions which are prewntable because of the availability of effective immunizing agents (typhoid fever, diphtheria, whooping cough and tetanus). These are receiving increasing attention. Here the need is threefold - namely, to collect epidemiological baseline data in order to determine the groups at greatest risk, to develop appropriate vaccine production facilities, and, as immunization campaigns once embarked upon are long-term, to arrange for these campaigns to be integrated into the existing, permanent henlth services from the beginning. SEA/RC18/2 Page 6

(3) Programmes for the development of vaccine production. At present, there are centres for freeze-dried smallpox vaccine in Burma, India (four), Indonesia and Thailand; for purified adsorbed diphtheria and tetanus toxoids and pertussis vaccine in Burma, India, Indonesia and Thailand; for oral live attenuated poliomyelitis vaccine in India, and also for freeze-dried BCG vaccine in India. In addition, an endeavour has been made to promote the production of the acetone-dried typhoid vatcine in principal vaccine-producing centres, since this vaccine has proved to afford greater protection with fewer injections than TAB vaccine.

@) Problems demanding priority attention in view of their changing or rapidly spreading epidemiological pattern. These include the dengue and chikungunya group of viruses (especially haemorrhagic fever), poliomyelitis, cholera El Tor, plnguo, venereal discases and W. Bmcrofti filariasis.

In pursuance of a resolution adopted by the Regional Committee at its last session (SEA/RC17/3), a study was made during the last year in selected infectious-disease hospitals to determine how to bring about improvemente, particularly in the laboratory diagnostic services and in-patient care, by link- ing these hospitals with the nearest paediatric hospitals and medical schools, so that their senior staff (physicians, paediatricians, bacteriologists and pmfessors of preventive and social medicine) can be interchangeable, and the infectious-disease hospitals also be used as suitable centres for student instruction on infectious diseases and as a starting point for further epidemiological investigative work, This effort will be conthued.

During the year three important vaccine field-trials were carried out with WHO assistance : (I) a second, large-scale, controlled ficld trial with cholera vaccines, (2) a continuation of the measles vaccine studies, with live attenuated measles vaccine, and (3) a controlled field trial of BNC~~vaccines (see Chapter 8).

1.1 Ndaria Eradication

Steady improvement in the malaria eradication programmes was maintained, as greater percentages of the population in the Region were brought into the consolidation and maintenance phases. WHO continued'to collaborate with UNICEF and USAD in its assistance to Member Countries.

The present status of malaria eradication in South-East Asia is shown in the following table, based, as usual, on reports from govements and other SEA/RC18/2 Page 7

information available in the Regional Office:

Total population 682.3 million

Population at risk (in originally malarious areas) 643.7 million

Population protected: Under attack phase 150.0 million Under consolidation phase 281.6 million Under maintenance phase 171.3 million

Population undef preparatory phase 5.4 million

Population still unprotected 35.4 million

The major increase in areas and population going from the attack to the consolidation phase h'as been in Indonesia, where withdrawal of spraying has occurred in 35 out of a total of the 42 zones in the central group of ishds. In West Java only one zone is in the attack phase; in Central Java there are three. and in East Java also three. However, this withdrawal of spraying and the consequent entry of the affected population into the consoLidation phase wiU have to be watched with great care. The areas in the Region now entering the maintenance phase are all in India, and this entry to maintenance has reduced the over all figures for consolidation. Afghanistan and Burma continued to show some progress, and there has been a great improvement in the plan* of the Thai programme,and in 1966 it will be possible for the first time to extend spray operations to cover the entire population at risk. Ceylon, unfoi-tunately, bad a setback at the end of the last quarter of 1964 and the beginning of 1965, when some 170 cases of indigenous malaria were repoirted. These consisted of P. fdlcimrum W fi malariae infections only; it was interesting to note that no indigenous case of P. vivax occurred. A short-term consultant is being assigned to advise the Government on the prevention of any further episodes of this nature. In Nepal, the programme has been expanded, and by the end of 1965 the Western Zone will also receive protection with insecticides. Steps were taken to examine the malaria situatioh in the Maldive Islands and to start a pilot spraying project in Male Atok

' During the year, new plans of operations were completed for Nepal and Thailand. In Thailand it has been planned to assign five WHO sanitarians, one for each of the five regions, to assist in supervision and tr'aining.

With the advance of national programmes, the type of WHO assistance also needs to follow the changing requirements. The increase in areas entering the consolidation phase has resulted in greater attention being paid by WHO Btaff to the improvement of the epidemiological services necessary for surveillance activities. As mentioned earlier in this report, further increase in areas going into the malntenance phase demands rapid integration of the existing malaria services into the general health services of each country, and there is also a growing necessity for buLlding up these health services so that they can take over the responsibility SEA/RCI8/2 Page 8

for the maintenance phase,once malaria is eradicated Opportunities were provided under the Scheme of Exchange of Scientific Workers for national staff to visit programmes in the maintenance phase as well as other programmes.

The annual independent assessment of the Indian programme was carried out by the Government, WHO and USAID from mid-January to the first week of February 1965. As usua1,there was a panel of consultants which discussed the findings and recommendations of each of the twelve assessment teams. This year's assessment included a large number of units planned for entry into the maintenance phase. An assessment of the Nepal malaria eradication programme was also made by a joint WHO/USAID team from the end of April to June 1965. This type of assessment is now a regular feature of our work.

Training of personnel, both professional and sub-professional, continued to be a major activity. All the countries have training centres for sub-professional staff, and WHO personnel assigned to the programmes continued to assist in training activities. In respect of all the countries (except India, which has full training facilities), the training given to professional staff within the country has been supplemented by attendance at international training centres; WHO has provided fellowships. However, for various reasons it has not been possible for spme countries to propose candidates for these fellowships.

So far, technical problems have not been a serious hindrance to the progress of any of the programmes, although the extent of resistance to insecticides by A, sundaicus and A. aconitus in Indonesia has spread considerably and might be a reason for outbreaks of malaria in localized areas. In India, in certain localized areas A. culicifacies and A. stephensi present problems, which have been met by judicious. increases in the dosage of DDT or by changing the insecticide. The use of lead-free aviation petrol in wells against A. stephensi breeding in urban areas has been continued. The problem of chloroquine resistance in Thailand was further investigated by the local authorities, and a WHO team was provided to assist in these studies.

Shortages of imported commodities and limitations of national funds have become a major handicap to the expawion of programmes in some countries, and this has resulted in premature withdrawal of spraying in some places and temporary breakdowns. This may become a serious threat to further progress.

WHO continued to assist in the exchange of technical and operatiom1 information and in co-ordinating malaria eradication activities between countries with common borders.

The following intercountry meeeswere held during the year:

Q) India-Nepal Border Malaria Co-ordination Meeting, held at Babirahawa in Nepal on 15 and 16 September 1964. GRAPH 3 - POPULATION AT MALARIA RISK IN THE AREAS UNDER VARIOUS PHASES OF MALARIA ERADICATION IN THE SOUTH- EAST ASIA REGION - I AUGUST 1963, 1964, 1965.

POWLATION (Mtlllons) ( SOURCE GOVERNMENT REPWS AND REGIONAL OFFICE RECORDS )

Preporatory Phma Attack Phore Canrol~dat~~Phars Mantaancc Phore Nd Cavared by ME oparotbonr

Population in million

- ~~ .~ - -~-~ - Year Preparatory Attack Consolidation Maintenance , Not covered by malaria eradication phase phase phase phase ! I I operations. SEA/RC18/2 Page 9

(2) India-Pakistan Border Anti-Malaria Co-ordination Meetings, held near Ferozepur (India) on 24 October 1964 and at Sulemanki (West Pakistan) on 27 April 1965.

(3) Eighth Burma-India-Pakistan Malaria Co-ordination Meeting, held in Chandignrh (Punjab) from 21 to 23 December 1964.

The Fifth Asian Malaria Conference and the Anti-Malaria Co-ordination Meeting are scheduled to be held in Colombo at the end of October 1965.

WHO participated in the annual meeting of malaria and filaria workers of India, held in Calcutta from 17 to 20 June 1965.

A circular letter has been issued to the Governments of Afghanistan, Burma, Indonesia, Nepal and Thailand, stressing the need to utilize the facilities available at the WHO centre in Kasauli for the cross-checking of blood smears from malaria eradication programmes. It is very discouraging that this facility, provided at the request of the Regional Committee, is so little utilized and for this reason may have to be discontinued.

1.2 Tuberculosis

It is generally recognized that tuberculosis is the most important specific communicable disease in the world as a whole1 and that even in countries with mted resources all the basic requirements to make an impact on the problem can be met to-day, with a good understanding of the epidemiological and social situation, reliable diagnostic tools and preventive and curative measures that are efficient and cheap.

It may be recalled that recognition of the above view was reflected in the discussions and recommendations arising from the technical discussions on the subject of "Case-finding and Domiciliary Treatment in Tuberculosis Control", held during the sixteenth session of the Regional Committee in 1963, and in the extensive review, made at the seventeenth session, of the general policies being followed by WHO with respect to tuberculosis control activities throughout the Region. Until very recently, some of the principles of present-day policy appeared unacceptable to many concerned with tuberculosis control, although these had been evolved after carefully a~lysedobservations from pilot projects in the countries of this region It was thcrcfore gratitifying that,in its Eighth'Report, the WHO Expert Committee on Tuberculosis, meeting in Geneva in August 1964, endorsed many policies and methods of approach which have for some time been followed in this region, and framed clear and specific guidelines concerning epidemiological lWId Health Org. Tach. Rev. Ser. 1960, 195, 4 2~ldHealth Orr[. Tech. Rep. Ser. 1964, 290 SEA/RC18/2 Page 10

indices, case-finding, chemotherapy and BCG vaccination in the formulation of an efficient tuberculosis control programme. It considered that technical, administrative and economic considerations make it mandatory for tuberculosis services to be integrated into the general health serviccs and that the specialized tuberculosis services should be concerned particularly with consultation, training programmes, and co- ordination and assessment of the programme. It also reviewed the studies carried out on direct BCG vaccination, that is, vaccination without prior tuberculin test, and recommended this as a public health procedure. The advantages are obvious: a reduction of operational costs by more than 50%; the elimination of the loss in coverage that occurs when many of those tested do not come for vaccination; a simplification of training, and an easier integration of the work with other existing public health activities such as smallpox vaccination, maternal and child health and other public health services. The foregoing basic considerations and recommendations were discussed at the WHO Inter-regional Seminar on Tuberculosis, held at Kuala Lumpur in November 1964. The principal conclusions of the Seminar were that systematic case-finding should not start until the majority of persons known to suffer from infectious tuberculosis can get adequate treatment and that suspected cases should be followed up until a clear diagnosis has been made. The Seminar agreed that the backbone of a national tuberculosis programme is efficient BCG vaccination and that mass case- finding and treatment must be considered only in the total context of the epidemiological, social and economic development of a country. The pilot area projects which are in operation in India, Indonesia and Thailand, in preparation for comprehensive country-wide tuberculosis control programmes, were already progressing on the lines of the report of the WHO Expert Committee, and the recommended new orientation is also being followed in the preparation of plans of operation or addenda to existing ones in respect of the other countries of the Region. In Afghanistan, for example, the scope of the tuberculosis advisory services has been reviewed with the object of promoting n community-oriented tuberculosis control programme for Kabul and the Shewaki community development area. Briefly, the activities in some of the countries of the Region are as follows: In Burma, a programme concentrating on the infectious reservoir detected through bacteriological exanlinations of people suffering from broncho-pulmonary symptoms has already been developed in a relatively short time, and is being integrated into the existing structure of the Greater Rangoon Health Scheme. Preparations for an expansion of the programmc to the north of the country are under way. Tuberculosis still remains a serious public health problem in Ceylon, where for many years great efforts have been made to reduce it. In order to intensify control measures, the Government has planned to embark upon a comprehensive provincial tubexculosis control programme, integrated into the existing and develop ing network of basic health services but technically guided and supervised by the provincial tuberculosis officers. In India, the national tuberculosis programme has progressed, with a steadily increasing number of district programmes being started. The determination of the Government to get on with this programme is reflected in the large-scale planning for the Fourth Five-Year Plan - planning which has been considerably assisted by the recommendations made by responsible national tuberculosis and BCG workers at an all-India conference held at Ahmedabad in February 1966. At this conference it was advocated that tuberculin testing should no longer be used as a routine in the Indian BCG vaccination programme. Based on the experience of a number of studies concerned with direct BCG vaccination, which has been given to children up to the age of six for some time, the conference recommended that direct BCG be given to all persons up to the age of twenty, and that the older population be disregarded altogether, in order to exploit to the full the operational advantage of this method. The research work being carried out in Madras and Bangalore is described in Chapter 8.

In Indonesia, direct BCG vaccination has also been shown to carry no serious risk and to be no less acceptable to the people than vaccination after tuberculin testing. The urban service programmes at Jogjakarta and Surabaja have developed well, and the rural pilot area project at Malang has also made progress.

In Mongolia, the Government has planned to intensify its tuberculosis control activities, with WHO assistance, particularly with respect to ambulatory and.domiciliary services. The means of collecting further epidemiological information required for future planning is also under consideration.

Nepal now has a combined tuberculosis and leprosy control programme, recently started, in which the collection of certain epidemiological base-line data is planned. Here too, direct BCG vaccination is expected to be introduced after a preliminary study of local acceptability.

Thailand is considering possibilities of formulating plans for tuberculosis control on a country-wide scale. Based on the experience and results of the two WHO assisted pfiot-projects, urban and rural, it is hoped to evolve a tuberculosis control programme using one province as the smallest workable administrative unit, and then extending the pattern to other provinces of the country.

Late in 19.64, visits were paid to the tuberculosis programme in Thailand and the National Tuberculosis Institute in Bangalore, India, by some of the participants in the Inter-regional Seminar on Tuberculosis mentioned above, following the meetings in Kuala Lumpur.

1.3 Quarantinable Diseases

During the seventeenth session of the Regional Committee, useful discussions on cholera took place, cspccially on the possible role of carriers in the international spread of the disease, and on the existing provisions under the International Sanitary Regulations in respect of cholera and other quarantinable diseases.

Representatives of Ceylon, India and Pakistan met in New Delhi in April 1965 to review the sanitary and quarantine measures which are being taken by the three countries in respect of yellow fever.

The figures of notifications of quarantinable diseeeee reported for the countries of the Region for the years 1962, 1963 and 1964 are given in the table on the following page. SEA/RC18/2 . . Page 12

Quarantinable Diseases Notified for Countries of the South-East Asia Region, 1962 to 1964 (Sources: WH* Me 1964 VoL 17, 2, 153-165, and l0, 501-512; 1965 VOL 18, 3, 163-175)

Typhus and Other Country Year Smallpox Cholera plague Rickettsial Diseases* Cases Deaths Cases baths Coeae Deaths Cases Death2 Afghanistan 1962 303 - - - ...... 12 - 1963 571 1 - - ...... 39 9 1964 168 - - - ...... 1 - Burma 1962 32 1 1 - 73 16 ...... 1963 193 21 3 019' 783 34 16 ...... 1964 23 1 922 172 - - ...... Ceylon 1962 66r 12r - - - - 32k ... 1963 1 - - - - - ... 1964 ------2724& ... India 1962 42 478 11 402 25 566 8 671 697 88 ...... 1963** 60 971 19 452 51 082 8 298 205 24 ...... 1964 32 480 9 118 52 960 7 015 109 15 ...... Indonesia 1962 3 582 - ... 1 659 525;; ...... los 1963 7 971 ... 471$ ...... 1964 + + 326 3 ...... Nepal 1962 + + ...... 1963 779 261 ... I ...... 1964 + + ...... Thailand 1962 za za - I - - - ...... 1963 - a- 2 2MET 15gET - - ...... 1964 - - 95arET 3oET - - ...... I

*Figures generally refer to louse-borne epidemic typhus **Recorded cases and deaths are 69 768 and 21 341 for smallpox, 51 156 and 18 307 for cholera, and 204 and 24 for plague respectively (communication from the DGHS, India, 2 July 1964) a ' ' ' Data mt available Includes one imported case 'Data not yet available r~eviseddata -Nil or of negligible magnitude Rother rickettsia1 diseases $~relimiuary,approximate or estimated data S~crubtyphus Ttl~lTorw cholera

1.3.1 SII~B~~DOX In l964 there wae a feU in the number of cams and deaths from smallpox h this region. when ampared with the correepondfng total in the preceding three years (me table above). This decrease in incidence muat be SEA/RC18/2 Page 13

interpreted cautiously, however. Whilst possibly due to the intensified mass vaccination efforts in 1964, it may also correspond in part with cyclical declines in incidence; it will be recalled that 1963 was a relatively bad year for smallpox, with epidemics in Afghanistan, India, Indonesia and Nepal. Also in some countries the reporting system is still incomplete.

The subject of the technical discussions held during the last session of the Regional Committee was "Smallpox Eradication". The discussions took the form of a useful and active review of the extent of the problem in the countries of the Region, the epidemiological factors responsible for the persistence of infection, and the planning, organization and execution of the national anti-smallpox programmes wherever the disease is still endemic.

During the year, varying degrees of progress were achieved in the programmes being carried out in Afghanistan, Burma, India, Indonesia and Nepal. For these programmes, the Organization continued to provide personnel, some transport and equipment, and also consultants in vaccine production and for assessment of progress. The WHO Smallpox Assessment Team visited Afghanistan and Burma, and a WHO medical officer went to various States in India and Nepal in order to study the smallpox eradication programmes, especially in regard to progress, speed of campaign and needs. The total amounts of freeze-dried smallpox vaccine distributed by the Organization in 1964 and up to June 1965 from the quantities donated by various vaccineproducing countries to the WHO Smallpox Eradication Special Account, were: to Afghanistan, 1 020 000 doses; Burma, 1 500 000 doses; India, 7 750 000 doses; Nepal, 200 000 doses. Also, the USSR has made a generous donation of about 400 million doses to Afghanistan, Burma and India during the past three years on a bilateral agreement. The assistance given in vaccine production is described in Chapter 4.

In Afghanistan, the campaign was extended to a few provinces outside Kabul. A Five-Year Plan was agreed upon, aiming at completing,within the next five years, the attack phase, entailing mass vaccination in all provinces and at the same time laying the foundation for the health services in the provinces to take over the maintenance phase of the programme. This is an ambitious target,which will require much greater resources and an even greater degree of field organization than seems likely at present. Vaccination of women presents a serious problem also.

In Burma, there was continued progress in the country-wide programme launched in 1963. This programme is based on dividing the districts into units of operation, in which mass vaccination is carried out in one third of the area of each unit every year, whilst primary vaccination, including that of new-born infants, is maintained in the remaining two thirds,so that,by rotation, the whole area could be covered by mass vaccination in three years.

Ceylon continued to be free from smallpox and maintained routine vaccination through its general health services. No cases have been reported since 1963, when there was one suspected case. SEA/RC18/2 Page 14

In India, 38 039 632 primary vaccinatiotvl and 287 139 237 re-vaccinations were carried out up to the middle of March 1965, covering 74.3% of the population (1961 census). There was a sharp decrease in the reported number of cases and deaths from smallpox in 1964 as compared with 1963 (the figures were: 35 627 cases and 10 067 deaths in 1964, and 60 971 cases and 19 452 deaths in 1963). Four conferences of zonal smallpox workers were held to review the programme and to recommend ways and means d achieving the principal objective of vaccinating more than 90% of the population in each age-group by the end of the Third Five-Year Plan, i. e. March 1966.

Intensified mass vaccination was continued in Indonesia, mostly in areas affected by the disease.

In Mongolia, smallpox is not endemic, and no cases have been reported. Periodic routine vacdnations and re-vaccinations are maintained through the health and medical services.

Systematic vaccinations continued in the Kathmandu Valley in Nepal, as part of the WHO-assisted smallpox control project. It was planned to extend the vaccination activities to fifteen districts within the next five years from mid-1965, with the aim of covering most of the country's population. Owing to Insufficient resources,and the difficulty of communications, this may take a longer time,

In Thailand, no cases of smallpox have been reported since 1962, when there was one autochthonous case and one suspected case. Periodic vaccinations and re-vaccinations are being given by the general medical and health services and by the treponematosis control teams.

1.3.2 Cholera

Cholera continued to be prevalent in India and also occurred in small ~ut- breaks in Burma, Indonesia and Thailand.

In India the incidence (52 960 cases; 17 015 deaths) remained at approximately the same level as in 1963, but it was noted that over 41 443 cases (78% of the total) were notified from four States alone: Maharashtra (12 783 cases), Andhra Pradesh (12 252), Madras (11 121) and West Bengal (5 277). The very high incidence in Maharashtra in the City of Bombay, in which cholera was reported for the first time since September 1958, represented a new development. The typing of strains suggested that there are several independent foci in India. Of concern was the demonstration that the El Tor vibrio was playing an important aetiologic&l role in the 1964 cholera outbreaks in Calcutta, constituting one more example of the progressive Wasion of many Asian countries by the El Tor vibrio since 1961. In Burma, Indonesia and Thailand there were fairly small outbreaks of cholera EL Tor.

In anticipation of a possible major epidemic year in 1967-1968, forecast on the basis of the known cyclical epidemicity of cholera, the Government of India SEA/RC18/2 Page 15

completed a detailed study of all available data in the past ten years, in order (a) to define 2s closely as possible districts or community blocks most affected and (b) to carry out the necessary surveys and make preliminary engineering and budget estimates for providing safe water supplies to thcse hyper-endemic areas, undcr a special priority programmc for implerncntation undcr the forthcoming Fourth Fivc-Year Plan. This is n bold and imaginative approach which deserves full support. As described in Section 6.4 (Environmental Health), the Organization continucd to give high priority to national programmes for the provision of safe water supply and sewage disposal, particularly in those areas where cholera is endemic.

Of major importance was also thc still relatively high case-fatality rate reported. Between 1954 and 1963, for example, the rates recorded were as high as 54.9% in Kerala, 53.2% in Assam, 47.1% in Orissa, 43.8% in Andhra Pradesh and 39.6% in West Bcngd. This may be attributed partly to (a) poorer notification of cases than of deaths, and @) lack of adequate and prompt treatment facilities. As reported last year in the Sixteenth Annual Report of the Regional Director, the treatment studies undertaken at the Infectious Diseases Hospital in Calcutta- .- have shown that. with ~rom~trehvdration. correction of acidosis. restoration of the electrolyte bal&cc &d coL~binedantibiotic therapy (WHO ' Bulletin 28, 297-305 and 33 795; Bulletin of the Calcutta School of Tropzd ~edicine3964, 34), the case fatality rate has been brought down to less than 3%. Prompt and early rehydration is the most important life-saving measure, and immediate thought needs to be given to the establishment of rehydration centres in all existing medical and health facilities in cholera cndemic areas, and also to the provision of readily available intravenous infusion sets and the training of staff. The feasibility of local production of cheap, disposable infusion sets (consisting of a plastic container with isotonic saline, plastic tubing and needle) must be urgently investigated.

A detailed "Review of recent trends in research and control of cholera", prepared by a WHO consultant1 and presented at a WHO seminar on cholera which was held in Manila from 12 to 18 November 1964, is recorninended to all concerned in the control of cholera.

Both this seminar and a training course in cholera control organized by WHO in Calcutta in May 1965, which were attended by several cholera workers from countries of the South-East Asia and Western Pacific Regions, emphasized the newest methods of diagnosis, prophylaxis and treatment.

The field trials of cholera vaccines being carried out in Calcutta and the work of the WHO International Centre for Vibrio Phage Typing, which was also established in Calcutta, are described in Chaptcr 8. l~r0. Felsenfeld, Geneva, 1965. WHO Headquarters unnumbered document. SEA/RC18/2 Page 16

WHO grants for medical research and training were awarded to junior and senior research investigators in the Region in order to broaden their fields of interest and experience.

The Regional Committee at its 1964 session expressed concern over: (a) the known or suspected presence of foci of sylvatic plague in India, Burma, Indonesia and Mongolia, (b) the persistent occurrence of human cases of plague in the central areas of southern India and in Magwe, Meiktila and Myingyan Districts of Burma, and (c) the obseryation that the flea vectors had developed resistance to some types of insecticide, in particular to DDT.

The Organization has kept in contact with all the governments of the Region in order to ascertain the nature and extent of the problem, to assess the arrangements for the establishment or maintenance of plague surveillance programmes and to stimulate and assist in starting a regional survey of the susceptibility of fleas to insecticides in known or suspected endemic areas, so that base-line data for speedy action will be available when the disease flares up. WHO also offered assistance in giving senior personnel the necessary training in the epidemiology and control of p'lague.

Further reports were received of an alarming increase of uncontrolled rat infestations in countries of the Region. In India, for example, according to a rough estimate made through sample surveys, there are approximately 2 400 million rats, i. e. five times more than the human population There is an enormous economic loss in food grains due to rats, and the need to establish close co-ordination of the work of the Ministries of Health and of Agriculture in this regard is imperative.

As reported last year, a WHO consultant assisted in the study of factors responsible for the persistence of plague in South India. His recommendations are being followed up by the National Institute of Communicable Diseases in Deihi, which is currently making a stucb. of the epidemiology of resurgent plague in the areas adjoining the inter-state borders of Andhra Pradesh, Madras and Mysore. Investigations were continued in South India on the role of peridomestic and field rodents as reservoirs of plague infection, and a detailed, comparative evaluation of DDT, BHC, diazinon water-dispersible powder and dust formulations against rat fleas in endemic villages was carried out. The results so far obtained have given unequivocal evidence that sylvatic foci are present in thi? above- mentioned areas, where P. pestis was isolated from species of Tatera indica and Bandicota bendensis and from X collected from their bodies and from their burrows. Some reports from Iran indicate that P. pestis can survive not only in animal hosts and vectors but also in carcasses and in the soil of burrows, but this may not have practical implications, since the soil contamination seems to be rather low. SEA/RC18/2 Page 17

In Burma, the Central Epidemiological Unit organized, in 1965, a pilot study in Mciktila and Myingyan Districts, to clarify the various factors responsible for persistence 3f plague in endemic areas, as n preliminary part of a plan for a long-term surveillance programme.

In Thailand, plague has n~tbeen reported since 1952, but surveillance measures are being maintained.

1.3.4 Typhus

Sporadic cases of louse-borne typhus wcrc reported from Afghanistan, especially among migratory groups. In Ceylon, India nnd Thailand sporadic cases of scrub, as well as murinc, typhus occurred. Some investigations have been conducted by the Epidcmiological Unit, Colombo, thc National Institute of Communicable Diseases, Delhi, and the Faculty of Tropical Medicine, Bangkok.

1.3.5 Ycllow Fever

As mentioned in Chapter 4, during the year, for the first time, the Central Research Institute in Kasauli, India, was ablc to produce its first batch of yellow- fcvcr vaccine.

WHO was reprcsented at the sixteenth meeting of the Ycllow Fever Advisory Committee of the Government of India (sce list in hex4).

1.4 Other Endcmo-epidemic Diseases

1.4.1 Bacterial Diseases

(1) Leprosy

Leprosy is endemic in all the countries of the Region except Mongolia. The magnitude of the problem in India, where there are approximately 2.5 million cases, with a high concentration in imdhra Pradesh and Madras; in Burma, with approximately 200 000, mostly distributed in the central provinces; in Thailand, with ab&t 150 000 in the North-east, North and Ccntral provinces, md, to a lesser extent, in Indonesia, Afghanistan, Ceylon and the Maldive Islands is now better known. Recent data also emphasize that most cases occur in the age- group of5 to 14 years. In Burma, for example, in highly endcrnic districts, as many as 26 to 40 cases per thousand were detected in children of school- going age. Also the frequency of disabilities in these children may be as high as 11to 19 per cent. SEA/RC18/2 Page 18

A natural corollary is the need for special attention to the child population and the household contacts of the children affected,

For leprosy, as for other chronic diseases requiring long-term treatment, the efficiency of a control programme cannot be measured in terms of the number of cases detected but by the number of those on regular treatment. Surveys -, with no simultaneous, adequate provision for long-term treatment, should not be encouraged. In control programmes, a public health approach with a more critical study of administrative and operational requirements, is required, so that the best possible use of the resources, personnel and equipment may be made. Full advantage is still not being taken of existing resources and knowledge so as to discover and treat the maximum number of patients, priority being given to those who are infectious or who are liable to become so. This is all the more important in that treatment with sulphones or other drugs must be continued in lepmmatous and borderline patients for a long period - over three years as a minimum. The "acceptance rate of the drug" constitutes the greatest challenge in leprosy control.

WHGassisted campaigns continued to evolve along technically agreed lines in Burma, India, Indonesia and Thailand, with emphasis on areas of high prevalence, regularity to treatment and the supervision, teaching and training of all categories of personnel, and on achievhg the closest collaboration with the existing health services. The co-operation of school-teachers and village headmen was sought through a more enlightened health education approach WHO continued to provide leprologists, leprosy control officers and consultants, and UNICEF assisted with supplies and transport vehicles in most of the countries.

In Burma, case-finding has evolved gradually and soundly, as has the establishment of a treatment organization capable of dealing with the increasing case-load. A five-year plsn for an extension of the leprosy control programme has been approved, and emphasis continued to be placed on the training of permnneL A WHO leprosy research team continued its work in the Mandalay region (see Chapter 8).

In India, a review of the national leprosy control programme showed that in the last five years 12.2 million people were examined,250 000 cases registered and 227 074 put on treatment. A progressive step was taken in March 1965, when the voluntary agencies working in India established a natianalleprosy orgmimth to co-ordinate all anti-leprosy work. In the project in the Srikakulam District in Andhra Pradesh, jointly assisted by WHO and the Danish Save the Children Organization, there was a considerable expansion of activities. In three years of work in this project, 24 359 patients hkve been brought under treatment.

In Indonesia, leprosy control activities are fairly well established in Java and Bali, where they have been integrated into the existing health services. During the year some work was undertaken in assessing the extent of the prevalence of leprosy and existing control activities in some of the islands outside Java, principally in Sumatra. SEiJRC18/2 Page 19

In Thailmd, tEc stl-cngthcning of apcratians and consolidation of aehizvc- ments of the lcprosy campaign procccded satisfactorily. The project now aperates in 26 provinccs, and thcrc is a total of about 70 000 registercd cases. f, stricter systccl of control of the admissian, registration, follow-up nnd discharge of patients was introduced.

VJHO also gave zssist2ncc to idgh,mistan, where a WHO consultant carried out 3 leprosy survey in Gamiynn Province, in which it was confirmed that the disease constituted a lscalized pr~blcmamong the Haarajats; t,s the M,aldive Islands, whcrc trcatment of leprosy cascs in Male was organized with thc nssistancc of the TIHO incdicnl officer assigned t~ the public health pmgrammc, and to Nep,?l, ~vherc,as mcnti~ncdenrlicr, 2 cxnbincd lcprosy/tubereulosis control pilot pr3jcct in the K2.thmnndu Valley has l~censtarted with thehelp of a WHO team.

In Ccylon, there werc 4 194 cascs 3f leprosy an trcatment in 1964, and 218 ncw cases werc registered, as csmpared to 2G4 during 1963.

On the whole, thc c~ntrolof lepr?sy will remain a slow and prolonged affair in this licgian.

For practical purposes, yaws transmission can bc considered to have ceased in Ccylon and Thailand, to havc been reduccd to an insignificant level in the yaws-endemic areas of the Statcs of Orissa, fddhm Pradesh and Madhya Pradesh in India, and t3 havc ccascd in Java and Bali in Indonesia; in some of the other islands 3f the Indanesian archipelago, however, it is still a public health problem.

In Thailmd, yaws survcill,?nce has been integrated into the general health serviccs in-211 the 46 provinccs in which the disease was endemic

(3) Venereal Discnscs

Venereal discascs - syphilis, gansrrhoea, chancroid and nan-g~nococcal urethritis - arc n pcrmmcnt and ever-growing prablcn~in our principal cities. Unfortunately, the existing scrviccs arc not yet gcarcd to provide reliable and comprehensive informati311 an the variety and incidence of the infection, far less to provide adequate trcg.t.mcnt. Thcre is a gcncral lack of interest in the problem of venereal diseases. VJhcrc facilities for diagnosis and training are available, ,it is apparent that they. .are not being fully utilized.

Thcrc would seem to bc an urgcnt need to pay much mare attention to teaching about venereal dismses at thc undergraduate level. While special campaigns arc inadvisablc and impractical, with more adequately trained personnel, SEA/RC18/2 Page 20

the existing medical and health services would be in a better position to use facilities for diagnosis and treatment, as mentioned in Chapter 1 (Communicable Diseases). Congenital syphilis is still to be seen in general and paediatric wards, and it is a great pity that even today routine ante-natal blood testing is not a universal procedure. This speaks very poorly of our maternal and child health services.

The epidemiological significance of the loss of relative cross-immunity to syphilis following mass campaigns against yaws in the rural areas, and the possibility of infiltration of venereal syphilis from the cities into these rural areas, from which yaws has now been practically eliminated, needs to be watched. However, this will again depend on the effectiveness of basic health services.

Assistance was given to several countries of the Region in upgrading diagnostic facilities for venereal syphilis and gonorrhoea - in Ceylon, particularly with respect to the introduction of fluorescent diagnostic techniques.

The recommendations of the WHO consultant who last year studied the problem of the control of venereal diseases in Thailand are being followed up by the Government.

Plans have been made to provide a WHO consultant to review the nature and extent of the problem of venereal diseases and control measures being taken in India.

(4) Diarrhoeal and Enteric Diseases

Diarrhoeal Diseases

The significance of this group of diseases as a leading cause ofmorbidity and mortality among infants and children has repeatedly been stressed.

Meeting last year, the WHO Expert Committee on Enteric Infections reviewed available knowledge and indicated the policy to be followed in the complex field of enteric infections, including diarrhoeal diseases. 1

In Ceylon, much progress has been made in the long-term studies on diarrhoea1 diseases since the start of the WHO-assisted project about two years ago. Supporting services have been provided or established by the Epidemiological Unit,@ the Children's Hospital, Ragama Hospital, the Angoda Fever Hospital and the Medical Research Institute, Colombo. Valuable preliminary data on the prevalence and incidence of Shi~ella,Salmonella, pathogenic -, E. histolvtica and intestinal worm infestation were collected. Improvements in basic sanitation and health education were initiated in an attempt to reduce the load of diarrhoeal diseases in infants and children in a rural community. A pilot project on ascariasis control, with blanket treatment with piperazine citrate, was started.

WHO Tech. Rep. Ser,_g64, 288. SEA/RC18/2 Page 21

In India, studies on the subject were continued in Delhi and Vellore, under the sponsorship of the Indian Council of Medical Research and by the National Institute of Communicable Diseases.

Assistance continued to be given to a few laboratories requesting identification and classification of enterobacteriacae and enteroviruses through the WHO network of international and national reference centres for Salmonella, Shigella, Escherichia and the enteroviruses.

Twhoid Fever

At the last session of the Regional Committee, attention was called to the relatively high level of typhoid morbidity in the Region, particularly in children, and emphasis was placed on the importance of introducing systematic programmes of immunization among school-children, through the co-ordinated efforts of the Ministries of Health and Education The striking protection shown to be given by the acetone-dried typhoid vaccine and its administrative advantage over the heat- killed, phenol-preserved vaccine were noted. As a follow-up of the resolution adopted on this subject (SEA/RC17/R2), a survey was started to determine the feasibility of converting the production of all principal typhoid vaccine production laboratories from the present heat-killed, phenol-preserved typhoid vaccine to the heat-killed, acetone-dried variety.

(5) Diphtheria, Whooping Cowh and Tetanus

Although reliable data are not available, recent limited epidemiological surveys and studies of hospital statistics indicate that more attention needs to be given to this large group of preventable diseases.

Efforts were made to collect pertinent information in Kabul, in the Rangoon area of Burma, in Ceylon and in the principal cities of India, Indonesia, Mongolia and Thailand. In Mia, for example, diphtheria occurs in both the urban and the rural areas, and, on an average, 3 000 to 5 000 cases are annually admitted to each of the principal infectious-diwase hospitals. In Ceylon, hospital figures average about 1 000 cases annually, the 1-6 year age-group being most affected. In Kabul and Rangoon an increase in incidence in recent years has been recorded.

Whooping cough is known to contribute to much morbidity and mortality in infants and toddlers,from secondary complications. Seasonal epidemics occur regularly.

Theimportance of the problems of tetanus, tetanus neonatorum and puerperal tetanus is illustrated by the fact that fatality rates in respect of tetanus cases admitted to hospitals are often quoted as reaching 40 to 46 per cent; among newborns the rate is up to 76%.

WHO and UNICEF co-operated in giving assistance to the estabLishment or strengthening of existing local production of triple vaccine (see Chapter 4),and systcmatic diphtheria, pertussis and tetanus immunization programmes were started in the Rangoon area of Burma and continucd in the Western Province of Ceylon.

1.4.2 Virus Diseases

(1) Trachoma

Experience m the trachoma control programmes being carried out in the Region has shown how increasingly difficult it is to continue to maintain and develop them as specialized programmes, because of the cost of employing the large number of specialized staff required for an indefinite number of years in order to accomplish a single objective. With the chronically uilsatisfactory conditions of environmental sanitation prevailing in endemic are& gnd the indufficiency of drugs, thbee programmes have necessarily to last a long time. As mentioned earlier, the consensus now is that the broad objectives of such long-term programmes can be achieved only by integrating trachoma control work into the general health services and by training trachoma and other communicable-&ease control personnel as multi-purpose workers so that they may perform a number of selected health functions. In this scheme it is important that health education be given a prominent place.

In Afghanistan, the attack phase of the trachoma control pilot project being c&ied out in a part of Herat City and in several neighbouring villages has been co~pletedand the consolidation Phase started.

In India, most of the comp~unitydevelopment blocks selected for the control of tradhoma and associkt&3 cdni~unicableeye diseases have now been covered by mass treatment. The majority of those blocks in which treatment has been given are located in the States of Punjab, Rajasthan and Gujarat, where the prevtilence of the disease is over 50%, and in highly endemic areas of the States of Uttar Pradeeh, Bihar, mdhya Pradesh and Jammu and Kashrnir. A scheme for the gradual integration of the trachoma control activities into the .work of the primary health centres, in selected areas where the malaria eradication programme has entered the maintenance phase, has been adopted. This plan contemplates the appointment and training of peripheral multi-purpose basic health workers able to cope with a workload of three to four thousand people, ss against the previously agreed workload of 10 000 people for the malaria workers in the maintenance phase of the malaria eradication programme. This first step towards btegration should pave the way for further development of the rural health services, increasingly involving maternal and child health and selected communicable-disease control activities. Quarterly meetings to review the progress of the national trachoma control programme and to achieve greater coverage were organized by the Government, and a National Symposium on Trachoma was held in March (see list of meetings, Annex 4). SEA/RC18/2 Page 23

In Thailand, trachoma control extended to additional districts in Nakornrajsimha and Khon Kaen Provinces. The trial integration of trachoma control into the health services in fifty villages showed encouraging results: the prevalence of active trachoma was reduced in the various agegroups of the population By systematic and repeated health education it was possible to obtain better participation of the people in purchasing antibiotic ophthalmic ointment, at a reduced price, for self-application of the drug. In the above- mentioned area, about 90% of the households in which there were active cases of trachoma bought at least one tube of antibiotic eye ointment.

(2) Poliomyelitis

There is increasing evidence of the ever-present risk of outbreaks of poliomyelitis in the Region, and of the consequent need for further improvement in the notification of the disease and for serological surveys of representative samples of the population, to detect,in time,possible changes in the epidemiological pattern of the disease. Governments have been informed that WHO can assist in the planning and conduct of these investigations, in co-operation with the WHO reference laboratory centres or national consulting laboratories established in various countries.

In Burma, an increased number of cases of paralytic poliomyelitis in young children was reported from Rangoon in the last months of 1964 and the first part of 1965.

In Ceylon also, there was an increase in poliomyelitis cases during the last months of 1964 and the beginning of 1965,in Colombo and in the Western Province. Most of the cases reported occurred among children under five years of age. Trivalent oral polio vaccine was used for the control of the outbreaks. A WHO consultant assisted in the assessment of the poliomyelitis immmization programme carried out in 1962 and 1963. Nuch stronger follow-up action is needed. Arrangements were made for testing samples of stools and sera from suspected cases at the Haffkine Institute, Bombay.

In India, the Indian Council of Medical Research continued serological studies on the prevalence of infection from polio viruses in various urban and rural communities. The Enteric Virus Laboratory attached to the Central Public Health Engineering Research Institute, Nagpur, and located in Wadgaonsheri, Poona, continued its studies on the pollution of drinking water by viruses and their removal from contaminated waters, and succeeded in elaborating a method for the isolation of poliomyelitis virus from contaminated waters by tissue culture. This method is being tested for other enteroviruses of the Caxsackie and ECHO groups. Further progress was made in the establishment of facilities for the production of oral polio vaccine at the Pasteur Institute, Coonoor (see Chapter 4). WHO fellowships were awarded for training in production techniques and in virologic and neurovlrulence testing. SEA/RC18/2 Page 24

In Mongolia, a serological survey for poliomyelitis and other viral agents is being undertaken as part of the WHO epidemiological team's serological survey of brucellosis, in collaboration with the WHO Serum Bank at the Institute of Epidemiology and Microbiology in Prague, Czechoslovakia.

In Thailand, a, survey of polioviruses and other enteroviruses has recently been undertaken by the Government.

(3) Mosquito-Borne Haemorrhagic Fever

As brought out at the WHO Inter-regional Seminar on Haemorrhagic Fevers, held in Bangkok in October 1964, haemorrhagic fever,as well as dengue and chikungunya infections, constitutes a problem of increasing importance in the Western Pacific and South-East Asia Regions and possibly also in some areas of the Eastern Mediterranean In aU countries so far affected, cases or outbreaks of haemorrhagic fever have occurred every year, with the disease threatening to spread to new areas. There was another major epidemic of haemorrhagic fever in Thailand in 1964, when, from January to December, there were 5 336 cases among hospital admissions in Bangkok/Dhonburi, with 274 deaths. Outbreaks also occurred in Korat, Ubol and Chiengmai. The fatality rate outside Bangkok/ Dhonburi was about 10%.

Particularly in view of the changing epidemiological patterns and rapid spread of diseases such as haemorrhagic fever, the Organization is promoting a global surveillance programme (see Section 2.2), and in this connection all governments have been requested to send, by airmail, to the Division of Communicable Diseases at WHO Headquarters, weekly reports, including negative ones, of cases and outbreaks of hemorrhagic fever and monthIy reports on epidemics of dengue-like diseases, specifying the aetiology whenever possible. WHO has arranged to circulate this information to all countries, when received To facilitate this reporting, an informational note on a "Suggested definition and nomenclature for diseases suspected to be of dengue or chfkunguqya virus aetiology", issued as part of the report of the WHO seminar mentioned above, was sent to ail governments in the Region It was also suggested to the governments that paired sera be collected from cases with clinical syndromes resembling haemorrhagic fever or that serological surveys be carried out in representative areas of each country, to determine the occurrence of antibodies against dengue and chikimgunya viruses, so that a clearer picture of the importance and extent of the problem could thus be gained

As the control of AZdes aemti is the only available and practical controI measure against haemorrhagic fever and dengue and chikungunya infections, all countries have been asked (a) to initiate or continue studies to determine the distribution of this mosquito, as well as its density index), seasonal variation and susceptibility to insecticides in the areas affected or likely to be affected by these diseases, and @) to intense efforts to keep ports and airports free from ABdes aemti,in accordance with Article 20 of the Jnternational Sanitary Regulations. SEA/RC18/2 Page 25

The Organization has assisted in the planning and organization of studies on Agdes a.emti bionomics in Thailand and in developing a practical methodology for serological studies on haemorrhagic fever and dengue and ch&ungunya infections. Assistance has also been offered in forwarding the sera collected in those surveys or the paired sera from suspected cases to WHO arbovirus reference centres, to the WHO Collaborating Virus Research Centre in Poona, or to national consulting virus laboratories such as the Virus Research Institute and the Virus Unit of the SEATO Medical Research Laboratory in Bangkok In addition, pertinent reference antigens and sera, as well as test kits for studies on the AEdes aemuti or other vectors of haemorrhagic fever, can be supplied to govenunent-designated institutes or individuals.

An Ai5des ae~pticontrol pilot project was undertaken in a very small selected area in a suburb of Bangkok, and a WHO consultant assisted in the continuation of studies of this vector, advising on the feasibility of embarking on an expansion of control measures to further areas of the city.

In India, an outbreak of haemorrhagic fever occurred in Visakhapatnam, Andhra Pradesh, in October/November 1964. Earlier, a st* was made of the dengue group of diseases (dengue viruses of types 1, 2 and 4 and chlkmguya virus) at the time of an epidemic of dengue-like fever which broke out in JuIy 1964 in Madras and some other cities of South India, when more than 200 000 cases were reported: in this epidemic, all age-groups and both sexes were affected, including elderly persons; the mortality was low.

(4) Other Arboviruses

A WHO consultant visited the following laboratories which are undertaking investigations on the arboviruses: the Medical Research Institute, Colombo; the Virus Research Centre, Poona; the HaMrine Institute, Bombay; the Bio Farma Institute, Bandung, and the Virus Research Institute and SEATO Medical Research Laboratory, Bangkok.

In Ceylon, serological evidence of the presence of Japanese encephalitis and dengue fever was obtained; expansion of laboratory activities in the field of arboviruses is planned.

In India, further progress was made in (a) obtaining evidence by serology of the circulation of 11 viruses in Southern India (Semllki, Dengue, West Nile, Zika, Ntaya, etc.); (b) a study of Japanese encephalitis, and (c) further studies of the Kyawur Forest disease. The Haffldne Institute continued its search for an effective and safe vaccine against Kyasanur Forest disease. The presence of African horse sickness and of a new virus of the Bunyamwera group (Chittoor vlrue) was established. The Chittoor virus was isolated from Anopheles tessellatus and some C-species, but not from man or from sick animals.

In Indonesia, the Bio Fnrma Institute in Bandung carried out a serological study of arboviruses, when the presence of dengue type 1and of Japanese encephalitis had been established. SEA/RCl8/2 Page 26

Much work was done in this field at the Virus Research Institute, Bangkok, where, in addition to undertaking detailed surveys on the dengue viruses, dengue- like viruses and chikungunya viruses mentioned above, the Institute obtailled serological evidence on Japanese encephalitis in the northern part of the country,

(5) Respiratory and Other Viruses

At the Pasteur Institute, Coonoor, which has a Department of Respiratory Viruses and which is a WHO national influenza centre, work was continued on influenza epidemiology, isolation of influenza and other respiratory viruses, adenoviruses, para-influenza, etc. Other activities on respiratory viruses are proceeding in the Department of Bacteriology of the All-India Institute of Medical Sciences, New Delhi, and in the Bacteriological Department of the Pate1 Ghost Institute, Delhi.

At the Institute of Microbiology of the Medical Faculty in Djakarta, also a WHO national influenza centre, in addition to studies on influenza viruses, studies on human smallpox virus were continued. At the Bio Farma, Institute, Bandung, strains of influenza A2 virus were isolated last year, and studies on smallpox have continued.

Interest in respiratory virus investigations was maintained at the Respiratory Virus Laboratory of the Virus Research Institute, Bangkok, where studies on influenza, adenoviruses and smallpox viruses were started.

(6) Viral Hepatitis

The term "viral hepiititis" covers both infectious hepatitis and serum hepatitis, the two types usually being reported together, as there is at present no sure way of differentiation between these clinically similar conditions, Reports from most countries of the Region received during the year, in particular from India, Mongolia and the Maldive Islands, showed an apparent increased incidence of these conditions. As viral hepatitis is increasing and spreading, much more attention will be required from all countries in the coming year to improving the diagnosis, reporting and follow-up of cases and thus help to determine the exact degree of severity in terms of sequelae and mortality.

1.4.3 Parasitic Diseases

(1) Filariasis

Filarial infections have caused increasing concern in Burma, Ceylon, India and the south of Thai land In India alone, over 122 million people are estimated to live in areas in which filariasis transmission occurs (the estimate in 1953 was 25 million and in 1963 over 64 million); W. bancrofti is very largely urban and is increasing rapidly in importance, with the excessively rapid SEA/RC18/2 Page 27

-tion, whereas B. malavi is rural and localized. In Burma, filariasis due to W. bancrofti is known to be prevalent in Rangoon, Mandalay, Tennasserim and in towns in the low-lying areas. In Ceylon, B. malayi infection, previously endemic, has disappeared since the early 19501s, but has been replaced by W. bancrofti, which has spread rapidly within the south-western coastal belt, mostly among urban populationk. In Thailand, B. malavi is confined to the rural areas in the eastern coastal belt of the peninsula in the south; the infection is almost exclusively due to periodic B. malayi, but there are also foci with sub-periodic B. malavi and nocturnal periodic W. bancrofti. This species is known to be present in parts of West Irian and in the Maldive Islands.

The control of filariasis remains disappointing, in the face of limitations of mass treatment and prophylaxis and difficulties in controlling the principal vector, Culex fatigans. However, research by means of pilot projects to discover and apply practical methods of control must continue, along with long-term improvements in environmental sanitation. The training of medical officers, entomologists and ancilliary staff should be pursued.

In Burma, the WHO Filariasis Research Unit continued its studies on the epidemiology of f ilariasis and on the ecology and bionomics of C-in the Rangoon area (see Chapter 8).

In Ceylon, parasitological surveys carried out throughout the island did ~t reveal any foci of W. bancrofti outside the known endemic area in the south- western coastal belt. A WHO consultant and an entomologist have been assigned to the filariasis control project. An epidemiologist will join them later in the year.

In Thailand, a WHO consultant assisted the Faculty of Tropical Medicine and Endemic Diseases, Bangkok, in its studies on the bionomics of Cdex ~i~iens fatims, in particular the larval habitat, and in evaluating the effectiveness of the newer insecticides which could be introduced for practical use.

(2) Dracontiasis (Guinea Worm)

As mentioned last year, India has a very large problem of Guinea-worm disease. The major causes as well as the methods of prevention are well known, but progress in tackling the disease is slow because the only solution would be the abolition of step wells and provision of protected water supplies - a long-term and expensive programme, the more so since water is not easily available in some of the areas in which the disease is prevalent. Progress was made in the develop ment of a rural water supply project, with the assistance of the Government, WHO and UNICEF in the most greatly affected area - Udaipm District in Rajasthan.

(3) Bilharziasis

In contrast with other communicable diseases in the Region, which are well defined in number and in prevalence, bibarziasis is conspicuously restricted SEA/RC18/2 Page 28 to one focus of S. haematobiurn in Gimvi (Maharashtra State), India, and to one of S. jauonicum in a localized area of Nakornsrithamaraj Province in the south of Thailand.

No new foci were reported during the year.

(4) Leishmaniasis

In Afghanistan, cutaneous leishmaniasis is known to be prevalent in some provinces, such as Herat There are reports that visceral leishmaniasis is re-appearing in some States of India, especially in those areas from which residual spraying for malaria has been withdrawn. Vigilance is therefore required.

(5) Paragonimiasis

The only known endemic areas of paragonimiasis in the Region are in a district of Saraburi Province in central Thailand, where the infection rate is estimated to be 22%, and in a localized area in southern Nepal.

1.4-4 ~eterinaq'Public Health

The significance and extent of the zoonoses in man continue to be grossly underestimated in the Region because of the shortage of veterinarians working in public health, the lack of co-operation among departments of public health, animal husbandry and agriculture, inadequate laboratory diagnostic services, and incomplete statistics resulting from poor reporting. Unless veterinarians are trained at both the undergraduate and post-graduate level, the gap in this field of public health will continue.

In India, a Department of Zoonosis has been established in the National Institute of Communicable Diseases.

Brucellosis

In Mongolia brucellosis is undoubtedly one of the most important health and economic problems. Because of its very complex nature, it is recognized as a long-term problem. A WHO epidemiological team, working in Mongolia with national staff and also with interested institutions and services in the health and veterinary fields, has collected much new information on the epidemiology of brucellosis in man and in animals, and initiated well planned, controlled field trials of Brucella vaccines.

The possibility that brucellosis might be of greater importance in other countries than previously thought is borne out by some data collected by a health laboratory in Punjab, India, between 1959 and 1964. In that laboratory, 87 strains of Br. melitensis and Br. abortus were isolated, 29 of them from blood cultures SEA/RC18/2 Page 29 of human cases of brucellosis. In previous years isolated human cases were reported in India from Kashmir, Rajasthan, Gujarat (Baroda), Maharashtra (Bombay), Kerala, Madras State, Andhra Pmdesh, Assam, Bihar and the Union Territory of Delhi. A closer collaboration among health laboratories, clinicians and officers of the departments of agriculture, and increased awareness of this disease, are necessary before its pattern will become clear.

In Nepal, the possibility of occurrence of brucellosis in the cattle-raising area of Siraha must be kept in mind for further study, as in this area a disease clinically resembling brucellosis has been recently reported

Rabies

Ceylon has launched a rabies control programme in Colombo and the Western Province. By April 1965 about 41 000 dogs had been vaccinated with avianized rabies vaccine.

2. EPIDEMIOLOGY

2.1 Epidemiological Services and Training

Coptinued efforts were made in the further implementation of the resolution adopted at the eleventh session of the Regional Committee (SEA/RCll/R3) in September 1958, to establish or strengthen epidemiological units based on health laboratory and statistical services as an integral part of the national health administration. Since 1958, epidemiological units have been established in Health Directorates in Afghanistan, Burma, Ceylon, India (Central Government and in eight States), Indonesia (Central Government and in the provincial Health Directorate of Java), Mongolia, Nepal and Thailand The National Institute of Communicable Diseases, Delhi, started its first training course in epidemiology in 1964 and a second one in April 1965. Plans were made for setting up an epidemiology department within the Faculty of Tropical Medicine, Bangkok.

Much greater progress in the development of epidemiological services is needed. This requires:

(1) Periodic critical appraisals of the function of an epidemiological service and its proper place in the administrative structure, as well as its relationship with other existing elements of the health services.

(2) Education and training in epidemiology, microbiology and health statistics, including training and apprenticeship experience under local conditions, wherever possible, and, later, study abroad for advanced workers, WHO has continued to give assistance in training to all the countries in the Region through both individual country projects and inter-country programmes. SEA/RC18/2 Page 30

(3) Continued support to the National Institute of Communicable Diseases, Delhi, and the Faculty of Tropical Medicine, Bangkok, to help them develop their facilities for teaching and demonstrating applied epidemiology in the field, laboratory and hospital to national workers and possibly fellows from other countries.

(4) Improving the principal infectious-disease hospitals so that they can not only provide better diagnosis and patient care than available today but also serve as suitable teaching centres and as a starting point for further epidemiological investigative work.

A WHO team continued to assist the Public Health Institute, Kabul, in strengthening its epidemiology and statistical and microbiology departments, with a view to co-ordinating work with the other service6 of the Ministry of Public Health in the country and increasing their usefulness in teaching and field research.

In Burma, the services of a WHO microbiologist were continued during most of the year; a WHO statistician and medical records officer are also in position

The Epidemiological Unit in Ceylon continued with its epidemiological studies, and a WHO consultant, as mentioned in Section l.4.2, assisted in these studies and in the initiation of basic investigations on viral encephalitis. Another WHO consultant advised on the strengthening of virological diagnostic services.

In Thailand, the Epidemiological Unit in the Division of Communicable Diseases undertook studies on the cholera problem in the country and continued research on haemorrhagic fever. A WHO consdtant advised on the establishment of an epidemiological department within the Faculty of Tropical Medicine and End6knic Diseases in Bangkok.

During the year, fellowships were awarded to enable candidates from the Region to attend a number of training courses or seminars: on epidemiology in the USSR; on mosquito-borne haemorrhagic fevers in Thailand; on cholera control in Calcutta; on thc enterobacterlacae in Colindale, London; on plague control in the USSR; on entomological methods in vector control, also in the USSR; and on imrnuno-fluorescent techniques at the Staten Serum Institute, Copenhagen.

2.2 Global Epidemiolo~calSurveillance Programme

There is an increasing awareness of the need for promoting, on both a regional and global basis, an epidemiological surveillance programme of diseases of national or international imporwe, particularly of conditions showing a changing epidemiological pattern.

Global epidemiology began with the study and control of the spread of the six quarantinable diseases. During the last twenty years, louse-borne typhus SEA/RC18/2 Page 31

and relapsing fever have declined in importance. Today there is a threat of the possible recrudescence of plague, and a marked change has occurred in the epidemiological picture and steady spread of cholera, particularly cholera El Tor. Constant alert is neccssary for influenza epidemics that might stem from changes in the types of influenza viruses strains. The epidemiological picture of poliomyelitis is always changing, and the rapid spread of mosquito- borne hemorrhagic fever and encephalitis in the Western Pacific and South-East Asia Regions has posed formidable problems. The aim of epidemiological surveillance is to maintain a constant study of live and changing situations. With international collaboration and assistance, much can be done to ensure early recognition of any new epidemiological trends, to gain new knowledge,and to disseminate such information, along with technical advice and guidance, more promptly, so that countries can be alerted to study the problem further and plan appropriate preventive measures.

At this stage of development of health services, an epidemiological surveillance programme in this region will entail, in its first stages, no more thanan attempt to obtain and disseminate more systematic and reliable Mom- tion on a limited number of conditions, carefully selected according to the importance attached to them by countries of the Region A suitable initial programme in the Region would include maintaining, with WHO co-operation and co-ordination, a "watch" over certain diseases, including bacterial diseases (cholera, cholera El Tor and plague) and viral diseases (smallpox,mosquito- borne hemorrhagic fever and encephalitis, poliomyelitis, influenza and possibly measles), which are changing or are expected to change their epidemiological pattern either in nature or extent.

Such a regional surveilknce programme will entail the creation or strengthening of systems of notification and reporting of the above-mentioned diseases, and of a chain of "principal" and reference laboratories. Laboratories have been started or planned in respect of the following4

Cholera Indian Institute for Biochemistry and Experimental Medicine, Calcutta, SEATO Medical Research Laboratory, Bangkok, and Bio Farma Institute, Bandung

Plague National Institute of Communicable Diseases, Delhi, and Wfkine Institute, Bombay

Diarnosis of Virus Research Centre, Poona, Moscluito- Borne Medical Research Laboratories, Bangkok, and Arboviruses Bio Farma Institute, Bandung

Laboratory Haffkine Institute, Bombay, Diagnosis of Pasteur Institute, Coonoor, Enteroviruses Virus Research Institute, Bangkok, and Bio Farma Institute, Bandung SEA/RCi8/2 Pagc 32

Influenza Pasteur Institute, Coonoor, and University of Djakarta.

3. HEALTH LABORATORY SERVICES

Hospital, public health, university and research laboratories have continued to develop to a greater or lesser extent, independehtly or in an uncoordinated fashion This has resulted in services of greatly varying standards of efficiency, with wasteful duplication of effort and failure to make the best use of the available resources. This situation is the outcome of a lack of planning for national health laboratory services as an integral part of the national health service.

It is felt that the following should be avoided:

(1) The establishment of laboratories without due consideration of the immediate, full requirements of the health services and the need for the eventual expansion of laboratory services, with the expected development of tbe health services in the area. A laboratory service cannot be viable if it is set up as a self-contained and self-acting unit, and not adapted to the broad requirements of the surrounding general health services.

(2) Inadequate detailed planning of the required physical facilities, equipment, regular supplies of chemicals and reagents and of technical personnel, on a phased basis and as part of a long-term plan

(3) Concentration of effort on providing laboratory facilities only to the centre, with no projection into the periphery by means of a network of laboratories of different grades and connected by a two-way referral system.

For the adequate organization, development and expansion of a health laboratory service it is considered necessary that planning and co-ordination of the work should be established through the appointment, at directorate level, of a health officer with a background and experience in microbiology and laboratory services. Laboratory services should be projected and co-ordinated at the peripheral level, and integrated into the work of the rural health services. A regular supply of profesaidand technical personnel must be ensured by providing training facilities of suitable standard and attractive work and service conditions.

WHO assistance in health laboratory services was increased through the appointment of a Regional Adviser in Health Laboratories, the appointment of microbiologists and laboratory technicians on a long-term basis, the assignment of consultants, the establishment of schools of medical laboratory technology, and the provision of post-graduate training in microbiology or clinical pathology through fellowships.

In Afghanistan, a.WHO microbiologist and laboratory technician assisted in the further development of the Microbiology Department at the Public Health Institute, Kabul. This unit is now well equipped and provided with trained personnel. SEA/RC18/2 Page 33

In Burma, a comprehensive plan for a national laboratory service has been prepared by the Government,but its implementation has been handicapped by shortage of trained personnel.

In Ceylon, the laboratory service is centralized. Efforts were directed toward upgrading specific facilities with regard to bacteriology, parasitology, and virology, and a WHO consultant advised on the strengthening of the virological diagnostic aspects. Appreciable progress was made through the WHO-assisted project on diarrhoea1 diseases (Ceylon 66). The School of Medical Laboratory Technology in Colombo,previously supported by WH0,maintained its standard in training high-grade laboratory technicians, including fellows from other countries of the Region The difficulty of meeting the entrance criteria has prevented its more extensive use for the Region

In India, some assistance was given in strengthening the existing laboratory services at State and district levels and integrating them into the over-all rdhnal programme of development of community health services being assisted by WHO and UNICEF. Mherassistance was given to strengthening the establishment of new laboratory diagnostic facilities for communicable diseases in various institutes, including the National Institute of Communicable Diseases (Delhi), the Pasteur Institute (Coonoor), the Haffkine Institute (Bombay), and some infectious-disease hospitals. A project for training laboratory technicians was started,with WHO assistance,at Trivandrum, in Kerala State.

In Indonesia, the Government has prepared a plan for the re-organization of laboratory services on a national basis, with the Bio Farma Institute, Bandung, as the central laboratory. A WHO microbiologist is under recruitment to assiet in this development.

In Mongolia, a WHO consultant studied existing laboratory services at central and provincial levels. His recommendations for upgrading the Central Hygiene Station and the Sanitary/Bacteriological Institute in Ulan Bator, as well as provincial laboratories, forms the basis for a project to be assisted by WHO and UNICEF.

Efforts in Nepal were directed toward establishing a central laboratory in Kathmandu. A new building is under construction, and preparations were made for equipping it and training laboratory personnel.

In Thailand, a ten-year plan has been prepared for the development of provincial laboratories: this programme is being assisted by WHO and UNICEF. Emphasis is placed on programmes for training labomtory personnel. A central venereal-disease reference laboratory is being established in Bangkok. s~Afic18/2 Page 34

4, VACCINE PRODUCTION

In order to help meet the needs of the immunization programmes being carried out against the major preventable discascs, WHO has assisted several projects concerned with production of bacterial and viral vaccines. This assistance has included technical advice on enlarging the existing production, on introducing modern techniques, on carrying out dependable control tests, and on the upkeep and breeding of laboratory animals (for this a consultant visited eight centres in India as well as Colombo and Bangkok).

In the field of bacterial vaccines, WHO and UNICEF co-operated in giving further assistance to the Burma Pharmaceutical Institute, Rangoon, the Central Research Institute, Kasauli (India), and the Bio Farma Institute, Indonesia, to establish or expand the production of diphtheria-pertussis-tetanus triple vaccine.

Small-scale production of acetone-dried' typhoid vaccine was planned at the Hamine Institute, omd day.

WHO assistance was planned for the BCG Vaccine Laboratory, Guindy (Madras), for large-scale production of freeze-dried vaccine.

In the field of viral vaccines, considerable help was given by WHO and UNICEF to establish, expand and modertLize the production of the freeze-dried smallpox vaccine for the campaigns in progress, and to train personnel in most countries. Fellowships were awarded; a WHO consultant was provided and a demonstration course on the use of shelf-drying equipment and production techniques organized.

Further prcgrcss was made in the production of oral live attenuated poliomyelitis vaccine at the Pasteur Institute, Coonoor, in India,and for its testing at the HaMcine Institute, Bombay.

The Central Research Institute in Kasauli, India, was able to produce its first batch of yellow-fever vaccine from the 17/D virus strain, satisfying international requirements.

5. HEALTH STATISTICS

. National committees on vital and health statistics or their equivalents now exist in six countries of the Region. During the year under review only one of these committees met. There is thus ample scope for greater co-ordination of activities of diverse agencies that producc vital and health statistics

The publication of available health statistics by the countries of the Region as part of their annual health reports or separately is still far from complete. During the year a supplementary annual vital statistics report for 1962 was issued by the Government of Burma. The Director-General of Health Sarvicee, India, SEA/RC18/2 Page 35

issued two publications on this subject: one on health statistics of India for the years 1959 and 1960, and the other the annual report of the Directorate of Health Scrvices for 1957. The Dircctor of Health Serviccs in the State of Assam brought out his annual rcport for the year 1959; the Government of Orissa published the annual administration report of the Health Department for the yenr 1962; thc Government of Maharashtra, the aualreport on civil hospitals and dispensaries for 1958; the Bombay PJIunicipal Corporation, the annual report of the Executive Health Officer for 1963, and the Corporation of Nagpur, mortality statistics for 1958-1963. The Ministry of Public Health in Thailand issued a publication entitled "Public health statistics", which contains a number of tables on vital statistics up to 1962 and health statistics up to 1963.

The collection of hospital statistics in the various countries has begun to improve in coverage as well as scope. In Afghanistan, the collection of in- patieht morbidity statistics continued, with nearly 100% coverage of the hospital beds. Processing of the material is going fonvard, with assistance by WHO. Medical records departments were being established in two major hospitals in the country.

In Burma, the work of collecting in-patient morbidity statistics along sound technical lines was extended to all hospitals under the health services, with special arrangements for large hospitals having full diagnostic facilities. In these hospitals, medical records departments are being established and developed. The collection of administrative statistics from hospitals was reorganized, and an instruction manual on the subject issued. Processing of both types of data is proceeding; VJHO staff assisted in all these activities.

In Ceylon, particular attention was paid to the quality of in-patient morbidity statistics. WHO is assisting in strengthening the departments in larger hospitals.

In India, the collection and processing of in-patient morbidity statistics in West Bengal are proceeding.

In Nepal, the collection and processing of administrative statistics of hospitals in the Kathmandu Valley continued.

WHO staff have assisted with the collection and processing of in-patient morbidity statistics in Thailand, where geographical coverage was extended; the published data for 1964 contained information not only from hospitals in Bangkok but from over 50% of the provincial hospitals. Medical records departments in the larger hospitals were established or strengthened.

Training of medical records officers continued in Vellore (India) and also in Bangkok, where from five countries of the Region nine medical records officers completed a nine-month training course, conducted with WHO assistance, and SEA/RC18/2 Page 36

returned to hospitals in their respective countries. Training courses for medical records technicians were planned in Burma and India. Training of medical coders continued in Nagpur (India),

In most countries of the Region, recording and collecting relevant data for the assessment of activities in the rural health services continued to be a problem. With WHO support, a system for collection and presentation of out- patient morbidity statistics was tried out, and studies of a maternal and child health records system continued.

Cause-of-death statistics based on events occurring in hospitals received some increasing attention in India., In Delhi, for example, a trial scheme supported by WHO increased its coverage to cover about 6 000 deaths per year.

The lack of completeness in vital statistics registration remained a problem in several countries of the Region, making a simple assessment of important social and health programmes difficult.

The Registrar-General of India has issued a publication entitled "Vital statistics of India for 1961". A sample registration system introduced in the States of Bibar, Gujarat, Kerala, Wrashtra and lYysore worked satieEactorfly in twenty selected villages in each State, and the scheme is now be- extended to cover 150 vjllages selected by stratified random sampling in &ch of the Stateah A similar trial was continued in five sectors (each with a population of 10 000) in urban areas of each of the same States.

6. PUBLIC HEALTH ADMINISTRATION

6.1 Community Health Services

The urgent need for advancing the development of basic health services has already been mentioned in Chapter 1.

The establishment of widespread basic services requires that much attention be paid to the control of these services. Some difficulties havealready arisen where certain categories of staff are controlled administratively by local authorities. This responsibility to a non-technical employer has been confusing to the health workers and frustrating to the health administrators. It is suggested that when large numbers of lowe~gradehealth staff are to be employed, the provision of services can be considerably prejudiced unless their technical and administrative coqtrol is the responsibility of the national health admhi&ration

In Afghanistan, the rural health programme has continued to develop slowly: it now covers 19 projectfareas, and five more are expected to be added before 1966, UNICEF is providing supplies. Assistance has been given in drafting an interim plan of operations for the provision of basic health services, based principaLIy on SEA/RC18/2 Page 37 the malaria eradication fr?rrevrork, A WHO consultant also assisted in the preparation of a long-term plan for national health services

In Burma, malaria eradication work has already been partially linked with the basic health services. The organization of the health services has been revised. For the purposes of administration and supervision, the country has been divided into six zones, each under the control of a deputy director of public health, who, in turn, kas a staff of assistants, whose responsibilities include the supervision of the township medical officers. The employment of these township medical officers for the supervision of health assistants has been further developed. UNICEF has provided supplies and equipment to support this supervisory function and for upgrading township hospitals

With respect to Ceylon, a WHO consultant made a report on the future pattern of activities at the Institute of Hygiene, Kalutara, which is at present being developed, in part, as a training centre for public health staff, including newly appohted medical officers and public health inspectors.

The Government of India has been engaged in preparing for the Fourth Five-Year Plan, which is to begin in April 1966. The future shape of basic health services has already been cast. The governing influence has been the initiation of integration of malaria eradication services into the basic health services, and the pattern evolved has been based on the primary health centre. It is planned to attach to this unit additional sub-centres, through which the basic health workers will carry out a domiciliary function; the sub-centres will also form the base of work for auxiliary nurse-midwives; plans have been made for adding laboratory side-room workers. At district level, more supervisory personnel will be added, and district hospital staff will be enabled to visit peripheral clinics at smaller hospitals and at health centres.

In keeping with this expansion of the basic services, WHO and UNICEF have developed subsidiary plans of operations for the various States of India, in order to support important aspects of the programme. These include assistance in training, assistance to centrcs, hospitals and laboratories, and provision of transport vehicles.

. The low salaries of doctors posted to primary centres pose a.serious problem. In some States they are the equivalent of barely fifty U.S. dollars per month.

A Central Health Service, with an authorized strength of 2 333 posts, has been established by the Government of India. Doctors in this service will not be allowed private practice, but will receive a non-practising allowance.

Colqpulsory service in rural areas for a limited period for all medical graduates now qualifying is in force in the States of Andhra Pradesh, Kerala, Punjab and Rajasthan and is under consideration in Gujarat and Pondicherry. This is a great help in providing doctors for rural areas. SEA/RC18/2 Page 38

Personnel a ssipr~r!to lndia in connection with community health services during the year have included a WHO consultant who made recommendations on the operation of integrated services in Fmjab State,with special reference to the district organization Wh'O is assigning a public health officer to assist in following up on these recommendations.

The Government of Indonesia has continued to study programmes for the development of basic health services in the outer islands, looking, as in the case of other countries, to the co-ordimtion of the malaria eradication programme and the general health services.

In the Maldive Islands the training of multi-purpose health assistants, nurse aides and indigenous midwives was continued, with the assistance of WHO. As malaria is a serious problem in the islands, a new plan has been drafted, incorporating a malaria pre-eradication programme in the framework of the basic health services.

In Nepal, a five-year development plan for basic health services has been prepared, combining malaria eradication and general health services so as to provide widespread basic health care - mainly, in the first instance, to the areas covered by the malaria eradication programme, but later to be expanded to the whole country.

The Government of Thailand was assisted in evolving a plan for the further development of basic health services in the province of Pitsanuloke,including a study of the work of newly appointed basic health workers in one district, and the integration of malaria eradication and other programmes into the basic services.

Little progress was made in the field of urban health development. The formidable problems which arise in both the environmental and the personal health fields have been multiplied by the rapid growth of urban communities. Inadequacies in town planning, in housing, slum clearance, sanitation and water supply, as well as failure to take precautions against the outbreak of epidemics and occupational health hazards,are only some of the factors which throw a burden on both the population and the local authorities. Solutions are very expensive. At the same time, unless intensive planning of ways and means for dealing with these problems is undertaken, they may become so immense as to defy solution.

The reports of two WHO consultants on urban health were issued during the year - one for Bangalore City, and the other for the Bangkok Municipality.

WHO staff members have taken part in numerous meetings and semiaars concerning rural and community development in Bangkok, and on rural health, maternal and child health and in connection with the programmes of the National Institute for Health Administration and Education (New Delhi), in India. SEA/RC18/2 Page 39

6-2 Maternal and Child Health

The sustained growth of the child population continued to pose severe problems in the way of improvement of child health services. Attention was, however, given to the more effective use of the existing services and planning of maternal and child health activities as an integral part of general health services now being developed. Progress in undergraduate and post-graduate paediatric education has been encouraging, particularly in the co-ordination and integration of paediatric teaching and services with those of other deprt- ments and peripheral units.

In Afghanistan, a project to develop maternal and child health services and auxiliary nurse midwifery training courses in major provincial towns is shortly to be started, with personnel from WHO and supplies and equipment from UNICEF.

In Burma, the paediatric education programme has greatly improved The subject of child health was introduced as a major subject in the final medical examiwti~n. WHO provided a team consisting of a visiting professor of paediatrics and a paediatric nurse educator. Paediatric units under the charge of paediatricians were establjshed in two major regional hospitals.

Assistance was provided to the Government of Ceylon by the assignment of a professor of paediatrics and a paediatric nurse educator by WHO, with supplies and .quipment from UNICEF, for the further upgrading of paedlatric t and obstetric education, including all hospitals associated with medical education.

In India,. the paediatric education programme has expanded satisfactorily. By the middle of 1965, the total number of medical colleges, district hospitals and associated hospitals receiving assistance from UNICEF and WHO had risen to 55, 55 and 10 respectively. This assistance has been extended also to surgical pediatric departments. A WHO consultant in social obstetrics is being recruited to study the departments of obstetrics in medical colleges and to assist in improving the teaching of obstetrics. Consultative services by paediatricians and obstekric@ns on the staff of the medical colleges were increasingly made available to district hpspitals in the States.

Early in 1965, WHO organized ,a medical education study tour for teachers of paediatrics in medical colleges, with ten participants from various countries in the Region. A WHQ oonsultant in paediatrics acted as the leader of the tam, and the whole group visited medical institutions in Bangkok and in hdis and held discussions with the professors of paediatrics at these institutims.

Better use of staff in school health programmes has resulted in increased emphasis on routine screening of children by nursing personnel and teachers, with referral to the doctor of only those needing professional medical attention. SEA/RC18/2 Page 40

Recruitment of WHO personnel for a programme to improve and expand paediatric teaching in Indonesia is in progress. WHO provided a team consisting of a senior paediatrician and a public health nurse to assist in a study of maternal and child health services.

A consultant in maternal and child health has also been provided to assist the Government of Mongolia in a comparable study.

In Nepal, considerable progress has been made. The WHO-assisted project continues, and plans have been made to expand maternal and child health services to major centres in areas of Nepal outside Kathmandu Valley, in accordance with the national plan for the development of comprehensive health services.

6.3 Nursing

The development of nursing education and services has shown further progress on the lines which have been evolved in recent years. There is an increasing recognition of nursing needs in both curative and preventive health services, together with a growing perception of the essential nature of the contribution of nursing personnel to a balanced health service. An encouraging trend is the greater awareness of the partnership between doctors and nurses in the care of the patient and the community. There is an increasing appreciation of the administrative responsibility of the nurse within her sphere, resulting in a growing effort to train senior nurses to undertake administrative functions.

Some further progress has been made towards the development of both basic and post-basic nursing education within the university setting. However, in most countries of the Region, hospital schools of nursing have been in operation for many years, and nurses who have been trained in such schools are occupying senior administrative and teaching positions. It is considered that a primary requisite for the improvement of nursing education is the development of post- basic degree programmes at the university level, especially to cater for those nurses who have received their basic training in hospital schools. This should have priority over the development of basic nursing degree programmes, though it is recognized that in some countries it has proved satisfactory to develop a limited number of basic degree programmes simultaneously with the establishment of post-basic university degree programmes.

h most countries, however, it is premature to visualize a complete, or even a major, change from hospital nursing school programmes to basic nursing degree programmes: the need for hospital nursing schools will persist for many years. In countries where the development of nursing is in its early stages and where there are as yet no senior nurses in position, consideration might be given to the promotion of basic degree programmes.

It is impracticable to contemplate within the measurable future the possibility of providing adequate coverage in nursing services by the employment SEA/RC18/2 Page 41 of professional nurses alone. IE most countries of the Region, the number of doctors available greatly exceeds the number of nursing personnel, while it is gencrally accepted that for'a balanced health service the contrary should be the case. In order to obtain the desired nursing coverage, there is a need in every country for both a professional and an auxiliary level of nursing personnel. Training and utilization of auxiliary nurses have accordingly been promoted and assisted in Burma, India and Thailand; unfortunately, because of some difficulties, auxiliary nurse training in Ceylon has been discontinued There is some recognition of the desirability of employing auxiliary nurses to supplement the work of the professional nursc in hospitals and not to restrict their employment to peripheral health units. This is a satisfactory and realistic development.

It is considered that the emphasis LT professional nursing education should be on improvement of quality and raising of standards, while in auxiliary nurse programmes it is the quantitative aspect that should be stressed and the number of auxiliary nurses augmented as rapidly as possible. None the less, insistence on quaitity should not lead to permitting the basic educational standard required for entrance to auxiliary nurse training to drop below an acceptable minimum.

During the year, WHO-assisted nursing education programmes were in progress in most of the countries of the Region. In Afghanistan, the three-year basic programmes for nurses continued at the Aliabad and Shararah Schools. In Burma, assistance was given to paediatric nursing and midwifery education. In Ceylon, short courses for matrons werc organized, and paediatric nurse training was continued in basic schools. In India, post-basic nursing education programmes are being developcd in the States of Gujarat, Madras, Mysorc and Punjab. Short courses for nursing personnel are also being organized at diffcrent centres; after some experience such assistance will bc extcndcd to other countries. In Indonesia, the WHO nursing adviser has concentrated on assistance to nursing education. In Nepal, assistance was continued in improving nursing services and educationand a post-basic course for ward sisters was conducted. In Thailand, WHO maintained its activities with respect to the Division of Nursing; the basic nursing curriculum is belng rcviscd, and a new school of nursing was opened at Chanthaburi.

Thc development of a curriculum guide for basic schools of nursing has made satisfactory progress. Although this work has been undertaken in India, in the context of the Indian basic nursing syllabus, it is believed that this guide, when completed, will be of great value in all countries which follow a comparable pattern of basic nursing education.

At the end of 1964, WHO assisted in the conduct of a seminar at the College of Nursing, New Delhi. The aim of the seminar was to develop a methodology to assist in the determination of staffing patterns in the field of public health nursing and in out-patient departments. The seminar is being followed up by studies designed to field-test the methodology evolved; this is aa important new development. SEA/RC18/2 Page 42

A significant accomplishment in Afghanistan WAS the successful completion of a basic nursing programme by four senior midwives. This achievement has qualified the candidates as professional nurse-midwives and has fitted them for post-baqic study in nursing education or administration. This should enable them to become leaders of the nursing profession in the country and should constitute a potent force for the furtherance of this profession.

6.4 Environmental Health

These activities have increased in several countries. During the year, WHO has provided assistance in various fields such as urban and rural commdty water supply, public health engineering education and training, public health engineering research, and the training of sanitarians and health inspectors.

Encouraging progress has been made in the field of community water supplies in Ceylon, India and NepaL

In Ceylon, the WHO Sanitary engineer continued to assist in various aspects of the provision of community water supplies. Emphasis has been placed on the development of the engineering and administrative organization required for the proposed programmes. Draft legislation for the creation of a National Water Supply Board has been finalized by a Special Sub-committee appointed by the Government.

In Nepal, activities connected with community water supplies have been partiany extended to the larger communities outside Kathmandu Valley. The WHO sanitary engineer assigned to the Ministry of Irrigation and Water Supply is assisting the Government in the preparation of a master plan for water supply and sewerage for the major towns of Kathmandu Valley. Assistance has also been given in preparing a five-year plan for community water supply and sewerage.

As a follow-up of the recommendations of a national Seminar on Financing and Management of Water and Sewerage Works, which was organized by the Government of India with assistance from WHO in April 1964, the Government is actively engaged in the preparation of a number of concrete schemes for financial aid from international sources. With the assistance of WHO consultants who are expected to arrive in the second half of 1965, a review of the most advanced schemes will be made and a "package proposaltt for several major towns prepared.

Progress in the preparation of the master plan for the provision of water, sewerage and drainage in the Calcutta Metropolitan District has continued. An Interim Summary Report prepared by the WHO consultants with assistance from the United Nations Special Fhd, on the survey of water resources of Greater Caloutta was sent to the Government. The draft bill to create a Calcutta Water and Sanitation Authority was approved by the West Bengal Cabinet in June 1965 and was due to be submitted to a special session of the State Legislature in July. SEA/RC18/2 Page 43

WHO and UNICEF have also given increased assistance to the development of typical rural water supply schemes in Afghanistan and India. In India, nine schemes in seven States are now under implementation; depending on population and some technical considerations, pipod water supply through standposts has been proposed for the larger villages (those with a population of over 1 OOO), and sanitary wells with handpumps for smaller communities. Discussions with local leaders, block development officers, taluk officers and others seemed to show that there was considerable community support for piped water supplies, and that local authorities were ready to commit funds for the operation of the schemes. It was the general view of the community and its leaders that handpumps, especially for villages with a population of 1 000 or above, were of limited usefulness.

A proposal far starting a pilot rural water supply scheme in Nepal is also under preparrition.

In the field of research, the main efforts were concentrated on assistance to the Central Public Health Engineering Research Institute, in Nagpur (~naia). WHO short-term consultants assisted the Institute in reviewing and organizing the research programme and in the operation and maintenance of the scientific equipment provided through the United Nations Special Fund (see also Chapter 8).

The lack'of the trained staff required for a rapid development of comm'*ty &ter supplies been increasingly noticeable in the countries of the Region. Assistance through the fellowship programme has been maintained; it is, however, apparent that much more attention needs to be given to local training at various, ,, ., ,.-. levels. .$

W~Ohas continued to assist in the training of environmental sanitation personnel in most of the countries of the Region. Experience has shown that there is need for supervisory staff at the intermediate level; advanced courses for the training of such staff have been started in India.

6.5 Health Education

mterest in health education, planned as an integral part of health programmes, has increased. At the seventeenth session of the Regional Committee, in the general discussions and also in the technical discussions on smallpox eradication, , its importance at all stages of planning and implementation was stressed. Specifically, the Committee expressed a desire.for criteria to be evolved for an evaluation of the effectiveness of health education in various programmes. . . In accordance with the wishes of the Committee, action has been takemto" . collect infdrmation on methods used in planning health education in existing programmes and in evaluating the resylts of the activities. In addition, a prdjec< : start'gd 'b$fjiear, for eliciting information on studies of peoplef 6 attitudes and , , : beliefs; thkir'kmwledge, practices and other cultural and social factors useful for SEA/RC18/2 Page 44 health planning is continuing. The importance of this aspect of programme planning is being increashgly recognized by those responsible for drawing up national plans for economic development,

Health education units have been established at health directorate level in all countries of the Region Activities to strengthen them and to extend health education in all health programmes of the respective countries were maintained.

In Afghanistan, the Section of Health Education has considerably developed. and has directed much effort towards trying to integrate health education into school teacher-training programmes. In Burma, the Hdlth Education Bureau continued to assist workers ih various disease-dohtrdi prbgrammes. Ceylon has concentfited on community omtionby health workers, mainly public health inspectors at the community level, to secure the co-operation of the people in various health programmes and prepare them to receive the hemservlces offered, Nepal has promoted the extension of health education by assigning trained health educators to special programmeaIndia has been concentrating on building up state health education bureaux and strengthening the health education aspects of various programmes, including those for training teachers. Indonesia has continwd to give high priority to training activities and to the production of visual aids. Thailand has employed health education personnel in special programmesLlrd haa also taken steps to measure the impact of health education in one programme.

There has been an appreciable increase in activities of a co-ordinating nature in several countries of the Region. In Afghanistan, for example, representatives of the Government, UNESCO, US AID, and WHO have wnrked jajntly with a view to incorporating health education in the purricula and contents of textbooks for teacher training programmes. Ceylon has formed school health counoils at country and divisional lelrcl and health committees at school level. The National School Health Council of Macontinued its efforts in this direction, with committees organized locally for co-ordinating purposes. A seminar on school health services was held under the aegis of the local committee in Delhi. Plans were advanced in two countries - India and Thailand - for courses to train health educators at the post-graduate level.

WHO has also assisted in planning health education in national programmes for the control or eradication of malaria, smallpox, leprosy and trachoma and for the improvement of water supply and nutrition

Two further circulars on health education were brought out by the Regional Office and distributed to health and health education leadere 14 the countries of the Region (see Section 9.2).Copies of WHO Techuical Rewrt Serieg No. 278, the "Report of a PAHO/WHO Ipter-regimal Cooference on Poskgmdwte FTeparaticPl of Health Workers for Health Ed&thdt, were distributed to directors of health eduakbn at national and state levels. SEA/RC18/2 Page 45

The Fourth All-India Health Educators1 Conference, organized by the Central Health Education Bureau in New Delhi in April 1965, was conducted as four simultaneous workshops, followed by a whole day devoted to joint planning, for implementation by directors of public health, professors of preventive and social medicine and assistant directors in charge of health education in the States of India. Representatives of WHO as well as of the Ford Foundation and US AID took part.

WHO has also collaborated in UNESCO/UNICEF-assisted general education projects in Afghanistan, Burma, Indonesia and Thailand and has agreed to take part in a general science education project in India.

6.6 Nutrition

In a discussion on goitre control during the seventeenth session of the Regional Committee for South-East Asia in September 1964, attention was drawn to the extent and severity of endemic goitre as a health problem in the Region. Studies carried out in 1956 by the Government of Thailand with WHO assistance and by the Government of India in 1956-1957 have led to goitre control programmes through the iodization of salt for human consumption in the Province of Prae, Thailand, and in the sub-Himalayan area of India, in which endemic goitre is prevalent. Some surveys have been made in the past to determine the extent of endemic goitre in Afghanistan, Burma and Ceylon, but control measures have not yet been developed. A considerable amount of endemic goitre has also been reported from Nepal.

In the Nutrition Research Laboratories in Hyderabad, India, a second three- month course in nutrition was held from December 1964 to February 1965. This course, assisted by WHO and UNICEF, was attended by fifteen participants from countries of the Region,all of whom were highly qualified medical graduates - teachers of paediatrics, preventive and social medicine, general medicine and public health, and others working in the field of school health or in public health departments. A similar course will be held later this year, and further courses in successive years. consideration was also given to the introduction of a longer and more broadly based course leading to a diploma.

In November/December 1964, a joint FAO/WHO "Training Course in the Fundamentals of Nutrition and Their Application" was held in Bangkok. This course was attended by 27 participants from 13 countries in the South-East Asia and Western Pacific Regions (details are given under "Inter-regional 196" in Part 111 of this report).

Preliminary study has been given to a proposal for the establishment of a national nutrition training centre in Bangkok, with assistance from UNICEF, FA0 and WHO, to give basic training in applied nutrition to teachers from teache~ training colleges and from schools for nurses and midwives, as well as to community development, social welfare, agricultural and home economic extension workers. fA VIHO medical consultant spent five months in India, studying the Applied Nutrition Programme, which is receiving assistance from FAO, VJHO nnd UNICEF. On thc basis of his report, thc iiegional Officc preparcd recommendations with spccial rcfcrcncc to the role of thc hcalth scrvices in nutrition work in thc various States af India.

Thc Government of India has creatcd a Nutrition Unit in the Dircctoratc General of Hcalth Services under thc charge of a Scnior Nutrition Advisor supported by other scientific and research officers.

The pilot project in cxpandcd nutrition in Ubol, Thailand, has been expanded to include additional villages.

Proposals for assistancc under the World Food Programmc concerning the following were examined with regard to their nutritional and health implications: (1) boarding schools in Afghanistan; (2) a voluntary labour development plnn ih Ceylon; (3) construction and renovation of bunds and tanks in India; (4) a pilot project for land settlcmcnt and extension in South Kalimantan, and rehabilitation of people affected by volcanic cruption in Rzli, Indonesia; and (5) develop mcnt of the Lowcr Mckong Basin, with which Thailand and two other bordering countries arc conccrncd.

6.7 Mental Hcalth

During the ycar, WHO hns been able to assist programmes in Burma, India and Thailand.

In Burma, a psychiatric nurse tutor has rcccntly been assigned to help in thc training of psychiatric nursing personnel.

In India, a WHO consultant in psychiatry visited a nurnbcr of psychiatric institutions in India and made rccommcndations for the further improvement of psychiatric education. A WHO visiting professor assisted the Baroda- Medical College in the developmcnt of its teachmg programme and in the integration of psychological medicine into other hospital scrvices. Also, a VJIIO consultant in mcntal hcalth was assigned to visit several mental hcalth institutions in India and to advise Dn the re-organization and upgrading of mcntal health services and on the introduction of modern methods of treatment of psychotics.

A WHO psychiatric nurse is assisting in the improvement of psychiatric nursing cducation in Thailand.

Participants wcrc selected from two countries in the Region to attend a Travelling Seminar on the Organization of Mental Hcalth Services in the USSR in mid- 1965. SEA/RC18/2 Page 47

6.8 Dental Health

A short-term consultant will be assigned to the Government of Burma to advise on the development of dental education at the Institute of Dentistry in Rangoon.

Arrangements have also been made for WHO assistance to a dental education programme based on the Government Dental College in Bangalore, India.

6.9 Social and Occupational Health

In view of the great amount of industrial development which is taking place in India, occupational health is of increasing concern to the Government. The Regional Office was represented at the International Seminar on Health and Productivity held in Bombay and Ahmedabad in February. This seminar was sponsored by the Society for the Study of Industrial'Medicine in India.

A WHO consultant completed a six-month study of industrial and occupational health problems in India.

Following upon the recommendations of two WHO consultants on medical rehabilitation, the Government of India has drafted a plan for the establishment of rehabilitation centres and the manufacture of prosthetic appliances In this connectiun, a member of the United Nations Bureau of Social Affairs visited India early in 1965 to assist the Government in preparing a plan of action for training personnel in prosthetics, physiotherapy, occup~tionaltherapy and speech therapy,and in VOC~~~ON~counselling and the social and educational aspects of rehabilitation work WHO will co-operate in giving assistance to this programme.

The School of Physiotherapy in Solo, Indonesia, ' continued to make good progress. Plans were made for WHO assistance to a school of physiotherapy to be esbbfished in Bangkok

Ceylon has started an Eye Bank on a pilot basis, and now has some 600 eyes and a potential of 35 000 donors. The rehabfitation of polio-paralytics in Ceylon continues to be seriously hampered by lack of accommodation for in- patients, and of essential simple equipment.

6.10 Radiation and Isotopes

In May, a WHO consultant was assigned for two months to assist a part of the course in radiological physics at the Atomic Energy Establishment in Bombay. The Establishment has created a "gamma garden" to study the effects of gamma radiation on phnt growth; it has also been carrying out a radio- ecological survey of the monazite-bearing high background radiation areas of the Kerala coast and adjoining regions. SEA/RC18/2 Page 48

In co-operation with WHO and the Government of New Zealand, the Government of Thailand has planned to develop a programme for the protection of the population against the hazards of ionizing radiation A WHO consultant visited Bangkok early in 1965 to initiate the project. The Government proposes to create a Division of Radiation Protection within the Ministry of Health and to set up a National Radiation Advisory Council. Fellowship training for key staff members was arranged.

The newly created School for Radiological Technology set up with WHO assistance at Siriraj Hospital, Bangkok, has made satisfactory progress. Phs for the establishment of similar training schools in Chandigarh (India) and in Kabul, with WHO aid, were under preparation.

Arrangements were made for WHO to assist with training technicians in electro-medical techniques and in the maintenance of equipment in Indonesia.

61Cancer

Research on the histopathology and epidemiology of oropharyngeal turnours, sponsored by WHO Headquarters,is being continued in Agra and in Mainpuri (India) (see Chapter 8).

A WHO consultant was assigned to India in November/December 1964 to study possibilities for a pilot project in cancer control.

Discussions were held with the Indian Council of Medical Research regar+ ing the establishment of an Indian Registry of Pathology. A "multi-lesion" Registry, of all types of diseases as well as cancers, and covering clinical, pathological and histopathological specimens, is envisaged. The proposal includes the creation of as many as eight regional registries, one of which would also eerve as the co-ordinating centre.

7. EDUCATION AND TRAINING

It has not yet been possible to overcome the threat of lowered standards of medical education which has followed rapid multiplication of medical colleges, increased student intake and scarcity of medical teachers. This scarcity remains pronounced in the pre-clinical and para-clinical departments. Therefore, more emphasis is rightly being placed on ways and means of training future teachers and on the development of post-graduate education, particularly in India, where the need is felt most. Increased efforts are also being made by governments to establish post-graduate schools of public health in some of the countries in which such training facilities are lacking (Burma, Ceylon and Indonesia).

A new hospital has been opened in Jalalabad, Afghanistan, which is intended to serve as a teaching hospital for the newly-established Medical Faculty. SEA/RC18/2 Page 49

In Burma, as reported earlier, following a reorganization of the university administration, the various medical faculties in October 1964 became "Institutes of Medicine", conferring their own degrees and diplomas. There are now three such Institutes, in Rangoon, Mingaladon and Mandalay respectively. Preparations for the establishment of a new School of Public Health and Tropical Medicine in Rangoon are continuing.

The Medical Faculty of Peradeniya, Ceylon, has made satisfactory progress. Considerable. success has been achieved in the development of the teaching of preventive and social medicine and in the integration of the teaching of this subject into that of other disciplines.

The Government of India has planned four more institutes of post-graduate medical education, (in Hyderabad, Bombay, Madras and Pondicherry) in addition to the three already existing, at Calcutta, Delhi and Chandigarh. A team of medical educators from the United Kingdom visited India to consider future assistance to one of these institutes, under the Colombo Plan.

In November 1964, n conference on post-graduate medical education was arranged by the Indian Medical ,Council, and in February 1965 a similar conference was organized by the Indian Association for the Advancement of Medical Education. Important recommendations were made for the improvement and strengthening of post-graduate education at both these conferences.

With the creation of an assistant-directorship of medical education in Mysore State, a total of three States .in India uow have separate wings on medical education under the State organizational set-up - Punjab, Madras and NIysore - and in Kerala, medical colleges are directly responsible to thc State Secretary of Health.

The Ministry of Health has published a "Report on Medical Colleges and Teaching Hospitals", prepared by the Buildings Project Team of the Planning Commission, Government of India. This is a comprehensive document, giving in detail the physical and architectural requirements of a medical college hospital suited .to conditions in India.

In Indonesia, a committee was set up, under the chairmanship of the Professor of Public Health, University of Indonesia, to establish a post-graduate school of public health, which will train paramedical personnel for a Bachelor's Degree in Public Health and will also give training to doctors, veterinarians and dentists, leading to a Master's Degree in Public Health. By writing a thesis, students will also be given the opportunity to obtain the Doctorate in Public Health degree.

In December 1964, an All-Indonesian Conference of Physiologists was held in Jo~jakarta,and an Indonesian Physiological Society was established. With both theseactivities the visiting WHO of physiology was actively associated. SEA/RC18/2 Pagc 50

In Nepal, the cstablishrncnt of a medical c3llege in Kathmandu has been included in the country's Five-Year Dcvelspment Plan. It is intended that the existing hospitals in Kathmandu will be cnlarged and upgradcd so as ta became t caching hospitals for the new medical col lege.

The Rockefcllcr Foundation has agreed to assist the Government of Thailand in establishing an Institute to Basic Medical Sciences, which will take in 50 to 60 students annually for a four-year degree course. h third medical college has been planned at tho Women's and Children's Hospital in Bangkok. Possibilities of establishing a rncdical college in South Thailand are also being studicd by the Government.

7.1 Direct Assistance to Medical Institutions

VIHO's direct assistance to medical institutions continued to expand despite difficulties in recruitment. In Nghanistan, the visiting professor of physiology continued his work at thc Medical Faculty, Kabul; a consultant in preventive and social medicine and another in hospital administration were also provided. Two consultants were assigned to Burma: one in public health, to assist in preparations for the cstablishlnent of a School of Public Hedth and Tropical Medicine, and ,mother in hospital administration, to advise on tho fuFthcr development of the new Institute of Medicinc I1 at Mingaladon.

In Ceylon, a visiting professor in preventive and sooial medicine has been helping to organize the various departments of the new medical college at Peradeniya. A consultant paediatrician has also advised on the teachhg of social paediatrics in Colombo and Peradeniya and the initiation of a post-graduate course,

WHO assietance to a long-term project for the development of departments of preventive and social medicine in India, which was started in 1956. was completed in 1964. There are now 61 full time departmeqts in this subject. Also, with the technical advice of WHO, UNICEF has continued to provide supplies, equipment and transport vehicles to these departments, and so far forty medical colleges have been assisted in this way.

The WHO-sponsored "Edinburgh Team", consisting of professors in various disciplines, supplemented by consultants from time to time, continued its work in Baroda Medical College. Assistance to the All-India Institute of Medical Sciences in New Delhi was given by three WHO consultant professors. as members of a "Reviewing Committee" appointed by the Government of India to make suggestions for further development and improvement. SEA/RC18/2 Page 51

The Department of Physiology of the Faculty of Medicine in Jogjakarta, Indonesia, is being assisted by a WHO professor; a consultant in preventive and social medicine has advised on undergraduate teaching in that subject and also on the development of post-graduate education in public health.

In Thailand, a consultant in parasitology and another in epidemiology completed their assignments at the Faculty of Tropical Medicine and Endemic Diseases, Bangkok

Under an inter-country project, a WHO consultant visited India for two weeks and also participated in the Second Thai National Conference on Medical Education held in Bangkok (August 1964). A further inter-country project, a study tour on the teaching of paediatrics, is described in Section 6.2.

7.2 Fellowships

(1) WHO Programme

During the period under review, 150 new fellowships were awarded. Particulars of these awards, showing the country of origin of the fellow, source , - of funds, subject of study and type of fellowshi~aregiven in Tables I and I1 of Annex 5. Awards under "Health Organization and Services" were generally intended to strengthen the basic health organization and under this head are included fellowships in public health administration and planning, epidemiology, environmental sanitation (with special reference to water supply and sewage disposal), health education, vital and health statistics, nursing education and nutrition. One fellowship was awarded in the testing of drugs.

Awards in malaria eradication, which again constituted the largest number, were mostly for attending WHO-sponsored courses.. Awards were also made for studies in the control of tuberculosis, venereal diseases, filariasis and enteric diseases.

L Fellowships under "Medical Sciences and Education" were, for the most part, for studies in preventive and social medicine, physialogy, bacteriology, pathology, paediatrics, obstetrics and gynaecology, and surgery. In the field of medical sciences the main subjects of the fellowships were manufacture of freeze-dried smallpox vaccine and medical rehabilitation Other important subjects were medical radiography, medical laboratory technology and physiotherapy.

In the selection of candidates to attend specially designed courses and courses leading to n post-graduate degree or diploma, priority was given to key professional personnel with responsibility for specific activities in their countries.

Short-term fellowships went to officers in over-all charge of national tuberculosis programmes. Similarly, provincial health officers were given orientation in malaria eradication and its integration into the general health services. Such SEA/RC18/2 Page 52

fellowships were also provided to enable professional teachers to attend the three-month training course in nutrition, described elsewhere.

Candidates from this region also participated in some short-term gmup education activities sponsored by WHO Headquarters and in several travelling seminars organized in the USSR: on environmental sanitation, obstetrics and gynaecology, the public health component of the training of medical personnel, the organization of epidemiological services and their role in the controk of communicable diseases, rabies control, the organization of mental health services, and the public health aspects of housing.

As in previous years, training possibilities within the Region were kept in view, and where the requirements were @equate, fellowships were awarded for such training; 50 regional fellowships were given for courses in malaria eradication, tuberculosis control, nutrition, epidemiology, laboratory techniques and vital and health statistics, and, for the purpose, placement waa arranged at the National Institute of Communicable Diseases in Delhi, the National Tuberculosis Institute in Bangalore, the Nutrition Research Laboratories in Hyderabad and the School of hxedical technology in Colombo, as well as in Thailand (for tuberculosis control), and in Ceylon, Indonesia and elsewhere in India (for malaria eradicatiod.

During the year, 28 fellows from 16 countries (Brazil, Cambodia, Chile, China, Germany, Iran, Iraq, Japan, Kenya, Korea, AMaysia, Mauritius, ~akisk, the Phflippines, Vier-Nam and West&l\nSamoa) and from one territory (the Fiji Islands) outside the Region came to South-East Asia on study tours.

Placement was also arranged for fifteen nurses from outside the Region who were awarded UNICEF fellowships to attend a ten-month course in public health nursing at the All-India Institute of Hygiene and Public Health, Calcutta.

A two-week field training programme in India was organized for WHO fellows from the Malaria Eradication Training Centre in Manila, in which fifty- one trainees, in three groups, pgcipated.

The following is an analysis of 761 reports received from 1954 onwards from former WHO fellows, who are asked to report, when back in their countries,on the utilization of the knowledge, experience and skills whicb they gafned drrring dhefr studies abroad:

1, 1 730 (95.9%~&e employed in the subject of their fellowship studies: ' , 464 (61.0%) have assumed .@eater responsibilities in their former , , , 'fields of activity; 332 (43.6%) have begun new activities in keeping with their fellowship studies; 524 (68.9%) have been able to introduce new methods; 308 (40.5%) have established new services; : 494 (64.9%) have imparted the knowledge gained to others by means of conferences and by articles in medical journals; . . :641.(84.2%) are engaged in traing activities; , , GRAPH 4 - FELLOWSHIPS AWARDED BY WHO. SOUTH-EAST ASlA REGION ( 1960 - 1964)

By Number of Felloabps, Major Sublacts and Yeor of Award

0PUBLIC HEALTH SERVICES AND COMMUNICABLE DISEASES ADMINISTRATION MALARIA MEDICAL EDUCATION

OTHERS ( Clirical msdicine , labomtory , etc. )

-YEAR OF AWARD

FELLOWSHIPS AWARDED TO CANDIDATES FROM THE SOUTH-EAST ASlA REGION FOR STUDY IN OTHER REGIONS AND VICE VERSA DURING THE PERIOD 1 AUG. 1964 TO 1 AUG. 1965 ( INCLUDING THOSE AWARDED FOR STUDY WITHIN THE REGION )

Western 1 African Region of South-East European Mediterranean Pacific 1 Region Americas 411a Regton Reglon Region Region

~ -~ - ..~ From South-Earr , 6 26 50 67 4 16 Aria Region to: I

~~ - To South-East Aria 2 - 2 14 37 Region from: GRAPH S - FELLOWSHIPS AWARDED BY THE SOUTH-EAST ASIA REGIONAL OFFICE ( 1960 - 1964 )

AFGHPINISTAN BUrlMA CEYLON INDIA INOONESIA M&LO

229 (30.1%) are engaged in some type of research work; 149 419.6%) have maintained some degree of contact with other fellows and officials whom they came to know during their studies; and 28 ( 3.7%) have been on international assignments.

. (2) Fellowships in Medical Subjects from Other Sources

Tn addition to fellowships awdrded by WHO and UNICEF, according to available information, the Colombo Plan awarded 2 fellowships to Afghanistan, 23 to ~urma,9 to Ceylon, 16 to India, 7 to Nepal and 8 to Thailand. The USAID awarded 5 fellowships to Afghanistan, 37 to India, 6 to. Nepal and 23 to Thailand. In addition, Afghanistan received 10 fellowships from the'French Gouernment, 4 from the Government of USSR and 3 from the FederalRepublic of Germany; India received 5 from the Rockefeller Foundation and 2 from the Ford Foundation; Thailand received '7 from the French Government, 2 from the British Council, 2 from FAO, 1 from the Swedish Government ad3 from other sources. , .. . . ! . , . . 8. ASSISTANCE TO RESEARCH

8.1 Malaria

Dynamics of Drug Resistance_ of Plasmodia A research on the mechanism and dynamics of resistance of malaria parasites to drugs was continued at the National Institute of Communi- cable Diseases, Delhi, with a,gr'ht'f'roi-WO Headquarters. The comparative studies indicated that the size of primary inoculation influenced the degree of resistance and that the dose ofthe drug and also the sikeof'parasitepopulation at the time of exposure play a role in the speed of selection of the resistant strain. . ..

,. . ~'32ifoldl'eiistant straih df P.C. bastianellii m'&t&ed without exposue to pyrimethamine and sub-passaged 29 times retained a residual eight-fold resistance, whereasan eigfit-fold pyrimethamine reitstant strainselected in the presence of intense immunity of thc hosts remained stable whch'it was sub- passaged 25 times without exposure to the drug. . ,;,:.,.,. A 128-fold pyrimethamine rebistant strain && noted t3 be seisitive to a combination of DDS and pyrimethamine.

, . ., ,,> I.! ,.. ,, , . . . . , '' . . : ,', SEA/RC18/2 Page 54

A resistant strain against chloroquine could not be selected in splenecto- mized animals even in the presence of a high parasite population of P. c. bastianellii.

Investigation of Simian Malaria in Ceylon

Investigation of simian malaria in Ceylon was undertaken at the Department of Parasitology, Colombo Faculty of Medicine, with support from WHO Headquarters. Since the beginning of these investigations, 64 monkeys have been examined, 16 of which have been found to be infected with different Plasmodium species. At least three species of Plasmodium have been isolated from local monkeys, namely a P.-ynomolrti-type parasite (probably a different sub-species), P. shortii, which is generally evident in chronically infected monkeys but becomes masked by the P. cynomolRi parasite when infected blood is transferred to clean monkeys, and a new parasite, closely related antigenically and morphologically to P. coatnw.

Attempts so far to find a laboratory vector or to transmit the parasite to man have proved unsuccessful.

Relation of Haemoglobin T-s and Thalassaemia to Susceptibility to Malaria Infection, with Particular Reference to Infanta and Children in Thailand

This research is being continued, with a grant from WHO Headquarters,' in the Faculty of Tropical Medicine, University of Medical Science6,in Bangkok

A pilot survey was carried out in Nakornrajsrima Province, in north-east Thilandon blood samples collected from 15 infants (3-12 months old) and from 75 children (1-3 years old). The results obtained revealed that:

(a) the percentage of children with HbE trait (AE + EE) was 28.8

@) the percentage of children with thalassaemia trait (a and b) was 4.4

(d) the incidence of P. falciwrup was 66.6% and that of P. vivax 33.4%

(e) the normal individuals (AA) had a P. falcipanun infection rate of 10.6 per cent

(0 the individuals with hemoglobin E trait (AE + EE) had a P. falciparum infection rate of 12.5 per cent.

Another survey was conducted in Rayong Province, in which 413 blood samples were collected (from 120 infants and from 293 children) and examined for GGPD deficiency and malaria parasites. Initial results of the analysis indicated that haemoglobin F and E possibly have something to do with protection against SEA/RC18/2 Page 55

malaria, but that definitely GGPD deficiency offers no protection. It may be possible to give a dear-cut answer after some 500 more children have been examined.

As part of a global research programme for the control of plague, mosquito-borne haemorrhagic fever and filariasis, the Organization, in collaboration with governments in the Region, undertook investigations on the susceptibility of flea vectors, Acdcs aegypti and Culex fatigans, to various insecticide compounds.

A good deal of work in this field as applicable to Culex fatigans is being done in association with the work of the WHO Filariasis Research Unit in Rangoon.

WHO Headquarters periodically issues an up-to-date series of recommended methods of vector control, including information on thc toxicology of the various compounds in usc.

8.3 Tuberculosis

The Tuberculosis Chemotherapy Centre in Madras continued its basic research on the devclopment of suitable, practical and economical treatment regimens for tubcreulosis, applicable to countries whosc resources are limited.

As a continuation of earlier studies, the relapse ratc among patients initially treated for one year in their homes or in a sanatorium was investigated over a four-year follow-up period; there was no differencc found between the two groups of patients, demonstrating that diet, the amount of rest and conditions of accommodation can influence very little thc occurrcnce of relapse when good chemotherapy is administered for an adequate length of time. It was also shown that the attack rate among contacts of the patients in the groups mentioned was the same over a five-year period of follow-up.

Another study, still in progress, is to determine whether isoniazid given in different dosages and lengths of time to patients with bacteriologically quiescent disease can prevent relapse in cases with and without residual cavitation after one ycar. Other studics rclatc to the comparative cfficacy of various combinations of drugs given to patients who failed to respond to primary chemotherapy,and the comparison of the isoniazid-plus-thiacctazone regimen with two regimens of isoniazid plus PAS (about five times as expensive). The thiacetazone regimen appear6 to be equally effective.

Following the success of the twice-weekly intermittent regimen, a study was started to investigate various once-weekly regimens with or without an initial period of intensive treatment. Another new study was designed to determine SFA/RC18/2 Page 56

effective treatment for patients who failed to respond satisfactorily to previous treatment for pulmonary tuberculosis and are resistant to streptomycin and isoniazid. In connection with the main clinical study on once-weekly intermittent regimens, the determination of blood concentration of the respective drugs at 1, 2, 3 and 6 hours is carried out by the laboratory, and proportional sensitivity tests for these drugs are madec Furthermore, different methods for the detection of isoniazid and its metabolites in the urine were compared, and new tests were designed not only for the detection of imhiatid and its metabolites in urine but also for drugs such as pyrazimmide, cycloserine and ethionamide. Other studies dealt with pyrazinamide toxicity and the determination of this drug in serum and in the tissues of mice, the metabolism of ethionamide in man, P-aminosalicylic acid levels in guinea-pig blood, and the estima- tions of serum glutarnicoxalacetic acid and transaminase activity. The identification, characterization and estimation of the metabolic degradation products of relevant drugs in man and experimental animals are essential for the study of the absorption, distribution and excretion patterns of such drugs and the identification of the active principles in them.

A list of papers prepared by the staff of the Centre duringthe year under review is given in Annex 6.

Research has also been carried out in other tuberculosis projects in the Region, e. g. on the acceptability of thiacetazone combined with iwniazid and on the relationship between tuberculin allergy and development in time of local BCG vaccination lesions. Manifold operational, epidemiological and sociological studies were undertaken at the National Tuberculosis Institute, Bangalore, India, A list of publications emanating from this Institute is given in Annex 7.

The Tuberculosis Research Unit at Madanapalle (India), which has received financial assistance from the WHO research programme, continued with its three major enquiries - namely, a study of the tuberculosis epidemiology and the effect of modern tuberculosis control methods in a rural population of about 68 000 in and around Madanapalle, the community effect of domiciliary drug therapy on all existing tuberculosis cases in twelve small tow118 within a distance of 100 miles of Madanapalle, and a bacteriological investigation into the types of mycobacteria which are prevalent in the study area.

The Smallpox Research Unit at the Infectious Diseases Hospital, Madras, was assisted with a further grant from WHO Headquarters. The Unit continued its studies on the epidemiology, immunology, prevention and treatment of smallpox, including trials with anti-viral drugs. SEA/RC18/2 Page 57

8.5 Cholera

A WHO Scientific Group on Cholera Research met in Manila in November 1964, and reviewed the progress made since its last meeting and the meeting of the group of laboratory workers on vaccine studies, both held in 1962. Various aspects of cholera research, such as microbiological and serological studies, studies in pathophysiology nnd therapy, epidemiologicd studies, prevention, etc., were considered, and the progress ~f the cholera vaccine field trials carried out in the Philippines, Paklstan and India was reviewed. On the basis of these studies, proposals were formulated for a global WHO research programme on cholera.

The results ot the controlled field trials of cholera vaccines carried out in Calcutta in 1964 were analysed. As there was, hgwever, an unusually low cholera incidence in the study area in 1964, the Government, the Indian Council of Medical Research and WHO agreed, in ~rdertc~ obtain in 1965 statistically significant results 3n the degree of cffectiveness of vaccines for classical cholera and El Tor, tO initiate an extended field trial as from February 1965. This trial, in which a WHO team is participating, is proceeding satisfactorily.

The WHO International Ceqtre for ~ibriiPhage Typing, established earlier at the Indian Institute of Biochemistry and Experimental Medicine, Calcutta, has continued its very useful assistance in phage-typing and tracing the progressive invasion of El Tor vibrio into countries of the South-East Asia and Western Pacific Regions.

Also supported by WHO Headquartcrs were (1) genetic studies of vibrios, .by the Calcutta Institute of Public Health and by the Central Drug Research Institute, Lucknow, and (2) research into the pathsphysiology of cholera, of cholera vaccines and of experimental cholera in infant rabbits, by the Haffkine Institute, Bombay.

8.6 Leprosy

WHO Headquartcrs continued to asslst the Central Leprosy Teaching and Research Institute, Chingleput (Madras State), in its research work on the value of chemoprophylaxis with sulphanes in healthy child contacts, on trials with anti- leprosy drugs, and on the standardization of lepromin.

Assistance was given to studics Jn the cultivation of M. leprxe cbz'ied out by the Indian Cancer Research Ccntre, Bombay.

A WHO leprosy team continued its studies in Bufma 3n the epidemiolsgy , of leprosy and the possible rale of BCG in the prevention of the disease, in an inter-regional project. SEA/RC18/2 Page 58

8.7 Treponematoses

The studies at the Venereal Disease Laboratory of the Institute of Venereology, Madras, aimed at defining certain survival factors of treponemes in vitro and in are still being supported by WHO Headquarters.

The Venereal Disease and Yaws Research Institute in Surabaya, Indonesia, continued its research on the survival of treponemes on the body surface, which WHO also assisted

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

The Bombay Natural History Societywas further assisted in its studies on the role of birds as disseminators of arthropod-borne viruses, Field stations, staffed by ornithologists from the Society and also with entomologists and uimlogists from other institutions, were established along the routes of migrating birds during the migration season. Birds are netted, ringed and examined for ectoparasites;ectoparasites were collected from entomological atudles and for virus investigations, and organs, tissues and samples of blood from birds were also obtained for virological and immunological studies.

As part of a WHO collaborative study, the Bombay Natural History Society collaborates with the Virus Research Centre, Poona, the Institute of Diseases with Natural Foci in Omsk, USSR, and the Regional Reference Centre for Arthropod- Borne Viruses at the Institute of Poliomyelitis and Virus Encephalitis in Moscow.

8.9 Rabies

The Pasteur Institute, Coonoor, has in recent years collaborated in WHO research into the immunization of man and animals against rabies. The research is continuing on (a) the paths and mode of spread o'f the rabies virus in the animal body, using the fluorescent antibody technique for the identification of the virus, @) the immunogenicity of duck-embryo and avianized vaccines in experimental animals - comparative studies to assess their efficiency in post-exposure treatment, and (c) the immunization of exposed persons with antirabies serum and vaccines, using techniques comparable with those employed in previous WHO co-ordinated studies.

8.10 Measles Vaccine Trials

The All-India Institute of Medical Sciences and the Irwin Hospital, New Delhi, have continued to take part in the WHO collaborative studies on measles vaccines, including live attenuated and inactivated vaccines. The aim of the studies is to SEA/RC18/2 Page 59

determine (a) the relative severity of the reactions and the level of antibodies produced by thc various mcasles virus vaccine strains available, and @) the rcaction and degree of protection affordcd by the regimen in which one dose of inactivated vaccine is followcd by onc dose of livc vaccine.

8.11 Diarrhoea1 Diseases

Thc study on diarrhoea1 diseases being carried out in Ceylon with the assistance of a WHO bacteriologist is dcscribcd in Section 1.4. l(4).

8.12 Hacmorrhagic Fever

The global surveillancc programme being promoted by WHO Headquarters and the measures being planned to control haemorrhagic fever and dengue and chikungunya infections arc described in detail in Section 1.4.2(3).

.The WHO consultant in Mdes aewpti assigned to Bangkok assisted in the continuation of studies of this vector in Thailand.

8.13 Other Arboviruses

Assistance was given by a WHO consultant to various laboratories undertaking investigation on the arboviruses. Work being done in the countries of the Region is described in Section 1.4.2(4).

8.14 Respiratory Viruses

As part of a WHO collaborative study and with assistance from the Owation, a survey of virus infections in children under five years of age has been initiated at the All-India Institute of Medical Sciences, New Delhi The aim is to ascertain the importance of virus diseases as a cause of morbidity and mortality in children in countries from which data are not available. It is expected that other laboratories will participate in this work in the coming year.

8.15 Filariasis

The Filariasis Research Unit in Rangoon set up by WHO Headquarters in 1962 continued its basic studies on mosquito vectors of filariasis, particularly on their ecology, bionomics, genetics, vectorial capacity, insecticide susceptibility and cross-resistance to different compounds. The unit also serves as a centre for visiting research workers on filariasis from South-East Asia and from other regions. SEA/RC18/2 Page 60

Assistance was given to the Dqpartmeent of Parasitology, University of Ceylon, in establishing a laboratory vector for Bwia buckleyi, with the aim of studying the life cycle of the parasite in the vector and in vertebrate hosts, and in undertakir;g immunochemical studies.

8.16 Brucellosis

Work continued on the controlled field trial of Bruqella vaccines, to determine the degree of protection afforded to man and animals, which is being carried out as part of the WHO-assisted project in Mongolia~

8.17 Environmental Health

The Central Public Health Engineering Research Institute, Nagpur (India), has expanded the scale of its research activities. Many technical papers on the various subjects under study have been produced or are under preparation. The main emphasis is at present on water, sewage and industrial wastes; attention is also given to industrial hygiene, air pollution and rural sanitation.

The following grouping gives an idea of the main topics under study: water quality criteria; flocculation, coagula.tion and sedimentation; fi1tration;deminerali- zation, electrodialysis and solar still; defluoridation; disinfection; distribution; characterization of sewage; characteristics .and treatment of industrial wastes; design of sewerage systems; sedimentation of wastes; high-rate digestion of organic waste solids; high-rate "bio-filtration"; modified activated sludge treatment; oxidation ponds; effluent for farm irrigation; high-rate mechanical cornposting of refuse; industrial hygiene; air pollution, and rural sanitation.

Under the allocation from the United Nations Special Fund, a substantial amount of research equipment has been provided during the year, and WHO short- term consultants have advised on the programmes.

8.18 Nutritional Anaemias

The Department of Pathology of the All-India Institute of Medical Sciences, New Delhi, continued to make an important contribution to the WHO-assisted research programmes on anaemias.

Studies on anaemia in pregnancy are being carried out in India in a rural area (Balabgarh, Punjab) and in an urban one in south Delhi. These studies include determinations of serum iron, serum iron-binding capacity, vitamin B12 and folate levels. Serum vitamin Bl2 and folate levels in pregnantwomenappear to be significantly lower in rural as compared to urban areas. SEA/RC18/2 Page 61

The Department of Pathology of the Institute also serves as a reference centre for collaborative studies on tissue iron content and undertakes evaluation of haemosiderin in liver specimens taken from medico-legal or hospital autopsies. Liver samples arc reccived for examination from cowtries in Africa and from Venezuela, the United States of America, the Unitcd Kingdom, Malaysia (Singapore) and Hong Kong. The lowest iron concentrations of all have been found in specimens from India, and this tallies well with the high prevalence of iron'deficiency anaemia in the country.

The Intcrnational Reference Centre for the Histopathology of Oropharyngeal Tumours, established at the S. N. Medical College in Agra (India), and assisted by WHO, has continued its work and is making satisfactory progress.

In Mainpuri District of Uttar Pradesh (India), an epidemiological survey of oropharyngeal tumours, involving a population of approximately one million, is being carried out. In this survey any case or suspected case of oropharyngeal tumour seen by general practitioners or at out-patient clinics is at once referred to one of the several diagnostic centres. Health visitors, public health nurses and interviewers take part in a homevisiting programme for case finding and encouraging people to seek medical advice and a proper diagnosis of suspected lesions.

9. REPORTS, TECHNICAL PUBLICATIONS, DOCUMENTS AND REFERENCE SERVICES

The Regional Office has maintained its work of preparing and issuing reports and of distributing WHO and Regional Office documents, publications and other technical material. Fbrther expansion of the sale of WHO publications was effected. The Library increased its services, and documentation and reference assistance was provided for various meetings, including the Seminar on Mosquito-Barne Haemorrhagic Fevers, held in Bangkok in October 1964.

The sel-vices of the Rcports Officer were lent to the Regional Office for Africa for a period of two months to help that office in re-organizing its Reports and Documents Unit.

9.1 Reports

An indication of the expansion of WHO'S assistance in the Region over the past ten years may be seen in the increase in the number of reports from WHO project staff, consultants and Regional Office staff,and reports on seminars, training courses, etc., formally issued and distributed by the Regional Office in SEA/RC18/2 Page 62 the course of a year, For the calendar year 1954, these numbered 16; in 1959, the number had quadrupled to 64; in 1964, the total was 108.

In the period under review ,80 assignment and final reports of WHO project staff,l3 field visit reports by the technical advisers of the Regional Office, and 15 miscellaneous reports wefe edited and distributed, A list of technical reports issued by the Regional Office during the year is given in Annex 84

9.2 Preparation and Distribution of Other Documents

Among the documents and publications issued and widely distributed were the final report and minutes of the seventeenth session of the Regional Committee, the conclusions ahd recommendations arising from the Regional Committee's technical discussions on smallpox eradication, a third revised edition of Notes for the Practising Midwife (a Regional Office publication), the report of the WHO Seminar on Mosquito-Borne Haemorrhagic Fevers in the South-East Asia and Western Pacific Regions, Research News (No. 8), and two further issues of the Medical Education Bulletin. In addition, two further technical circulars on health education (TC/HE/15 and 16), containing material on such topics as "Communication in Health Matters", "Modern Trends in Health Education1', "Guidelines for Planning Health Education in the Malaria Programme and for Developing a Teaching Manual", "Development of Health Education in Teacher- Training Programmes and Schools" and annotated lists of WHO publication% were issued. SEAR0 NEWS, introduced in 1961 with the principle object of keeping field and other staff in touch with the Regional Office and vice versa, was also brought out regularly.

Among the publications received from outside and given wide distribution were WHO Technical Report Series No. 290 (the eighth report of the WHO Expert Committee on Tuberculosis), and about 3 500 copies of reprints of certain papers issued by the Tuberculosis Chemotherapy Centre, Madras, which were sent to numerous research workers, hospitals, institutions, etc. ; a leaflet, "Guide for Rabies - Specific Post-exposure Treatment" prepared by the WHO Regional Office for the Americas; the tenth (1965) edition of the booklet "Control of Communicable Diseases in Mant1, published by the American Public Health Association; a publication entitled "Nutrition Science in the Service of Developing Countries", edited by J. C. Somogyi and containing lectures given in a symposium organized by the Institute for Nutrition Research of the "Green Meadow Polmdation" in Zurich, Switzerland, and regular numbers of "Environmental Health", a journal brought out by the Central Public Health Engineering Research Institute in Nagpur, India.

9.3 Sales and Sales Promotibn

Revicws of 22 WHO publications and annotated bibliographies on nine subjects covering 60 publications were compiled and widely distributed, along SEA/RC18/2 Page 63

with catalogues and a brochure explaining the system of purchasing these publications from WHO at a di~count~payablein local currency. A Kardex system was put into use, and address lists were reclassified and supplemented. As a result, publications on more subjects were sold to a wider variety of readers and institutions (which now include a number that are non-medical, such as engineering colleges, university departments of anthropology and industrial establishments).

Notes for the Practising Midwife (Third Edition), Operation and Control of Water Treatment Processes, Milk Hygiene, Equipment for Vector Control, and the World Directory of Medical Schools elicited keen interest: 1 500 copies of the first, 245 copies of the second and more than 80 of the third had been sold by the end of June 1965.

The total value of sales during 1964 was $5 300, calculated at 50% of the list price, excluding subscriptions. This is 65% higher than in previous years. The subscriptions amounted to 97 100.

Although a fair number of medical colleges and research institutes, their specialized departments and branches, and central public health organizations and their field units havc subscribed to WHO publications, there still remain many which have not responded to our offer to provide these subscriptions at concessio~lrates. It is considered that every medical college in the Region should take all important WHO tcchnical publications and that each district health officer should have access to at least the WHO Chronicle, WHO Technical Rewrt Series and WHO Bulletin. In order to help WHO realize this level of diffusion of technical information contained in its publications, even greater co-operation on the part of the national health authorities is requested

9.4 Library

During the year under rcvicw, 1 140 new books and pamphlets and 128 WHO publications - a total of 1 268 (as compared with 590 five years ago), were added to the Library, which now also regularly receives 206 current periodicals (170 in 1959-1960), 104 on subscription and the others free or in exchange for WHO publications.

With improvcmcnts in the services, such as: the inclusion in the Library News (brought out monthly and sent to field staff as well as to staff in the Regional Office) not only of lists of accessions but of n short bibliography calling attention to articles of special interest which havc appeared in periodicals received in the Regional Office, and the circulation to appropriatc Regional Office staff members of Headquarters' "Current Litcnture Cards", referring to articles appearing in j0urNls available in the Headquarters Library, the Library is being more widely used, and requests for reprints, photocopies, and books and periodicals on loan steadily increase. Altogether 1 700 books were issued on loan during the year, and large numbers of photocopies provided. SEuRC18/2 Page 64

Bibliographies have been prepared for the use of WHO staff and in response to ohtside requests.

In the course of the year, it was possible to provide some libraries in different countries in the Region with duplicate copies of periodicals, lists of which were circulated to medical colleges to ascertain their interest. A considerable response to %is, as well as in the Headquarters scheme for "Intcnational Exchange of Duplicate Medical Literature", was evoked.

The Librarian of the Public Health Institute, Kabul, was awarded a four- month fellowship by WHO to study library procedures in the Regional Office Library. After he completed this training, the Regional Office Librarian visited Kabul to advise on setting up the Library of the Public Health Institute, which has bceq appointed as a depository library for all WHO publications. SEA/RC18/2 Page 65

PART I1

ORGANIZATIONAL AND ADMINISTRATIVE MATTERS SEA/RCl8/2 Page 67

1. REGIONAL COMMITTEE

The seventeenth session of the Regional Committee was held in the Regimal Office in New Delhi from 22 to 28 September 1964.

It was attended by representatives of eight Member Countries1 . Represen- tatives of the' United Nations Technical Assistance Board, UNICEF, FAO, LO, UNESCO, and fifteen non-governmental organizations,as well as one observer, were also present.

The session was inaugurated by the Vice-President of India, Dr Zakir Husain, and at the opening meeting an address was given by India's Minister of Health, Dr Sushila Nayar.

Dr V. T.H. ~unarjtne,Dikector of Health Services, Ceylon, was elected

: chair+;and Dr D. Baidya, Director of iiealth Services, Nepal, Vice-Chairman., , , . The Committee approved for transmission to the Director-General the Proposed Regional Programme and Budget Estimates for 1966, amounting to $7.4 million (including the cost of equipment and supplies which it was expected would be provided by UNICEF).

The Regional Director's Annual Report on the past year's work was reviewed in detail. The Committee felt that many difficulties which were retarding the progress of the health programmes in the various cowtries of the Region would continue for sohe years; the independent assessments of national malaria eradication programmes were appreciated, as also the necessity for evaluation of health education programmes. Much interest was shown in the pfiot projects for promotion of rural water supplies in the Region. Considering the high prevalence of enteric diseases, especially in children, appropriate immunization programmes in schools were recommended. The Committee also stressed the need for urgent improvement of infectious-disease hospitals by proper staffing and equipment and close links with teaching hospitals. It was concerned about the spread of dengue-type haemorrhagic fever in the Region and agreed that increased reporting of epidemiological information should be arranged by governments. The importance of national health planning was also stressed.

Two papers - one on a trial of reconstituted salt in the control of goitre, by the Government of India, and the other on the international Sanitary Regula- tions, with special reference to cholera, plague and smallpox, from the Govern- ment of Burma - were presented and discussed.

'~f~hanistan,Burma, Ceylon, India, Indonesia, Mongolia, Nepal and Thailand. SEA/RCl8/2 Page 68

The technical discussions, on the subject of smallpox eradication, were centred on the planning, organization and execution of national eradication programmes. Recommendations were made on the necessity for concerted national action when such programmes were moving from control to eradication and for special attention to be given to the maintenance and mopping up phases, on the great need for adeqqate provision of freezedried vaccine, inter-country co-operation, uniformity of terminology and reporting, health education, evaluation and legislation.

"Integration of Malaria Eradication into the General Health Services" was selected as subject for the technical discussions at the eighteenth session.

The Committee confirmed its acceptance of the invitation of the Government of Afghanistan to hold its 1965 session in Kabul. It decided to hold its seasion in 1966 at the Regional Office in New Delhi, and noted the announcement that a for@ invitation would be received from the Government of Mongolia for the 1967 serseim to be convened in Ulan Bator. . . 2. ADMINISTRATION

2.1 General

$he 'c+&&# ~creaein hkaltb programmes t$e ~e~lohdescribed elsewhd+eibthib, ,r! ,, ??kti +s resulted the steady, growth of the technioal

responsibilities' bf the R'e$onal office, with a resuUant additional adrninistr8- tive w&oad.. ,, , . . , , ', , , ., , ,:.,,. . ., , TK6 present office accdmmodation is adequate adpleasant adhas Mther

condib:uted.,. towards.,, the ge~qraiefficiency of the office.

: ., 3, , A number of confer6hces and seminars.wF;reheld, especially inter- regional and kr-country ,fdr which adrnkistratiw and technical facilities were

provided. I:' i

: ;, ,I ._ ~egulhr&ekly meetings of the unit heads of the Office of ~h and Finance, !, were,.., ,,, held to review administrative problems arising,fr,orqthe planned deliveryof,pr'ogram,mes.,, ,, Similarly, in order to brief the secret;trial, swff os ! , I,., variok essenihl functions required of them in their day-to-(lay tasks; hi* , : offibe, routine secretariest meetings were continued , . :. ,.

Staff in Afghanistan, Ceylon and Nepal were visited by the Personnel Officer during the year. The Administration and Finance Officer visited Nepl to look into some administrative problems. SEA/RC18/2 page 69

Matters relating to local salary survcys, post adjustnlents, children's klillbwazicc; ac'commodation,' per dicm ratcs for local and professional staff in India, ctc., wcrc discusscd at the quartcrly mcctings of thc heads' of thc United Nations and spccirlizcd agcncics in Ncw Delhi. Similar mcctings wcrc hcld in other countries of the Region. ApprOijrintc local salary incrcascs in ccrtain aregs wcrc cffccicd, in confarinity with thc policy proccdures of the United Nations and its spucializcd agencies.

The Policy and Proccdurc Handbook and Secretaries Guidebook in use in the Rcgional Officc and by p,rojcct st,lSf, wcrc kept undcr review.

The banking facilities in curtain countries havc bccn modified to conform with thc most rccent local laws and conditions.

A brochure on "ViHO Rcprcscntativcs in thc South-East Asia Region: Early Concepts and Dcvclopmcnt of Functions", for thc use of ncw WHO representatives and other staff, was prepared and issued during the year.

At the Regianal Director's thirteenth meeting with WHO Representatives, held in March 1965 in the Rcgion,al Office, various matters of technical and administrative interest werc discusscd and the 1967 programme and budget proposals formulated. 2.2 Organizational. Structure 'There has been no changc in the organization structure. Certain reassign- ments wcrc cffectcd during thc ycar: the Regional Public llcalth Officer was aspigncd to the post of Assistant Dircctor of Health Services; the Regional Adviser in Nutri- tion, who had temporarily been working as VIHO lieprcsentative in Th,al&d, resumed his appointment in thc Rcgi~nalOffice; the posts of VIHO Representatives in Afghanistan and Thailand were fillcd, as were thosc of Chief of Admhistration and Finance and Mcdical Supplies Officer, both of which had fallen vacant. Both posts of Rcgional i.dviscr in Cammunicable Discascs were vacant; one of them was filled for a short time during the year.

'Other posts which had not been fillcd at thc end of the year under review werc thosc of Public Health Officer, Entomologist (in the Malaria Unit), Health Statistician, Budgct and Finance Officcr (being filled shortly), Finance Officer, and Information Officer.

fa organizational chart is attached as imcx 1.

," 2.3 Personnel

A list of the professional staff attached to the Regional Office is given as part of the organizational chart (Annex 1). 6EA/RC18/2 Page 70

The geographical distribution of We professional staff as on 30 June 1965 is shown in Annex 2. Additional countries represented this year are Iraq, Panama and Viet-Nam

The following table shows the number of professional and general service category posts established and actually filled during the period under revtew, both in the Regional Office and in the field:

Established posts Posts actually filled for 1965 jas on 30 June 19651

(I) Regional Office Staff (a) Professional Regional Office Regional Advisers WHO Representati~ea

(b) General Service Clerical Custodial

(2) WHO Representatives' Offices Clerical 11 Custodial 8

(31 Project Staff (s) Professional Regular and TA

(b) General Service Regular and TA

In addition, four professional staff members and one from the general service category were on leave without pay at the end of June 1965.

The salary scales for general service category staff in New Delhi and Indonesia were revised, as were the post adjustments for the professional staff stationed in Afghanistan, Burma, India, Nepal and Thailand.

Efforts to improve procedures for vbrlefing" new staff members assigned to field projects or to the Regional Office were continued, Work was begun on compiling a standard list of reference books on countries in the Region for the use of newly recruited staff members. SEA/FlC18/2 Page 71

2.4 Staff Welfare

The Staff Society held its annual General Body meeting on 31 March 1965, and elected its new office bearers for the year 1965-1966. The Society continued to be represented on the Regional Meritorious Increase Committee, the Regional Board of Appeal and the Regional Surveillance Committee on Health Insurance. It continued to assist the Administration in improving conditions of service and amenities.

2.5 Finance, Budget and Accounts

The total obligations incurred in field activities from all funds during the last five year (1960 to 1964) are shown below:

Source of Funds (Expressed in US Dollars) I I I Other Extra- I budgetary Year Regular TA MEs ~unds(as Total budgeted) 1960 1928 960 1 258 891 995 316 3 578 167 4 982 100 8 560 267 1961 1 365 244 1 178 223 875 679 3 419 146 4 097 69~~7 516 844 1962 1 628 653 1 198 771 858 826 3 686 250 5 776 185~ 9 462 435 1963 1 808 669 1 251 262 794 538 3 854 469 7 137 730' 10 992 199 1 1964 1 1 961 473 1 1376 543 1 792 0071 4 130 023 1 4 947 721d ' ( 9 077 744 1 :~ncludes $278 250 from the United Nations Special Fund

%eludes $472 185,from the United Nations Special Fund . ' ,. ..

C~ncludes$127 730 from the United Nations Special Fund .,,, ... . d~ncludes$425 771 from the United Nations Special Fund

In 1964, nearly 100% of the allocations under kegular funds and 99% of those under Technical Assistance funds were utilized.

The staff health insurance scheme continued to function satisfactorily. Reports on the working of the scheme, which are prepared at the end of each quarter, give the following figures from 1962 onwards: r Numbers of claims settled Amount of reimbursement Quarter 1962 1963 1964 1965 1962 1963 1964 1965 ,, $ $ $ $ First 392 353 451 443 3 188 3 226 6 597 5 394 Second 335 386 484 511 2 325 4 794 6 418 . 6 254 Third 329 512 460 2 895 6 690 6 067 Fqurth 392 426 560 4 477 4 723 6 372 Total 1448 1677 1 955 12 885 ' 19 433 25 454 SEA/RClB/2 Page 72

2r 6 Cultural Contributions to the Regional Office Building

At a brief ceremony on 25 September 1964, the Director-General of Health Services, Afghanistan, formally presented six Afghan carpets to the Regional Office, as the final instalment of Afghnistan's cultural contribution to the new building.

The Mongolian contribution and some more furniture from Ceylon have been promised.

2.7 Constitutional and Legal Matters

Contacts with Member Governments of the Region were maintained through the WHO Representatives and by means of visits to the various countries by the Regional Director and technical and administrative staff.

Negotiations with Member Governments on plans of operations for approved projects, exchanges of letters, and addenda to the existing plans of operatiom were undertaken as usual.

3. PROCUREMENT OF SUPPLIES AND EQUIPMENT

Supplies worth $374 000 were procured during the year under the Rephr. EPTA and UNSF funds. These covered a wide range of items, including laboratory equipment and chemicals, drugs, teaching equipment, medical literature, vehicles, etc. Supplies were also procured on behalf of research institutions out of the WHO grants to these institutions. Among the centres for which supplies involving large amounts were provided were the Central Public Health Engineering Research Institute, Nagpur (India 176) and the Tuberculosis Chemotherapy Centre, Madras (India 53).

Freeze-dried smallpox vaccine donated by the United Kingdom, the Nether- lands, Switzerland, the USSR and ~adagasca' to the WHO Smallpox Eradication Special Account was distributed to various countries in the Region (see Part I, Section 1.3.1).

In pursuance of a resolution of the Executive Board (EB33.R44),medical bocks and literature were procured for the University of Ceylon on a reimbursable basis.

Action was also taken for the procurement of spare parts for transport vehicles on behalf of the Government of Nepal on a reimbursable basis.

Consequent on the withdrawal of UNICEF from Indonesia, action was initiated for the provision of some of the most urgently needed supplies for projects. SEA/rlC18/2 Page 73

The Medical Supply Officer visited the Tuberqulosis Chemotherapy Centre, Madras, in order to review the supply requirements of the Centre with the project staff and to establish better planning for the procurement of drugs and laboratory supplies. He also took the opportunity to look into the stock position at the Centre and prepared an inventory of all capital equipment.

4. COLLABORATION WITH OTHER AGENCIES

There has been continued collaboration yith the United Nations, its specialized agencies and bilateral agencies both at the Regional Office and at country level, through frequent consultations, regular meetings and participation in conferences on subjects of mutual interest,

4 1 United Nations

WHO continued to work in close co-operation with the United Nations, Special areas of collaboration with the various argans and agencies of the United Nations are described below, and meetings called within the ~egi&by United Nations agenqies, attended by representatives of WHO, are listed is Annex 3. In addition, assistance was given to the United Nations Information Service in various countries of the Region in planning the observance of the "International Co-operation Year", and a special article on international co-operation in health was prepared.

4.1.1 Unite$ Nations Technical Assistance, Board (UNTAB) and United Nations Special Fund (UWF)

The Executive Chairman of the Board called at the Regional Office and discussed with the Regional Director and technical staff matters of mutual interest. The Resident Technical Assistance Representatives in Afghanistan and Ceylon also visited the Regional Office to review the progsrek of technical assistance programmes in thoae countries. Close contacts with RTARs at country level were, as usual, maintained by the WHO Representatives.

WHO continued to be the Executing Agency for two projects in Mia assisted by the United Natioos Special Fund. A United Nations team visited the Regional Office en qoute to Madras on a watersupply survey.

The possibility of assistance by the UNSF and the World Bank to watersupply programmes in South Mia was discussed locally. SEA/RC18/2 Page 74

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

Collaboration with ECAFE was continued. WHO maintained participation in the work of the Asian Institute for Economic Development and Planning in Bangkok.

WHO took part in the ECAFE-sponsored statistical training course in Bangkok and the Sixth Regional Conference on Water Resources Development. WHO was also represented at three other meetings held in Bangkok under the auspices of ECAFE (see Annex 3).

4.1.3 United Nations High Commission for Refugees

An office of the United Nations High Commission for Refugees has been established in Nepal, and WHO has offered its co-operation.

4.1.4 United Nations Children's Fund (UNICEq

. Day-to-day contact was maintained with the UNICEF Regional Offices in Delhi and Bangkok,and as in the past, WHO/UNICEF joint assistance to health programmes continued to be one of the notable features of intemtional co- operation in the Region. Matters of mutual interest were discussed with the Deputy Executive Director of UNICEF,and the Director for Planning, UNICEF Headquarters, when they visited the Regional Office.

Other matters of interest discussed with UNICEF officials have related to the WHO/UNICEF assisted programmes in Afghanistan and UNICEF assistance to improve water supply in hospitals in Burma and to the leprosy control programme at Pogiri, India.

In co-operation with WHO, UNICEF has started assistance to Nepal and is planning to help Mongolia beginning in 1966.

4.1.5 World Bank

Representatives of the International Bank for Reconstruction and Develop- ment visited the Regional Office; useful discussions have been held on the Calcutta Water Supply project and onfuture prospects for similaxactivities. . . 4.2 Specialized Agancies

4.2.1 Food and Amiculture Organization of the United Nations (FAO)

WHO continued to maintain close co-operation with FAO, especially with regard to the Applied Nutrition Programme. Discussions were held with the Technical Secretary of the WHO/FAO/UNICEF Protein Advisory Group, New York, who came to India to observe the work,being carried out on protein-calorie mal- nutrition and development of protein-rich foods. FA0 and WHO also collaborated in the inter-regional Training Course in the Fundamentals of Nutrition and their Application, held in Thailand. WHO, along with FAO, was represented at a meeting called by the Ministry of Food and Agriculture of the Government of India on the occasion of a visit by the Executive Director of the United Nations World Food Programme.

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

WHO continued to take part in UNESCO-assisted education projects in Afghanistan, Burma and Thailand. In Afghanistan, representatives of the Government, UNESCO, US AID and WHO worked together in the various sub- committees and in the Co-ordinating Council in developing syllabi and textbook material for the UNESCO-assisted education project.

Among the important meetings sponsored by UNESCO which were attended by WHO representatives (see 1istqAnnexes 3 and 4) were the Fourth Session of the Consultative Steering Committee on Social and Economic Development in Southern Asia, the Seminar on Education for International Understanding, organized by the lndian National Commission for Co-operation with UNESCO in New Delhi, and the conclbding session of a Travelling Seminar (Teaching Workshops) of the International Brain Research Organization established by UNESCO.

4.3 Inter-governmentd and Bilateral Agencies

A large amount of bilateral assistance in the health field is being given in various countries of the Region. The work with which WHO has been particularly concerned is outlined below. SEA/RC18/2 Psge 76

4.3.1 United States Agency for International Development (US AID)

Co-operation with the United States Agency for International Develop- ment on malaria eradication programmes in India, Nepal and Thailand continued. It seems that US AID assistance to most of the health programmes, ,with the exception of those on malaria eradication, may cease in 1966 owing to changed priorities.

The WHO Representatives have held meetings with officials of the Health Division of the US AID from time to time.

In India the US AID has supported programmes on malaria, communicable-disease control, nursing education, the training of medical educators and public health education.

A number of officers of the United States Public Health Service visited the Regional Office to discuss the organization of a major tuberculosis prevention trial and assistance to the National Institute of Communicable Diseases in Delhi; discussions with US AID staff were also held on a course on ground water developmnt to be given in India in 1966 under US AID auspices.

Health programmes in Nepal were dfscussed with the Director of US AID in Nepal when he came to New Delhi.

In Thailand, US AID has been helping in malaria and village sanitation and has supported the University of Medical Sciences.

4.3.2 Colombo Plan

The Colombo Plan has continued to assist in health projects in Burma, Ceylon and India. In Burma it is supporting the Institute of Para-medical Sciences by assigning teachers, is helping to train X-ray technicians, and is providing fellowships and the services of a nurse educator in radiotherapy, who has been working in Mandalay. In Ceylon, it has offered a number of fellowships in the medical and health fields, and in India, its assistance has taken the form of fellowships, consultants to assist in post-basic nursing training, the provision of cobalt-beam therapy, development of workshops for repair of electro-medical equipment (Australia) and plans for supporting one of the post-graduate medical institutes (United Kingdom). In Thailand, as well, arrangements are being made for Colombo Plan aid through the New Zealand Government for assistance in radiation health protection. The Colombo Plan has also made plans for assistance to Afghanistan. SEA/RC18/2 Page 77

WHO has continued to take part in the co-ordmation of assistance, particularly in regard to fellowships, post-basic nursing training in India and the radiation health protection programme in Thailand.

4.3.3 Other Bilateral Agencies

Collaboration was continued in the Indo-Norwegian health project; in Kerala State .(India U7),for which WHO has been providing the services of a public healthnurse, with the Indian Aid ~issionin Nepal, which is giving assistance for the expansion of the maternity hospital and for community water supply programmes, and with the West German team in Afghanistan, which is helping the Institute of Public Health; Kabul. . . .,.. . ~... 4.4 International Nan-governmental Organizations

Representatives of fifteen non-governmental organizations attended the seventeenth session of the Regional Committee.

WHO was tepresented ;at a meeting on the geographical pathology of CanWr:in:the ~dianSub-Continent, which w& convened in Bombay by the . ' ~nternati:&%l.Unibn,ApiRst Cancer in August 1964 and at a meeting of a prep&+tory committee con~n&'in'NewDelhi bv the World Medical Association;in connectid with:* Thlkd world Confbrence on Medical ~ducation,to'heheld in New elh hi'' ! 1 in 1966. WHO has also co-oprated with the World Federation of United Nations' Associations and took part in the Nineteenth Plenary Assembly of this orgdda-. . tion; also'in New Delhi, 'in ,January 1965. , ,.; 4 .;' ' ,, . , The International Committee on Laboratory Animals, on behalf of WHO, sent a consultant to visit several institutions in India and Ceylon to give advice on the management of laboratory animals.

A full list of the meetings called in this region by theseand other non- "

UniWNations organizations during the year, at which WHOwas represented; ' '.' , . is given in Annex 4.

4.5 Other Or&nizations-

Close collaboration has contmued with the Danish Save the Children's Organization, with whieh WHO is working in a joint project of assistance to the Government of India in leprosy control in Andhra Pradesh (India 81.2). SEA/RC18/2 Page 78

The Rockefeller Foundation has continued to give considerable assistance in the health field to India by way of fellowships, travel grants, equipmat and grants-in-aid for medical colleges and other training institutions. It has continued its assistance to the All-India Institute of Medical Soiences in Delhi and provided a nursing educator for the B.Sc. course at Trivandrum Nursing College. It is also planning to assist the Government of Thailand with an Institute of Basic Medical Sciences (see Chapter 7 of Part I). An observer from the Rockefeller Foundation attended the seventeenth session of the Regional Committee.

The Ford Foundation has granted financial assistance to ten institutions in India, including the Gandhigram Institute of Rural Health, the Institute of Obstetrics and Gynaecology, the National Institute of Health Administration and Education and the Central Family Planning Institute, and is awarding numerous fellowships in the health field. It is substantially supporting famlly planning programmes.

Among other organhations with which WHO has co-operated are the Order of Malta, Emmaus Suisse and Deutsches Hilfswerkpho are making a valuable contribution to leprosy work in Burma, India, and Nepal). Contacts have been maintained with CARE (the Co-operative for American Relief to Everywhere), which is assisting Afghanistan (as CARE-MEDICO), Ceylon and Indla with feeding programmes for school-children and which, in Afghanistan is also providing a professor of surgery, an orthopaedic surgeon and assistance in organizing a training course for auxiliary nurses at Avicenna Hospital; also with the Asia Foundation, which, in Ceylon, assists the University and is also providing school libraries and community centres with boob and other literature, and the Thomas Dooley Foundation of the USA, which is planning a health survey in Nepal.

WHO has also maintained close contacts with a large number of national governmental organizations, and the more important meetings convened by governments within the Region at which the Organizaticm has been represented are included in those listed in Annex 4.

5. PUBLIC INFORMATION

In addition to producing and placing its own material, the Regloha1 Office continued to stimulate and give some assistance to the outside production of material on the work of WHO and on public health in general, with good results.

Assistance was given to US AID in the production of a major feature film on malaria eradication for release in the United States of America and India; to the SEA/RC18/2 Page 79

Canadian Broadcasting Corporation in producing a series of programmes on health in South-East Asia; to the British Broadcasting Corporation in programmes on smallpox eradication in India; to the Danish State Radio in collecting material for programmes on health promot~onin South-East Asia and on WHO; to TIME- LIFE Magazine with documentation and photographs for a picture essay on health and disease; to All-India Radio in programmes on WHO-assisted projects, and to the "Voice of America" in producing a programme on the seventeenth session of the Regional Committee.

The Regional Office's own productions included coverage in text and photographs of "Smallpox Eradication Week, New Delhi", the manufacture of freeze-dried smallpox vaccme, smallpox control in Afghanistan and Nepal, leprosy control in India and the technical discussions held at the seventeenth session of the Regional Committee.

In addition, fourteen taped interviews with WHO staff were prepared for UN Radio, and film footage and a text on leprosy control in Andhra F'radesh, India, prepared for Danish Television. This footage will also be made available to AlHndia Radio as part of a series of televised programmes on healaplanned for joint production with WHO in connection with the forthcoming expansion of television in India.

Documentation, texts and photographs were provided to two authors working on health bocks for children, and a book on the work of WHO was published by the United Nations Council of Indian Youth.

Fifty press releases and articles were issued, and 24 speeches, state- ments and messages prepared to answer requests from medical and other professional associations.

WHO films are constantly in demand, and negotiations are in progress with the Government of Ceylon with respect to producing some of them in the Sinhalese and Tamil languages.

WHO'S monthly magazine yorld Health continued to arouse interest in the Organization and its work, and 320 new addresses were added to the mailing list, on request.

About 3 000 requests for information were attended to, and visits of groups of teachers, students, nurses, etc. to the Regional Office arranged. Information activities outside the Regional Office included talks to Rotary Clubs and other similar organizations and participation in various meetings. SEA/RC18/2 Page 80

The theme of World Health Day 1965 was "Smallpox - Constant Alerttt. Articles and press releases on smallpox cantrol and eradiatian campaigns in South-East Asia prepared by the Regional Office appeared ia the press throughout the world, and considerable efforts were made by Member Governments in the Region to arouse public interest in smallpox control.

Preparation of articles, news releases and radio programmes in connection with the observance of the International Co-operation Year (1966) was begun* SEA/RC18/2 Page 81

PART 111

ACTIVITIES UNDERTAKEN BY GOVERNMENTS

WITH THE HELP OF WHO SEA/RClB/2 Page 83

PROJECT LIST

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

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

In the first column (under "Project No., Source of Funds, Co- operating Agencies1') "R" means the Regular budget; "TA" means Technical Assistance funds; "UNSF" the United Nations Special Fund; "UNICEF" the United Nations Children's Fund, and "USAID" the United States Agency for International Development. Names of co-operating agencies, except for UNICEF (see above), whether or not they have contributed funds, are given in parentheses. In the second column, under the title of the project, the starting and, where relevant, finishing dates are shown within brackets.

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

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

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

SEA/RC18/2 Page 85

L AFGHANISTAN

Two of the articles of Afghanistan's new Constitution, adopted in October 1964, envisage, within the limits of the State's resources, the provision of facilities for medical treatment and prevention of disease for the p~pulatim,and of compulsory primary education for children.

Social and economic improvement is expected to be accelerated following the recent re-organization of the country into 29 provinces, each administered by a gavzmar, who is responsible for the implementation of all development projects in his province. It is planned to appoint a chief medical officer in each province, charged with the administration of the hospitals, clinics and preventive health services.

Construction of roads and highways (e. g. the Salang highway, including a tunnel, built during the year), and provision of community water supplies continued to receive high priority. A'Itventy-five-Year Plan for the development of Kabul city was prepared, and during the year much work was done on a survey of water sources and on laying new water mains for the piped water supply for the capital. Work on several hydro-electrical projects continued briskly.

Pakhtia Province and Hazarajat in Bamiyan Province were selected as the areas in which to begin a new development plan for communications, agriculture, education and health.

As part of the Second Five-Year Plan, six hospitals, with a total of 163 beds, and 14 dispensaries were established, and during the first two years of the Plan, 125 doctors graduated. Thus the total number of doctors was brought up to 525 and of hospitals to 65, with a bed capacity of 2 082.

Other significant trends in the health field were: (a) the strengthening of the Directorate General of Health Services by the appointment of additional health officers, (b) planning for health legisition, (cj planning for greater and more effective co-ordination and co-operation between the various Departments (in particular those of Health, Education, Rural Development, Public Works, etc.), and (d) the increasing health consciousness of the public, noticeable also among the nomadic populations. A great achievement in nursing was the successful graduation of the first four women senior nurse-midwives; the planning of maternal and child health activities in major provincial towns also made some progress. SEA/RC 18/2 Page 86

WHO assistance continued itr the major fields of (a) communicable diseases (the eradication or control of malaria, smallpox, tuberculosis, trachoma and leprosy); @) the development of rural health services; (c) medical education, in Kabul and Jalalabad; (d) training of nurses and sanitarians; (e) sanitary engineering, and (f) health education. Cloee co-operation and co-ordination of work were also maintained by WHO and the Government with the representatives of the United Nations Technical Assistance Mission, IJMCEF, UNESCO, FAO, the United Nations Special Fund, non-governmental organizations and bilateral agencies workfng in the health fieid. SEA~CIBR Page 87

PROJECT. LIST

Project No. Source of Funds Co-operating Agencies Title

Afghanistan 11 Malaria Eradication A (AUK. 1956 - ) UNICEF

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

Assistance provided by WHO during the year. (a) Three malariologists, an entcnol~gist,a sanitarian. three laboratory technicians, two secretary-stenographers and one clerk-typist; (b) four two-month fellowships for study in India and tun one-mmth fellowshipn to attend the malaria eradicatien training course in Manila; (c) two transpcrt vehicles.

Probable duration of assistance. Until the end cf 1969.

Work done during the year. In 1964, spraying operatinns covered an estimated population of over 4 000 000. It was planned to include an additional population of 462 000, hitherto unprotected by DDT spraying in the 6perations during 1965. The recommendations of the WHO assessment tcam made in 1964 are being implemented. The withdrawal of spraying from selected areas as originally planned for 1965 has been postponed until 1056 in order to strengthen surveillance activities and allow time for the collection of adequate epidemiobogical data for the initiation of the consolidation phase. As internal assessment conducted in April 1965 by a joint government and WHO team revealed that additional unit areas could be consldered suitable for withdrawal of spraying in 1965 if surveillance activities were strengthened by more staff, equipment and vehicles.

Entomological activ1ties.which were reorganized in 1964, have been further reinforced by the provision of trained personnel. The main vectors continued to be susceptible to DDT.

Afghanistan 13 Medical Education R (Jan. - Aug. 1952; Sept. 1953 - )

Aim of the project. To strengthen departments of the Faculties of Jkdicine of the Universities of Kabul and Nangarhar and to train national staff.

Assistance provided by WHO during the year. (a) A professor of physiology, a secretary-stenographer, a consultant in preventive and social medicine and a consultant in hospital administration; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1968. Work done during the year. The WHO visitlng professor of physiology continued his work in the Department of Physiology. One of the three assistants in this department left in September 1964 on a fellowship awarded by the Government of France. The other two continued to work with the WHO professor. One of them was engaged in translating the lecture notes into "Darl", the language of instruction.

In February 1965, the national counterpart to the WHO professor, together with some other members of the Faculty, left for France to study the organization and administration of the Faculty of Medicine of Lyon (with which the Kabul Faculty is affiliated). Earlier, one of the national staff went to Jalalabad to organize practical work and demonstrations for students at Nangarhar Medical College; a member of the Jalalabad Medical Faculty was also trained.

The Faculty arranged a special three-month preparatory course in all pre- clinical and para-clinical subjects for medical auxiliaries who had been trained in the Medical School (now Faculty) in Kabul and who had since worked in rural districts for aboit sixteen years. After successful completion of the course they will be given a chance to enter the third class of the Faculty.

A WHO consultant in preventive and social medicine was assigned to the project in April 1965, and another in hospital administration in May.

Afghanistan 20 Vaccine Production, Kabul TA (Jan. 1955 - Nov. 1960; ~uly- 0ct. 1961; UNICEF Dec. 1962 - Nov. 1964)

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

Assistance ~rovidedby WHO during the year. R bacteriologist.

Work done. WHO has been assisting the Vaccine Production Centre, Kabul, since 1955 with bacteriologists and consultants. Fellowships in bacteriology and laboratory technology have been awarded to medical officers and laboratory technicians, and supplies and equipment provided by both WHO and UNICEF.

During the period of assistance by WHO, working conditions at the Centre were improved and modern techniques introduced, ensuring better conditions for sterile work and more economical and large-scale production of vaccine conforming to accepted standards, Accommodation for animal breeding was expanded, and the control of vaccines by sterility, and in some cases potency, tests was initiated.

'r The production of glycerinated smallpox lymph and of rabies (human and animal), TAB and cholera vaccines was stepped up; for example, the productidn of glycerinated lymph was increased from about 1 million doses in 1958 to about 3 million in 1963, and about 56 litres of human rabies vaccine were issued in 1963 as against 20 in 1958. During the cholera outbreak in 1960, the Vaccine Centre supplied 1 620 litres of cholera vaccine against an average yearly production of about 50 litres in Previous years. In 1964, the WHO bacteriologist prepared a programe for possible future expansion of the programme and for collaboration between the Vaccine Centre and the Microbiological and Epidemiological C

The WHO bacteriologist, who had been working with the project Since December 1962, completed his work in November 1964. Hereafter assistance to the Centre will continue to be provided on a part-time basis by the WHO microbiologist assigned to the Public Health Institute in Kabul.

Af~hanistan24 Health Education R (oct. 1958 - Sept. 1959; May 1962 - 1

Aim of the project. To develop health education services in the Country; to promote health education in teacher training; to train health staff in health educatlon; ta cstlbli-h and develop ;health educatlon section in the Institute of Public Health, Kabul.

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

Probable duration of assistance. Until the end of 1967.

Work done during the year. The main activities of the proJect during the year were strengthening the Health Education Section, including the field iaboratory; helping to secure the inclusion of health education in schools, teacher-training programmes and training programmes for health personnel; planning health education in various health programmes, and preparing educational materials (including the health content of textbooks).

Health education teaching was included in the curriculum for flrst and second-year students in the School for Sanitarians, in cowses for teacher trainees in the UKBSCO-assisted project at the Higher Teachers' College and in USAID-assisted projects at the Faculty of Education. The WHO health educator co-ordinated the WHO contributions to teacher training and uas associated with the Ministry of Education's Sub-Committees to advise on curriculum planning and textbook revision.

Training in health education was included in courses forvaccinatnrs,and intensive health education activities in the smallpox control programme were organized in Kandahar. Students in social work and those in social and preventive medicine were assisted during field practice at Shewaki.

The Health Education Section assisted in planning progranunes for World Health Day and for other special occasiens~andwith a regular weekly radio feature.

The doctor in charge of the Health Education Section continued his studies in the USA on a WHO fellowship. A sanitarian from the Section is studying health education in Beirut under a fellowship from USAID,and the Head of the School tor Sanitarians 1s on a British Council fellowship in health education in London. ~fghmlstan26 Rural Health TA (April 1956 - ) UNICEF

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

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

Probable duration of assistance. Until the end of 1968.

Work done durine the year. A revised pl-n of operations redefining the objectives of the project has been under discussion with UNICEF. More specifically, the programme of work of the project staff has been reviewed in order to ensure that maximum use is made of the services of a11 the available staff. Co-ordination between the Ministry of Public Health and the Rural Development Department was improved.

Three more health units were established, making a total of nineteen.

Water supply and latrine construction activities in all the 19 project areas were based on a revised plan for environmental sanitation. Sanitation work made good progress. With the material support of UNICEF,the local manufacture of stalldards for handpumps has been started. Thirty-six prototypes tested were, except for a few minor defects, found to be robust and well made.

Closer relationships between the Rural Development Department an3 the Public Health Institute, Kabul, particularly in the field of sanitation, have been effected.

With the assistance of the Statistics Section of the Public Health InstStute, the records and statistics maintained at Shewaki Health Centre were studied with a view to making improvements.

A noteworthy feature has been the keen interest shown by the Ministry of Public Health in devcloplng a national health services plan for the whole country.

Afghanistan 28 School for Sanitarians, Kabul TA (July 1955 - )

Aim of the project. To train sanitarians for community health services throughout the country.

Assistance provided by WHO during tile year. A sanitarian.

Probable duration of assistance. Until the end of 1965. SEA/RC~~/'Z Page 91

Work done during the year. The projeit has continued to develop satisfactorily.

The end-of-tern examination for junior and senior courses ended early in January 1965, with satisfactory results. With thirteen students completing the course this year, the total number of trained sanitarians has increased to 145. after eight years of operation of the projcct. Field observation and demonstrations have been improved by arranging for students to visit tho rural health project, where they observe sanitation construction work. Practical work by the senior students in the manufacture of parts for vault-privy latrines and in disassembling, repairing and refitting handpumps has been introduced into the work of the field laboratory.

The h'HO sanitarian and his counterpart assisted the Higher Teachers' College, Kabul, with lectures in environmental sanitation.

The WHO sanitary engineer working with the Institute of Public Health In Kabul gave lectures to the sanitarians on water supply and sewerage systems.

Afghanistan 31 Institute of Public Health, Kabul R (April - May 1956; Nov. - Duc. 1958; March - UNICEF May 1961; May 1962; Aug. 1962 - )

Aim of the project. To develop the Institute of Public Health for investigations. research and the training of public health workers.

A-r. A-r. (a) A microbiologist, a statistician- cum-epidemiologist, a laboratory technician and a sanitary engineer; (b) two twelve-month fellowships - one for stlldy in India and one for stuly in the United States of America (to begin in Septem~er), two three-month fellowships fnr study in India and one six-week fellowship for study in Yugoslavia and Iran; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1968.

Work done during the year. A laboratory departrent was set up at the Public Health Institute,lnd large supplies of equipment received from WHO and UNICEF were checked, assembled and put into use. Basic laboratory services were organized, and staff trained in their operation; diagnostic tests for communicable diseases by culture and serology werc started, and surveys werc undertakcn for diphtheria. Salmonella and Shlgella carriers. B3cterlological and chemical testing of the

Kabul city water supply was carried out as 3 routine check. Testing methods for food and drinks were set up and surveys of food shops and food handlers undertaken. Independent bacteriological control of the vaccines produced at the Vaccine Centre, Kabul, was also established. Plans were made to extend the laboratory services to Shewaki Health Centrc and to the princlpll cities in the provinces, in co-ordination with the work of the expanded epidemiological services. A training course for laboratory assistants was organized.

The WHO sanitary engineer has been giving lectures to undergraduate civil engineering students at the University of Kabul. Since April 1965 he has been assisting the Department of Housing and Town Planning. Ministry of Public Works. Kabul. With his assistance,a report was prepared for the Municipality of Kabul, SEAhcl8/2 Page 92

describing environmental sanitation problems, such as water, food, excreta disposal and refuse collection, and giving suggestions for their improvement; it has been accepted by the Municipality for implementation.

Processing of statistical returns from hospitals and out-patient services proceeded. A draft notification system for communicable diseases was prepared,and assistance was given to the smallpox control programme in the design of a recordsand reports system and in training field personnel. The WHO statistician-cum-epidemiologist and his national counterpart conducted courses in health statistics and epidemiology at the School for Sanitarians.

The librarian of tire Institute completed a three-month fellowship for training in library methodology in the Regional Office.

Afghanistan 33 Tuberculosis Advisory Services TA (June - Dec. 1958; June - July 1961; UNICEF Nov. 1962 - Marcn ly64; March 1765 - )

Aim of the projcct. To expand tuberculosis control services in Kabul and its environs in the first instance, ard to establish a pattern for tuberculosis control in the provinces.

Assistance provided by WHO during the year. (a) A medical officer; (b) supplies, equipment and two transport vehicles.

Probable duration of assistance. Until early 1968.

Work done during the year. An addend,im to the plan of operations was prepared and agreed upon; it gives in detail tile plan of action to be followed in the next few years in the developing practical ambulatory treatment services,to deal with the infectious case-load in Kabul and with case-finding and differential-diagnostic referral examinations. Simple csse-finding and ambulatory treatment services will also be set up in the rural area of Shewaki, and will be integrated into the developing basic health services so as to provide a pattern for a possible future expansion into the rcst uf the country. UNICEF has agreed to assist this project with supplics and equipment.

A WHO medical officer assumcd duties in Kabul in March 1965

Afgharlistan 35 Nursing Advisory Scrvices TA (June 1957 -

Aim of the project. To organize and develop nursing and midwifery training programmes and tc co-ordinate and expan? nursing education and the nursing services of the country.

Assistance provided by WHO during the year. (a) A nursing adviser and three nurse educators; (b) a twelvr-month fellowship for study in the United Statcs of America.

Probable duration of assistance. Until the end of 1969. Work done during the year. The WHO-a-sisted teaching programmes were continued at the Aliabad Nursing School for men and the Shararah Nwse-Midwifery School for women; both schools have three-year basic programmes. Assistance to the Mastoorat Nursing School for women was given through periodic visits and advice.

The five senior midwives mentioned in last year's report successfully completed the nursing portion of the nurse-midwifery programme. They are the first professional nurse midwives to qualify in the country. Two ather midwives have started the course and are due to qualify in 1966.

Of note was the fact that in March 1965 the full complement of 32 students, the maximum number it is possible to accept, had volunteered for admission to the Aliabad School for men.

Teaching materials have been translated into "~ari". These translations, to make available more reference material in this language for the national tutors,are aimcst complete as CaI' as lesson plans and course outlines are concerned.

A course outline for auxiliary nurse midwives was completed and has been approvcd by the Government; it has also been translated. Training of this category of worker should do much to meet the nursing needs of the country. Some progress was also made in the organization of schools for these auxiliaries in the provinces.

Afghanistan 43 Leprosy Control R (Aug. 1964 - )

Aim of the project. To determine the prevalenc~ of leprosy in those areas in which the disease is known to be endemic, to carry out a survey and to advise on case finding, contact tracing and "reatment of patients.

Assistance provided by WHO during the year. A consultant leprologist for one month.

Probable duration of assistance. Until the end of 1967.

Work done during the year. A WHO consultant visited Afghanistan in August 1964 and conducted a survey to assess the leprosy problem in the Hazarajat area of Bamiyan Province. He confirmed that leprosy is mostly confined to that province, where there is a pocket of high prevalence, with 4.47 per mille known cases, in Yakaowlang District. Prevalence in the country as a whole is estimated as being between 0.3 to 0.6 per millc.

In view of the above, it is planned to start leprosy control activities in Yakaowlang District,integrating them into the existing basic htalth services of the Yakaowlang Health Centre, with emphasis on the training of all health personnel. For this purpose, further consultant service by WHO is envisaged. SEA/RCIB/Z Page 94

Afghanistan 44 Trachoma Control R (Nay - June 1958; Sept. - Oct. 1962; July 1965; April - May 1964; June 1965 - I

Aim of the project. To study the epidemiological aspects of trachoma in Herat Province; to initiate control activities; to develop a programme of health educatlon in communicable eye diseases, and, irk tho light of the data and experience so gained, to develop such control programmes as may be required.

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

Probable duration of assistance. Until mid-1967.

Work done during the year. As stated in the Sixteenth Annual Report, a WHO consultant was assigned to Afgtlanistan in April 1964 for two months. He helped to start trachorna control activities in the City of Herat and in tcn villages of Injeels District. Since then, the worK has been carried out by the national team.

Tne attack phase of the pilot project in Herat and in the villages was completed, and activities in the consolidation phnsc have been started. Soon after the arrival ofthe WHO vehicle ordered last year, health education activities were reinforced in the District of Injeels.

Supplies of antibiotic eye ointment in 1964 and 1965 were provided by WHO. A WHO medical offlcer was assigned to this project in July 1965.

Afghanistan 54 Communicable-Disease Control (Smallpox Cmtrol)' T A (July 1964 - )

Aim of the project. To develop the smallpox eradication programme and to plan field epidemiological Investigations of the major prevailing communicable diseases (including smallpox) as necessary; to train national personnel in field epidemiology and communlcablc-disease control.

Assistance provided by WO during the year. (a) A medical officer; [b) supplies and equipment.

Probable duration of assistance. Until the end of 1968.

Work done during the year. Smallpox control activities have been extended from the City of Kabul to several provinces. A Smallpox Assessment Team irom WHO Headquarters visited Afghanistan in December 1964,and its rrecommendations have been sent to the Government. Based on this assessment, an addendun to the plan of operations for a national smallpox control programme was prepared. It embodies the Government's plan to complete the attack phase in all the provinces in the

a~rcvioustitlc: Conmunlc~ble-DiseaseControl (Si,~llp,>xEradlcationl next five years, by laying, as soon as possible, the foundation for the maintenance phase through integration of the smallpox control activities into the existing or developing health services. Several male and female vaccinators were recruited and trained in Kandahar Province, and refresher courses for field workers were held. WHO csntinued to provide the serviccs of a medical officer and freeze-drkd smallpox vaccine.

Afghanistan 59 Development of Basic Health Services R (April - My 1%5; - 1

Aim of the project. To establish basic health services to give coverage throughout the country.

Assistance provided by WHO during the year. E. consultant for six weeks.

Probable duration of assistance. Until the end of 1975.

Work done during the year. A draft plan of oper3tions for extending basic health services throughout the country, making use of the malaria eradication services already establishedris under discussion with UNICEF. A short-term consultant advised on the development of the national health services in the country. His report has been sent to the Government.

Afghanistan 200 Fellowships R

Organization of National Medical Associations: A two-week fellowship for study in India.

Afghanistan 201 Fellowships TA

Medical radio log^: A twelve-month fcllowship for study in the Union of Soviet Socialist Republics.

SEA/RC18/2 Page 97

2. BURMA

Health services at directorate and intermediate levels in gurma have been reorganized. The country is now divided into six divisions (Rangoon, Central, North-Western, South-Western, Eastern and South-Eastern), each being placed under the charge of a divisional assistant director, who is assisted in his day- to-day work by a deputy divigional assistant director at Headquarters. In addition, one or more deputy assistant directors are responsible for supervision of a number of t3wnship medical aff icers , according to the size and population of the division.

A new university law was promulgated on 29 May 1964, followed by the setting-up of the "Universities Reorganization Committee", with 18 members; the "Central Council of University Education", to supervise the new system of higher education, and the "Council of University Academic Bodies", which prescribes the standard and curricula of university education,

The Rangoon Children's Hospital became an administratively independent institution, with medical, surgical and laboratory unite. Child health has been accepted as a major teaching subject with a separate examination. This has been accompanied by an accelerated expansion and upgrading of the Department of Child Health at the Institute of Medicine No. I, Rangoon, and on a smaller scale in Mandalay.

Progress was made in the programme for the strengthening and co- ordinating basic and post-basic education for nurses and midwives.

The new Workers1 Hospital of the Social Security Board was inaugurated on 13 June 1964.

The country launched a natiml smallpox eradication campaign and, in the Rangcon area, an immunizati3n programme agninst diphtheria, tetanus and pertussis. Reparations were made for the production of diphtheria-pertussis- tetanus vaccine and of freeze-dried smallpox vaccine at the Burma Pharmaceutical Institute, Rangoon.

Leprosy control was greatly intesified in all project areas, bringing the total number of patients under treatment to wer 125 000. The tuberculosis control programme in Rangoon developed well. It is being integrated into the existing health services of the Greater Rangoon Health Scheme. Similar tuberculosis control services were planned for Mandalay. SEA/RC18/2 Page 98

The new system of vital registration has covered 78 municipal towns, the three satellite towns of Thaketa, North and South Okkolopa and the Mingaladm Cantonment town. Further progress was recorded in the improvement of hospital statistics and in the reorganization of medical records offices in the Rangoon hospitals.

In addition to numerous field projects,two WHO research programmes, one on filariasia and the other on BCG in the prevention of leprosy, continued to develop, with the full co-operation and assistance of the national authorities. PROJECT LIST

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

Burma 17 Leprosy Control R (April 1960 - ) UNICEF

Aim of the project. To expand and intensify the leprosy control programme in order to covcr all endemic areas of the country, and to traln personnel for this purpose.

Assistance provided by lJHO during the year. A leprologist.

Probable duration of assistance. Until tho end of 1968.

Work done during the year. The project continued to make good progress. All field activities in respect of surveys, case-finding, contact-tracing,and treatment were intensified. In the whole of the country. 125 501 patients were registered and placed under treatment. Of these, 107 922 were from the project area.

The WHO leprologist continued his assistance and contributed to the training activities with rcspect to the staff required for the intensification and expansion of the programme. A second WHO leprologist was recruited in July.

The Ooverment appointed the requisite staff for the expansion of the project to five districts of the Delta Division during 1964-1965. A five-year plan for the further expansion of the programme was also approved.

Negotiations were concluded by KiO for assistance by three voluntary agencies (Order of Malta, Emaus Suisse and Deutsches Hilfswerk fllr Aussatzlgen) with grants totalling $150 000 over the next five years, to help aover salaries of the additional auxiliary workers required for intensification of the leprosy control programme in the WHO-assisted project areas.

Burma 22 Vital andHealth Statistics, Rangoon R (Dec. 1955 - June 1961; 'Jan. 1962 - 1

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

Assistance provided by WOduring the year. (a) A health statistician and a medical records officer; (b) supplies and equipment.

Probablo duration of assistance. Until the end Of 1967. SEAhclE/z Page 100

Work done during the year. lhe operations in the new medical records units in Rangoon Oeneral Hospital and Dufferin (Maternity) Hospital were further improved. and similar units were established in the Children's Hospital in Rangoon, and in Wandalay General Hospital and Sao San Hun Hospital in Taunggyi. Assistance was given to the State Mental Hospital in the production of new record forms and development of records procedures. From such large hospitals individual discharge reports were collected by the Health Statistics Branch; a simplified version was introduced for district hospitals.

Trial tabulations of in-patient morbidity statistics from groups of hospitals were completed, and routine processing of in-patient morbidity data was continued.

A previously issued instruction for the completion of hospital returns was revised, printed and distributed. The quality and completeness of administrative hospital returns have improved. By October 1964, out of 190 hospitals 165 had submitted returns; this means that 16 out of 36 districts were completely covered as regPrds ac?-i*nistratr--ch?spital w:atistics.

A central index of individual hospitals was established and was being regularly used.

The project participated in three training courses and seminars for medical 0fficers.which included Orientation as to hospital recorns systems and hospital Statistics.

Burma 31 Malaria Eradication R (Feb. 1957 - 1 UNICEF

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

AssistanceDrovidedA one-month fellowship for study in Indonesia.

Probable duration of assistance. Until the end of 1967.

Work done during the year. During 1964, against a target of 9.6 million people. actually 6.5 million people were protected by spraying, using paid labour in thinly populated areas difficult of approach and VOluntaPY labour in densely populated plains with good communications. The shortfall was attributed mainly to difficulty of access to the hill areas of Shan and Kachin States. The population under consolidation phase was 9.4 million, with 2.47 million in the pre-maintenance phase.

Burma 37 Mental Health, Rangoon R (Oct. - kc. 1955: .4pril 1965 - )

Aim of the project. To develop basic,and post-basic nursillg education progrmes in mental health and in-service education for personnel in position,in order to improve nursing care in psychiatric hospitals. SEA/RCIB/I? Page 101

Assistance providcd by WHO during the year. A psychiatric nurse tutor..

Probable duration of assistance. Until early 1967.

Work done during the year. The WHO nurse arrived in Burma in April 1965. After familiarizing herself with the nursing schools as well as with the Mental Hospital, she assisted in an in-service education programe. This is the first phase of the project. The next step will be to develop a post-basic programme to prepare teachers and supervisors to undertake a teaching programme.

Burma 44 Strengthening of Health Services (Epidemiology) TA (Jan. - Dec. 1961; July 1963 - March 1965; - )

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

Assistance provided by WHO during the year. (a) A microbiologist; (b) supplies, equipment and a transport vehicle.

Probable duration of assistance. Until the end of 1967.

Work done during the year. The WHO microbiologist assisted in the upgrading of laboratory diagnostic methods and procedures at the Rangoon and Mandalay laboratories.

At the General Hospital laboratory in Mandalay she helped to set up basic services (washing, sterilization, media preparation) and to put the existing equipment into operation. Bacteriological and serological tests for communicable diseases and water testing were introduced and the existing staff trained.

The microbiologist completed her assignment in March 1965, and a copy of her report has been forwarded to the Government.

It is proposed to provide further consultant service in 1967.

Nursing Advisory Services (March 1959 - )

Aim of the project. To upgrade and co-ordinate basic and post-basic education for nwses and midwives on a country-wide basis, in order to establish satisfactory standards of nursing and midwifery trainlng and services.

Assistance provided by WHO during the year. A paediatric nurse. SE~hCl8/2 Page 102

Probable duration of assistance. Until the end of 1968.

Work done during the year, A basic nursing programme in paediatrias tor students at the Rangoon General Hospital was organized,and guidance was also given to the school in Mandalay. An in-service programme was conducted for nurse-aides employed in the Children's Hospital. Rangoon, and nursing procedures were revised. The formula kitchen has been reorganized and is functioning well.

A three-month post-basic course for graduate nurses functioning in children's units in hospitals course was undertaken. A nine-month course to prepare teachers and supervisors in this specialty has been planned for 1966.

The post-basic nursing school in Rangoon was re-opened, with a course for public health nurses and one for midwifery tutors. The WHO nurse has given guidance in this activity.

Burma 65 Tuberculosis Co..tr>l TA (Jan. 1964 - ) UNICEF

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

Assistance provided by WHO during the year. (a) A medical officer and four short-term consultants (a public health nurse, a statistician, a laboratory technician and an X-ray technician); (b) supplies and equipment.

Probable duration of assistance. Ut..il the end of 1968.

Work done during the year. The Rangoon Tuberculosis Centre continued to expand its programme in the Rangoon area, treating patients according to the recornended scheme of chemotherapy by cavitary and bacteriological status. In vlew of the central role which this centre is to play in the country's tuberculosis programme, the Government has changed its name to "Union Tuberculosis Institute". Through its mobile advisory team, it gave the necessary guidance and technical supervision to ten peripheral treatment units in operation in various health centres. It is planned for more health centres to operate as treatment centres as soon as the requisite key staff, under training at the Institute, become available for assignment.

Four WHO short-term consultants assisted the project in the fields of: (1) public health nursing, to advise on the treatment organization for ambulatory patients; (2) statistics, to help plan the design of an epidemiological base-line survey and npnro-rlate rrcording zi-ri reporting in the routine control programme; (3) laboratory work, in order to improve b3cteriological diagnostic techniques for case-finding, and (4)radiography,to improve available X-ray facilities for the forthcoming base-line survey and to use them in the follou-up of symptoms which cannot be bacteriologically confirmed as being tuberculosis. The consultants also visited the Tuberculosis Centre, Mandalay, where they advised on the further development of control services on lines similar to those followed in Rangoon. SEAhCl8/2 Page 103

Thc criterion for BCG vaccination has been raised to 9 mm diameter of reaction to the tuberculin test. The training of basic health personnel in the techniques of tuberculin testing and in BCGvaccination progressed well; in 1964, the staff of 78 health centres, against a target of 60, received training.

After a review had been made of the achievements since the beginning of the project in January 1964, an addendum to the plan of operations was prepared for the future development of the national tuberculosis programme through its extension to Mandalay (as the Tuberculosis Centre for Upper Burma) and to other divisions in the North.

Burma 67 Paediatric Education R (June 1964 - 1 UNICEF

Aim of the project. To strengthen the departments of paediatrics in the three medical colleges of the country, to improve the teaching of paediatrics, particularly in its preventive aspects, and to develop peripheral services as training fields.

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

(A twelve-month fellowship for study in the United Kingdom and Uganda was awarded under project Burma 201.)

Probable duration of assistance. Until mid-1967.

Work done during the year. The development of services and teaching activities of the Department of Paediatrics at the Institute of Medicine No. I, ang goon? was fully accomplished. Some delay was encountered in the establishment of similar facilities in Mandalay Medical College, mainly due to shortage of teachlrg staff and a temporary delay in reconstruction of buildings.

For the first time in Burma, the final examination included "child health" as a major subject.

Two paediatric units, each with a senior medical officer holding the qualification of DCH, were established. at Bassein and Moulmein.

The Chief Paediatrlcian, Mandalay, proceeded on a WHO fellowship for advanced studies abroad. An in-service course and a refresher course in paediatric nursing were completed.

Burna 75 School of Public Health and Tropical Mcdicine R (Oct. 1964 - I Td Ain of the project. To establish a school of public health and tropical medicine.

Assistance provided by WHO during the year. A consultant in public health for about three wocks.

l~ccfootnote to project Burma 79 SE~Pcl8/2 Page 104

Probable duration of assistance. Until the end of 1970.

Work done during the year.' A WHO consultant in public health was assigned in October 1964 to study the available resources for establishing a post-graduate School of Public Health and Tropical Medicine. He recommended the requisite measures for this undertaking. A report on his findings has been sent to the Ooverment .

Plans were advanced to provide a second consultant in the latter part of 1965.

Burma 77 Burma Pharmaceutical Institute R (Feb. 1964; July 1964 - ) UNICEF

Aim of the pro!ert. To develop modern methods of production of vaccines. antitoxin and toxoids, and other biological products.

Assijtance provided by WHO during the year. Two fellowships - one for three and a half months and one for two months - for study in the United gtnedom (awarded under Burma 201).

Probable duration of assistance. Until the end of 1967.

Work done during the year. The report of the WHO consultant who had visited Burma in July 1964 to advise on the production of DPT vaccine has been forwarded to the Government. A Plan of operations for the expansion of production of this vaccine and the start of an immunization campaign of children against diphtheria, pertussis and tetanus in the Rangoon area was agreed on. UNICEF is assisting with the required equipment and the initial supplies of DPT vaccine for the immunization programme.

Under the inter-country project "Production of Freeze-dried Smallpox ~acclne"(SEARO 38),assistance was also given last year through another WHO consultant to enable the Institute to change from glycerinated lymph to freeze- dried smallpox vaccine production. UNICEF is supplying equipment.

Fellowships have been awarded to a bacteriologist and to an engineer attached to the Institute for training in freeze-dried smallpox vaccine production and maintenance of equipment.

Medical Education (Dec. 1964 - Feb. 1965; - 1

Aim of the project. To improve undergraduate and post-graduate medical education; to train teaching staff; to develop the currioula in keeping with modern concepts; to initiate, encourage and guide research activities.

Assistance provided by WHO during the year. (a) A consultant in hoapltal administration; (b) supplies and equipment. SEA~CI~~ Page 105

Probable duration of assistance. Until the end of 1970.

Work done during the year. A WHO consultant in hospital administration was assigned for two months towards the end of 1964, to advise on the development and organization of the Mingaladon Institute of Medicine*. His recommendations are under consideration by the Oovernment.

Steps are in hand to recruit staff in various fields for assignments to the Institutes of Medicine in Mandalay and Mlngaladon.

Durma 200 Fellowships R

Epidemiology: A twelve-month fellowship for study in Europe am India.

Burma 201 Pellowships T A

Paediatrios: A twelve-month fellowship for study in the United Kingdom am3 Uganda.

Physiolo~: A twelve-month rellowship for study in Ireland.

EJidemiology: A nine-month fellowship for study in Europe.

Clinical Pathology: A twelve-month fellowship for study in the United Kingdom.

Manufacture of Freeze-dried Smallpox Vaccine: Two fellowships - one for three and a half months and one for two months - for study in the United Kingdom.

There are now three Institutes of Medicine in Burma - one in Rangoon, one in Mingaladon and one in Mandalay (see Chapter 7 of Part I of this report).

SEA/RC18/2 Page 107

3. CEYLON

Ceylon, favoured with good communications and with a wide network of health services in prevention and medical care, continued to show declining mr- tality trends. Morbidity statistics, however, reflect increasing pressure on hospital and out-patient facilities.

During 1964, the right to private practice by doctors in government service was abolished. A system of channelled consultant practice was introduced.

Tuberculoeis presents a serious public health problem to the country. During the year, the current three-year BCG programme was completed, and a second threeyear programme started.

Preventable diseases arising from poor environmental conditions - diarrhoeas, dysentaries, infectious hepatitis, poliomyelitis, etc. - are the major contributors to ill-health, particularly of mothers and children. The Government has been much concerned with the problem of providing safe water supplies and has concentrated its efforts towards the development of the technical and administrative organization required for the implementation of a natioual water supply programme. Broad principles for the achievement of the objecttve, including assistance from the United Nations Special Fund and international financing agencies, have been accepted. High priority is now being given by the Government to the provision of a numk of safe urban water supply schemes as a first stage in the national programme.

Ceylon was proceeding towards the maintenance phase of malaria eradication when several focal outbreaks, involving more than 200 indigenous cases, occurred from September 1964 to April 1965 in various areas. Although some weakness in the surveillance mechanism has contributed to the occmence of these outbreaks, the persistence of a number of asymptomatic cases of malaria in the population ie en important factor in the setback which demands careful consideration, A determined effort to eliminate the asymptomatic case hag been made. The affected areas have reverted to the attack phase and have been kept under strict observation.

There was a sudden increase in the incidence of pollomyelitte. Another mses-immunization programme was undertaken during 1964.

In the field af medical education, teaching and services in preventive and social medicine have been expended, and paediatric education is be@ further developed. Although there was no intake of new students ia the post-Basic School of Nursing, a short refresher course for matrons was given, with emphasis on better co-ordination and correlation between educational programmes and nursing services. The Institute of Hygiene in Kalutam ia being geared for the training of health staff as well as for the promotian of an integrated pattern of health services.

In December 1964, extensive damage wae caused in the northern part of the Ieland by a cyclone. There was considerable loss oflife amongst fiehermen and much damage to properly, crop and fie- veseels. Prompt precautions were taken by the Gwmm& .to prprcnent the onret of epldemio% SEA/RC18/2 Page 109

ZnOTECT LIST

Project No. Source of Funds Co-overatinti Agencies

Ceylon 5.2 --Venereal-Disease Control (Fluorescence R Laboratory Technique in VDT) UNICEF (Sept. 1964; - )

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

Assistance orovided by WHO during the year. (a) A consultant for about three weeks; (b) two three-month fellowships for study in India and Singapore.

Probable duration of assistance-. Until the end of 1967.

Work done dur1n.q the year. In September 1964, a WHO consultant; advised on the upgrading of laboratory facilities required in the venereal-disease control programme in Colombo and in the prJvinces. In particular, he assisted in the installation of fluorescence microscopy equipment and demonstrated its use in the diagnosis of syphilis and gonorrhoea. The equipment was provided by UNICEF.

Further consultant service is planned.

Ceylon Zj.g* . =Leal Stares Management R (July 1965 - I

Aim of the project. To study the present state of purchasing, store-keeping, storage and distribution of drugs, medical supplies and equipment conducted under the Department of Health, and to advise on further measures which are desirable for the reorganization and improvement of medical stores management.

Assistance urovided by WHO during the year. A consultant.

Probable duration of assistance. Two months.

Work done during the yeay. The consultant took up his assignment in July 1965.

Ceylon 38 Strewthenit%? of Health Services (E~idemiolo~ TA (Feb. 1756 - Scpt. 1960; Feb. - March 1962; Aug. 1962; Aug. - Nov. 1964)

Aim of the vro.lect. To establish an epidemiological unit in the Directorate of Health Services, Colombo; to make epidemiological surveys of disease distribution

*The first phase of the project was completed in December 1958 under project number "~cylon23". SEA/RCl8/2 Page 110

in Ceylon and assessments of the control programmes; to train undergraduate and post-graduate students and a counterpart; to plan future veterinary public health work, particularly on zoonoses and their control.

Assistance provided by WHO during the year. (a) A consultant on poliomyelitis for ten weeks; (b) supplies and equipment.

Work done. WHO provided an epidemiologist from February 1956 to December 1957 and another from April 1958 to July 1959; a one-year fellowship was avarded for advanced study in epidemiology. The first task was to make a preliminary study of the existing organization of health services and facilities for epidemiological investigations and teaching. In July 1959 a Division of Communicable Diseases was set up within the Health Directorate, under which were included the Epidemiological Unit, a Specialized Campaign Section and a Health Veterinary Section. On return from studies abroad the national counterpart to the WHO epidemiologist assumed full responsibility for the work of the Unit.

A specialist in infectious diseases, was assigned in July 1959. and improvements were made in the Angoda Fever Hospital and in provincial hospitals in isolation, diagnostic and laboratory procedures, as well as in management, administration and the teaching of infectious diseases. The WHO specialist completed,his work in September 1960.

Since then, the recording and reporting procedures have been improved. and the Epidemiological Unit has been advising and directing field investigations of communicable diseases. The laboratory examinations needed for the various investigations are conducted by the Medical Research Institute.

In 1962 a WHO consultant in veterinary public health was assigned for six weeks to help in preparing plans for investigations on the prevalent zoonoses and their control. The Epidemiological Unit undertook investigations on a poliomyelitis outbreak and on diarrhoea1 diseases in the Colombo area. A second epidemiologist, returned from a WHO fellowship and joined the Unit; a twelve-month fellowship was awarded to a veterinary public health officer.

In 1961(, a WHO consultant was assigned to assess the problem of poliomyelitis and the imunizati3n programme in progress. He studied the poliomyelitis vaccinations carried cut in 1762 and 1963, and the epidemiological and clinical data collected. Paired blood samples were sent to the Institute of Epidemiology and Microbiology, Prague. for examination of antibodies against polio and other enteroviruses, and aliquots of the sera wore also sent to the Communicable-Disease Centre, Atlanta, for testing with selected arboviruses and KPD antigens.

Evaluation. The Epidemiological Unit has been successfully established and is fully participating in the investigation of communicable diseases and in advising measures for their control. SEk/XC18/2 Page 111

Ceylon 45 Health StatisLlcs TA (Apr. 1957 - Dec. 1961; Sept, 1964 - ) ". Aim of the project. To revise the system of records and reports in the health services and to train personnel in the design of documents, processing of statistical data and qther advanced techniques in medical and health statistics.

Assistance pravided by WHO during the year. (a) A medical records officer; (b) a twelve-month fellnwship for study in the United States of America; (c) supplies and equipment.

Prabable dumtlan of assisuance. Until thc end of 1968.

Work done during the year. A WHO nedical recards officer took up duties in January 1965 and, after a period of urientation, started work toward improvement of the medical records system in Colombo South Hospital.

The WHO statistician attached to the Hospital Statistics Project (SEAR0 72). stationed in Bangkok, visited Ceylon in February. With the medical records officer, he proposed an outline for the development of the medical records System and the hsspital statistics system.

Ceylcn 4z Medical Education R (~ov.1963 - April 1964; Oct. 1964 - )

Aim of the project. To strengthen teaching in selected subjects in the Faculties of Medicine of the Universlty ^.f Ceylon at Colombo and Peradeniya.

Assistance provided by WHO during the Tear. A professor of preventive and social medicine and a shr,rt-tern c:>nsultant paediatrician.

Probable duration of assistance. Until the end of 1969.

Work done during the year. The WHO visiting professor of preventive and social medicine took up duties in October 1961L. He participated in field visits of groups of students detailed to nbservc tuberculosis and venereal-disease control work, food and water sanitation, and defective hnusing. The Curriculum Committee accepted his recommendations cn tile clntent of an introductory course in preventive and social medicinf and, as requested by the Committee, he submitted an outline for a five-year clurse and training programme in preventive and sc~cialmedicine.

Other accomplishments of the project included the introduction of a revised teaching programme in preventive and soclal medicine in the first and third years of the medical schrals of Colombo and Peradeniya. Bedside teaching of preventive and social medicine in the Colombo School was introduced as a joint enterprise of the Departments bf Medicine and Public Health. Also a family training programme, undertaken in co-operatl3n by the Departments ofPaediatrics and Public Health, covering field tralnlng in family medical care, was started by the Department of Public Health, Pcradeniya.

A short-term consultant paediatrician was assigned in May 1965 for a period uf nine months. He has assisted in strengthening the teaching of social paediatrics in Colombo and Pcradeniya and has advised on the initiation of posl-graduate paediatric education leading tu a Diploma in Child Health. Assistance to the paediatrie aspects of the project has been given by a WHO public health nurse assigned to the project "Nursing Advisory Services" (Ceylon 53). SEA/RC18/2 Page 112

Ceylon 51 Nursing Advisory Servi.ces R (~uly1960 - )

Aim of the project. To develop all aspects of basicand post-basic nursing education through the. Nursing mit in the Department of Health.

Assistance provided by WHO durina the year. A nursing adviser, a psycMsbtic nurse educator and a public health nurse educator.

Probable duration of assistance. Until the end of 1968.

Work dme during the year. No students have been admitted to the school since April 1964. The WHO nurses assisted with the organization and conduct of short COUrseS for matrons who are working in hOspitals where there are nursing schools. These courses have been successful in improving Patient care and in providing better correlation of nursing education and nursing services by giving the matron a deeper understanding of the educational programe.

The UHO nurses continued to assist with paediatric nursing education in basic schools of nursing,

The psychiatric nurse educator completed his assignment in November 1964, and the nursing adviser left, in Peblvary 1965.

Ceylon 56 Filariasis Control TA (Dec. 1959; April - July 1961; Sept. 1961; Aug. - Sept. 1963; June 1965 - )

Aim of the project. To.study the problem of filariasis contro-1, to strengthen the present filariasis control programme and to introduce such new control methods as may be indicated.

Assistance provided by WHO durinu the year. (a) An entomologist; (b) a twelve- month fellowship for study in bhe United Kingdom and India; (c) supplies, equipment and a transport vehicle.

Probable duration of assistance. Until the end of 1967.

Work done during the year. Parasitological and entomological surveys were undertaken in the larger urban areas on the south-west coast where W. bancrofti filariasis 1s endemic. To facilitate expansion of the antl-filarial control activities so as to cover small toms withln the endemic belt, WHO provided mlcrOscOpes to help increase case-finding and a transport vehicle for distribution of bulk quantities of oil and larvicides. (he fellowship was awarded to a medical officer of the project in September 1964.

An entomologist was provided by WHO in June 1965, and an epidemiologist/ parasitologist is expected to be in position in the second half of 1965. A short- term consultant visited the project in July 1965 to prepare a plin of action to cover the activities of the project in the next few years. SEA/RC18/2 Page 113

Ceylon 58 Malaria Eradication R (~ug.1y60 - j (USAID)

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

Assistance provided by WHO during the year. (a) Part payment of local costs for intensifying surveillance activities; (b) two three-and-a-half-month fellowships for study in the Philippines and India, and nine fellowships - one for six weeks and the rest for two weeks - for study in India (in addition, two fellowships - one for six and one for seven weeks - were swarded under the scheme for Exchange of Scientific Workers); (c) supplies and equipment.

Probable duration of assistance. Until the end of 1967.

Work done during the year. Spraying was withdrawn from the entire island from 1 my 1964, and the position appeared extremely satisfactorily. In September, however, it became apparent that a minor outbreak was taking place in the eastern and south-eastern parts of Ceylon, and between September 1964 and the end of April 1965 nearly 300 cases of malaria occurred. Remedlal measures IncluOed residual spraying, presumptive treatment and mass radical treatment. A consultant 1s being recruited to advise the Ouvenuncnt on measures to be taken to prevent further outbreaks.

Medical Rehabilitation (Poliomyelitis) (April 1962 - Sept. 1964; - )

Aim of.the prw. To provide facilities for the management and rehabilitiation of paralytic cases and to carry out an immunization programme for the control of the disease; to advise on the use of artificial respiration apparatus.

Assistance Provided by WHO during the gear. A physiotherapist.

Probable duration of assistancr. Until the end of 1966.

Work done during the year. The WO physiotherapist, after spending eleven months in Ceylon, left in September 1964. During her assignment she assisted in training physiotherapists and nurses in the rehabilitation and care of poliomyelitis patients and in planning the improvement uf rehabilitation services and facilities.

Her report stresses the nced for each case of bulbar polio to be seen, on admission to the Children's Hospital, by a physician experienced in the management of respiratory failure,and for a full-time orthopaedic surgeon to be appointed to deal with the numerous major orthopaedic problems that have resulted from the 1962 polio epidemic. Other needs are for intensive training of nurses, more equipment, an orthopaedic appliance workshop, more physiotherapists for rehabill- tation work, post-graduate courses and seminars, literature on rehabilitation and greeter attention to the education of parents and guardians in the home care of paralysed patients. SEA/Rc18/2 Page 114

Ceylon 64 Community Water Supplq R (oct. 1963 - )

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

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

Probable duration of assistance. Until the end of 1967.

Wo* done during the year. The main emphasis in the project continued to be on developing an engineering and administrative organization for the erficient implementation of a national water supply programme. Advice on both desim and maintenance of works was given to the Department of Water Supply and Drainage.

Following the programme for urban water supplies~presentedby the Director of the Department of Water Supply and Drainage in an interim report. high priority is being given to the development of several urban schemes which the Oovernment proposes to carry out before starting the main programme. Some technical reports, including one on public relations and another on some aspects of organization and management, were prepared by the WHO sanitary engineer.

Draft legislation for the creation of a National Water Board has been completed by a speclal sub-committee appointed by the Government. As a pilot project, the water supply schemes for toms north and south of Colombo, down ta and including Galle, were considered by the Government to be of the highest priority and suitable for the initial establishment of a Central Water Authority. In readiness for future possible international financial aid, bacpsr>und inf>rmati~n-n var1,us projects, In the lines 3f the IDA puesti~miru, hes been collected.

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

Aim of the Project. To make long-term studies of the epidemiology and control of diarrhoea1 diseases and to develop further the bacteriological diagnostic facilities for enteric diseases in the principal hospitals and in the field.

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

Probable duration of assistance. Until early 1968.

Work done during the year. This Droject developed satisfactorily,concentrating on improvement of diagnostic and treatment facilities for diarrhoea1 diseases in two major hospitals and on field epidemiological studies. SEA/RC18/2 Page 115

Laboratory diagnostic and treatment facilities for enteric diseases, particularly among children, were developed or introduced at the Angoda Fever Hospital and Ragama General Hospital.

Bacteriological and parasitological field surveys were continued in the study areas of Horape and Pclyagoda. The overall prevalence rate of different types of helminthic infections was as high as 85% among the child population under ten years of age. Ascaris lumbricoides and Trichuris trichuria were often associated. Trichuris topped the list and was followed by Ascaris. which was seen in 82% of the households, affecting not less than 65% of the children. It has been estimated that the Ascaris prevalence rate increases with age and is about 58% in children at the age of 2 years. 7C$ in those between 3-5 years and 80% in those between 6-10 years. A mass therapy pro- gramae against ascariasls was initiated, and the results are being folloued UP.

In-service training courses in entero-bacteriology and parasitology were undertaken.

The pnoject receives guidance fr3n the National Advisory Sub-cormnittee on Diarrhoea1 Diseases and maintains close association with the Medical Research Institute, Colombo.

A Seminar on Diarrhoea1 Diseases was held in Colombo on 26 and 27 February 1965. It was assisted by a WHO temporary adviser and the WHO bacteriologist attached to the project, who took an active part in the preparations and proceedings.

ceylon 74 Institute of Hy~iene,Kalutara R (July - Sept. 1964; - ) TA

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

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

Probable duration of assistance. mtil the end of 1967.

Work done durinu the year. A WHO consultant,who was assigned in July 1964, completed his work in September and submitted a report. His recommendations relate to the programme of the Institute, the administrative organization, and the training courses being given as well as to the services available. He has also stressed that the Institute could be developed not only as a training centre but as a health laboratory for Kalutara District and for the Southern Province. Kis report was sent to the Government. SEA/RCl8/2 Page 116

Ceylon 200 Fellowships R

Tuberculosis Control. A two-week fellowship for study in India

Ceylon 201 Fellowships TA

Sanitary En~ineerIn8. A four-month fellowship for study in Europe and the United States of America.

Radio~raphy. A twelve-month fellowship for study In the United Kingdom (to start in September).

m. A twelve-month fellowship for study in the United States of America (to start in August).

Public Health. A ten-month fellowship for study in Europe (awarded under the earlier pr~jectCeylon 4). The fellowship will start in October.

SEA/RClE/2 Page 117

4. INDIA

India's Third Five-Year Plan will draw to a close in March 1966. It is expected that in the Fourth Plan, beginning in April 1966, there will be an increased budgetary provision for health of almost three times the allocation in the Third Plan. The Ministry of Health is planning advance action during the remaining months of the Third Plan to ensure timely implementation,under the Fourth Plan,of programes such as those for water supply and sanitation, malaria and smallpox eradication, leprosy, cholera and cancer control, undergraduate and post-graduate medical, dental and nursing education, and the training of auxiliary health workers.

A Central Health Service, covering all medical and public health pats under various ministries and departments (of the Central Government only) except those of Defence and Railways, has been established.

The national malaria eradication programme, which has been operating for the past six years, expects to have almost all units in the consolidation or maintenance phase before the end of the Third Plan. Strengthening of the national health machinery, especially the primary health centres in rural areas, has continued,not only in the interests of the general health programme but also to make it possible to integrate into the services the maintenance phases of the malaria and smallpox eradication and other specialbed disease-control programmes.

The national smallpox eradication programme, since its inception two years ago, has covered 330 million people out of the total population of 470 million, resulting in a marked lowering of incidence as well as in mortality from this disease in most of the States. Production of freeze-dried smallpox vaccine in four centres in India is proceeding and should be sufficient to meet the country's needs in the maintenance phase of the campaign.

Cholera continued to be endemic in Calcutta and in 44 other districts. ho- vision of protected water supplies in these districts along with adequate drainage and sanitary facilities, as envisaged in the Fourth Plan, and the implementation of the master plan for the water supply of Greater Calcutta should help to remove the main endemic sources of infection.

The scheme for domiciliary treatment of tuberculosis, as worked out at the Madras Chemotherapy Centre and the National Tuberculosis Institute, Bangalore, gives great promise, but shortage of drugs will be a serious problem. SEA/RC~~/~ Page 118

The corr~cPAe+imof rlwal health services has made progress,but much greater expansion is urgently needed. A beginning has been made in strengthening health administration at the district level.

Plana have been made to increase admissions to medical schools from 11 000 in 1965-1966 to 20 000 by the end of the Fourth-Plan period and to post- graduate courses from 800 to 3 500; this will require a big effort Preliminary steps have been taken to establish four more institutes for post-graduate medical education, with emphasis on the training of teachers. This will be in addition to the three institutes already existing.

State health education bureaux have now been established in thirteen States, and it is expected that by the end of the Third Plan all the States in India will have such bureaux. sm/Ttc18/2 Page 119

PROJECT LIST

Project No. Source of Funds Co-o~erating bencies

India 5) Tuberculosis Chemotherapy Centre. Madras TA (Dec. 1955 - ) (BMRC) (ICMR)

Aim of the project. To undertake controlled trials in the search for simple. effective and inexpenslve methods of tuberculosis control through domiciliary chemotherapy of ambulant patients.

Assistance provided by WHO durin~the year. (a) Two medical officers, a bacteriologist, a laboratory technician and two short-term consultants; (b) supplies and equipment. (A five-month fellowship was awarded under India 201).

Probable duration of assistance. Until the end of 1969.

Work done during the year. The numbers of new patients and contacts attending the Centre, as well as the number of reattendances, have increased. With the increase in intake. home visits have also gone up considerably.

The study of a once-we~klyregimen of chemotherapy.started in February 1964,is being continued. A total of 140 patients have bcen admitted to this study, and approximately 110 patients are still needed to complete the planned intake. A comparative study of 200 cultures was carried out in the Centre and the Drug Resistance Survey Laboratories to examine quality control of the sensitivity tests performed in both laboratories. The study of methods of sensltlvity testing being carried out on strains fram patients in Study VII and the wlrk on serum and drug concentrations in urine proceeded well. The research work is described in detail in Part I, Chapter 8. In the laboratory, investigations also included 20 116 sputum smar examinations, 21 266 cultures. 5 112 sensitivlty tests, 18 068 urine examinations, 762 haematological examlnatlons and 1 646 microbiological assays 3f anti-tuberculosis drugs.

In the X-ray Section, 7 926 .persons were X-rayed and 280 persons tomographed.

The Centre was visited by two WHO shlrt-term consultants from the British Medical Research Council during the year.

A number of reports and papers have been published by the Centre and others are under preparation. These are listed in Annex 6.

Several doctors, nurses and technicians from countries of South-East Asia and four other regions were given tralning for varying periods. SEABCl8/2 Page 120

The Director of the Centre has been awarded a five-month WHO fellowship to visit a number of eentres in the United Kingdom and Europe 50 that he may observe their research methodology and activities in the field of tuberculosis.

India 71.2" Mental Health R (Aug. - Dec. 1964)

Aim of the ~rodect. To improve mental health services and psychiatric education.

Assistance provided by WHO during the year. A consultant in psychiatry for four months.

Work done. A WHO consultant in psychiatry was assigned from Arigust to December 1964 to advise on the upgrading of mental health services in India and on improved methods of teaching psychiatry at undergraduate and post-graduate levels. She visited mental hospitals and institutions in Bangalore, Ranchi, Agra . Amritaar, Lucknow, Banaras , Bareilly and Aligarh. Her report is und?? study.

The project has pointed to the need to improve education in psychological medicine and to increase facilities for out-patient treatment of psychiatric patients.

India 81 Leprosy Control

India 81.1 Leprosy Control (National Programmel R (Jan. 1961 - ) UNICEF

Aim of the project. To develop a country-wide programme for leprosy control.

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

Probable duration of assistance. Until the end of 1968.

Work done during tho year. The WHO leprologists worked in close co-operation with the Director of the National Leprosy Control Programme and the Directors of Medical Services of States in which leprosy is endemic. Special attention was paid to the intensification of leprosy control activities in Andhra Pradesh and Madras (which account for 50% of the total leprosy cases in India), to the provision of additional training facilities, and to the strengthening of supervision.

One leprologist completed his assignment in September 1964.

*The first phase of this project was completed in June 1960 under project number "India 71". SEA~Rc18/2 Page 121

The following data concerning control centres and other particulars relating to the National Leprosy Control Programme were r$p<;rted towards the end of 1964:

Number of control centres 166 Number of survey, education and'treatmrnt 'centres - 487 Number of centres run by voluntary agencies - 32 Number of training centres - 11 Total number of cases registered (through governmentaland non-governmental agencies) 580 000

Total number "f cascs under treatment (through governmental and non-governmental agencies) 530 000

India 81.2 korosy Control. Srikakulam R (Jan. 1962 - ) UNICEP

Aim of the project. To provide technical direction for 3 leprosy control project organized and naintained by the Danish Save the Children Organization, and to train leprosy auxiliary personnel.

Assistance provided by WHO during the year. A leprologist.

Probable duration of assistance. Until the cnd of 1968.

Work dune during the year. Leprosy control was cxtendcd to two new taluks of Srlkakulam and Nsrasannapeta, raising to five the total number of taluks in which activities are in operation, and bringing the total population coverage up from 798 391 to 1 096 659. Training of new groups of auxiliary workers was continued; this enabled the total number of field units to be increased from 40 to 54. Up to April 1965 thc total number of registered and treated cases was 24 359 - an increase of 9 076 in twelvc months. The headquarters of the project arc in Pogiri.

The Board ,if the Danish. Savc the Children Organization and the Government of India have agrced on the establishment of another leprosy centre at Oanjam in Orissa State . starting in . 1966. It is intended that leprosy control activities will be supervised by the WHO leprulagist based at Pogiri.

UNICEF has assisted the programme with transport and supplies.

India 84 Environmental Sanitation, Uttar Pradcsh TA (March 1958 - Dec. 1964) UNICEP

Aim of the Droject. To set up in 3 rural area a pilot project for improving water supplies and excreta disposal; to plan and carry out a sanitation programme, including the design, operation and malnccnance of simple, practical and cheap sanitary S~~,'ft~l8/2 Page 122

installations; to organize a programme of health education; to train technicians, sanitarians and other personnel.

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

Work done during the year. The main objective of the proJect was to demonstrate the improvement of public health in rural areas through the improvement of water supplies and,excreta disposal facilities and a bettgr understanding by the people of filth-borne disease. In the work on this project, it soon became evident that it would be essential to develop a system of sanitating villages in a manner suitable to physical, social and economic conditions in rural areas and adapted to the existing organization of government departments and staffing.

The project was carried out under the responsibility of the Planning Research and Action Institute, Lucknow. WHO provided a sanitary engineer from May 1958 to December 1964 and a sanitarian from March 1958 to December 1962. A station wagon and some eqiilpment and supplles were also provided. UNICEF gave materials ahd equipment for water supply construction work.

Suitable latrine structures were designed, tested and installed in the pilot areas, and a basis was laid for wide extension of the latrine scheme throughout the State. The methodology for the promotion, operation and maintenance of handpumps and small piped water supplies in rural areas was studied, and piped-water supply systems were under construction.

Evaluation: ~lthou~hthe project did not accomplish all the objectives originally set, it has significantly contributed to the solution if excreta disposal and water supply problems in rural areas. The satisfactory operation of the scheme for the construction and supply of latrines and latrine parts to villages in community development blocks constituted a major accomplishment. The programme for training well-drilling mechanics also will provide staff to carry out basic schemes for the supply of handpumped water for small ~ommunltles,and the insballation of piped-water supplies has provided valuable experience which can be used in the development of similar'systems in rural areas.

Incia )1 Traininn in Preventive and Social Medicine TA (Feb. 1956 - Dec. 19571 March 1959 - Sept. 1960; UNICEF Aug. 1961; July 1962 - Jan. 1963; Dec. 1963 - Sept. 1964)

Aim of the project. To develop the departments of preventive and social medicine in selected medical colleges, incorporating preventive medicine into the general curriculum and organizing'courses for undergraduates; to establish urban and rural public health practice fields for training; to train national counterparts to take over from the WHO professors.

Assistance provided by WHO dur1n.q the year. A professor of preventive and social medicine at Pondicherry Medical College.

Work done, WHO assistance to the project started in 1956 and ended in 1964. During this period, the Organization provided six visiting professors in preventive and social SEA/RC~~/Z Page 129

medicine, a consultantsand two one-year and nine two-year fellowships. The professors were assigned to medical colleges in Assam, Nagpur, Bombay, Lucknow, Kanpur and Pondicherry, where thcy assisted in carrying out the following activities:

Assam Medical Collc~c,Dibrugarh

The WHO profcsscr assisted in drawing up a curriculum. A field training centre for undergraduate expcricncc was i9rganized. A full Chair of Preventive and Social Medicine and staff fsr tho Department were sanctioned.

Medical College, N~SP-lr

The WHO prufessor worked In the Department uf Preventive and Social Medicine. His cauntcrpart was sent to Harvard University for training on a WHO fellowship for two years. The Dc~artmentwas firmly established and staffed;a curriculum of preventlye and social rncdicine, spread over four years of the medical course, was put into effect; field practice work was developed, and three field research projects were undertaken in callaboration with cther University Departments; a public health museum was set up. and training fsr curatsrship given to a sultable national staff member.

The professor .ilso made a survey of the tcaching of preventive and sacial medicine in the three medical cullcges in Bombay :I& discussed the planning of teaching with the relevant aitthorities.

Topiwala Naticnal Medical ColleRe. Bombay

The WHO professor assisted in organizing and revising the teaching of social medicine and jn training staff and students and gave lectures to academic bodies in Bombay. A Civlr of Preventive and Social Medicine has been established in the college. Studies ,on stillbirtlt, lncidcncc of cancer and suicldc in Barnbay were undertaken by the students .,f the Department.

K.G. Medical Colleae. Lucicnow

The WHO professor cullabarated in the teaching programme. Teaching in preventive and social medicine was extended to four of the five years uf the MBBS course. The number of hours of formal teaching was reduccd to allow morc time for field demonstrations. Activities were also directod towards the development of post-graduate training. Research work was started or) problems rcf immediate public health importance to India, and several studies were completed.

G.S.V.M. Medical Colleue, Kanour

The WHO professor assisted in the preparation nf a preliminary report on the tcaching of preventive and sucial mcdlcine. A coursc of lcctures based on the new programme was begun ulth first-year students.

Medical College, Pcndicherry

The WHO professqr took part in the lecture and training programme and helped in organizing integrated bedside teaching. The possibility of practical experience in preventive and social medlclne was explored. Classes combining the teaching of paediatrlcs, preventive mediclne and psychiatry were started. sm/Rc18/2 Page 124

During January-March 1962 a consi;..tant visited thirteen main rnedical centres in India, including twenty-four medical colleges and also the All-India Institute of Wgiene and Public Health, Calcutta, especially with respect to its course for the training of professors in preventive and social medicine. The object of his visit was tu assess the impact of the WHO fellowship schic- on ':hz teaching of preventive and social medicine in the country and to advise on furtl?-r steps tu be takon to make addi. tlonal improvements in the teaching. In his report (~h:ch is a si,;nol document on the subject) he made very useful suggestions and recommendations not only for raising the level of teaching.in preventive and social medicine but also for the general upgrading of medical education in the country;

In order to enhance the effects of this assistance, WHO has accorded technical approval to assistance by UNICEF in the provision of necessary supplies, equipment and transport vehicles to medical colleges in India for developing their departments of preventive and soclal medicine and their training areas. So far,forty medical colleges have been helped by UNICEF in this way.

India 98 Short Courses for Nursing Perso%? R (July 1957 - J

Aim of the project. To continue and expand educatisn programmes which provide for the development of concepts and skills in organization, conduct and evaluation of short courses for nursing personnel.

Assistance ~rovidedby WHO durinp, the year. A nurse educator; half the cost af travel and maintenance expenses of the participants in the courscs,and assistance from WHO nurses.

Probable duration of assistance. Until the end of 1968

Work done during the year. Three short courses were held during the year. Two of the courses were for nurse tutors; they were devoted mostly to curriculum planning and were held in Ahmedabad, from 8 August to 10 October 1964 and from 11 January to 6 March 1965, with 19 and 16 participants respectively. In the first, the new draft syllabus prepared by the Indian Nursing Council for the education of nurses was used as a basis for study. In the second, two weeks rrere spent in the rural training unit at Bavla, and the last three weeks were devoted to curriculum development. The other course. held in Chandigarh from 7 September to 3 Oct~ber1964, was for 19 senior nurse administrators, to give them a better understanding of the role of thc nursing superintendent within the health services. Here, particul3r emphasis was placed on administrative principles and procedures and on the increased responsibility of the matron in a teaching hospital.

A WHO nurse educator joined this project, on a full-time basis, in March 1965 and, in consultation with the Nursing Jc13.1ser i;l thc Government of India, prepared preliminary plans for conducting furt:-er short courses for nursing personnel and collected, prepared and organized reference materials tc be used in such courses. She assisted the Municipality of Bombay with a "workshop" in in-service education from 4 to 7 May 1965. This was attended by 19 senior nurse administrators from the City of Bombay and the State of Haharashtra. In July she conducted four "study-days" for ward sisters at Safdarjung Hospital, NEW Delhj. SEApCl8/2 Page 125

India 99 Nursing ErlucaLion (Public Health ~r>te~ratinn): Assistance to States*

India 99.3 Nursiw Education (Public Health ~rlte~ration), Orissa TA (May 1958 - Dec. 1964)

Aim of the DroJect. To integrate tr3ining in public health into the basic training of nurses; to provide supervised practical observation and experience for student nurses in a selected undergraduate school of nursing,

Assistance provided by WHO duriw the year. A public health nurse.

Work done. WHO'S assistance to nursing education at the .cuttack Medical College aospltal was startea in may 1958 and continued until the end of 1964, when the last WHO Public health nurse completed her assignment. This assistance was directed toward strengthening and upgrading all the activities of the Nursing School, with special emphasis an the concepts and practices of good public health nursing throughout the curricula. In a large measure these objectives have been achieved.

The following were some of th~impartant achicvcments during the period from 1958 to 1964:

(1) The minimum educational standard for admission to the School was raised to matriculation.

(2) A qualified midwifery tutor was placed in chargc of the midwifery programme.

(3) The pre-clinical (PTS) period was extended to three months.

(4) It was agreed that all students should be admitted to a single nurse education programme, rather than being divided into "public health students" and "general nurse students".

(5) The content and sequence uf the curricula were strengthened and ncw teaching methods introduced.

(6) Regular deputation of nurses to advanced educational programmes was established, and

(7) A Snctijr was appbinted to take care uf tke health of the studcnts.

Since the start of the projcct. 130 studcnts have followed the integrated programme.

'This project started in September 1957 and is expected to continue until the end of 1967. s~~/Rc18/2 Page 126

India 99.2 NuTsiw Education (Public Health Integration), Goa TA (Sept. 1963 - I

Aim of the uroject. To introduce patterns of basic nurse/midwife and auxiliary nurse/midwife education similar to those laid down by the Indian Nursing Council; to develop in-service training in all teaching hospitals; to improve patterns of nurclng administration for the nursing component of all health services.

Assistance provided by WHO during the year. A nurse educator.

Probable duration of assistance. Until the end of 1967.

Work done duriw the year. The project has made measurable progress. The opening of schools for both professional and auxiliary-level nursing personnel was delayed by the lack of physical facilities for both hostel and school buildings in three of the Four centres selected.

The first School for Auxiliary Nurse-Midwives was opened in Margao in September 1964. .

Work progressed on the renovation of the building which will form the Panjim Basic Nursing School, and it is planned to open the School for Auxiliary Nurse Midwives at the Asilo Hospital in Mapuca before the end of 1965.

An inspection committee set up by the' Maharashtra Nursing Council gave recognition and approval to the Margao school. Approval was also accorded to: the conversion of this school to a basic nurse training programme,and to opening the auxiliary nurse- midwifery school at Mapuca mentioned above.

India 99.6 Nursing Education (Public Health Inte~ration). Punjab TA (July 1965 - 1

Aim.To aTosist basic nursing schools being used as teaching centres for post-basic nursing education, to improve the overall administration of the educational programme and to provide sound learning experiences for student teachers and administrators.

-7. -7. A nurse educator.

Probable duration of assistance. Until the end of 1967.

Work done during the year. A WHO nurse educator was assigned to start WHO'S assistance to this project in July 1965, on transfer from the Post-basic Nursing Education Project, Punjab (India 136.3). -India 101 National Trachoma Control Programme R (Feb. - May 1956; Oct. 1956 - ) UNICEF

A:m of the project. To ?educe transmission of infection, morbidity and disabling conditions in the community to such a level that trachoma and secondary bacterial SEn/RCl8/2 Page 127

infections will cease td be a public health problem Ln the areas under treatment; to continue to give training in control measures to ophthalmologists, general physicians and field personnel; to pursue the programme of health education at all levels; to further the implementation of the policy of integration of communicable eye-disease control intn the general health services.

Assistance provided by WHO during the year. A trachomatologist.

Probable duration of assistance. Until the end of 1967.

Work done durinR the year.Trachoma control activities were continued, with 25 units in Rajasthan, 15 in Punjab, 7 in Uttar Pradesh, 6 in Gujarat, and one each in Bihar, Madhya Pradesh, and Jammu and K3shmir.

The assessment carried out in the States of Rajasthan, Punjab and Gujarat showed certain weak points and deficiencies in the programme. Steps have been taken to overcame these shortcomings and thus to strengthen the activities. Quarterly meetings were held to review progress and to agree on methods for greater coverage of the population.

WHO provided the services of a trachomatologist, while UNICEF supplied the required antibiotic eye ointment, vehicles and other equipment. The Government of India issued a notification allowing the sale of antibiotic eye ointment without licence through village panchayats, co-operative depots, village groceries, primary school teachers and others in the villages.

Taking into account the long-term nature of trachoma as a chronic disease and of its control with available antibiotic treatment.much study was given during the year %o working out a plan for a less specialized and less costly organization based on the integration of the control of the disease into other existing or developing health services at primary health centres and,in particular,as part of the services introduced for malaria eradication in the maintenance phase.

India 103 National Tuberculosis ProRramme TA . (oct. 1956 - Oct. 1957; Nov. 1957 - ) UNICEF

Aim of the project. To develop a national tuberculosis control programme by providing technical guidance and assistance based on model rural and urban control programmes, epidemiological findings and operational research; to train the requisite number of public health workers uf various categories to be employed in tuberculosis control centres at district and state level; to develop adequate methods and procedures for assessment of the country-wide programme.

Assistance provided by WHO during the year. Three medical officers, a statistician, a public health nurse and a short-term nurse consultant.

Probable duration of assistance. Until the end of 1968. sEApc1s/2 Page 128

Work done durim the year. In the natlonal tuberculosis programme, up to the middle of June 1965, 71 district centres had been assisted by UNICEP.and 67 of them had received government budgetary provision for travel, etc. BCG teams had been poated to 32 district centres, and peripheral activities had started in 35. Of these district centres, 46 have submitted reports on their work, and it is found that the average district has recently been diagnosing patients as tuberculous at the rate of 2.400 a year, compared.with 2 000 per year six months ago, when only 22 districts had reported. There was some variation in achievement from place to place.

hro more training courses for key personnel were conducted by the National ~rculosisInstitute. Bangalore. Since the beginning of the training courses in 1961, 900 persons have been trained, including 8 from other countries of the Region. A further training course (the tdnth in the series) started in July 1965 and will , raise the figure to over 1 000.

The Epidemiological Section of the Institute, in addition to carrying out subsidiary studies, resurveyed for the third time 45 out of 133 villages selected for longitudinal survey. Two epidemiologists, one from Trivandrum and another from Madras, completed a special three-month training course. The tuberculin testing of cattle was resumed on a small scale, and 33 of the 38 animals which were found positive some months ago were retested with Weybridge tuberculin. Among the subsidiary studies, an eighteen-month follow-up of the boosting investigation has been undertaken in eight villages of Magadi Taluk.

To study the experience of 212 personsmztebyl+h thibcetazone in Runkur District, the 30~1ologlcal~tlonlntervieued7F persons. It was declded to interview the remaiader after they had completed one year of treatment. Another study, 'Evaluation of tuberculosis as a health problem in rural areas", was started,and interviews Were held in five villages. Much time was devoted to coding and checking material obtained from the third-year follow.up of 206 resistant cases in Bangalore. The Sociological Section is now making enquiries into the action taken by patients Suffering from Infcctious tuberculosis discovered in the longitudinal survey. Another enquiry was started into suffering caused by tuberculosis compared with other diseases; this investigation is expected to throw light on the questLon of community awareness of tuberculosis. leprosy, dysentery, smallpox and other communicable diseases.

The Control Section, although engaged in the large-scale training programme of the Institute and the implementation of district tuberculosis programmes in the southern region, also undertook a major review of the operational aspects of BCG vaccination. The Bacteriological Section prepared for publication a paper on "Some operational factors influencing the relative utility of culture method in diagnosis of pulmonary tuberculosis".

At the Institute, efforts were made to define and formulate further the responsibilities of State tuberculosis centres and of the planned regional oentres, and the role of the public health nurse in the programme. In connection wlth this latter problem, a short-term consultant was assigned to the project from February to May 1965, and has presentrd a report on the subject. The various sectiona of thc Institute (X-ray Engineering, Bacteriological, Public Health Nursing, and Statistical) continuod to contribute both to the research work and to the practical aspects of devisinz and adopting the most suitable methodology for the national programme. The activities of the various sections of the Institute are also partly reflected in the list of papers given in Annex 7,

The WHO statistician and one af the medical officers left the project in pebruary arid ,:,il,;I;.!~,; ;, :.<. ctji;,. iy, , I x .I 1' 1,h.:l- c-ntiilts .

Hcalth Education: Assistance to Statesf

India 105.2 Health Education, 0rissa TA (July 1964 - )

Aim of the Dro,lect. To develop the Health Education Bureau in the Health Directorate on the lines of modern educatlon methods, including a field study and demonstration centre; to provide crainlrq in health education ti, health workers and teachers, and to plan for health education of the general public.

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

Probable duratlun of assistance. Until the end of 1967.

Work done during the year. The WHO health educator assisted in providing orientation training for two new staff members and re-orientation for existing staff of the Health Education Bureau. Planned interviews with heads of various programmes were used for orientation of Burea; staff and for identifying health education objectives. A newly assigned Pssistant to the Health Education OfPlcer of the Bureau attended a two-month job-oriented training course at tts Central Health Education Bureau, New Dclhi.

The organization of the Bureau w3s strengthened. Job descriptions were clarified, and procedures for planning the Bureau's activities in a systematic manner were worked out during regular staff neetings.

A build in^ to accommodate the Bureau was constructed during the year.

Advlce was given on the health educatlon aspects of !;;:;:n:nmds f .I, wa!...~ scpply, applied nutrition, smailpox eradication and teacher trainlng.

The Bureau prepared various materials and teaching aids, including exhibits, posters, pamphlets and flannelgraphs. The first issue of a health education journal was brought out.

The WHO health educator left the project in mid-June 1965 at the end of her assignment. A replacement is being recruited.

*The project started in mrch 1958 and is expected to continue until the end of 1968. SEA/RCl8/2 Page 130

India 110 Nursing Adviszrn to States*

India 110.r Nursing Adviser to Punjab TA (~ugust1961 - )

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

Assistance Drovlded by WHO during the year. A nursing adviser.

Probable duration of assistance. Until June 1966.

Work done during the year. The WHO nursing adviser, based in Chandigarh, continued her assistance tu this project.

The Assistant Director of Health Services (Nursing),who had been the national counterpart and who had been'auay on a WHO fellowship, returned after obtaining an M.D. Degree at Columbia University in New York, and was re-oriented to the work of the project. The routine of advisory'and supervisory visits throughout the State Was accelerated, and techniques for improving the assistance given during these visits were further developed. .

Plans were made for increasing the professional staff of the Nursing Section at the Health Directorate by employing a nursing education officer to take over the

work related to education for all levels of nursing personnel. ,

Assistance continued to be given to the College of Nursing of Punjab University, in Chandigarh.

India 110.4 Nursin~Adviser to Orissa TA (Oct. 1962 - )

Assistance Drovided by WHO during the year. A nursing adviser.

Probable duration of assistance. Until June 1967.

Work done during tho year. The HHO nursin(p adviser. stationed in Bhubaneswar, continued to assist with routine work in the nursing unit bfK1rhe1He4lth Directorate. In September 1964 her national counterpart left for one year on a WHO fellovsNp (awarded under project India 136).

The establishment of a nursing section in the Directorate with adequate admlnistrative authority has not yet been achieved. This has hampered the develcpment of nursing services. The nursing unit c,ntinuud to be raspcnsiblr td two other sectlons in the

*The project started in December 1957 and is expected to continue until the md nf 1968. SEA/Rcl8/2 Page 131

Directorate, and problems concerning communication, delegation of authority and responsibility and secretarial assistance were not fully solved.

The regular programme of advisory visits to hospitals and public health centres was maintained. Particular attention was paid to development of in-service education for nursing personnel.

India 110.5 Nursin~Adviser to 'Gudarat TA (Sept. 1963 - )

Aim of the projcct, To 'brganize and expand nursing education and nursing services in the State, and to co-ordinate supervisory services so as to ensure uniformly high standards of nursing and midwifery in the health prog6ammes.

Assistance provided by WHO during the year. A nursing adviser.

Probable duration of assistance. Until the end of 1966.

Work done during the year. The survey of nursing needs and resources'in Oujarat. which Was started in October 1963, has been completed, and the work of the nursing services has been geared to the findings. Efforts have been made to co-ordinate the services which the Division of Public Health provides tb public health nursing in the State with the overall work of the nursing unit of the Health Directorate.

Routine advisory and supervisory visits to hospitals, nursing schools and public health centres throughout the State werc maintained. Particular attention was paid to large training centres and to the development of in-service programmes.

Emphasis has'been placed {in the further development of the post-basic programme In nursing education.

India 110.6 Nursing Ad'liser to Himachal Pradesh TA (May -1965 - )

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

Assistance provided by WHO durinR the year. A nursing adviser.

Probable duration of assistance. Until the end of 1967.

Work done durln~the Year. The WHO nursing adviser arrived at Sirnla, her worlcing headquarters, in May 1965. She has begun to make a preliminary survey of nursing needs and resources In the State, ---India 114 Paediatric Education: Assistance to States R [August 1958 - 1 UNICEF

Aim of the project. To strengthen (1) the paediatric departments of selected medical colleges and (2) appropriate non-teaching and district hospitals.

Assistance Drovided by WHO during the year. Two consultants in paediatrics and a paediatric nurse.

Probable duration of assistance. Until the end of 1967.

Work done during the year. A study of paediatric education in medical colleges whlch have been assisted by WHO and UNICEF was undertaken in fifteen medical colleges in India by a WHO consultant in paediatrics. The study indicated limited utilization of established per'ipheral training centres, rnainly due to the insufficien8. time devoted to paediatrics in paediatric courses. It emphasized the need to strengthen undergraduate paediatric education and to make full use ot'field trafnlng facilities. The importance of developing field training areas in c.sllaboration with departments of preventive and social medicine and departments of obstetrics was stressed. It was recommended that child health should constitute a major subject In the final examination.

Another consultant In paediatrlcs visited the paediatric centre in the J.J. Group of Hospitals, Bombay, and discussed the development in that centre of a tupplementary course in tropical paediatrics for UNICEF fellows who have undergone training at the Institute of Child Health, London.

A WHO paediairic nurse joined the project in March 1965. She visited the threc centres in Incia which had been proposed as th>se in whlch to conduct three-month supplementary paediatric nursing courses for qualified nurses on an all-India basis.

----India 1111.1 Paediatric Education, erala R (Rug. 1958 - Aug. 1959; March - Sept. 1962; UNICEF May 1963 - January 1965)

Aim of the pro.iect. To expand, upgrade and reorient the teaching of paediatrics in Trivandrum Medical College.

Assistance ~rovidedby WHO during the'year. A paediatric nurse tutorrand assistance by a WHO nurse from project Afghanistan 26 for two months.

Work done. During the course of WHO assistance to this project, the Paediatric Department of Trlvandrwn pedlcal College was reorganized and set up as an independent unit. A Chair of Paediatrics was established and the paediatriy syllabus for under- &:-duate aedical students was revlsed and expantled. Four maternal and child health centres were upgraded to enable them to provide integrated curative and preventive care and to undertake teaching. SEAD Cl8/2 Page 133

The care of paediatric patients and education programmes for paediatrlc nurses were improved; better ward staffiig and supervision were introduced. Development of good practice, fields in social paediatrics has been slow, but improvements have been made in both urban and rural peripheral centres.

An all-Indln refresher courso in paediatric nursing was held in the Medical College, Trlvandrwn, from 1 December to 31 January 1965, with the assistance of a WHO nurse temporarily assigned to this project from Afghanistan.

Evaluation

The project was fairly successful in devel>ping better paediatrlc services and in introducing the social aspects of paediatrlcs as an integral part of the paediatric course of studies for medical undergraduates and nursing students.

India 114.4 Paediatric Education, Maharashtra R (Oct, 1963 - ) UNICEF

Aim of the project. To expand, upgrade and reorient the teaching of paediatrics in the medical colleges of the State.

Assistance provided by WHO duriw the year. A professor of paediatrics.

Probable duration of assistance. Until the end of 1965.

Work done during the year. The pr'ugramme continued to make steady progress. Attention was given to the establishment of a paediatric tuaching section with 180 beds at the Kasturba Infectious-Disease Hospital, Bombay, and to the further development of field training activities. At the Paediatric Centre of the J.J. Group of Hospita1s.expanded facilities included a third paediatric unit, a surgical paediatric department and an emergency service attached to the out-patient department. Reorganization of the Paediatric Department at K.E.M. Medical College Hospital provided improved facilities for teaching and nursing care. At the Nalr Medical College, construction of a multi- storeyed building, providing new accommadation also for the Paediatric Department. was in progress.

A fourth medical college (the Sion, or Lokmany Tllak. Medical college) was established in Bombay, and under the paediatric education programme assistance was extended to the paediatrlc department of the related teaching hospital.

The WHO professor of paediatrlcs, stationed in Bombay, visited other medical colleges in Maharashtra State and Goa 'and advised on improvement of physical facilities and teaching programmes.. He completed his assignment in July. A replacement is under recruitment.

India 121 Indian Council of Medical Research (Statisticsl H (Aug. 1962 - Feb. 1963; Dec. 1963 - )

Aim of the ~roject. To assist the Indian Council of Medical Research in setting up a statistical unit at its headquarters and in organizing and co-ordinating medical research activities. SEA/RC~~/~ Page 1%

Eplstance provided by, UFO d_urJehyear. A statistician.

Probable duration of assistance. Until the end of 1967.

Work done during the yEa2. A national counterpart to the WHO statistician and an assistant statistician were recruited by the Indian Council of Medical Research. The project reviewed thc organizational position of the Council's field statisticians ond made thc ncccssary rcc2ucndaticns to thc Director.

A rationalization of all the administrative procedures in the Council is under consideration. When improved practices have been established,this should help the Statistical Unit to ensure scrutiny of all incoming research proposals, etc.. for statistical content before they are brought before the respective expert groups of the Council. No major schemes, in any case, have received the final approval of the Council's Advisory Committee without first being examined by the Statistical Unit, which is represented by one or more staff members at all meetings of expert groups. Research workers from institutions with statisticgl units were advised to consult them before approaching the Statistical Unit of the Council.

Special attention was given to the following research projects: (1) growth and physical development of Indian infants and children; (2) controlled cholera vaccine trials in Calcutta;(>) investigation of tuberculosis patients in Delhi; (4) ophthalmological studies in Delhi; (5) mental health survey in Agra; (6) a dental health survey in Trivandrum, and (7) protein in fpod.

Assistance was given to research work in the fields of ischaemic heart digease, rheumatic heart disease, diabetes, and diarrhoea1 diseases.

The WHO statistician assisted in the teaching of health statistics in a training course on epidemiology at the National Institute of Communicable Diseases, Delhi. He completed his.assignment in June 1965. Further assistance ia planned.

India 126 Post-basic Nursing Education: Assistance to States*

India 156.2 Post-basic Nursing Education, 0u.jarat R (Jan.1963- )

Aim of the prolect. To expand post-basic nursing education and upgrade public health and institutional nursing services in the State.

Assistance p~videdby WHO durln,? the year. A nurse educator.

Probable duration ofassistance. Until the end of 1967.

*This projcct started in January 1962 agd is expected to continue until the end of 1970. Durinrr- the Tear under, review three fellowshi~swere awarded under this proJect - one of twelve months for a candidate from Orlasa for study in Canada, ong ,,f six months for a candidate from Delhi for study in Canada,and one of twelve months for a candidate from Mysore for study in the USA. SEA/RC~~/Z Page 135

Work done durina t)~. The regular course in public health nursing being given In Ahmedabad Medical College was continued. Further progress was made in the plans far upzrading and expanding the programme to include a ten-month course in nursing educatian,and this course was started in June 1965. Appointment of more nurse teachers has been sanctioned, and two further classrooms have heen released.

Discussions with Gujarat University regarding the establishment of a College of Nursing, offering a post-basic B.Sc. degree, were pursued.

India 136.3 Post-basic NursinR Education. Punjab R (March 1964 - )

Aim of the Drodcct. To develop a university-affiliated post-basic school of nursing in the State.

Assistance provided by WHO during the year. Two nurse educators.

Probable duration of assistance. Until the end of 1968.

Work done during the year. The educational programme at the College of Nursing continued to develop along sound lines despite the fact that full-time national staff had not yet been appointed as principal, readers and lecturers. One of the WHO nurse educators assisted in the routine functions of principal of the College.

Work has progressed on the building which is,to house the College. Temporary physical facilities have been provided in the Post-graduate Institute, khandigarh.

A great deal of effort has gone into developing learning experiences to provide the students with practice in planning, giving and evaluating comprehensive patient care. Emphasis has been placed on the need for the nurse teacher and administrator to be a goad nurse practitioner before she can become a specialist in any of the fields of nursing. Special care has been taken to integrate basic physical sciences throughout all related courses and to offer the student a sound background in modern concepts and practices of prevention of disease and preservation of health.

Assistance to the basic nursing school at the Post-graduate Institute continued. Llttle improvement in the housing and staffing of the basic school has yet been effected.

The WHO nurse educator assisting the basic nursing programme was transferred to the Nursing Education Proj~ctin Punjab in July 1965 (sec India 99.6) and was replaced by another.

India 136.4 Post-basic Nursing Education, Mysore R (Feb. 1964 - )

Aim of the prolect. To expand post-basic nursing educatipn and to upgrade public

health and institutional nursing services in the State. , Assistance ~rovidedby WHO durin~the year. A nurse educator. SEA/Rcl8/2 Page 136

Probable duratiun of assistance. Until the end of 1968.

Work done during the Year. The WHO nurse educator, located in Bangalore, continued to assist with the improvement and development of the post-basic certificate courses 'in nursing education and administration. Physical facilities were somewhat improved; electricity and telephone services for the school were, however, still lacking.

Planning was continued for the estabiishent of a university College of Nursing in 1967.

The nurse educator helped to form the staff of the Seminar an Nursing 'studies held in New Delhi In November-December 1964 (see India 223).

India 136.~ Post-basic Nursing Education, Madras R (June 1964 - )

Aim of the project. To establish a university-affiliated post-basic school of nursing in the State.

Assistance provided by WHO during the year. A nurse educator.

Probable duration of assistance. Until the end of 1968.

Work done during tne year. Work continued on the improvement and development of the post-basic diploma course in nursing teaching and administration. Physical facilities at the post-basic school were expanded.with the provision of further classroom.library and office space.

Initial discussions and planning for the proposed College of Nursing, University of Madras, were completed. Proposals regarding the administration of the college and the objectives and content of the post-basic specialty in medical-surglcal nursing, which will be the first programme to be offered, have now been presenccd to the Vice-Chancellor and the Syndicate of the University. A special committee has been constituted by the Syndicate to consider the details of the course. It is expected that the course leading to a bachelor's degree in nursing will begin in 1966.

Assistance was provided in the conduct of two-week refresher courses for nurses serving in the State health services. It is intended that these courses will continue to be offered regularly until all 275 head nurses in the State have taken them.

India 141 Public Health Programme. Kerala R (June 1960 - ) ummp

Aim of the Droject. To train personnel and to expand the health services in community development areas.

Assistance provided by WHO during the year. A public health nu~se,anda laboratory technician (for two months). SEA/RC~~/~ Page 137

Probable duration of assistance. Until March 1966.

Work done during the year. The WHO public health nurse assisted the Indo-Norwegian Health Centre at Needakara to develop a sound public health teaching field for all levels of nursing students.

Early in 1965 the overall administration of the Centre was transferred from the Directorate of Health Services to the Medical College, Trivandrum. This transfer has brought with it the use of the centre AS a training area for both medical students and nursing personnel, who are being taught in educational institutions operated under the general direction of the Medical College and its associated hospitals. In nursing these include:

(1) The College of Nursing, Trivandmm, which offers (a) a post-basic Bachelor's Degree in Nursing Education Administration and Public Health Nursing and (b) a Certificate in Public Health Nursing;

(2) A large basic hospital school of nursing and midwifery, and

3) An auxiliary nurse-midwifery course.

Plans have been made for the rotation, through the Centre, of students from all these courses. Domiciliary services in the district have been increased.and considerable improvement of the area as a teaching centre has been achieved.

On the iaboratory side, the Norwegian Ooverment has appointed a microbiologist and a laboratory technician to assjst with the technical development of.the laboratory, established at Quilon. A WHO laboratory technician.on a sho~tassimont, advised on the remodelling and expansion of the laboratory premises.

India 150.2 Public Health Programme, Maharashtra and Madras* TA (April 1963 - Nov. 1964 - ) UNICEF

Aim of the project. To develop a rural environmental sanitation programme and to improve the training of environmental sanitation staff.

Assistance provided bgWHO during the year. A sanitarian.

Probable duration of assistance. Until the end of 1967.

Work done durinu the year. The 1964-1965 course for sanitary 1nspectol.s. conducted at the Public Health Institute, Nagpur, proceeded satisfactorily as planned. The WHO sanitarian and his national counterpart took part in both theoretical and practical aspects of training. Practical training was improved. UNICEF has supplied suitable transport for field work. The course ha$ stimulated interest outside Maharashtra State; requests to reserve seats for other States have been received.

*Previous title: Public Health Programme, Maharashtra. The' first phase of the project was carried out from 1958 to 1961 under project number "India 150". SEA/F~C~~/Z Page 138

The WHO sanitarian left the project in November 1964 on transfer to another Region. A replacement is under recruitment.

India 15.3 Malaria Eradication R (Aug. 1958 - (USAID)

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

Assistance Drovided by WHO during the year. (a) Four malariologists (epidemiologists); ten malariologists (including six drawn temporarily from other projects in the Region) for one month; partial payment of salaries of the staff of the Regional Co-ordinating Organizations of the Government, and travel costs of national participants in malaria conferences and seminars; (b) six two-month international travel fellowships; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1971.

Work done during the year. The programme continued to make steady progress. The annual assessment for determining the areas for withdrawal of spraying and entry into the maintenance phase was conducted during January-February 1965 by twelve teams, with a panel of consultants from the Government, USAID and WHO. As a result of this assessment, entry of 24.82 units into the consolidation phase and 64.12 units into the maintenance phase was approved. The programme now has 80.26 units in the attack phase, 170.36 units under consolidation and 142.63 units in the maintenance phase. out of a total of 393.25 units in the country. Of those in the maintenance phase, only 43.70 units have actually handed over the responsibility for maintenance to the general health services; the others will do so only after the health services have reached the required standard.

The transmission of malaria in some urban areas where A. SteDhensi is the vector continued to be dealt with by anti-larval measures and intensification of surveillance activities.

India 155 Curriculum Guide for Nurs1n.q and Midwifery Training R (Jan. 1963 -

Aim of the prudect. To revise the present syllabus and regulations for the training of nurses and midwives established by the Indian Nursing Counci1,and to prepare a guide to the new syllabus, which is designed to co-ordinate, upgrade and standardize nurse/midwlfe training throughout India.

Assistance provided by WHO during the year. A specialist in nursing education.

Probable duration of assistance. Until the second quarter of 1966.

Work done during the year. The revised regulations and syllabus for the control of educational programmes in geniral nursing and midwifery In India and also the work on preparing the curriculum guide were completed. It is expected that this guide, which is to be printed, will be ready far issue in 1965.

The WHO specialist assisted the State r,f Andhra Pradesh in conducting two workshops. The first of these was for 22 nurse tutors working in auxiliary nurse midwifery schools, and was on the theme of the implomentation of the Indian Nursing ,Council's revised syllabus for auxiliary nurse midwives. The second, for 36 nursing superintendents and nurse tutors, had for its subject the hospital and community as a clinical field f9r student nurses.

India 170 Survey of Water Suvvly Resources of Greater Calcutta R (Oct. - Nov. 1959; Sept. - Nnv. 1961: Feb. 196) - ) UNSF

Aim of the projcct. To improve the water supply and drainage of Greater Calcutta.

Assistance provided by WHO during the year. A csnsultant sanitary engineer (planning); under a UNSF allocation, a consulting engineer, a resident engineer, and onc nine- month and one twelve-month fellowship for study in the United States of America.

Probable duration of assistance. Until the end of 1966.

Work done duriw the year. Substantial progress was made in the preparation of a master plan for water supply, sewerage and drainage. An Interim Summary Report on the Survey of Water Resources of Greater Calc~tta~preparedby the engineering consultants,has been submitted to the Government. Steps have been taken to follow up the tentative recommendations made in this report.

A Status Repnrt,based nn the Interim Summary Report and covering the activities of the project up to March 1965,was also prepared by the engineering consortium. The report embodies a number of recommendations on improvements of water supply, sewerage and drainage.

A revised draft plan of operation providine for extension of the master plan studies and also covering "supplementary engineering services" has been prepared.

The sanitary engineering planner continued' to advise the Calcutta Metropolitan Planning Organization on interim schemes and other related subjects.

A draft bill for the creation of the Calcutta Metropolitan Water and Sanitation Authority has been approved by the West Bengal Cabinet and will be considered soon by the State Legislature. Following discussions with a World Bank team, steps were taken to meet the need for management consultants to advise on the organization, management and fiscal control of the proposed Water and Sanitation Authority.

The followship programme of the project was implemented as planned. THO engineers of Calcutta Metropolitan planning Organization took up their studies in the USA. s~n/acl8/2 Page 140

India 172 Production of DF'T Vaccine, Kasauli R (Jan. - March 1961; Sept. 1961; March 1965; - ) UNICEF

Aim of the project. To develop the production of immunizing agents against diphtheria, pertussis and tetanus.

Assistance provided by WHO during the year. A consultant on laboratory animal produc tlun.

Probable duration of assistance. Until the end of 1967.

Work done durinu the year. Prodoction of diphtheria-pertussis-tetanus triple vaccine has been retarded on account of delays in the construction of the buildings and arrival of some additional equipment needed to increase the production of the pertussis component. Production of the diphtheria and tetanus. toxoid components proceeded satisfactorily.

In March 1965 a consultant visited Kasauli and advised in the management of laboratory animals necessary for vaccine production and vaccine testing and on the buildings required for their care.

He also visited the National Institute of Communicable Diseases, the All-India Institute of Medical Sciences and Vallabhai Patel Chest Institute in Delhi; the Haffkine Institute and the Indian Cancer Research Institute in Bombay; the Central Drug Research Institute in Lucknow, and the Pasteur Institute in Coonoor.

India 174 Freeze-dried Small~oxVaccine R (Sept. 1963 - 1

Aim of the prcject. To increase the production of freeze-dried smallpox vaccine.

Assistance provided by WHO during the year. Three short-term consultants.

Probable duration of assistance. Until the end of 1965.

Work done durinu the year. Two consultants visited smallpox vaccine production centres in India and advised on the expansion of the existing freeze-dried smallpox vaccine production in two centres (Vaccine Institutc, Patwadangar, and King Institute, Guindy, Madras) and on the conversion from glycerinated lymph vaccine production to freeze-dried smallpox vaccine in two additional centres (Vaccine Institute, Belgaum, and Institute of Preventive Medicine, Hyderabad). UNICEF supplied these four centres with shelf-dryers and automatic ampoule filling and sealing equipment. which, when established will help to give a total yearly output of 120 million doses 'of freeze-dried smallpox vaccine.

Last year, under project SEmO 38,two bacteriologists and two engineers were awarded fellowships for training in production techniques, equlpment maintenance and in vacclne control. A further fellowship was awarded to a bacteriologist in 1965 under project India 201. SEP.hCl8/2 Page 141

The institutes in Gulndy and Patwadangar have successfully started vaccine production, and preparations are being made for initiating production in the Belgaum and Hyderabad centres.

Another WHO consultant was assigned to the project in June 1965 for a period of six months.

India 175.2* Public Health Programme. Gularat TA (Nov. - Dec. 1964)

Aim of the project. To assist the Gandhlgram Rural Institute, Madras, in the development of an advanced training course for senior sanitary inspectors.

Assistanoe provided by WHO during the year. A consultant sanitarian.

Work done. A WHO sanitarian was assigned for six weeks in November/December 1964. He assisted the Gandhigram Rural Institute, Madras, with the development of a one- year advanced course for the training of senior sanitary inspectors. The course is being continued by the ttovernment.

India 176 Central Public Health Engineering Research 1116titute.Na~~ur R (Feb. 1961 - 1 UNS R

Aim of the prodect. To develop the Institute as a major research centre for environmental sanitation problems, to co-ordinate research programmes and to train research workers.

Assistance Drovided by WHO during the year. (a) A consultant in sanitary engineering research for two months and a consultant in instrumentation for thrce months; (b) supplies and equipmint [provided under UNSFJ.

Probable duration of assistance. Until the end of 1967.

Work done during the year. During the period under review, the Institute has been consolidated and is now satisfactorily housed, staffcd and equipped. The research carried out in various fields of public health engineering has been significant both in quality and quantity. WHO has continued to assist by providing consultants in various fields. The report of the consultant in sanitary engineering research was received and sent to the Government. The consultant in instrumentation arrived (for a second assignment) in June.

The supply of equipment by the United Nations Special Fund has been phased according to other developments.especial1y the completion of the physical plant. The UNSP allocation has been largely utilized, leaving only a small balance to meet the requirements for special equipment in 1966.

'WHO nssistance to the i?rlirr :,'rt 71' thi prcj~ctwas carried out under project number "India 175" and Completed in May 1963. SEAbC18h Page 142

India 180 Health Education in Schools (July 1964 - )

Aim of the project. To develop health education in the basic 'tsacher-training courses and teacher-training institutions in the country.

Assistance ~rovidedby WHO during the year. (a) A health educator; (b) health education literature.

Probable duration of assistance. Until the end of 1967.

Work done durin~the year. The health education element of syllabi for schools and for teacher training was studied and the WHO health educator assisted in an analysis of the health content uf the syllabi for general science and social studies with a view to using the results in curricul~umplanning...... Inventory forms were completed by teacher trainees in colleges and institutions in Delhi, giving information an,their health knowledge, present health practices and on the health topics of major interest to them. The results are intended also to be used for curriculum development.

The Central Health Education Bureau (School Health Education Division), New Delhi, provided information on health education for programmes being established by State institutes of education, the Department of Science of the National Council of Educational Research and Training and the Centrai Institute'of Education, and for the Task Force on Student Health Services of tho Education Comission.

Advice was given on the school health aspects of health education in training programmes for various health workers. A seminar on school health services for health and education personnel in the Union Territory of Delhi wak organized by the Central Health Education Bureau in New Delhi,and follow-up measures were recommended.

A workshop for the development of criteria far the health aspects of a schotll programme was organized in Ncw Delhi in May 1965. Participants included health and education personnel from the Central Government and Delhi Mnnicipality, and representatives of voluntary agencies. The criteria prepared will be tested before being recommended for adoption on a wide basis.

Progress was made in the development of a health education guide for teachers.

India 181 Applied Nutrition ~ro~ramme R (oct. 1964 - ) UNICEF (FAD)

Aim of the project. To expand and improve the health component of the Applied Nutrition Programme with particular reference to the health and nutritional status of pregnant and nursing women, infants and children. SEA~CIR~ Page 143

Assistance provided by WHO during the year. A medical consultant for five months.

Probable duration of assistance. Until the end-of 1768.

Work done during the year. The WHO consultant studied the operation of the Applied Nutrition Programme in four States with particular reference to the role of health services and personnel in the ,,peratinn of these programmes.

His report has been submitted to the Government, UNICEP and PAO. Recomendatians included development of nutrition health centres, better feeding programmes and strengthening of nutrition units in central and State health directorates.

A public health officer is bcing azsigncfl to tsslst irith the public health aspects.

Strennthening of Health Services (Epidemiology] (March 1963 - )

Aim or thc project. To establish ir improve health intelligence units in State Health Directorates; to train staff in epidemiology, health statistics, microbiology and communicnble-diseasc control; to devclop furthcr the National Institute of Communicable Diseases. Delhi.

Assistance provided by WHO during the year. (a) A bacteriologist, an epidemiologist and three short-term consultants; (b) a twenty-four-month fellowship for study in the United Kingd~m,and two nine-month fellowships for a course in epidemiology (these are in addilion to f7ur ten-month fellowships awardcd previously which are now being taken up); (c) suppltcs and equipment.

Another twelvc-m-nth fellowship was awardid under India 201.

Probable duration of assistance. Until the end'of 1968.

Work done during the year. A WHO bacteriologist and an epidemiologist have assisted in the development of the Departments of Microbiology and Epidemiology at the National Institute of Cnmmunicable Diseases, Dclhi.

A five-month training coursc In epidemiology was held in 1964 at the NICD, and a second course of twelve weeks' duration was organized in April 1965. During the period under review, the Organization has provided three short-term consultants to assist thr Institute in the organization and conduct of these training courses. Two fellowships were awarded by WHO to staff of thc NICD for training in microbiology. Arrangements were made fdr six fellows from India to attend an intensive course in epidcmiolagy in thc United Kingdom, Czechoslovakia, Yugoslovla and finally at the National Institute of Communicable Diseases, Delhi.

India 182 Medical Education, Oudarat State TA (Dec. 1962 - ) Aim of the project. To davelop medical education and medical research in Baroda Medical College. Assistance provided bs- WHO durin~the year. (a) Six visiting professors, a senior lecturer, a laboratory technician, an X-ray technician, four short-term consultants and a medical records officer; (b) five fellowships - four for twelve months and one for three and a half months for study in the uriited Kingdom; (c) supplies and equipment.

-Prob-ible duration of assistance. Until the end of 1968.

iJork done during the year. ks reported in the Sixteenth Annual Report, a team of five visiting professors (in internal medicine, hospital administration, clinical blochemistry, surgery, and psychological medicine) from Edinburgh University started wzrk in Baroda Medical College in July 1964. All continued to assist with teaching and qther activities in their respective specialties,and left in May 1965 at the end of their contracts. A senior lecturer in internal medicine, a professor of ~.adlology,a replacement for the professor of psychological medicine and an X-ray technician joined the project. A professor of pathology, a professor sf physiology and a professor of medicine were assigned for short periods. The work done is described below:

Internal medicine: Help in reorganizing the Department: participation by the professor in the teaching, including instruction in teaching methods; ParticiDation also by the senior lecturer in undergraduate and post-graduate teaching. A consultant professor of internal medicine and therapeutics assigned to the College during January-February 1965 reviewed the teaching programme and later visitea various research institutes in India to study facilities with a view to making recommendations on the feasibility of establishing a joint WHO/Wellcome Trust research centre at Baroda or at some other suitable place.

Hospital Administration: Efforts made to improve the medical records, Steriliza- tion and hospital facilities; preparation of plans for establishing a Screening Unit in the Out-patient Department to assist the teaching and hospital staff and to provide training faci1ities;consideration of schemes to improve the administration of the Casualty and Dispensing Departments. A WHO medical records officer advised on the development of a sound medical records system in the College. A national Medical Records Committee is now functioning.

Clinical Biochemistrr. Assistance by the WHO professor and laboratory kechnician In a review of the diagnostic facilities available in the Department of Biochemistry; a revtsion of all the analytical procedures and introduction of new tests; drawing up of schedules of maintenance of equipment and safety regulations. Lectures on

' clinical chemistry were given by the professor, who also assisted in conducting some post-graduate seminars on the subject and took part in a symposium on tissue culture organized by the Department in January 1965.

Surgerx: A study of surgical operation theatres; recommendations for procurement of same basic instruments; improvements in the wards and operation theat~es; dlscussinns, in the professor's teaching rounds, of certain clinical problems with other departments, resulting in better interdepartmental collaboration; establishment of a teaching museum and of a contra1 sterile supply unlt.

Psychological Medicine: Assistance in introducing a revised lecture programe; arrangements for students to attend the mental hygiene clinic at the hospital and to SE~hCl8/2 Page 145

participate in the psychiatric examinations of new cases. The Government has agreed to start a Psychiatric Department in the College, and recommendati3ns have been made with respect to plans for the department and ward. As a result of the visit of a Headquarters .cc,nsultant irl psychologLca1 mediclne toward the end of 1364, a psychiatric out-patient clinic has been started at the Primary Health Centre, Padra, as an experiment in rural mental health services. Efforts are being made tc ari!u;e interest in the clinic on tile part of the public.

Pathology: Assistance in strengthening and reorganizing the Department: participation in the teaching: discussions with the staff of the clinical units on arrangements frjr joint teaching. Tho WHO consultant professor recommended an increase in staff, nllocatlan .~fadditit>nal space, minor structural alterations to laboratories, amendment (ri the curriculum and improvement of facllltie~for the teaching .>f morbid anatomy.

Radiology: Systematic training of radiographers and radiography students.

. Physialoc~: Demonstration of experimental techniques on frogs, pigeons, rabbits and cats by the WHO consultant who visitrd the Department in December: lectures, study of thc various kinds of apparatus being used in the Department. and recommendations for thelr repair and maintenance.

In addition ti, the abuve, visits to other places in India were paid by some of the professors-among them: (a) a visit to medical colleges in Bombay. Madras. Yellore and Trivandrum to obtain an idea of the medical records systems and also of the mcthods used for ccntral sterilization, by the professors of hospital administration and internal mcdlcine: (b) attendance at a seminar on hospital administration organized by the National Institutc of Health Administration and -- Education in New Delhi, by the professor nf internal medicine: (c) a visit to Hyderabad to study the orgnnizati,:n of the central sterile supply service, visits to surgical departments of tha medical collegcs in Bombay and attendance at a meeting of the Indian Associatinn of Surgeons, In Bombay, by the professor of surgery: (d) a visit to the All-India Institute af Mental Health In Bangalore in connection with a seminar on refresher training in psychiatry, and to the Mental Diseases Hospital in Ranchi to study facilities for an undergraduate seminar on the teaching of psychiatry. by thc professor of psychological medicine; (e) attendance at the Annual Confurencf ,of the Indian Association af Pathologists in Bangalore, by the professor of pathol,,gy and the profess~rof clinical biochemistry: (f) participation in a conference on post-graduate medical education held in nelhi,by the professor of pathology, and (y) attendance at the Eighteenth Indian Congress on Radiology, held at Trlvandrum, by the professor of radiology and the X-ray technician. The professor of pathology also prepared a paper for the conference in Dclhi mentioned above, and the professor of radiology gave 3 lecture in Trlvandrum under the auspices of the University nf Kerala.

India 182 Strengthening of District Health Administration R (Jan. 1964 - ) UNICEF

Aim of the pro,iect. To study and develop the organization of district health services so as to provide the maximum possible service to the public with the avallable resources. SEA~CI~~ Page 146

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

Probable duration ok assistance. Until the end of 1969.

Work done durina the year. The strengthening of health services In Jamnagar District. using'the available staff and facilities, made satisfactory progress. One primary health centre area was selected for intensive work. In this area, a house-to-house survey was undertaken, and, based on the findings of the survey, intensive activities were planned. These Included the implementation of a water supply and water-seal latrine programme.

The Qovernment has sanctioned a proposal to establish two additional primary health centres and also to upgrade one civil hospital as a referral hospital.

In-service training of nursing personnel and training of da15 we're undertaken. Nursing staff of the primary health centres were also given refresher courses. The district tuberculosis programe continued to make good progress, with the appointment of a full-time medical officer trained at the National Tuberculosis Institute, Bangalore.

A special survey was made to study the village and population groups in relation to distances from the nearest treatment centres or other medical health services in Jamnagar District.

India 188 Strewthening of Laboratory Services -R (Feb. 1965 - )

Aim of the project. To strengthen health laboratory services and to improve the training of laboratory technicians.

Assistance provided by WHO during the year. A laboratory technician.

Probable duration of assistance. Until the end of 1968.

Work done during the year. A WHO laboratory technician (instructor) was assigned to the Medical College in Trivandrum, Kerala State, in February 1965, to assist in establishing a training centre for laboratory technicians. Two types of training courses are planned: a one-year course for training laboratory technicians to man peripheral laboratories, and a two-year course for those who will serve in medical college and general hospital laboratories.

A committee,ma.de up of representatives of both the Medical College and the State Health Services, has been established to advise the Medical dollege and to make a periodic review of all the technical aspects of its activities...... , ...... Plans were made for a similar training programme in Chandigarh. SEA/aCl8/2 Page 147

India 191 Development of Health Services in Community Develo~mentAreas R (Dec. 1964 - ) UNICEF

Aim of thc project. To strengthen the developmcnt of rural health services and to train staff,including multi-purpose health auxiliaries.

Assistance providcd by WHO durin~the year. A consultant in public health for three months.

Probable duration of assistance. Until early 1968.

Work done during the year. A WHO consultant was assigned to Punjab Statc under the programme of WHO/UNICEF assistance to community development areas. He advised on the development of health services in community development areas.

Jndia 195 Course in Radiolo&ical Physics, Bombay R (April 1962 - )

Aim of the projcct. To strengthen the training of radiological physicists.

Assistance Drovlded by WHO during thc year, A consultant for two months and payment of 40 per cent of stipends to 18 participants.

Probable duraticn of assistance. Until the end of 1966.

Work done during the year. Thc third course in radiological physics conducted by the Atomic Energy Establishment, Bombay, was started in September 1964 and was attcnded by eightecn candidates. WHO provided a consultant in radiation protection for twn months from April to Junu 1965. Hc gave a series of lectures and demonstrations and assisted in the general planning and conduct of the course.

A similar course is planned for 1966.

India 197 Industrial and Occunational Health R (April - Scpt. 1964; - )

Aim af the project. To study the medical facilities available in the various industrial undertakings and institutions in India; to study the potentialities for further strengthening and developing the train in^ facilities in industrial and occupational health; to prepare &ui.delincs for the promotion of occupational health in industry.

Assistance provided by WHO during the year. A consultant fur six months.

Probable duration of assistance. Until the end of 1967. Work done during the year. During the'kourse of his assignment,the WHO consultant vlsited industrial undertakings in Calcutta, Jorhat , ~hanbad,Durgapur, Jamshedpur , Hyderabad, Visakhapatnam, Madras and Nagpur, to study industrial health hazards. IIe assisted in preparing and conducting the first conference of medical inspectors of factories, held in Delhi from 18 to 20 September 1964, aid delivered a number of lectures to different groups of doctors. He completed his assignment in September.

His report included recommendations for the improvement of health services in industry and for training and research in industrial health.

It is expected that further consultant service will be required in 1967.

India 200 Fellowships R

Pharnacolo&. A twelve-month fellowship for study in .the United Kingdom.

Paedlatric Patholou. A twelve-month fellowship for studyin the United States of ArnGrica (to start in September).

Paediatrics. A six-month fellowship for study in the United Kingdom and Uganda (to start in September).

Sanitary Ewineerinq. A six-month fellowship for study in the United States of Anerica.

Health Education. A twelve-month fellowship for study in the United States of hnerica (to start in September).

Preventive and Social Medicine. A twelve-month fellowship for study in the United States of America, Costa Rica, the United Kingdom and Israel (to start in September).

Public Health lidministration and Planning. Two four-month fellowships for study In the Unitcd Kingdom.

Nutrition Traininp: Course, London and Ibadan. Two twelve-month fellowships for pai'ticipation in thc course (to start in October).

India 201 Pellowships TA

Vaccine and Sera Production. A six-month fellowship for study in the United States of America, Canada and certain countries in Europe.

Medical Stores Management. A three-and-a-half-month fellavship for- study in Eupope and in the United States of America. SEA/kcl8/2 Page 149

Testing of Druas. A six-nonth fellnwship for study in the United Kingdom, the United States of America and Switzerland.

Epidemiolouy_. A twelve-month fellowship for study in the Unitcd Kingdom, Czechosl:>vakla and Yugr,slavia (to start in Octubcr).

Physlolo~y. A twelvc-month felluwship for study in Germany and in the United Kingdom.

Manufacture and Assay of Freeze-dricd Smallpox Vaccine. A six-month fellowship for study in the Unitcd Kingdom.

Tuberculcsis Ct~omothcrapyResearch. A fivc-month fellowship fLr study in Europe.

Nursing Services Administration. Two six-week fellowships for study in Denmark, awarded under EURO 316 (to start in September).

Paedlatrics. A seven-month fellnwship f-r study in the United Kingdom, Yugoslavia and Lebanon (awardpd under former project India 137).

Venereal-Diseasc Control. An elght-month fellowship for study in the United States of America, the Unitcd Klngdom and Denmark (to start in September). This fellowship was 3warded under former project Indie 137.

India 215 All-India Institute of Medical Sciences, New Delhi H (NOV. 1964)

Alm uf the project. Tt, assess the standard of teaching at the All-India Institute of Medical Sciences, New Dcltli , to evaluate its research programme, to determine how far it has achieved its objectives and to advise an its future develapment.

Assistance provided by WHO during the Year. Three consultants for two weeks.

Work dunc. The WliU consultants rcported fur duty in November 1964. The Gcvernment of India set up a Reviewing Committee composed of four Indian medical education specialists and the three WHO consultants. Discussions were held at the Institute, in the Directoratc-Gencral oT Health Servlces and in the Minlstry of Health. The consultants alsu visited Hyderabad and Madras and later held discussions in the Regional Office and at the Direct2rate-General of Health Services with the other members of the Reviewing Committee, to complete the report, which embodies the findings and the recommendatlcns of the Committee.

India 223 Study 31. Nursing Services R (Oct. 1964 - 1

Aim of the pro,icct. To introduce seniar nurses to the latest developments in the application of ccrtain managerial tcchniques to nursing administration. &&stance ~Wyidedbv WHO during the veac. A nurse consultant (assigned by Hcadquarters).

Probable duration of assistance. Until the end of 1968.

Work done durinp; the year. A WHO consultant was assigned in 1964.

A Seminar on Nursing Studies was held from 16 November to 18 November 1964 at the College of Nursing, New Delhi. The purposes of this seninar were: (1) to develop a methodology for Studying nursing activities in hospitals, out-patient departments and the publlc health fieldsand (2) to introduce senior nurses to developments in the application of certain managerial techniques to nursing administration.

A draft guide for the study of nursing activities was prepared, and plans were made for testing it in the field. The first of these field tests was conducted in 1965.

The WHO nurse educatoi- assigned to the Nursine Education Project in Punjab State (India 79.6) has been appointed to assist with field tests.

SEA/RC18/2 Page 151

54 INDONESIA

In Indonesia, economic difficulties and the resulting inflation continued during the year. This has reacted unfavourably on the development of health services through the relative increase in the cost of health activities.

Spraying was withdrawn from some of the zones covered by the malaria eradication campaign. However, no major recrudescence of malaria during this year has so far been reported in any of the zones. The urban tuberculosis control programme in Jogjakarta was stabilized, and a pilot study, designed to work out the methodology of tuberculosis control in rural areas within the framework of the general health services, was started in the nei ghbourhood of Malang. Simultaneously a study of direct BCG vaccination was undertaken.

The Epidemiological Division of the Ministry of Health maintained its activities in investigating and advising on the control of communicable diseases. No expansion of provincial epidemiological sections was effected. An infectious- disease hospital was opened in Tondjung Priok. No serious outbreaks of cholera were reported. Smallpox remained endemic in some parts; small outbreaks were controlled by mass vaccinations carried out by malaria eradication staff. Further progress was made in improving the production of DPT and freeze-dried smallpox vaccines in the Bio-Farma Institute, Bandung.

The consolidation of the expansion of medical colleges continued satisfactorily, despite shortages of equipment and medical literature, and the fourteen medical colleges spread throughout the country continued their teaching activities. Progress was made with regulations for the Academy of Nursing. SFA/RC18/2 Page 152

PROJECT LIST

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

Indonesia 9 Leprosy Control R (July - Sept. 1955; sept. 1956 - ) UNICEF

Aim of the project. To develop a leprosy control programme within the framework of thc general health services in all end6mic areas of the country.

Assistance provided by WO during the year. (a) A leprologist; (b) supplies and equipment,

Probable duration of assistance. Until thc end of 1967.

Work done during the year. The WH'O leprologist visited Java, Ball, Sumatra and some of the outer islands in order to review the present extent of thc problem and to assist in the organization of control activities. High leprosy rates were observed in Surabaya and Madura. In Java and J3ali. the integration of leprosy control into the general health services was pursued.

The total number qf leprosy patients for the whole country at the end of 1964 was 49 091, with 3 120 new cases registered.

Indonesia 32 Malaria ~radication R (May 1955 - ) T A UNICFJ (USAID)

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

Assistance provided by WHO during the year. (a) Seven malariologists, one entomologist, three sanitarians, an administrative officer, three secretary-stenographers and onc translator typist; (b) two three-and-a-half month and four one-month fellowships fur study in the Philippines and India, and four fivu-week fellowships for study in India.

Probable duration of assistance. Until the end of 1974.

Work done during the year. The most noteworthy event was the withdrawal of spraying from 35 out of a total of 42 zones. This measure will demand very thorough surveillance. WHO staff has been considerably reduced. Indonesia 40 Vaccine and Sera Production TA/R (April 1959; June 1960; Feb. - March 1963; UNLCEF Sept. - Dcc. 1963; Dec. 1964; - )

Aim of the project. To improve methads of production of vaccines, antitoxin and toxoids.

Assistance provided by WHO during the Year. (a) A twelve-month fellowship for study in the United States of America (to begin in September);(b) supplies and equipment.

Frobable duration of assistance. Untll the end of 1966.

Work done during the year.- Contact was maintained with the Bio Farma Institute, Bandung, concerning the production of freeze-dried smallpox vaccine and of DPT vaccine. Batches of freeze-dried smallpox vaccine and DPT vaccine were tested with satisfactory results by independent laboratories abroad through arrangements made by WHO.

Additional equipment required for the expansion of freeze-dried smallpox vaccine is being supplied by WHO.

Nursing Advisory Services (Oct. 1957 - July 1959; Nov. 1960 - )

Aim of the project. To develop a Division of Nursing in the Ministry of Health which will co-ordinate institutional and public health nursing services and upgrade and expand training programmes for nurses and midwives.

Assistance provided by WHO during the year. A nursing adviser.

Probable duration of assistance. Until the end of 1968.

Work done durin~the year. It was decided that the chief function of the Nursing Division in the Ministry uf Health would be nursing education. This should have a considerable impact on nursing within the country.

Consideration was given to awarding a degree to students from the Academy of Nursing on completion of their programme of study.

The nursing adviser (public health nurse) assisted with an assessment of maternal and child health services (see SBWxO 95.2).

Indonesia 50 Tuberculosis Control R (JU~Y1961 - ) UNICEF

Aim of the project. To proceed with the national tuberculosis programme; to train national staff in rational case-finding and ambulatory treatment techniques and methods; to establish a central tuberculosis epidemiological wit which will direct the control operations throughout the country. sEA/R~18/2 Page 154

Assistance provided by WHO during the year, (a) A medical officer, a public health nurse, a laboratory techniclan. an X-ray technician and a statistician: (b) suppltes and equipment.

Probable duration of assistance. Until the end of 1967.

Work done during the year. The urban tuberculosis programme in Jogjakarta and Surabaja continued satisfactorily towards the set annual target.

In Malang (East Java), the rural pilot project was started in September 1964, and a sample survey was completed, with the examination of the fifth population group selected for the purpose. 'In this last group also, the coverage was satisfactory, reaching 94.9 per cent for tuberculin reading and 97.9 per cent for X-ray examination. AS regards BCO, 100 per cent of those eligible were vaccinated in two groups, and the coverage in the other two groups reached 99.7 and 98.1 per cent. 100 per cent coverage in X-ray examinations was achieved in one group, and the average of all groups was 99.4 per cent; 209 persons were allocated to anti-tuberculosis treatment, and all but one remained on treatment (One patient left the area).

Nine assistant "mantries" completed Special training as tuberculosis field workers and were posted to their respectlve districts, where they carried out case-finding by bacilloscopy, and undertook organization of treatment of detected cases.

The WHO laboratory technician was reassigned to. a project in India in September 1964.

Indonesia 62 Medical Education R (May 1964 - )

Aim of the project. TO assist selected departments of the various faculties of medicine in the country.

Assistance provided by WHO during the year. (a) A professor of physiology and a consultant in preventive and social medicine for two months; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1970.

Work done during the year. The WHO visiting professor of physiOlogy continued his work at the Medical Faculty at Jogjakarta. The teaching and the other activities of the Physiology Department continued to develop satisfactorily. and training of staff members Proceeded according to schedule. For the first time a system of written tests was introduced in the Department.

A proposal made by the WHO professor for research on "the sensitiveness of the cardiovascular centre in various phases of haemorrhagical shockU has received financial support from the Ministry of National Research. It is planned that the Department of Physiology should become a centre of cardiovascular physiology and should stimulate other departments of physiology in the country. Training of staff for physiology departments of new medical colleges may be organized in JogJakarta. sm/~c~e/z Page 155

The WHO professor visited the Rehabilitation Centre at Surakarta and the Departments of Physiology at Bandung and Djakarta to discuss matters of mutual interest and to advise on the development uf the teaching of physiology.

A WHO consultant in preventive and social medicine (public health) was assigned to the Medical Faculty of the University of Indonesia, Djakarta, in May 1965, to advise on undergraduate teaching of preventive and social medicine and on the development of post-graduate education in public health.

Plans were advanced for the assignment of a professor of pharmacology at Gadjah Mada University, Jogjakarta.

The Regional Adviser in Medical Education visited the Medical Faculty at JogJakarta and other medical faculties in Indonesia during the second half of 1964.

Indonesia 65 School of Physiutherapy. Solo R (March 1963 - )

Aim of the project. To improve, expand and upgrade the existing training of physiotherapists and to develop physical medicine and rehabilitation services.

Assistance provided by WHO during the year. A physiotherapy tutor.

Probable duration of assistance. Until the end of 1967.

Work done during the year. Sixteen physiotherapy aides completed their training at the Crlppled Children's Centre in Solo during the fourth quarter of 1964. All were successrul in their final examination, some of them on the first attempt. in October, and the others on the second, in December.

Fxaminatians for first and third-year student assistant physiotherapists were held in August and November 1964.

"The Akademi Farawatan Djurusan Physiotherapie" was inaugurated on 20 October 1964 at the Rehabilitation Centre, Solo, to upgrade the training being given to physiotherapists. All trained "assistant physiotherapistsn in Indonesia who had completed three years of experience after qualifying were invited to apply for the first "upgraded" course held from December 1964 to June 1965. Nineteen such trained assistant physiotherapists from several hospitals attended this course.

The WHO physiotherapy tutor helped to conduct a post-gmduate course in medical rehabilitation and physiotherapy at the Rehabilitation Centre from 27 July to 8 August 1964. It was attended by 24 doctors.

One of the two trained assistant physiotherapists who have been receiving further training in New Zealand under the Colombo Plan since 1962 is due to return at the end of 1965,and the other by October 1966. SEA/RC~~/Z Page 156

Indonesia 200 Pellow~hips R

Public Health. A nineduonth fellowship for study In the Nethevlands (to start in September).

Indonesia 201 Fellowships T A

Medical Rehabilitation. A nine-month fellowship for study in Denmark, awarded under EURO 210 (to start in September). SEA/RC18/2 Page 157

6. MALDIVE ISLANDS

Malaria is recognized as the leading health problem in the Maldives, and, following a preliminary study of the epidemiology of the disease and the feasibility of starting malaria control measures, plans have been made for embarking upon a pilot control programme as an integral part of the development of health services.

Training of health assistants has continued, though the establishment of health centres staffed by these auxiliaries in atolls distant from Male has made little progress. Nurse-aide training courses and midwifery training courses are being satisfactorily maintained, under the direction of a fully qualified national nurse (who completed her education as a nurse-midwife in Vellore, India, during the year), with the assistance of a WHO public health nurse.

Limited smallpox and DPT vaccination programmes were continued, and the treatment of leprosy and tuberculosis patients was maintained.

Some progress was made towards the completion of construction of a thirty-bed hospital in Male.

During the year the Minister of Health of the NIaldive Islands visited the VIHO Regional Office in New Delhi. SEA/RC~~/~ Page 158

PROJECT LIST

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

Maldive Islands 5 Public Health Administration R (Oat. 1959 - )

Aim of the project. To develop comprehensive badic health services and to train staff.

Assistance provided by WHO during the year. (a) A public health officer, a public health nurse, a laboratory technician, a sanitarian and a consultant entomologist for three months; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1971.

Work done during the year. A revised plan for integrdted health services was under consideration. It is envisaged that priority will be given to major factors which ', ,, have had an adverse'effect on the health and eco

At the time of reporting, a WHO team composed of a public health officer, public health nurse, laboratory technician and sanitarian was assisting in the development of the integrated health services. Training of nurse-aides, health assistants and indigenous midwives has been maintained. There was continued improvement in the work of health assistants.

DPT immunizations and anti-smallpox vaccinations were resumed. In June 1965, a short-term consultant entomologist started a study of the methodology of a pilot malaria control campaign.

Maldive Islands 202 Rellow~hlp~ MESA*

Malaria Eradication. A three-month fellowship for study in Nigeria.

Malaria Eradication Special Account,

SE%/RC18/2 Page 159

7. MONGOLIA

The period under review has been, in Mongolia, one of further progress in the strengthening of epidemiological and communicable-disease control services and of planning and preparation for the development of activities in further fieb of public health and education and training.

Most ueeful epidemiological information on brucellosis in man and animals in different geographical and ecological conditions in the country has now been collected. A controlled field trial of Brucella vaccines in man and animals has been initiated, and training activities are being carried out.

Arrangements have now been made for the implementation of a national tuberculosis ccntrol programme and for upgsading the laboratories at the Cenhgi Hygiene Station and the Sanitary/Bacteriological Inetitute, Ulan Bator, in the coming year.

Plans have been discussed for a pilot project in the field of provincial sanitation and water supplies.

In mid-1965, work was begun on a programme in maternal and child health, with emphasis on (a) the upgrading of basic courses for paediatricians and obste- tricians, @) the upgrading of the maternal and child health organhatlone in the aimaks, (c) the organizatiao of refresher courses for paramedical and auxiliary personnel, and (d) expansion of the training of nurses. The establishment of nine nurse training schods is envisaged. Health education will be given emphasis throughout.

The WHO programme of assistance continued to develop satisfactorfly. For all the above projects, which WHO is assisting, UNICEF ha8 agreed to provide supplies and wffl also give priority to the provision of dried milk and supplements for children. SEA/RC18/2 page 160

PROJECT LIST

Project No. Source of Funds Co-operating Agencies

Mongolia 1 Strengthening of Health Services (Epidemiology) (July 1965 - )

Aim of the project. To undertake epidemiological surveys of the prevailing communicable diseas'es in order to plan practical control measures; to advise all branches of the medical and health services on the use of epidemiological methods.

Assistance provided by WHO during the year. (a) An epidemiologist, a bacteriologist, a veterinary public health officerrand a consultant on brucellosis vaccine trials for about three weeks; (bl a twelve-month fellowship for study in Czechoslovakia; (c) Supplies. equipment and a transport vehicle.

Probable duration of assistance. Until the end of 1967.

Work done during the year. The WHO epidemiological team, consisting of an epidemlo- logist, a bacteriologist and a veterinary public health officer, continued the study of bruC@1810sis in man and domestic animalsin the various aimaks of the country. Theresults of the survey indicated high prevalence rates. phrticularly among the 15-19 year age-group and in most herds of domestic animals -'cattle, sheep, gqats., borses and camels., , . I * i /' A WHO consultant visited Mongoiia in October 1964 to assist in planning controlled Brucella vaccine field trials in man and in animals. These trials have proceeded satisfactorily. .:.. . . I .' . , .., AS Rart of the plan of action, intensified'trainlng activities in brucellosis and fn,general epidemi'olo@y were planned and carrie8,out in Ulan ato of. during the winter months.

The WHO team assisted in the investigation or outbreaks of viral hepatitis and influenza and contributed to the start of serological surveys of some other diseases (principally poliomyelitis, virus Influewa, the arbovim infections and the rlckettsioses), in collaboration with a WHO reference laboratory.

Mongolia 2 Public Health Laboratory Services TA (May - Aug. 1964; - )

Aim of the project. To develop health laboratory services and to train personnel in health laboratory procedures and practices. SEA/RC18/2 Page 161

Assistance provided by WHO during the year. (a) A consultant far about four months; (b) a nine-month fellowship for study in Bulgaria and in the Union of Soviet Socialist Republics.

Probable duration of assistance. Until the end of 1967.

Work done during the year. The WHO consultant who went to Mongolia in May 1964 reviewed the laboratory services in Ulan Bator and in a few provinces. He completed his assignment in August 1964, and his recommend3tions for the upgrading of the Central Hygiene Station and the Bacteriological Laboratory (Vaccine Production Centre) in Ulan Bator arc being followed up. UNICEF has 3groed to assist with equipment and supplies and WHO with personnel and fellowships.

Mongolia 4 Maternal and Child Health Services T A (June 1964 - )

Aim of the project. To review the existing maternal and child health services in rural and urban areas and to advise on the further strengthening of these services, the method of their integration into the general health services and appropriate measures for the improvement and expansion of relevant training programmes.

Asslstance provided by WHO during the year. A consultant in maternal and chlld health for three months.

Probable duration of assistance. Until the end of 1967.

Work done during the year. The consultant arrived early in June 1965 and started a study of the maternal and child health services. This study 1s to cover both rural and urban areas.

Mongolia 200 Fellowships R

Public Health Administration. A six-month fellowship for study in the Union of Soviet Socialist Republics.

Medical Statistics. 12 ten-month fellowship for study in Czechoslovakla. Yugoslavia and the Union of Soviet Socialist Republics.

Mongolia 201 Fellowships TA

Paediatrio Surgery. .C six-month fellowship far study in Czechoslovakia.

Gynaecologe. A six-month fellowship for study in Bulgaria. SEA/RC18/2 Page 162

Haematology. A ten-month fellowship for study in the Ur.iOn of Ssvict Socizlist Republics and Czechoslovakia.

Training Course on Medical Services Admlnistration, Moscow lnd Pr.eui. 'Pro nlni month fellowships for participation in thc course lawarded under EURO lji3.jB).

SEA/RC18/2 Page 163

The preparation of the Government's Five-Year Development Plan has been completed. The main health features are the progressive development of health services in 14 zones and 75 districts, with the establishment of zonal 50-bed hospitals, of district hospitals or hospital health centres, of health posts and mobile units attached to them.

The principle of integrating malaria work into the health services during the maintenance phase of the eradication programme has been accepted; this will necessitate retraining a part of the malaria project staff. Difficulties in administration and logistics have hampered the malaria eradication programme.

Despite setbacks, mainly due to lack of acceptance on the part of the population, the smallpox vaccination programme in the Kathmandu Valley has been successfully pursued. Outbreaks of smallpox of some extent were reported only outside the Kathmandu Valley, from parts of the country in which such vaccination as is done is not yet properly co-ordinated.

Reorganization of the Central Chest Clinic has brought about improvements in the control of tuberculosis in the Kathmandu area.

The quantity and quality of drinking water in Nepal vary from time to time and from season to season. To control water-borne diseases, numerous schemes have been started in variorls parts of the country. Chlorination of the Kathmandu water supply is now improved, and repairs of the plants have been going on. Plans were made for the training of technical staff through extension of courses in sanitary engineering for overseers, organized at the Engineering School, Patan.

To check unfair profiteering in the sale and manufacture of medicines, a limited liability co-operative, the "Sajha Health Service", has been established by medical and social workers. The Government Civil Medical Stores has been incorporated with this service.

The development of maternal and child health services has started well and has expanded its scope within the Kathmandu Valley to Patan and Bhaktapur. Four maternal and child health clinics were opened, and smallpox vaccination and training of student nurses and assistant nurse-midwives introduced. A limited programme of domiciliary midwifery service has started.

The veterinary laboratory built on the premises of the Veterinary Hospital is nearing completion. It will prepare animal vaccines and sera, including rabies vaccine. SEA/RG18/2 Page 164

The construction of a new Auxiliary Health Workersr Training School on the site of the Kanti Hwpital was stad The drop in the number of students in the School has caused concern. SEA/RC18/2 Page 165

PROJECT LIST

Project Nq. Source of Punds Co-operating Aeanctee -Title

Malaria Eradication R (June 1954 - ) (USAID)

Aim of the project. To eradicate malaria throughout the country in progressive Stages.

Assistance provided by WHO during the year. (a) Two malariologists, an entomologist, a sanitary engineer, three sanitarians, a laboratory technician, an administrative officer, one administrative assistant, two supply assistants, one secretary-stenographer and one office assistant (clerk-typist); (b) one six-week and four one-month fellowships for study in India, two three-month fellowships for study in Nigeria,and two flve-week fellowships for study in the Philippines and India; (c) supplies, equipment and four transport vehicles.

Probable duration of assistance. Until the end of 1973.

Work done during the year. The programme continued to make steady progress. A long-term Plan of operations for malaria eradication has been prepared. The second cycle Of DDT Spraying in the areas of perennial transmission, which was started in November 1364, was completed. The first cycle, started in March 1965 in the two Central Zones and in the East Zone was being compldted at the end of June. In the West Zone, geographical reconnaissance progressed satisfactorily, and spraying operations were Planned to start in November 1965.

From the end of April to June 1965, a joint USAID and WHO assessment team carried cut an appraisal of the programme. Based on the findings of thls assessment,action will be taken to improve the working of the programme.

Case-detection activities were continued in the Central Zones and in the East Zone. In two areas of Central Zone "B", the rates of positive cases, which were respectively 0.15 and 0.11 per 1000. suggest that those areas with a populatlon of 800 000 could be considered for entry into the consolidation phase early in 1966, Provided further improvements can be made in spray coverage, in stabilizing surveillance activities and in investigation of positive cases. Active case-detection activities were started in two areas in the East Zone, covering n population of 500 000.

Entomological investigations were continued in areas in which an increased number . of positive cases had been reported. For the first time in Nepa1.A. sergenti has been recorded in the West Zone. Susceptibility tests carried out on A.fluviatilis indicated that this species was still susceptible to DDT. ss~/hcl8/2 Page 166

Nursing Education (Nov. 1954 - )

Aim of the project. To establish a basic nursing school in order to prepare qualified nurse-midwives for the country's health services,and to upgrade and improve nursing Services within the Bir Hospital so as to provide a better clinical field for student nursing practice.

Assistance Provided by WHO during the year. (a) A nurse administrator; a consultant in nursing for about four months; (b) a two-year fellowship for study in Canada; (c) Supplies and equipment.

Probable duration of assistance. Until the end of 1968.

Work done during the year. The WHO nurse educator who worked with this project until August 196& was replaced by a nurse administrator, who is required to assist in improving nursing services within the Bir Hospital. Initially she has been concerned with the educational programme at the School of Nursing.

A national miEwifery tutor who had been awarded a one-year WHO fellowship returned from study at the College of Nursing, Delhl.

With thc assistance of a short-term ccnsultant, who was assigned in December 1964. a three-month ward administration course was successfully completed by nine staff nurses from the Bir, Maternity and Kanti Hospitals.

Nepal 3 Training of Health Assistants, Kathmandu TA (June 1955 - Jan. 1962; Dec. 1962 - )

Aim of the project. To train health assistants and to plan for their effective use in the rural health services.

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

Probable duration of assistance. Until the end of 1972.

Work done during the year. The WHO public health officer and the sapitarian assisted in reorganizing the training course for health assistants. Emphasis was on producing multi-purpose auxiliary workers; the training of sanitarians has been temporarily suspended. The hW0 sanitarian left the project in October 1964.

The content of both theoretical and practical aspects of the health assistants' Course was revised, and increased attention was given to the practical training in the Bir Hospital, the laboratory, the school and the public health field practice area.

In the vacation months, the WjlO public health officer accompanied WHO malaria eradication personnel on a field visit to the eastern part of Wepal, and tooK the Opportunity to study the work being done at health centres, rural hospitals and sEAhCl8h Page 167

malaria units. Information regarding the training and educational background of superintendents, inspectors, and supervisors attached to the National Malaria Eradication Organization was obtained,and plans were made td give such staff further training and absorb them gradually in an integrated health service.

A draft plan of operations for the strengthening of health serviccs in Nepal is under ccnsideration by the Government.

-Nepal 8 Maternal and Child Health Services and Training* R (nec. 1963 - ) ' UNICEF

Aim of the prcject. To develop maternal and child health services and to establish referral facilities.

Assistance provided by WHO during the year. A maternal and child health officer.

Probable duration of assistance. Until the end of 1967.

Work done dui7ing the year. By the timi of reporting, the Maternal and Child Health Section of thc Department of Hcalth and the maternal and child health scrvices in Kathmandu Valley had'been fairly well established and the staffing pattern considerably strengthened.

It has been agreed to expand these services to other parts of the country, initially to zonal headquarters, where training of auxiliary nurse midwives is planned. The expansion envisnees thc development of maternal and child health services within the framework of the basic health services and their co-ordination with country-wid., schemes for the control or eradication of communicable diseases.

Studies on Schick-test convprsion rates among children in different age groups and the examination of a small group of women and suspected cases of congenital syphilis by the use of blotting paper (rondelles) were in progress.

Considcration was given to starting refresher courses in maternal and child health for fcmle mcdlcsl officers before they are posted to hospitals at ZDnal headquarters.

The counterpart to the WHO maternal and child health officer returned to Nepal, having obtained an M.A. Degree in Public Health in the United States of America (under a fellowship awarded by USAID).

A WXO public health nurse, recruited for the project, is oxpected to Start work in August 1.965.

'Previous title: Maternal and Child Health. SEA/RC~~/Z Page 168

Smallpox Control Pilot Project (Reb. 1962 - )

Aim of the project. To initiate and develop a smallpox control pilot project In the Kathmandu Vallcy and subsequently to expand the programme gradually, as and when the situation permits.

Assistance provided by WHO during the year. (a) A smallpox control officer: (b) freeze- dried smallpox vaccine. and a transport vehicle.

Probable duration of assistance. Until mid-1967.

Work done during the year. Further progress was achieved in the smallpox control activities under w?y in the Kathmandu Valley. The Government has planned to extend the vaccination campaign to several districts in the Central and Terai Regions and later to the rest of the country, and for this purpose an addendum to the plan of operations was prepared.

The WHO smallpox control officer continued to assist in the work. The freeze- dried smallpox vaccine and the vehicle were received, and supplies of freeze-drled Smallpox vaccine have also been received from bilateral sources.

This project was closely associated with the tuberculosis/leprosy COnt1'0l aroject (Nepal 16), when the latter project was started in March 1965.

Nepal 14 Community Water Supply R (June 1964 - )

Aim of the project; To plan and co-ordinate tho development of activities in the field of community water supplies.

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

Probable duration of assistance. Until the end of 1967.

Work done during the year. In thesc activities, close co-operation was maintained with the Indian Aid Mission,and liaison was established with the UNTA Consultant on Town Planning, particularly with regard to population distribution and resettlement in the satellite towns which are to be set up in the iiathmandu 'Valley.

Proposals for croation of a suitable governmental agency to be responsible for sanitary engineering work were prepared for consideration. Some improvement in the standard of training in sanitary engineering subjects 'at tho Engineering School has been affcctcd.

A draft for a five-year plan for community water supply has been prepared. the assistance of the WHO sanitary engineer. Several engineering schemes for imPr0V- in8 the existing water treatment plants at Balaju and Maharajganj were prepared and put into effect. SEA/RCl8/2 Page 16'1

Nepal 16 Tuberculosis and Leprosy Control R (March 1965 - )

~f the project. To develop control services for tuberculosis, leprosy and other communicable diseases in the Kathmandu Vzllcy.

Assistance provided by WHO during the year. (a) A medical officer, a BCG nurse and 3 leDr0sY control officer; [b) supplies and equipment and two transport vehicles.

Probable duration of assistance. Until the end of 1167.

Wcrk done during the year. A plan of action for this Project, to be direcLed flrst towards tuberculosis and leprosy was Prepdred and agraed upon. A WHO medicalafficer and a BCG nurse assumed duty in Kathmandu at the end of March 1965, and a leprosy control officer joined t'nem in May.

A preliminary study was made of the problems of tuberculosis and leprosy'in the Valley,and training activities were started.

Nepal 200 Fellowships

Vital and Health Statistics. A ten-week fellowship for study in India.

Nepal 201 Fellowships TA

Laboratory Technology. A two-year fellowship for study in Ceylon.

SEqRC18/2 Page 171

The budget provision for health services in Thailand was increased by five per cent as compared with 1984.

The plan for the national malaria eradicatica programme was expanded, with the aim of covering the whole population at risk by 1966. Again no caae of smallpox waa recorded. Plague- has ceased to be a problem for a number of years, but the eurveillance administration for plague is bdng md... Scnttered outbreaks of cholera El Tor again occurred.

1964 was another year of high incidence of haemorrhaglc fever, a further departure from the earlier pattern of alternate years of high and relatively low incidence. The disesee has spread from its main focus in Bangkok/Dhcaburi to thecentral hnd Northern Provinces. A Raemorrhagic Fever Study Centre baa been created for research. The WHO-sponsored Inter-Regional Seminar on Mosquito-Bome Hasmorrhagic Fever, held in Bangkok in October 1964, aroused great interest and received major contrilmticas from Thai workers.

The national tuberculosis control programme made good progress in mok,Khon Kaen and Chiengmai, but transport probleme have not been solved. In rural and less accessible are- it is planned to put major reliance on an axtension of the BCG programme and m the follow-up and treatment of cases diagnosed at provtncial hospitals and health centres.

The Second Thai National Conference on Medical Education was held in August 1964, Aa the training of teachers and research workers hn the bic medical sciences is regarded as a prerequisite for imprwing medical uder- graduate education, it has been decided to establish, in Bangkok, an Institute for the Basic Medical Sciences, with the assistance from the Rockefeller Founda- tion. Here it is planned to provide a four-year course leading to a science degree. It is also planned to start a new medical echo01 in Bangkok for selected studenta completing their studies at the Basic Science Institute.

A programme for training radiographers was started at Siriraj Hospital. Melapment of radiation health protection services within the Ministry of Health made satisfactory progress.

A pilot project intended to strengthen rural health services with a view to the integration of specialized campaigns was continued in Pitamloke Province, where, in order to secure adequate populatim coverage, it appeared necessary to introduce and train a new category of basic, or village, health worker. SEA/RCI~/Z Page 172

PROJECT LIST

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

Thailand 2.2 Strengthening of Health Services (Yaws Control T A and Integration)* (Jan, 1964 - )

Aim of the project. To integrate specialized communicable-disease control programmes into the general health services and to develop further and organize the rural health services.

Assistance provided by WHO during the year. A public health officer, a public health nurse and a laboratory Cechnlcian.

Probable duration of assistance. Until the end of 1968. -. -. The Tre~oneponeses Control Division maintained three yaws teams to continue surveillance of yaws in the Provinces of Warathivas and Pattani, where there was a residual pocket of infection. In 1964 the yaws surveillance teams examined 261 745 people, diagnosing and treating 399 active cases, including 84 infectious cases. Mass-treatment of children was carried nut in all villages with infectious cases. In addition, a total of 232 413 anti-smallpox vaccinations was performed by the national teams. Yzws surveillance by the rural health services was extended to 45 provinces (7 in the south, 15 in the north-east, 11 in the north and 12 in the south).

The process of strengthening the health services was carried further, with the organization and conduct of multi-purpose refresher courses for health staif in the project area. Both national and WHO staff members assisted with these courses.

Accompanied by the WHO public health officer and the WHO nurse, all key personnel of Pltsanuloke Province completed observation programmes on a tour intended to famlliarize them with "integrated" services and special programmes. A plan of action for the further strengthening of health services in this PrOvFnce has been under consideration. The closer co-ordination of hospital and health services in the Province was discussed, and useful moves towards the integration of health services were planned. Also, the programme of work for "tambol" health workers In the district of Wat Bot has gone forwared. Transport was provided by WCEF.

The WHO nurse accompanied nursing chief's of the Ministry on visits to study nursing programmes. In Pitsanuloke, she prepared work schedules and job descriptions for nursing personnel.

h he first part of this project dealing with yaws control was completed in December 1963 under project number "Thailand 2". when the WHO yaws adviser cempleted his aaslgnment. SEAhCl8 /? Page 175

The training given in laboratory work was haniticapped for lack of a suitable laboratory in which to do practical teaching. The WHO laboratory technician prepared simplified material for rural health workers. Also, progress in upgrading venereal- disease laboratories was maintained. A ten-yelr plan for the gradual expansion of a network of provincial llboratories, co-ordinated and supervised by the Central laboratory, Bangkok, was approved. The first provincial laboratory was set up in Pitsanuloke and preparations were made for a screening programme in a selected district of Wat Bot. In Bangkok, 23 maternal and child. health and municipality health centres were upgraded,with the assistance of the WHO laboratory technician and supplies from UNICEF.

Thailand 17.2 Mental Health Education and Services* H (Jan. 1965 - I

Aim of the project. To strengthen training programmes for psychiatric nursing and to improve the mental health services.

Assistance provided by WHO during the year. A psychiatric nursing adviser.

Probable duration of assistance. Until the end of 1968.

Work done during the year. The WHO psychiatric nurse arrived in January 1965 and, after a period of orientation to nursing within the country and especially to the mental health services, assisted in developing and conducting an in-service courses for nursing staff in mental hospitals. The training of student nurses at the Samdit Pry0 Hospital was revissd to include new concepts in mental health nursing both in prevention and cure.

Thailand 21 Nursing Advisory Services TA (April 195k - Dee. 1957; Jan. 1958 - 1

Aim of the project. To establish a Division of Nursing in the Ministry of Public Health which will co-Ordinate nursing activities and nursing education within the country.

Assistance provided by WHO during the year. A nursing adviser, a nurse educator and a. consultant for four months.

Probable duration of ahsistancc. Until the end of 1968.

Work done during the year. For the first time 3 national examination for nurses was held. Legislation governing nursing practice was in preparation. Job descriptions for the nurses in the Division of Nursing were drafted. The Division of Nursing continued with its work of oo-ordination of nursing activities, and received an increasing number of requests for assistance from schools of nursing and public health organizations.

P~revioustitlc: Mental Health Services. Activities up to February 1964 were reported previously under project number Thailand 17. SEA/Rc18/2 Page 174

The nursing adviser left the project in December. The nurse educator complet~d her work at the school of nursing at the Women's Hospital and has assisted with the development of a new school of nursing in Chanthaburi. This school opened in May 1965. A consultant was assigned in July 1965 to assist with the revision of the basic nursing curriculum and with formulating legislation.

Thailand JO Leprosy Control R (Oct. 1955 - ) UNICEF

Aim af the project. To expand and intensify the leprosy control programme to cover all endemic areas of the country, and to train personnel.

Assistance provided by WHO during the year. A senior consultant leprologist, a leprologist and two leprosy control officers.

Probable duration of assistance. Until the end of 1967.

Work done during the year. The project maintained satisfactory progress; the total number of "sectors" (administrative units for the project) has now been reduced to twelve. These "sectors" control and supervise the survey and treatment activities in 26 provinces. In addition, the activities in Bangkok, Thonburi and Phrapradaeng areas were continued by the Government. A limited expansion to the provinces of Trad and Chanthaburi in the north-east in the next two years is envisaged.

At the end of June 1965, in the areas of operation there were approximately 70 000 patients on the treatment register.

In the northern provinces, special attention continued to be paid to the supervision of static and mobile work in the provinces of Udon, Nongkai, Sakon Nakhon, Nakhon Panom and Lampang. At the end of March 1965 the following numbers of patients were on the provincial registers and under treatment: Udon (2 216); Nongkai (332); Sakon Nakhon (1 231); Nakhon Panom (575); tampang (868 ); Chiengrai (1 205 ); and Nan (563).

The Leprosy Control Directorate was reorganized and strengthened to give close supervision to project sctivlties. Considerablp changes were made in the technical policies in order to consolidate and strengthen the operations. The administrative unit was reduced from the "expansion area" to a smaller "sector", in size, and the sector chief was made directly responsible to the leprosy control headquarters. This change brought about a considerable improvement with special reference to more ~ccuratesurveys, regularity of clinic attendances, effective surveillance of contacts and stricter control aver discharge of patients.

The patient register in all sectors was revised so that the number of active cases needing treatment and thc number of patients xctually treated could bc sscertalned accurately. The record form was standardized in order to provide accurate statistics at quarterly and yearly intervals. Thailand 42 Tuberculosis Control* T A (Oct. 1958 - May.1959; Dec. 1959 - 1 UNICEF

Aim of the project. In the first instance,to establish a pilot project in an urban and in a rural area to demonstrate the organization of tuberculosis case-finding and treatment services suitable for country-wide application and to provide a training field for national personnel; to establish and develop an epidemiological centre for the collection and elucidation of information on the problem of tuberculosis in the country.

Assistance provided by WHO during the year. (a) A medical officer, a statistician, a laboratory technician and an X-ray technician; (b) one two-week and one four-month fellowships for study in India; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1969.

Work done during the year. Based on the findings and experience of the pilot project. a mass campaign to cover the whole of the urban population of ~angkokhhonburiwas successfully initiated. The rural pilot project was completed in Chiengmal and control operations were continued. Work has started in a third project area in Khon Kaen.

The seven mobile X-ray units in operation in the project area (five in Bangkok, one in Chiengmai and one in Khon hen) exceeded their target of 1 000 exposures weekly.

A new reporting system was introduced in the Tuberculosis Control Division. This is defiigned to indicate the current total workload of the Divislon.mainly in terms of patients diagnosed or detected and those under active supervision and BCG vaccination. A document "Statistics from the Field Project, 1960-1964" was prepared. It recapitulated the most important baseline data collected during the period. To gain some experience in tuberculosis control carried out by non-specialized health personnel. the Tuberculosis Division has started a number of small-scale experimental projects, especially in the Northwestern Province.

The drug trial comparing the acceptability of 1NH/PAS and ~NH/thiacetazone was continued; preliminary results indicated that regularity of treatment was the same for both regimens and that the bacteriological conversion rate to non-Infectious tuberculosis showed no difference, being 79 per cent for both regimens. On the basis of these results, the Government Is considering the employment of ~~H/thlacetazone as the standard dual drug regimen with the elimination of the use of the expensive PAS.

A co-operative study of IMI-resistant mycobacteria in children with tuberculous meningitis was started, and in this connection 26 specimens of spinal fluid from two co-operating hospitals were received.

WHO technical recommendations advocatingtheintroduction of direct BCG vaccination with freeze-dried vaccine, 1.e.. without prior tuberaulin testing,were under consideration. This practice will permit the integration of BCO vaccination into the

4 Previous title: National Tuberculosis Programme - Pilot Project. SEAhcl8h Page 176

work of the general health centres. The national BCG assessment team continued to Supervise the technical quality of the work. The laboratory technician and X-ray - technician were transferred to other projects in January.

The experience gained from these studies in Bangkok, Chlengmai and Khon &en may how be used in the development of s realistic provincial tuberculosis programme which can be applied to all parts of the country.

Thailand 43 Trachoma Control R (July - Aug. 1959; April 1961; Oct. 1961 - UNICEF April 1962; June 1962 - )

Aim of the project. To develop a trachoma control programme and to integrate it into the public health services in those areas in which trachoma is known to be endemic.

Assistance provided by !+liO during the year. A trachomatologist.

Probable duration of assistance. Until early 1967. -. -. Trachoma control activities were continued in accordance with the agreed plan of action in the plan of operations. An addendum to the plan of operations tc cover additional districts in Korat and Khon Kaen Provinces was signed by the Government, UNICEF and WHO.

A trial integration of trachoma control into the health services, carried out in 50 villages, showed encouraging results in the control of the disease. By a systematic and repeated health education campaign for self-application of the antibiotic ophthalmic ointment am¶ by making the drug available locally at a reduced price, it has been possible to secure the active co-operation of the people.

The WHO medical officer continued his assistance to the project; UNICEF provided vehicles, antibiotic ophthalmic ointment and other supplies. The Government is supplying the villages with an antibiotic ophthalmic ointment prepared at the Oovernment Pharmaceutical Laboratory, Bangkok, at a subsidized price (2 bahts for a 3.5 gm ointment tube).

Thailand 52 Faculty of Tropical Medicine and Endemic Diseases (Aug. - Sept. 1959; June - Aup. 1961; June 1962; June - July 1963; Jan. - May 1964; June - Dec. 1964; - )

Aim of the project. To strengthen the Post-graduate School of Tropical Medicine and Endemic Diseases of the University of Medical Sciences, Bangkok.

Assistance provided by WHO during the year. A consultant in parasitology for three months and a consultant in epidemiology for two and a half months.

Probable duration of assistance. Until the end of 1968. Work done during the year. A WHO consultant in parasitology was assigned in June 1964 for three months. He advised on research programmes in parasitology and assisted in the teaching of the subject at the Faculty. Advice was also given on setting up a Department of Parasitology in the Faculty of Medicine.

A WHO consultant in epidemiology was assigned in September 1964 for a period of three months to assist in the development of the D2partment and in teaching programmes.

Further consultant service to the Faculty is planned for 1967.

Thailand 60 School of Pharmacy. Bangkok R (NOV. 1962 - Oct. 19641

Aim of the project. To train qualified pharmacists and post-graduate students to prepare them for teaching in schools of pharmacy; to carry out pharmaceutical research; to build up a cadre of qualified pharmacists to staff pharmaceutical departments.

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

WorR ame. The WHO professor of pharmacy completed a two-year assignment in October 1964. In addition to his general teaching activities, he assisted the School of Pharmacy in the revision and development of the curriculum in accordance with modern concepts of pharmaceutical education, in the institution of improved classroom and laboratory methods for teaching, in introducing courses in drug evaluation and professional communications, and in drafting proposals for post-graduate studies and internship programmes. His report has been sent to the Oovernment.

The project has effected a measurable advance in undergraduate and post- graduate training of pharmacists. A stimulus was given to pharmaceutical research.

Thailand 63 Nutrition R (Aug. 1963 - Aug. 1964; Feb. - March 1965; - )

Aim of the project. To strengthen nutrition education programmes.

Assistance providcd by WHO during the year. A medical nutritionist and a temporary adviser on nutrition.

Probable duration of assistance. Until the end of 1967.

Work d&e during the year. The Yljl0 medical nutritionist completed his assignment in August 1964.

A temporary adviser t~ the Regional Director visited Thailand for about two weeks In February/Maroh 1965, and advised on the development of nutrition projrammes. Further assistance is being planned. S~Ah~18/2 Page 178

Thailand 65 Malaria Eradication R (Jan. 1962 - ) (USAID)

Aim of the project. To eradicate malaria from the entire country.

Assistance provided by WHO during the year. (a) An entomologist, a malariologist (epidemiologist) and a translator-typist; (b) one six-week and four one-month fellowships for study in India and three one-month fellowships for a study tour in India and Ceylon; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1972.

Work done during the year. Expansion of the progrme has been taking place since August 1964, and it is hoped that 24 to 25 million people will be protected by DDT residual spraying. A WHO engineer is being added to the team, to asaibt in the spraying operations. Five additional WHO sanitarians have been requested by the Oovernment to render assistance in malaria eradication operations, and WHO has agreed to provide this additional staff,as well as transport.

A consultant malariologist and a laboratory technician were assign~4to Thailand to investigate the problem of chloroquine resistance of P. falciparum infection (see SEAR0 7). The sanitary engineer (malaria) from the Regional QfSice has also assisted.

Thailand 66 Food Control TA (Aug. - Oct. 1964)

Aim of the project. To reorganize the Department of Food and Drug ~dministration of the Ministry of Health.

Assistance provided by WHO during the year. A consultant for about nine weeks

Work done. The WHO professor of pharmacy attached to the School of Pharmacy. Bangkok (under project Thailand 60),undertook a short assignment during August/Ootober 1964 to assist the Ministry of Public Health in the organization of its work in drug control. His recommendations are under consideration.

Thailand 61 Radiation Protection Services R (April - May 1963; Feb. - March 1965; - )

Aim of the project. To develop radiation protection measures and to establish a Division of Radiation Health Protection within the Ministry of Public Health.

Assistance provided by WHO during the year. A short-term consultant.

Probable duration of assistance. Until the end of 1967.

Work done during the year. Assistance to this project is being undertaken in co- operation with the Oovernment of New Zealand, which is brovlding fellowships and equipment under the Colombo Plan. . A WHO consultant visited Thailand for one month auring Februaryharch 1965 to advise the Government on the establishment of a Division of Radiation Health Protection within the Department of Medical Sciences of the Ministry of Public Health. During this period, agreement was reached between the Ministry, the Thai Atomic Energy Commission and the Radiological Society of Thailand on the broad principles of the composition and operation of the National Radiation Advisory Council andsat the same time, of an enactment for radiation protection. The nucleus of the future staff of the Division of Radiation Health Protection was selected and arrangements were made for their formal training. Two staff members have slnce attended a two-month course at the School for Radiological Technology. Bangkok, and two others have commenced their training in New Zealand on Colombo Plan fellowships.

Further consultant service is planned for 1966 and 1967.

Thailand 70 Vector-Borne Disease Control (Haemorrhagic Fever) R (June1961- )

Aim of the project. To study the epidemiological factors responsible for the persistence of haemorrhagic fever, principally the bionomics of the responsible vectors, in order to take effective control measures.

Assistance provided by WHO duringthe year. A consultant for about two months.

Probable duration of assistance. Until mid-1967.

Work done during the year. Cases of haemorrhagic fever continue to occur in Thailand (see Section 1.4.2(1)). The A'edes aegypti Control Pilot Project, started in a suburb of Bangkok in 1964 by national health staff, usfng DDT, was successfully completed. In March 1965 WHO assigned a consultant to advise on further studies of ABdes aegypti and on the extension of the control area. A plan of operations was prepared for the purpose, and a medical officer will be provided to the project on a long-term basis.

Thailand 71 -k T A (Jan. 1965 - 1

Aim of the project. To establish a school for the training of radiographers.

Assistance provided by WHO during the year. A radiology tutor.

Probable duration of assistance. Until the end of 1967.

Work done during the year. The School for Radiological Technology was established, with WHO assistance, at Siriraj Hospital, Bangkok, for the training of X-ray technologists in diagnostic radiography leading to a diploma and a B.Sc. degree. WIphasls has been given to maintenance of equipment and prevention against radiation hazard. The School also conducts short courses to give additional training to personnel who are at present serving as X-ray operators but who have had no formal courses. SEA/RCIB/Z Page 180

The WHO tutor started work in January 1965. Curricula for the training courses were prepared, and teaching equipment was assembled. Two two-month refresher courses for X-ray operators were held in the first half of 1965; the first course was attended by twelve of the nurse X-ray operators from Sirlraj Hospital and by two staff members from the Department of Medical Sciences, the second course, by fifteen X-ray operators from nine hospitals in Bangkok and a further group of nurse X-ray operators from Siriraj Huspital.

Thailand 200 Fellowships R

Venereal-Disease Control. A six-month fellowship for study in Denmark.

Epidemiology. A three-month fellowship for study in India.

Enteric Diseases. A two-month fellowship for study in the United Kingdom (to start in August).

Thailand 201 Fellowships TA

Preventive and Social Medicine. A ten-month fellowship for study in the United Kingdom (to start in October).

Anaesthesiology. A eleven-month fellowship for participation in the Anaesthesiology Training Course in Copenhagen (awarded under EURO 52). SEA/RC~~/Z Page 181

10. INTER-COUNTRY

Projeot No.

BCG Assessment ~eam*

BCG Assessment Team, Indonesia (May 1963 - Feb. 1965)

Aim of the project. To strengthen BCG vaccination programmes and to introduce freeze- dried BCG vaccine.

Assistance provided by WHO during the year. (a) A medleal officer (attached to Indonesia 50) and a BCG nurse; (b) supplies and eauipment.

Work done. The team continued to operate in Indonesia. Freeze-dried BCG vaccine was introduced in almost all the provinces of the country, leaving only a few actlve BCG teams in the outer islands still using the liquid vaccine. It is hoped that this can be remedied byarramini: forthe leaders of these teams to be trained in Jogjakarta.

A study 02 the effect of freeze-dried vaccine stored at room temperature for different peribds was undertaken. The study of the relationship between tuberculin allergy and the development of a local BCG vaccination lesion in time was completed; the preliminary findings indicated that persons with tuberculin reactions larger than 10 mm induration produce a higher mean of post-vaccination tuberculin sensitivity as well as of vaccinal lesions than do those with tuberculin reactions of 9 mm or less before vaccination.

Among other activities carried out by the Assessment Team were: the evaluation OP Vaccinations done by three mass campaign teams in Central Java where freeze-dried vaccine had been used; check-up of the work' of the Jogjakarta mass campaign team with respect to the techniques of testing, reading, reconstitution of freeze-dried vaccine, and vaccination and tuberculin testing of tuberculous patients in and near Jogjakarta; tuberculin testing and vaccination of a village population of 1 130 to determine the naturally acquired tuberculin allergy for use in estimating the age-infection rate (a post-vaccination examination was carried out twelve weeks later).

The Assessment Team concluded its field work in Indonesia in February 1965. The natlonal team is continuing the work as a permanent feature of the country's tuberculosis programme, with assistance from the !4HO staff assigned to that programme (Indonesia 50).

* The project started in 1958 with assistanoe to Ceylon (from November 1958 to October 19591, and after that to India (November 1961 - March 1962) and to Burma (April 1962 - April 1963). SEA/RC18/2 Page 182

SEARO 7 Regional Assessment Team on Malaria Eradication R (May 1959 - Dec. 1961; Nov. 1963 - )

Aim of the project. To make an independent appraisal of the status of malaria eradication or of any special aspects of the programme in countries or the Region.

Assistance provided by WHO during the year. (a) An entomologist and a laboratory technician; three consultant malariologists and a consultant laboratory technician for two months; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1968.

Work done during the year. The entomologist visited Thailand from 16 March to 18 April 1965 and, with a WHO consultant on haemorrhagic fever (see project Thailand 70). assisted in carrying out susceptibility tests on larvae of Afdes aegypti in eleven localities of the urban area of Bangkok. He also 1nvestigated.some entomological aspects of the malaria programne. In June, he was assigned temporarily to NepB1.

The laboratory t6chnician assistedthe Regional Centre for'&ternal Cnoss- Checking of Blook Filmssat ~aSauli(India) from August 1964-to ~pril1965' (see SmO 94) and was reassigned to the malaria eradication project in Nepal in May 1965.

...... piom April to june 1965, two consultant malariologists carriedout an assessment oi the malaria eradication prograke fn ~epalincollaboration with USAID.

Another consultant malariologist and a laboratory technician went to Thailand In June to make a study of chloroquine resistance of malaria parasites.

SEARO 30 Smallpox Eradication TA (oct. 1962 - )

Alm of the project. To assist the countries of the Region in carrying out the control, and ultimately eradication, of smallpox.

Asaistance provided by WHO during tho year. A medical officer.

Probable duration of assistance. Until the end of 1967.

Work done during the year. The WHO medical officer assisted in the assessment of the smallpox control pilot projects in Afghanistan, Burma. India and Nepal and advised on measures to be taken for further progress of the field activities.

It was estimated that countries of the Region would require, up to 1967, about 300 million doses of freeze-dried smallpox vaccine, and WHO assisted in communicating these requests to possible donor countries. A major portion of this quantity is expected to be obtained from bilateral sources. During the year, WHO provided freeze-dried vaccine to Afghanistan, Burma, India. the Maldive Islands and Nepal. (The supply to India was to assist in controlling a smallpox outbreak in Bombay.) Freeze-dried smallpox SEA/RC18/2 Page 183

vaccine has also been supplied to the Government of Ceylon for vaccination of persons exposed to the risk of high infection and for carrying out comparative observations of the reaction produced by this vaccine and the locally produced glycerinated lymph vaccine.

Potency tests of the freeze-dried vaccines being used in India, including a field trial of an Equador strain vaccine to compare its reaction with reactions to vaccines prepared with sther strains, have been carried out.

SEARO 50 Reorganization of Rural Health Records and Reports R (Jan. 1961 - )

Aim of the project. To organize a system of rural health service records and reports in selected centres and to train personnel in the collection, processing and presentation of vital and health statistics at the rural health centre level.

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

Probable duration of assistance. Until the end of 1967.

Work done during the year. The project continued operations in the State of Gujarat with emphasis on out-patient and maternal and child health records systems.

Out-patient morbidity statistics, collected by sampling procedures from primary health centres in Ahmedabad District during 1962, were processed and reported.

Revision of drafts of ante-natal, delivery and children's records continued, in consultation with maternal and child health workers in Gujarat and .Punjab.

The WHO statistician attended a meeting on the sample registration scheme for the improvement of vital statistics, and also a seminar on the evaluation of peripheral health activities.

SEAR0 61 Training Course for Medical Records ~f~icers* R (June 1964 - March 1965; - )

Aim of the project. To train personnel. of different grades to work in hospital records and statistics departments.

Assistance provided by WHO during the year. Assistance by the WHO staff assigned to the Hospital Statistics Project in Bangkok (SEAR0 72) and guest lecturers from the Siriraj College of Medicine.

Probable duration of assistance. Until the end of 1967.

Work done during the year. The first course,which was started in Bangkok on 9 June 196k with nine participants (2 from Afghanistan, 1 each from Burma, Indonesia and Nepal

Previous title: Hospital Records Training Course. SBA/RCl8/2 Page 184

and 4 from Thailand),ended satisfactorily on 15 March 1965. Fellowships had been awarded by the Regional Office last year, at the beginnin& of the course, to the participants from Afghanistan. Burma, Indonesia, Nepal and one from Thailand who came from Chiengmai (the other three were from Bangkok). After the course tihe participants from Afghanistan and Bepal visited the Medical Records Department of Christian Medical College, Vellore (India) on their return journey to their respective countries.

The first six months of the course.included formal teaching (lectures and laboratory exercises) in medical record science, medical teminolow, hospital statistics, and basic medical sciences. In addition, field trips were made to hospitals in northern, central and southern Thailand. The last three months were devoted to practical field work, during which the trainees. in groups of three, analysed records procedures in a hospital, made recommendations for rationalization and, when these were accepted, worked towards their implementation.

Similar courses in other countries are planned.

Development of ommu mu nit^ Water Supply Programme (April 1965 - )

Aim of the project. To provide governments of the Region with consultant services for the development of their urban and rural community water supply projects.

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

Probable duration of assistance. Until early 1968.

Work done during the year. A WHO sanitary engineer was assigned to this project in April 1965. Initially based in the Regional Office. hehas been working on special assignments relating to various water supply projects in the Region.

SEARO 72 Hospital Statistics TA (Jan. 1963 - )

Aim of the project. To help governments of the Region to organize an efficient aystem for the maintenance and flow of records in selected hospitals; to collect, process and present hospital statistics data efficiently on a national scale; to train medical records and hospital statistics personnel.

Assistance provided by WHO during the year. (a) A statistician, two medical records officers and S typist: (b) supplles and equipment.

Probable duration of assistance. Until the end of 1968.

Work done durins the year. Field activities in.Thailand continued.

The Annual Statlatical Report for 1963 for Sirfraj Hospital, Dhonburi, and a Similar report for 1963, covering five hospitala located in the City of Bangkok and SEA/RC18/2 Page 185

27 out of 83 provincial hospitals. were printed and issued. The data for the 1964 report are being processed. This report will cover, in addition to Bangkok hospitals, 46 provincial hospitals containing 4 813 beds (representing 56% of the total number of beds in provincial hospitals).

In February 1965 the WHO statistician visited Ceylon for a week and, together with the &O medical records officer already working in Colombo (see Ceylon 45). reviewed the medical records systems and the arrangements for collection, processing and presentation of hospital statistics in Ceylon.

The WHO project staff completed the teaching in the first training course for medical records officers conducted in Bangkok (see SEARO 61).

Studies on Filariasis (~ov.1962 - )

Aim of the project. To carry out research on filariasis in order to evolve more effective methods of control.

Assistance provided by WHO during the year. (a) An epidemiologist, an entomologist and six consultants - all provided by Headquartersnand an epidemiologist-cm-parasltologis provided by the ~egionalOffice; (b) supplies and equipment (provided under'the Head- quarters' allotment).

Probable duration of assistance. Until the end of 1967.

Work done during the year. The WHO Filariasis Research Unit, established in Rangoon in 1962 as part of the WHO global filariasis research programme, continued its studies on mosquito vectors of filariasis, with particular reference to their ecology, bionomics, flight-range, susceptibility to insecticides and cross-resistance' to different compounds. An epidemiological summary of the situation in the project area was prepared by the WHO epidemiologist. The work of the Unit is carried out in close collaboration with several research institutes and laboratories in different parts of the world concerned with studies on insecticides and Culex pipiens fatigans control.

Medical ~ducatiodStudy Tour (Paediatrics) (25 Jan. - 20 Peb. 1965)

Aim of the project. To enable a group of teachers in paediatrics from various countries of the South-East Asia Region to study modern techniques and practices of the teaching of paediatrics.

Assistance provided by WHO during the year. A consultant for two months and travel costs and subsistence allowances for ten participants.

Work done. This study tour was held from 25 January to 20 February. A group of ten senior paediatricians from medical colleges in the South-East Asia Region (1 from Afghanistan, 1 from Burma, 1 from Ceylon, 3 from India. 2 from Indonesia. 2 from SEA/RC18/2 Page 186

Thailand) participated, with a WHO short-term consultant in paediatrics acting as team leader. Visits were made to medical institutions in Bangkok and in India,and discussions were held with professors of paediatrics inthoseinstitutions. The group also attended the Second All-India Paediatrics Conference, held in Patna (Bihar State).

The report on the study tour contains useful suggestions for further development of the social paediatrics aspect of paediatric education in the Region.

External Cross-Checking of Blood Films (June 1963 - )

Aim of the proJect. To provide facillties for external cross-checking of blrod films from malaria eradication programmes in the South-East Asia Region.

Assistance provided by WHO during the year. (a) A laboratory technician (from SEAR0 7): (b) a grant to the Government of India to meet the cost of employment of national staff and contingencies.

Probable duration of assistance. Until the end of 1967.

Work done during the year. The Regional Centre for External Cmss-Checking of Blood Films.established in KasaUli.in 1963 continued its activities. During the period from August 1964 to May 1965 it received 19 000 slides from Ceylon, 2 500 from Burma and 638 (2 036 smears] from Thailand. The number of slides examined during this period included 18 935 from Ceylon, 1 392 from Burma and 636 (2 030 smears) fmm Thailand.

Maternal and Child Health Assessment ~eam*

SEAR0 95.2 Maternal and child Health Assessment Team. Indonesia R (Feb. - May 1965)

Aim of the prdjeot. To study the administration and organization of maternal and child health services in countries of the Region with a view to advising on further international assistance.

Assistance provided by WHO during the year. A consultant in maternal and child health and a public health nurse (from project Indonesia 41).

Work done. A maternal and child health consultant and a public health nusse were assigned to this project from the middle of February to May 1965. They worked closely with the senior officers of the Divisions of Nursing and mternal and Child Health in the Ministry of Health.

Their study enOaFledvisits to a representative number of maternal and child health centres in Java. The team also studied in some detail health aspects of services provided in day-care centres, orphanages and treatment centres far handicapped children. Relevant material was collected concerning morbidity and mortality

'under this pro,ject,assistance to Thailand was given from December 1963 to March 1964. Assistance to another country is planned in 1966. SEA/RC~~/Z Page 187

among women and children, standard health promotion aspects of the services, workload, staffing patterns, administration and supervision, and the training in maternal and child health of relevant health personnel at all levels.

Thc findings lent support to the current maternal and child health policy of the Ministry of Health. The consultant recommended a commensurate increase in services and training facilities, the strengthening of supervision at all levels, extended inter-departmental co-ordination in the Ministry of Health and collaboration wlth the Ministry of Social Affairs in all matters related to welfare of mothers and children.

SEAR0 97 Nutrition Training R (nee. 1963 - ) UNICEF

Aim of the pnject. To assist in giving training in applied nutrition and, by means of a grant, to support the Nutrition Research Laboratories, Hyderabad (India), in carrying out the training programme.

Assistance provided by WHO during the year. A grant-in-aid to the Nutrition Research Laboratories, Hyderabad, and nine three-month fellowships for candidates from Afghanistan, Burma, Ceylon and Thailand to attend the training course.

Probable duration of assistance. Until the end of 1967.

Work done during the year. The second nutrition training course, which started on 1 December 1964 at the Nutrition Research Laboratories in Hyderabad, ended on 28 February 1965. The course was attended by a total of fifteen participants from five countries of the Region (1 from Afghanistan, 2 from Burma, j from Ceylon, 6 from India, 3 from Thailand). All of them were medical officers who were working as teachers in Departments of Paediatrics, of Social and Preventive Medicine, School Health, General Medicine and Public Health. The next course will start in December 1965 and will be mainly for medically qualified tfainees.

. Plans are under consideration for the development of a diploma course in nutrition which will be open to graduates in science, agriculture, home economics and other disciplines, as well as to medical graduates.

Further courses will be organized in 1966 and 1967.

SEAR0 102 Asian Institute of Economic Development R and Planning UNSF (Jan. 1964 - ) ECAFE UNICEF

Aim of the project.' To strengthen the faculty of the Asian Institute of Economic Development and Planning, established with the help of the United Nations Special SEA/RCI~/Z Page 188

Pund and UNICEF, and to assist with the training in health aspects of planning and public health administration.

Assistance provided by WHO during the year. A public health administrator (consultant).

Probable duration of assistance. Until the end of 1969.

Work done durlng the year. The WHO consultant public health administrator completed his first assignment in August 1964. He was reassigned to the Institute in January 1965, men, on arriving in Bangkok, he took part in meetings of the staff of the Institute at which administrative and curricular details of the second teaching programme were discussed.

As a result of the experience gained in the first annual training course, which extended for nine months in 1964, it was decided to modify the pattern,and. in order to attract hard-to-spare personnel, the basic course was reduced to six months, with extra time available for an "advanoed" course of two to three months. It was planned that suitable candidates would be invited to take both courses.

The WHO consultant has visited'the Weatern Paciflc and Eastern Mediterranean Regional Offices of WHO to discuss the aims and the work of the Institute.

The 1.965 course started in February wlth twenty-eight candidates attending (2 from Afghanistan, 2 from Ceylon, 3 from Qlina, 4 from India, 2 from Korea. 1 from Laos. 2 from Malaysia, j from Nepal, 3 from Pakistan, 2 from the Philippines, 3 from Thailand and 1 from Viet-Nan).

me hl30 consultant took part in the teaching of social planning and introduced discussions on "Health Planning: Perspeotlve~.Procedures and Strategiesu. He also guided seminars on health considerations in agricultural development planning. "Social Plaming", inclusive of the health factors, was adopted as one of the four subjects to be offered tc candidates for the advance0 course in the latter part of 1965. He was "leader" of a field study tour arranged for general-course fellows, to see developments in hiwan and in Japan. The short courses on planninx techniques were conducted - one in Indonesia and one in Singapore.

SEAR0 115 Post-graduate Medical Education R (~ugust1964)

A-. A-. To assist in the development of post-graduate medical education.

Assistance provided by WHO durlne the year. A consultant for two weeks.

WoM done. A WHO consultant was assigned to India for two weeks to assist in a review of the situation of post-graduate medical education in the country. He visited Delhi, Chandigarh and Lucknow, discussed with the national authorities the problems to be faced and advised on possible measuPes to be taken.

The consultant also participated in the Second Thai National CcnPerence on Medical Education, held in Bangkok from 17 to 22 August. SEA/RC~~/~ Page 189

11. INTER-REGIONAL (PROJECTS WITHIN THE REGION)

Project No. Source of Funds Co-operating Agencies

~nter-regional190 ~eprosy/BCaTrial, Burma R (April 1964 - )

Aim of the pruject. To carry out a trial of BCQ vaccination in the prevention of leprosy.

Assistance provided by WHO during the year. A leprologist., a laboratory technician and a statistician; a consultant statistlcian.

Probable duration of assistance. Until the end of 1968.

Work done during the year. The WHO leprologist and the laboratory technician continued the study on the epidemiology of leprosy in Burma with special reference to BC5 vaccination in the prevention of the disease. A consultant statlstlcian visited the project 111'1964 for about two and a half months to assist in this study. Later, he was succeeded by a regular statistician who joined the project in May 1965. The project, which is necessarily a long-term one, is progressing satisfactorily.

1nter-regional 196 Training Course in the Fundamentals of TA Nutrition and Their Application. Bangkok (FA01 (2 NOV. - 15 Dec. 1964)

Aim of thepmject. To provide an introduction to the fundamentals of nutrition and their a~plicationfor those working in the fields of public health, agriculture, education and home economics.

Assistance provided by WHO during the year. Secretarial assistance and 50% of the total cost, including the costs of seven short-term consultants and of travel and per diem for 27 partlcipants (the other 50% was paid by FAO).

Work doae. Prom 2 November to 15 December this joint PAO/WOtrainips course, held in Bangkok and Chienmai, was attended by 27 partlcipants ar.d 6 observers frodl3 countries in the South-East Asia and Western Pacific Regions - 1 from Afghanistan, 1 from Burma, from Ceylon. 3 from India, 3 from Indonesia. 1 from Nepal, 10 from Thailand (including 5 observers), 2 from Japan, 2 from Korea, 3 from Malaysia. 4 from the Philippines (including 1 observer), 1 from China and 1 from the Marianas. Among the participants were medical officers working in maternal and child health and nutrition, nutritionists, home economists, biochemists, agriculturalists, a food chemist and a public health nurse. A syllabus covering the general fieid of nutrition was prepared by FA0 and WHO. This syllabus was dlvlded into four main topics: foods and nutrients, nutrition and dieease, action programmes, and nutrition SEA/RCI~/Z Page 190

education and its evaluation. Teaching was carried out by means of leotures, group discussions of problems in food science and nutrition, films and field visits.

~nter-regional218* cancer ~dvi~oryTeam, 1ndiaS R (AW. 1963 - )

Aim of the project. To study the relationship between oral and pharyngeal tumours and some environmental factors, particularly betel and tobacco chewing and smoking habits.

Assistance provided by WHO during the year. An epidemiologist and a short-term consultant.

Probable duration of assistance. Indefinite.

Work done during the year. A WHO epidemiologist, who came to India ln August 1963 and remained until October 1964,and a short-term consultant, assigned from August to September 1964, assisted in the design and implementation of an epidernlological study on oropharyngeal tumours, as part of the WHO Headquarters' programme in cancer researoh. An epidemiological study was set up In minpuri District of Uttar Pradesh, covering a population of about one million. Suspected cases of oropharyngeal tumour. seen by general practitioners or at dispensaries, are referred to one of the three centre8 established in Mainpurl District for examination and diagnosis. These patients and a similar number of control subjects (matched for age, sex, residence and occupqtion) are Interviewed with regard to: (1) smoking and chewing habits, (2) alcohol consump. tion, (3) diet and nutritional factors. (4) cleaning of teeth,and (5) socio-economic factors. The study is being carried out with the asslstance of the Department of Pathology, 3.N. Medical College, Agra, which also acts as a WHO Referenoe Centre for Oropharyngeal Tumours.

Aim of the project. To exchange information on the present knowledge of the epidemiology, treatment and control of mosquito-borne haemorrhagic fevers.

Assistance provided by WHO during the year. (a) A short-term consultant. four temporary advisers (two from South-East Asia and two from the Western Pacific Region) and secretarial assistance from the Regional Office; (b) cost of attendance of 27 participants (13 from the South-East Asia Region and 14 from the Western Paeific Region).

Work done. mis seminar was held in Bangkok from 19 to 26 October 1964.. It was attended by 84 participants and observers: 57 from the South-East Asia Region (2 from Burma, 1 from Oeylon, 5 from India. 1 from Indonesia, and 48 from Thailand), 26 from the Western Pacific Region and 1 from the USA. Three staff members from WHO Headquarters, one from the South-East Asia Regional Office and one from the Western Pacific Regional Office took part.

The Weetlng of Investigators on the Epidemiology and Pathology of Oropharyngeal Tumours, held in New Delhi in October 1963, in which the WHO epidemiologist participated, was described in the Sixteenth Annual Report under this project number. S~A/Rc18/2 Page 191

At the Seminar, the ecological, epidemiological, clinical and therapeutic, and control features of haemorrhagic fevers occurring in the affected countrie's were reviewed. Useful recommendations were made for international co-operationand for further research in certain topics related to dengue and chlkungunya viruses, their reservoirs and vectors, and the control and treatment of haemorrhagic fever. The report of the Seminar was widely distributed.

The Organization is assisting in the implementation of the recommendations, as mentioned In Part I of this report, Section 1.4.2 (3).

Inter-regional 228 Training Course on the Control of Cholera. R Calcutta (10 May - 8 Juno 1965 - )

Aim of the project. To give the national Participants comprehensive training in various basic aspects of the epidemiology, diagnosis, treatment and control of cholera. - .. Assistance provided by WHO during the year. (a) Three consultants; (b) payment of travel costs and subsistence allowances of eight participants.

Probable duration of assistance. Until the end of 1966.

Work done durlng the year. With the assistance of three WHO consultants provided by WHO Headquarters, this training course was organized at the Calcutta School of Tropical Medicine. from 10 May to 8 June 1965. with emphasis on basic aspects of the epidemiolo&y, diagnosis, treatment and control of cholera. Participants were invited from countries of both the South-East Asia and Western Pacific Regions. For Want of sufficient accommodation, the number of participants was limited to sixteen, but in view of the interest shown in this training. a repetition of the course is under consideration.

Travel costs and subsistcncc allowances of scven participants from the South- East Asia Region (1 each from Burma. Indonesia, Nepal and Thailand and 3 from India) were paid by WHO. SEA/Rc18/2 Page 192

12 INTER-RBGIONAL (PROJECTS OUTSIDE-THE REQION IN WHICH CANDIDATES PROM THE SOUTH-EAST ASIA REGION PARTICIPATED) . (1 August 1964 - 1 August 1965)

Project No. and No.of Participants Source of Funds -Title from South-Bast Asia

Inter-~aaional113.2 Training Course in the Epidemiology and Control TA of Tuberculosis, Rome and %nisia (1 March - 31 May I 1965)

Inter-realonal 120.1 Anaesthesiology Training Course. Copenhagen TA (13 January - 18 December 1964)

Inter-regional 133.8 Tuberculosis Training Course, Prague and Copenhagen R (15 March - 21 August 1965) 2

Inter-reaional 137.2 Waining Course in Human Genetics for Teachers in TA Medical Sohools, Copenhagen (1 September - 30 November 1964) 2

Inter-regional 169 Seminar on Tubercullsls Control in Developing R Countries, Kuala Lumpur (5 - 11 November 1964) 7

1nter-realdnal 178 Training Course on Nursing Services Administration, TA Copenhagen [12 September - 24 October 1964) 2

Inter-renional 181 Training Course for Teachers of Physical Therapy, TA United Kingdom (6 July 1964 - 30 June 1965) 5

Inter-reaional 18% Conference on the Establishment of Basic Principles R for Medical Education in Developing Countries, Oeneva (7 - 11 September 1964) 2

Inter-regional 198.2 Travelling Seminar on the Organization of Epidemio- TA logical Services and their Role in the Control of Communicable Diseases, USSR (13 October - 2 November 1964) 5

Inter-regional 208 Travelling Seminar on the Public Health Component TA in the Training of Medical Personnel, USSR (5 - 24 October 1964) 4

Inter-regional 222 Travelling Seminar on the Public Health Aspects of TA Housing, USSR (17 Mey - 8 June 1965) 1 SEA/RC18/2 Page 193

Course on Recent Advances in the Applicatisn of Basic Medical Sciences to Surgery, Copenhagen (1 September - 30 November 1964) 2

Travelling Seminar on the Control of Environmental Sanitation, USSR (7 - 30 September 1964) 4

Seminar on Cholera Control, Manila (12 - 18 November 1964) 8

Course on Child Ddntal Health, Copenhagen (1 March - 29 May 1965) 2

Travelling Seminar an the Organization of Mental Health Services in Developing Countries, USSR (14 June - 2 July 1965) SEA/RCL8/2 Page 195

ANNEXES SEA/RCl3/2 ORGANIZATIONAL CHART Page 197 1 ~ugust 1965 Annex 1

OFFICE OP THE REGIONAL DIRECTOR PUBLIC INFORMATION REGIONAL COMMITTEE 1 Regional Director Public Information Officer Dr C, Man1 Mr J.G. Milwertz I r Information Officer , OFFICE OF HEALTH SERVICES (Vacant) Director, Health Services Dr H. Richards I Dr R.P. Lopez Lanzi ASSISTANT DIRECTORS, HEALTH SERVICES Malariologists OFFICE OF ADMINISTRATION AND FINANCE - Dr a. Doraisingham Dr D.R. Mehta Chief. Office of Admin. and Finance Dr J4& Petrie Dr V. Paris1 Mr W.R. Hornett Dr A. Zahra Dr F.R.S. Kellett hdmin. and Finance Officer - Mr T. VigL I I Entomologist REGIONAL A DVISERS 1 II (Vacant) - Dr K.L. Hitze PERSONNEL UNILPT Communicable Diseases - (Vacant) Sanitary Engineer (Malaria) Personnel Officer Communicable Diseases - (Vacant) Community Health Services - Dr D.H.S. Griffith Community Health Services Officer - Dr P. Rajasingham FINANCE, BUDGET AND ACCOUNTS UNIT Public Health Officer - (Vacant) Budget and Finance Officer Health Laboratory Services Dr R. Madica I I - (Vacant) Health Statistics - Dr H.F. Helweg-Larn REPORTS AND DOCUMENTS UNIT HFinance Officer - (Vacant) I Health Statistician - (Vacant) Reports Officer Budget Officer - Mr J.E. Morgan Nursing - Mrs L.H. Holsinger Miss M. Wheldon Nursinn- - Miss D.C. Hall I' Health Education Mrs A.R. Moore - ADMINISTRATIVE SERVICES UNIT Maternal and Child Health Dr A.M. Gade -- -. Administrative Services Officer ~utrition - Dr G.J. Stott ~nvironientalHealth - Mr L.F. Mantilla Afghanistan - Dr R.M. Malan Mr J. Schilling Sanitary Engineering - Dr Lopez de Nava 1Medical Education, 1 !m - Dr F. Loven Dr E.A. GilliS 1 - 7:;: 1 MEDICAL SVPPLIES UNIT , Indonesia - Dr H. Holler ,Medical SUDDlie.5 Officer Malaterre - Dr A. Mr G. Nickltas FIELD PROJECTS Thailand - Dr J.J. Alcocer , SEA/RC18/2 Page 198 Annex 2 Ccogrnpkl~alD1~t:ib~tio:l 01' inteInatlcr.&l Staff ,Issignel t~ :n? icutt:-E=~st.1s1~ Rtgicll,as cf 30 J,x,u;e 175;

Regional Field Country Advisers Total Office. Staff

Afghanistan - - 2 2 Argentina - - 2 2 Australia i - 4 6 Belgium - - 1 1 Bolivia - - 2 2 Brazil - 1 - 1 Canada 1 1 8 10 Ccylon - 1 6 7 Cuba - - 1 1 Czechoslovakia - - 1 1 Denmark 2 2 3 7 Ecuador - 1 1 2 France 2 - 1 3 Germany. Federal Republic of - 1 7 8 Greece 1 - - 1 . . India 2 1 6 9 Indonesia - 1 - 1 Iraq -. -. 1 1 Ireland - - 5 5 Israel - - 1 1

Italy 1 2 1 ' 4 Japan - - 4 4 Korea. Republic of - - 1 1 Lebn~lsn - - 1 1 Malaysia - 1 - 1 Mexico 2 - - 2 Nepal - - 1 1 Netherlands 1 - 4 5 New Zealand - - 2 2 Norway 1 - 1 2 Pakistan - - 1 1 Panama - - 1 1 , . Pcru . . . - 1 - 1 Philippines - 3 3 Poland - - 1 1 Sweden - - 1 1 Union of Soviet Socialist . . Republics - 3 3 United Arab Republic - - 3. 3 Unitod Kingdam of Great Britain and Northern Ireland 2 5 33 40 United States of America 2 2 15 19 Viet-N-m - - 1 1 Yugoslavia - - 5 5 I Total 19 20 134 173 SEA/RCI~/~ Page 199 Annex 3

Conferences and Meetings in the South-East Asia Region Called by the United Nations and Specialized Agencies at which WHO was Reuresented

(1 August 1964 - 1 August 1965)

14 ~uly- ECAPE: Regional Statistical Training Centre for Bangkok 4 September Organizers of National Training Centres

2-12 September ECAFE: Meeting of the Working Group on Develop- Bangkok ment of Indigenous Teaching ftaterials for Social Work

28-29 September UNESCO: Fourth Session of the Consultative New Delhj Steering Committee of the UNESCO Centre on Social and Economic Development in Southern Asia.

12-19 November ECAFE: Sixth Regional Conference on Water Bangkok Resources Development

23 November - UNESCO and Government of India: Symposium on Jodhpur 2 December Problems of the Indian Arid Zone

2-8 December ECAFE: Meeting of the Expert Working Group on Bangkok Evaluation of Population and Housing Census Data in Countries of Asia and the Far East

3-7 December UNESCO: Twentieth Session of UNESCO Advisory Jodhpur Conunittee on Arid Zone Research

9-22 December ECAFE: Sixth Conference of Asian Statisticians Bangkok

4-15 February ECAPE: Seventeenth Session of the Committee on Bangkok Industry and Natural Resources

18-19 February ECAPE: Fourth Meeting of the aoverning Council of Bangkok the Asian Institute of Development and Planning

17 my UNICEF/FAO: Meeting to Discuss the Pattern of New Delhi Supplementary Feeding Progranune for School-children SEA/RCIB/~ Page 200 Annex 3

17-19 May UNICEF:. .. .Asian ...... Conference on Children and Ya.vth in New Delhi NationalPlanning.. .and . Development - Meeting of the of Advisory Group. .. Consultants on the Pre-school Child

24 June - ECAFE: Eighth Session of the Working Party on Bangkok 2 July Housing and Building Materials SEA/RC~~/Z Page 201 Annex 4

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

(1 August 1964 - 1 August 1965)

10-12 August International Union for the Control of Cancer: Bombay Meeting 0.n Geographical Pathology of Cancer in the Indian Sub-continent

17-22 August Government of Thailand: Second Thai National Bangko k Conference on Medical Education

19-27 August Governments of India, Indonesia and the Philippines: Djakarta Second Afro-Asian Paedlatric Conference

23 August Indian National Institute of Health Administration New Delhi and Education: Seminar for Senior Health Adminls- trators of Punjab State

26 August Government of India: Fourth Meeting of the Bombay National Advisory Committee on Nutrition

28 August Natlonal School Health Council, Bombay: Seminar Bombay on Minimum Basic Health Services for School-children

3 September Government of India, Applied Nutrition Programme New Delhi Co-ordination Committee: Meeting of the Sub- Committee on Training

7-19 September Government of India: Seminar on Hospital New Delhi Administration

9 September Government of India: Seminar on Immunization Na jafgarh (near Delhi)

11 September Government of India: Meeting of the Co-oralnation New Delhl Committee of the Applied Nutrition Pragramnle

11-13 September Government of India: First Zonal Meeting on New Delhi Smallpox

"This list does not include meetings of project committees in connection with projects to wNch WHO is providing staff. and which may be regarded as normal work In connection with the projects, or meetiws sponsored by WHO. SEA/RCIB/~ Page 202 Annex 4

14-15 September WDP1d Medical Association: Mceting of the New Delhi PreperatbPy Committee in connection with the Third World Conference on Medical Education to be held in New Delhi in 1966

17-19 September Government of India: Meeting of the Health New Delhi Education Committee of the Central Health Education Bureau

4-23 October Indian Academy of Medical Sciences: Travelling New Delhi Seminar (Teaching Workshop) of the International Brain Research Organization set up by UNESCO for the Promotion of ~asicSclences and Education in Brain Research

19-31 ~ctobdr Government of Mysore: Conference of District Mysore Rtblic Health Nursing Supervisors of Mysore State

21-25 October Qovernment of India: lkelfth Meeting of the Srinagar Central Council of Health

28-31 October Qovernment of India. Central Public Health Nagpur Engineering Research Institute: Symposium on Evaluation of Rural Latrine Designs

29-30 October Government of India. Central Public Health Engineering Research Institute: Symposium on Problems of Water Treatment

1-12 November United Schools International, India: Asian New Delhi Regional Seminar on Teaching About the United Nations

6 November - Indian Council of Medical Research: Annual New Delhi 21 December Meetings of the Advisory Committees/Expert ffroups

14-16 November Indian Association of Pathologists: Annual Bangalore Conference

23-27 November Medical Council of India: Conference on Post- New Delhi graduate Medical Education

26 November XXXVIII International Eucharistic Congress: Food Bombay and Health Seminar .- - - - . . . 14-19 December Indian National Comission for Co-operation with New Delhi UNESCO: National Seminar.on Education for Inter- national Understanding SEA/RcI8/2 Page 203 Annex II

27 December - Silver Jubilee Celebrations of the Association Bombay 15 January 1965 of Surgeons of India and the Fifteenth Annual Conference of the Indian Society of Anaesthetists

28 December - Government of India: Seminar on School Health New Delhi 2 January 1965 Services

15 January Indian National Institute of Health Administration New Delhl and Education: Annual Day Celebrations

18 January Government of India: Third Meeting of the New Delhi Steering Committee on the Five-year Programme for the Devalopment of Teaching of General Science

21-28 January University Grants Commission and the University of Baroda Baroda: Seminar on Tissue Culture

22-26 January Association of Radiologists of India: Eighteenth Trivandrum Indian Congress on Radiology

23-jc January World Federation of the United Nations New Delhi Associations: Nineteenth Plenary Assembly

27-23 January Hind Kusht Nivaran Sangh: Sixth Conference of the Madras Indian Association of Leprologists and the Ninth All-India Lcprlsy Workers' Conference

27-29 January : Government of India: Meeting of the State New Delhi Assistant Directors of Health Services (Maternal and Child Health)

31 January - Indian Academy of Faediatrics: Second National Patna 2 February Conference

1-3 February Indian Association for the Advancement of Medical New Delhi Education: Rifth Annual Conference and Seminar on Post-graduate Medical Education

1-2 February Government of India: Seventh All-India BCG Ahmedabad Workers ' Conference

3-5 February Tuberculosis Association of India: Twentieth Ahmedabad Tuberculosis and Chest Diseases Workers' Conference SEA/RCI~/Z Page 204 Annex 4

11-12 February Government of India: Inter-State Meeting of Ahmedabad Smallpox Workers

14-22 February Society for the Study of Industrial Medicine in Bombay and India: International Seminar on Health and Ahmedabad Productivity

19 Pebruary Government of India: Meeting of the Co-ordination New Drlhf Committee of International and Bilateral Agencies

22-23 February Institution of Engineers of 1ndia: Annual Session Luclolow of the Public Health Engineering Division

22-25 February Rural Health Research Project, Narangwal (Punjab): Narangwal 'ThlFd Annual Conference on arientation to Rural Health Services

23-24 February Trained Nurses Association of India: Annual New DelN Council Meeting

25-26 February Indian Nursing Council: Meetlng of Principals of New Delhi Colleges of Nursing and State Nursing Superintendents

25-27 Pebruary Government of India: Inter-State Meetings of Calcutta Smallpox Workers of Zone I1

26-27 February Ceylon Public Health Association: Seminar on Colombo DiarFhoeal Diseases

1 Wrch All-India Institute of ~edicalSciences, New Delhi: New Delhl National Symposium on Trachoma

5-6 April Government of India: Sixteenth Meeting of Yellow New Delhi Fever Advisory Committee

12 April Indian National Institute of Health Administration New Delhi and Education: Preliminary Meeting on the Conference on Teaching of Preventive and Sociai Medicine

19-23 April Government of India, Central Health Education New Delhi Bureau, New Delhi: Fourth Health Educators ' Conference

30 April Government of India: Meeting on Cholera Control New Delhi

7-8 Government of Pondicherry: Tuberculosis Conference Pondicherry (India) SEA/RCl8/2 Page 2C5 Annex 4

ffovernment of India: Co-ordinating Meeting to Kasauli (India) Review the Production of DPT Vaccine at the Central Drug Research Institute, Kasauli

17-22 MY Govermnt of India: Workshop to Develop Criteria New Delhi for the Health Aspects of School Programme

26-28 my Conference of Chairmen of All-India Voluntary New Delhl Organizations Working in the Field of Social Welfare

31 WY Indian Psychiatric Society: Seventeenth Conference Srinagar jl May - 6 June College of Nursing, Bombay: First Workshop for Bombay Collegiate Nursing Education in India

7-9 June Government of Ceylon: Conference of the Heads of Colombo Decentralized Units and Specialized Campaigns

17-20 June Government of India: Annual Meeting of Malaria Calcutta and Ailaria Workers

19 June Indian Public Health Association: Symposium on Calcutta Cholera Fellowships Awarded by WHO

(1 ~ugust1954 - 1 nugust 1965)

Table I: Source of Funds and Type of Fellowship

Source of Funds Inter- Country Regional Regular TA regional Afghanistan 13 3 16 7 9

Burma 4 6 10 7 3

Ceylon 19' 7 26 13 13

India 21** 22 43 43 -

Indonesia 11 3 14 10 4

Maldive Islands 1 -. 1 1 -

Mongolia 5 4 9 9 -

Nepal 10 2 12 5 7

Thailand 14 5 19 5 14

98 100 50 - Total 52 150 - 12 of these were awarded by WHO Headquarters under the Scheme for Exchange Of Scientific Workers. **2 of these were awarded under the United Nations Special Fund. SBA/RC18/2 Tlble 11: Fellowship Awards: Distribution Page 207 by Subject of Study and by Country Amex 5 SEA/RClB/Z Page 208 mex 6

List of Reports and Fapers Published, or Under Preparation, h\berculosis.'memotherany centre, Madras

11 I.wust 1964 - 1 August 1965)

No. Title Author Reference

A. Reports and Papers Published 1. A controlled comparison of S. Vclu, Tubercle (1964). streptomycin plus pyrazinamide J.J.Y. Dawson, , 144 and streptomycin plus PAS in the S. Devadatta, retreatment of patients excreting Wallace Fox. isoniazld-resistant organisms K.G. Kulkarni, K. Mohan, C.V. Ramakrishnan and H. Stott

2. The emergence of isoniazid- J.B. Selkon, Bulletin nf the resistant cultures in patients S. Devadatta, World Health with pulmonary tuberculosis K.G. Kulkarni, Organization during treatment with isoniazid D.A. Mitchison, (1964).2.273 alone rr isonlazid plus PAS A.S.L. Narayana, C. Narayanm Nair and K. Ramachandran

3. A concurrent clmparlson of Tuberculosis Bulletin of the intermittent (twice-weekly) Chemotherapy World Health isoniazid plus streptomycin and Centre, Madras Organization daily isoniazid plus PAS in the (1964) ,a247 domiciliary treatment of pulmonary tuberculosis

4. Virulence in the guinea-pig and S. Joseph, Tubercle sensitivity to PAS and thiaceta- D.L. Mitchison, (1964). %, 354 zone of tubercle bacilli from K. Ramachandran South Indian patients with and J.B. Selkon pulmonary tuberculosis

5. Virulence in the guinea-pig and C. Narayanan Nair, Tubercle (1964). susceptibility to hydrogen S. Joseph, 9. 345 peroxide of isoniazid-sensitive E.M. Mackay-Scallay, tubercle bacilli from South K. Ramachandran Indian patients SEA/RC18/2 Page 209 Annex 6

No. Title Authors Reference I B. Reports and Papers with the Publishers I I The diet, physical activity and C.V. Ramakrishnan,et a ilulletin of the accrmmodation of patients with World Health quiescent pulmonary tuberculosis Organization in a poor South Indian community

A simple test for the detection K.V.N. Rao, Tubercle of pyrazinamide and cycloserine L. Eidus, In urine C.V. Jacob and S.P. Tripathy

A comparison of various methods P. Venkataraman. Tubercle for the detection of isoniazid L. Eldus. and its metabolites in urine K. Ramachandran and S.P. Tripathy

A five-year study of patients J.J.Y. Dawson. Bulletin of the with pulmonary tuberculosis S. Devadatta, World Health admitted to a comparison of home Wallace Pox, Organization and sanatorium treatment for one S. Radhakrishna, year with isoniazid plus PAS. C.V. Ramakrishnan, P.R. Somasundaram, H. 3tott and S. Velu I C. Reports and Papers in Preparation 1. A comparison of supervised spot specimens and collection specimens of sputum

2. An investigation into the contamination rate of cultures set up for the isolation of tubercle bacilli fron patients with pulmonary tuberculosis in South India

3. Cycloserine and ethionamide (TH131'4) in the treatment of chronic drug- resistant pulmonary tuberculosis in South India

4. Rate of elimination of sensitive organisms SE~fiCl8h Page 210 Annex 6

1 5. Post-treatment viru1ence;Nethodology 6. The guinea-pig virulence, catalase-activity and peroxide susceptibility of isoniazid-resistant cultures which emerged during treatment

7. Association between virulence. .peroxide . susceptibility, catalase and , degree of isoniazid resistance

8. Five-year follow-up of home and sanatorium patients

9. Five-year follow-up of home and,sanatorium contacts

10. Evaluation of urine tests for do+clliary treatment with lsoniazid

11. A simple test for simultaneoui determination of pyrazinamide and cycloserine

12. Response of patients with pretreatment isoniazid resistance to treatment with isoniazid alone with PAS or thiacetazone

1 A urine test for control of ethionamide ingestion

14. Serum isoniazid levels in patients under treatment with isoniazid alone or with PAS or thiacetazone

15. A method for quantltative deteriliation bf N-aoetyl INAH in biological fluids

16. A concurrent comparison for one year of isoniazid plus PAS with isoniazid plus low dosage PAS for 6 months followed by isoniazid alone for 6 months and iscniazid plusthiacetazone in ths domiciliary treatment of pulmonary tuberculosis

17. The value of periodic smear examination in assessing the progress of patients with pulmonary tuberculosis.on chemotherapy

18. Effect of pyridozine dosage on vitamin B6 concentrations and glutamio oxalacetic transaminase activity in blood of tuberculosis patients receiving high dosage isoniazid

I s~n/ncl8/2 Page 211 Annex 7

List of Papers Published or Under Preparation, National Tuberculosis Institute, Bangalore (1 ~ugust1964 - 1 August 1965)

A. Papers published

1. Goth1 G.D., Kul Bushan, Nair S.S., Baily G.V.J.: BCG without tuberculin test, proceedings of the XIX Tuberculosis and Chest Diseases Workers' Conference.

2. Kulbushan: My experience of mass BCO campaign, Bull. Dev. Prev. Tuberc. 10.12.

3. Nagpaul D.R.: Chemotherapy programmes and drug regimens in developing countries, Bull. IUAT. 35. 242.

4. Nagpaul D.R.: Role of nursing personnel in the National Tuberculosis Control Programme, Nursing Journal of India, &, 109:

5. Nagpnul D.R.: Development of a national tuberculosis control programme in India, -, Vol. 38, Z, 643.

6. O'Rourke J.: Tuberculosis work In India, Patna Journal of Medicine, Vol. 38, 12, 609.

7. O'Rourke J.: Evaluating control programs, proceedings of the XIX lhbercu1osi.s and Chest Diseases Workers' Conference.

8. Zachariah A.: The role of nurses in the National Tuberculosis Programme, Bull. Dev. Prev. Tuberc. 10, 15.

Epidemiological Section

1. Epidemiological considerations of case-findina (Paper prepared for discussion. at the Twentieth Tuberculosis Worker's Conference held at Ahmedabad).

2. Problems connected with the estimation of the incidence of tuberculosis infection.

3. Enhancing of tuberculin allergy by previous tuberculin tests.

4. Tuberculosis control in India (justification for BCG trial).

5. Epidemiological aipects of resistant strains.

6. Infection and disease among households in a rural community. senhci8R Page 212 Annex 7 Control Section

1. Recent developments in the application of BCG vaccination,

2. Operational aspects of BCG vaccination programme.

3. Technical aspects of direct BCO vaccination.

4, Cperational investigations in Tumkur Distridt.

5. Intermittent treatment with isoniazid and streptomycin in a rural area.

6. Treatment of patients with isoniazid and thiacetazone in a rural area.

7. Follow-up analysis of patients under observation in a tuberculosis clinic,

8. Tuberculosis control in cities.

Bacteriological Section

1. Some operational factors influencing the relative utility culture method in diagnosis of pulmonary tuberculosis.

2. Comparatlve study of prevalence of drug resistance to anti-tuberculosis drugs in different practical situations.

3.. Bacteriological aspects of mass chemotherapy of patients with isoniazid and thiacetazone.

Sociological Section

1. Tuberculosis - a problem of social planning in developing countries.

2. A one-year study of domiciliary treatment of tuberculosis patients in a rural area.

3. Self-administered drug treatment - third-year follow-up.

Public Health Nurses' Section 1. Hope for millions. 2. The district tuberculosi~programme. 3. Chemotherapy in tuberculosis. 4. Motivation and defaulter action for tuberculosis patients. 5. Training of personnel for the tuberculosis- programme. 6. The B.C.G. campaign. Other Sections 1. Role of the generalpractitioner in the tuberculosis control. 2. The operational and technical assessment of a district tuberculosis control programme. anrlilcle/z Page 213 hex 8 List or Technical Reports Issued by the Regional Office (1 Aqqu~t1964 - 1 i~wust1965)

Document No. and Date Title Author

Addiction-Producing Drugs l-----1 SEA/APDL Assignment report on narcotic drugs Dr J. Fort 25 August 1964 control in Thailand (Thailand 681, I February - March 1964

Dental Health

SEA/DH~ Report on a visit to Burma (advice Dr Mario M. Chaves 19 March 1965 and on establishing a dental school). Corr.1 23-26 December 1964 26 my 1965

Diphtheria

SEAhiphtheriah Report on Schick-testing studies on Dr V.E. Vichniakov 11 March 1965 and unvaccinated groups of the population and Corr .1 in the Kabul Area. March-June 1964 h M. Saidi 18 May 1965

Environmental Sanitation

SE~hnv.San. h7 Assignment report on water pollution and Mr C.D. Parker 24 August 1964 and waste-water disposal. Central Public Corr.1 Health Engineering Research Institute, 19 April 1965. Nagpur(1ndia 176),5 May - 10 July 1964

SEA/Env. San. /~8 Final report on environmental sanitation Mr D.M. Knez, 16 February 1965 I project in Uttar Pradesh (India 841, Dr B.S. Sehgal, March 1958 - October 1964 Dr K.N. Joshi and Mr S.P. Arora

Assignment report on Central Public Professor J.C. Morris Health Engineering Research Institute, Nagpur (review of research programme and equipment needs) (India 176). 29 January - 7 April 1965

Epidemiology

SEA/EP~~/S Assignment report on strengthening of h F. Patocka 5 January 1965 health services (epidemiology) (India 182). June - December 1964

s~~hpid/lo Assignment report on strengthening of Dr Magda Melkumyan 24 May 1965 health services (epidemiology) (Burma 44),July 1963 - March 1965 -- --- . .-I sE~hcl8h, ' Page 214 hex8

Document -N~.xd Datc ~.~-Wtle Author : ,, ,

Haemorrhagic Fever

SE~/llaem.~ever/6 Report of the WHO Seminar on Mosquito- IRhaem.Pever/Sem.l/: Borne Haernorrhagic Fevers in the South- 26 October 1964 and East Asia and Western Pacific Regions, Rev. 1 held in Bangkok (Thailand), 22 January 1965 (SEAR0 99hR219) ,19 - 26 October 1964

Health Educatlon

Assignment report on health education, Miss M. Bookhardt Orissa, (India 108.51, July 1964 - June 1965

Health Laboratory Methods

SEA/~M/~ Assignment report on health laboratory Mr H.W. Cotton 12 January 1965 aspeots of tk public health programme, Kerala (India 147). October - December 1964

Leprosy

*s~~/Lep/l8 Report on leprosy survey in Burma, WHO Leprosy ~dvlsor: 4 August 1964 and January - June 1963 Team Corr .l 8 September 1964

SEAhepb9 Assignment report on leprosy oontrol Dr M.J. Mallac 16 October 1964 programme in Andhra Pradesh. India and (India 81.1). February October 1964 Dr C.T. Hemachandra - . . SEA/L~P/~O Assignment report on leprosy control Dr P. Hernerijckx 16 March 1965 in Afghanistan (Hazar jat area), (Afghanistan 43 ) , August 1964

Malaria

SEAhalhg Report on assessment of malaria eradi- ~r P.C. Issaris, 21 August 1964 cation programme in Afghanistan, by Mr D.A. Muir and the WHO Regional Assessment Tean Mr W. Rooney (SENLO 7). 18 April - 16 June 1964

SEA~~AO Assignment report of assessment team Mr P.G. Renaud 2 September 1964 on malaria eradication (laboratory aspects). Maharashtra (India 153). August 1962 - March 1963

Issued by UHO Headquar SEAhCl8h Page 215 Annex 8

Document No. and Date Title Author

SEAhalA1 Assignment report on malaria eradica- Dr V.P. Jacob 21 September 1964 tion. Afghanistan (Afghanistan 11). Corr.1 November 1959 - August 1964 16 December 1964

SEAhalA2 Report on Special Course on Advanced 16 October 1964 Malaria Epidemiology, held in New Delhi, India (SEAR0 114). 9-30 March 1964

SEAhalA3 Pield visit report on the Maldiva Dr V. Parisi 10 November 1964 Islands (survey of malaria). 15 April - 10 May 1964

SEAhalA4 Report on a visit to the malaria Dr G. Gramiccia 17 December 1964 eradication programme in Afghanistan I (Afghanistan 11). 19-26 November 1964

SEAhaliV5 Assignment report on malaria eradica- Mr Thomas J. MacInnes 14 March 1965 tion programme, Nepal (Nepal 1). 24 I October 1958 - 3i October 1964

SE~hlalA6 Field visit report on malaria eradica- Dr O. Gramiccia 23 February 1965 tion programme, Ceylon (Ceylon 58). 18-25 January 1965

SEAhalA7 Assignment report on malaria eradication Dr I.A.H. Ismail 24 February 1965 programme ,Afghanistan (Afghanistan 11 ) , November 1963 - January 1965

A brief note on the entomological acti- Mi- H. Ramoo vities of malaria eradication programme in the East Zone of Nepal (Nepal I), (1962-19641

SEAhalA9 Field visit report on malaria eradica- Dr D.R. Mehta 25 February 1965 tion programme, Thailand (Thailand 65 ) . 4-10 January 1965

Field visit report on malaria eradica- Dr G. Gramiccia tion programme, Thailand (Thailand 65). 5-18 April 1965

SEAhal/51 Field visit report on malaria eradica- Dr P.R.S. Kellett 14 Mag 1965 tion programme, Ceylon (Ceylon 58). I 19-23 April 1965

SE~halh2 Assignment report on entomological Mr A.S. Badawi 3 June 1965 aspects of malaria eradication programme, Indonesia (Indonesia 32). November 1959 - November 1964 SEA/RCl8/2 Page 216 Annex 8

Document Nb. and Date I Maternal and Child Health I I SEAhCH/29 Assignment report on paediatric education, Dr R. Lightvooa 11 September 1964 Uttar Pradesh (Paediatric kpartment, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur) (India 114), 22 January - 11 March 1964

SEAhCHhO Final report on assistance to Departments Dr E. Budiansw 3 November 1964 of Paediatrics, University of Medical Sciences, Bangkok (Thailand 58). May 1962 - July 1964

Assignment report on paediatric education. Dr E. Budiansky India (India 114). September 1964 -

I 1965 I Medical Education I I SEAhed.Educ .h2 Assignment report on assistance in parasi- Dr Manabu SaSa 11 September 1964,and tology to the Faculty of Tropical Medicine Rev. 1 and Endemic Diseases, University of Medical 10 November 1964 Sciences, Bangkok (Thailand 57). 1 June . 1 September 1964

SEAhed.Educ .h3 Assignment report on training in Dr J. Gallagner 5 October 1964' preventive and social medicine (Dhanvantari Medical college, Pondicherry) (India 911, December 1963 - September 1964

SEAhed .Educ .h4 Report on academic and clinical facilities Dr W.E.S. Kisrnan 6 October 1964 and requirements of psychiatry in Baroda Medical College. Gujarat, India (India 183)

~~~fied.~duc.h5 Final report on assistance to medical Dr George W. Gale 10 November 1964 and education in Thailand (Thailand 62). Corr .l September 1960 - June 1964 15 January 1965

SEAhed. Educ .h6 Assignment report on School of Public Professor Maurice 24 November 1964 Health and Tropical Medicine (Burma 75). Backett 3-27 October 1964

~E~hed.~duc.h7 Assignment report on Faculty of Tropical Dr J.H. Ackerman 1 Pebruary 1965 and Medicine and Enaemic Diseases, Bangkok Corr .I (Thailand 57). September - December 1964 2 April 1965 ~EAfiC18h Page 217 Annex 8

Document No. and Date Title ~uthor

SEAhed .Educ. h8 Assignment report on assistance to Dr D. Whitteridge 16 February 1965 medical education - physiology - Oujarat State (Baroda Medical College). (India 183). December 1964

SEAhed .Educ ./59 Assignment report on medical education - Dr Alexander Brown 5 March 1965 and hospital administration - Burma (Burma 79) corr.1 17 December 1964 - 12 February 1965 7 May 1965 sEAhed.Educ. /60 Assignment report on assistance to Professor 0.1. 5 March 1965 medical education - pathology - Montgomery Oujarat State (Baroda Medical College) (India 183). November 1964 - February 1965

SEAhed. Educ ./61 Assignment report on assistance to medical Dr E.B. Prench 30 March 1965 education - internal medicine - Oujarat State (Baroda Medical College) (India 183). July - December 1964

SEAhed.Educ ./62 Assignment report on assistance to medical Professor R.H. 9 April 1965 education - internal medicine and Oirdwood therapeutics - Oujarat State (Baroda Medical College) (India 183). 5 January - 27 February 1965

~EAhed.Educ ./63 Assignment report on assistance to Dr Warren E. 19 April 1965 School of Pharmacy, Bangkok (Thkiland 60). McConnell November 1962 - October 1964

SEAhed .Educ ./64 Assignment report on assistance to medical Dr W.P. Small 12 by 1965 education - surgery - Oujarat State (Barod3 Medical College) (India 183). July 1964 - May 1965

~EAhed.Educ ./65 Assignnent report on assistance to medical Dr W.E.S. Kiernan 24 June 1965 education - psychological medicine - State (Baroda Medical College) (India 183). July 1964 - May 1965

SEAhed .Educ ./66 Assignment report on assistance to medical Dr A.P. gem 30 July 1965 education - clinical biochemistry - Oujarat State (Baroda Medical College) (India 183). June 1964 - May 1965

~~~hed.~duc./67 Report on medical education study tour Dr E. BudiansQ 30 July 1965 (paediatrics) (SEAR0 81). 23 January - 20 February 1965 SEA/RClBR Page 218 Annex 8 - Document No. and Date Title .-Author

Nursin&

sE~/Nurs/82 Assignment report on field Graining for 2 September 1964 public health nurses in Thailand Corr.1 (Thailand 21). October 1963 - January. 10 December 1964 and 1964 Rev. 1 10 December 1964

~~~hurs/83 Assignment report on nursing advisory Miss Sheelah V. 2 September 1964 services in Indonesia (Indonesia 41). Archer . . November 1960 - August 1963

~EAfiursh4 Assignment report on nursiw aspects Miss F.A. Zimmerman 2 November 1964 and of paediatric education, Kerala Corr.1 (India 114). May 1963 - July 1964 20 January 1965

1 s~n/tr~s/85 I Assignment report on nursihg- education, /Miss C.J. Smith I 4 September 1964 Nepal (Nepal 2). August 1962 - August I 1964 SE~/Nurs/86 Assignment report on nursing advisory Miss B.J. Stubbs 9 October 1964 and services, Bwma (Burma 56 ) . January and Corr .I 1962 - July 1964 Daw Wint Myint Kyi 3 December 1964

SEA/N*s/87 Information on short-term refresher Miss F.A..Zimmerman 3 November 1964 course in paediatric nursing, held at the College of Nursing Trivendrum (India 114.11, 1 June - 26 July 1964

SEn/Llurs/88 Information on all-India Refresher Miss B.Darbyshire 6 November 1964 Course for Nursing Superintendents held at the Institute of Post-Graduate Medical Education and Research, Chandigarh (India 981, 7 September - 3 October 1964

SEAfiurs/89 Assignment report on nursing advisory Mr R. Swann 25 November 1964 services - psychiatric nursing - in Ceylon (Ceylon 53). January 1963 - November 1964

*SEA~(U~S/~O Assignment report on nursing studies Dr Marion Perguson 5 March 1965 seminar (SEARO 122). 1 October 1964 - 30 January 1965

~~~/Nurs/gl Information on All-India Refresher Course Miss M.E. Ieavy 5 March 1765 in Paediatrlc Nursing held at the Medical College.Tr1vandrwn (India 114). 1 December- - 1964 - 31 January 1965 - *Issued by WHO Headquarters, Oeneva sEA/Rcl8h Page 219 Annex 8

Dccument No.and Drte Title kuthor s~nhurs/92 Assignment report on nursing education Miss D.M. ROSS 15 April 1965 (public health integration), Orissa ane (India 99.3), May 1958 - January 1965 Miss Suprity Patnai

~EAhurs/93 Report on a workshop for Mysore State 19 April 1965 district public health nurse supervisors held in Pangalore, Mysore Stp.te. India (SEAR0 981, 19 to 31 October 1964

SEAhurs/94 Assignment report on nursing advisory Miss B.E. Ritter 20 April 1965 services, Thailand (Thailand 21), February - December 1964

SEAhurs/95 Assignment report on nursing in the Mrs L.H. Holsinger 7 May 1965 Bureau of Public Health, Municipality of Bangkok, January - March 1965

SEAfiurs/96 Assignment report on nursing advisory Miss E. Kunderman 14 June 1965 services. Ceylon (Ceylon 551, March 1963 February 1965

Nutrition s~~ni~tng Report on the Applied Nutrition Program 21 April 1965 in India (India 181). October 1964 - March 1965

Plague

Assignment report on plague control, India (India 1981, January - April 1964

Poliomyelitis

Assignment report an medical rehabilita- Miss Lorna Prior tion (poliomyelitis) (Ceylon 63 I, 6 October 196U November 1963 - September 1964

Public Health Administration

SEADHA~~ Assignment report on urban public health Dr C.E. Cook 20 August 1964 and administration, Bangkok (Thailand 69). Rev. 1 October - December 1963 10 March 1965

SEA/?HA/39 Assignment report on urban health Dr J.L. Burn 27 August 1964 development in Bangalore (India 1891, November - December 1963 SEA~CIBR Page 220 Annex 8

Docment No. and Date I Title

SEA/PHAAO Assignment report on Asian Institute 2 September 1964 fcr Economic Development and Planning, Bangkok (SEAR0 102). January - August 1964

SEADHAA~ !,ssignment report on aspects of 8 October 1964 laboratory senvices in the Public Health Institute, Kabul (Afghanistan 31), February - August 1964

SEADHAAZ Assignment report on Institute of Dr R. Calderuood jl December 1964 Hygiene, Kalutara (Ceylon 74), July - I September 196u

SE~/pHn/43 Assignment report on development of Dr R.E. Barrett 15 March 1965 health services in community development areas, Punjab (India 191). December 1964 - I February 1965

SEA/PHAb4 Assignment report on public health Dr H.J.J.A. Niemer 29 Aprll 1965 and administration, Maldive Islands (Maldive cow.l Islands 5). July 1962 - January 1965 18 June 1965

SEA/PHA/ll', Assignment report on course in hospital Dr R.L. Mehra 2& May 1965 administration and management, Ceylon (Ceylon 73), December 1963 - April 1964

SEA/%'HA/~~ Assignment report on development of sir Eric Pridie 23 June 1965 basic health services, Afghanistan (Afghanistan 59). 5 April - 15 May 1965 I Radiation I I sEAhadh0 Assignment report on development of Dr G.E. Roth 23 June 1965 radiation protection services in Thailand (Thailand 67), April 1965 s~~,&ad/Zl Assignment report on a course in Dr Hanson Blatz 30 July 1965 radiological physics held at the Atomic Energy Establishment, Trombay (India 195). 19 April - 17 June 1965 I Smallpox I I SEA/Smallpox/6 Smallpox eradication: conclusions and 23 October 1964 recommendations arising out of the

technical discussions held during the ' seventeenth session of the Regional Committee for South-East Asia, September 1964 senhcl8h Page 221 Annex 8

Document No. and Date T_itle Author

SE~/Smallpoxh Assignment report on smallpox eradica- Dr V.E. Vichniakov 3 December 1964 tion in Afghanistan (SEAR0 )O), October 1962 - June 1964

SE~/Smallpox/8 Field visit report on smallpox control Dr V.E. Vlchnlakov 9 March 1965 and pilot project, Nepal (Nepal 9), 22 Corr 1 October - 5 November 1964 I3 May 1965

Trachoma

SE~/Trach/l6 Assignment report on trachoma control Dr Satnam Singh 27 August 1964 in Afghanistan (Afghanistan 441, 4 April - 3 June 1964

SE~/Trach/lO Rev.1 Report on the survey of geographical Dr V.V. Preobrajenslq Add.1 distribution of trachoma in Uttar Pradesh and 20 November 1964 and (India 101), April 1961 - June 1963 DF U.C. Oupta Corr .l c2 February 1965

Tuberculosis

SEAA'Bh5 Assignment report on tuberculosis control Di- K. Toman 6 August 1964 in Mongolia (Mongolia 3), December 1963 - January 1964

SEAmh6 Assignment report on BCG assessment in Dr E. ~jhbye 12 August 1964 Burma (SEAIIO 31, April 1962 - March and 1963 Dr U Aung Tan

ssAh/57 Assignment report on national tuber- Dr C.G.I. Gordon 5 October 1964 culosis programme (pilot project).Thailand, (Thailand UZ),April 1962 - March 1964

SEA~A~ Assignment report on tuberculosis Mr B.T. Suitters 10 February 1965 and control, Burma (Burma 651, 30 November- Corr.1 19 December 1964 6 April 1965

SEA~B~~ Assignment report on laboratory aspects Mr B.T. Suitters 12 February 1965 of the national tuberculusls programme (pilot project), Thailand (Thailand 42). May 1963 - January 1965 SEAhCl8/2 Page 222 Annex 8

Document No. and Date Title

SEA/FE/~O Assignment report on tuberculosis 12 February 1965 and control, Burma (Burma 65). 30 Corr .l November - 17 December 1964 6 April 1965

SEA/'l'B/61 Assignment report on Tuberculosis 15 February 1565 Chemotherapy Centre, Madras (India 53) November - December 1964

sEA/'PB/~~ Tuberculosis Advisory Services. 24 February 1965 Afghanistan (Afghanistan 33). report prepared by the Regional Office based on reports from the project

~EAh/63 Assignment report on nursing aspects 8 April 1965 of BCG assessment team, Indonesia (SEAR0 3.3). March 1964 - February 1965

SEA~B/~~ Assignment report on tuberculosis 13 April 1965 control, Burma (Burma 651, 17 May - 30 September 1964

SEA/'PB/~~ Assignment report on national tuber- 15 April 1965 and culosis programme, India (India 103). Corr.1 March 1960 - February 1965 24 June 1965

SEfim/66 Assignment report on tuberculosis 28 April 1965 and control, Indonesia (Indonesia 50). Corr.1 March 1963 - September 1964 2 JU~Y1965

Assignment report on tuberculosis control programme in Burma (Burma 65 1. 17 September - 6 December 1964

Vaccines

sE~flaccine/l6 Assignment report on production of 19 ~ugusti964 and DPT vaccine in Burma (Burma 77). Corr .l 7 - 24 JUIY 1964 14 September 1964

SE~flaccine/l7 Final report on vaccine production in 15 December 1964 Kabul (Afghanistan 20). December 1962 - November 1964 SEA~~CIBR Page 223 Annex 8

( Document No. and Date Author

SEA/Vaccine/l8 Report on a visit to the freeze-dried Dr S.S. Marennikm 2 February 1965 smallpox vaccine production centres in India, 23 September - 9 October 1964

SE~/\raccine/l9 Assigrunent report on freeze-dried Dr Colin Kaplan 30 April 1965 smallpox vaccine, India (India 174). 17 March - 20 April 1965

SEA/traccine/ZO Report on a visit to the Medical Dr C.R. Cold 14 May 1965 Research Institute, Colombo. (experimental animal management) 26 February - 2 March 1965

SEA/\raccine/~l Report on the production and manage- Dr C.R. Cold 14. May 1965 ment of experimental animals in India, February - Marcb 1965

Venereal Diseases and Treponematosls

SEA/VUPR Eissigment report on venereal-disease Dr C.W. Chacko 9 Octokr 1964 and control (fluorescent laboratory Corr.1 technique), Ceylon (Ceylon 5.2). 15 December 1964 September 1964

sEA/~~/B Assignment report on strengthening Dr Axel Perdrup 19 January 1965 of health services, Thailand (Thailand 2 April - June 1964

Vital and Health Statistics

SEA/'i"dS/5'7 Repopt on a visit to Ceylon hospital Dr Lowell A. 28 April 1965 statistics project (SEAR0 72). Woodbury 14 - 22 February 1965

Report on a visit to the National Dr H.F. Helweg- Tuberculosis Institute, Bangalore Larsen (India 103). 5 - 9 October 1964

SEAnMS h9 Report on a visit to Medical College Miss W. Marsh 30 July 1965 Hospital, Baroda (India 183). 23 Dccember 1964 - 6 January 1965

SEAAHS/60 Assignment report on assistance to Mr J. Thillemann 21 July 1965 the Indian Council of Medical Research and (India 121). December 1963 - June Dr A.D. Taskar 1965 SEA/RC~~/Z Page 224 Annex 9 Training Activities Carried out by Governments with the Assistance of WHO Staff (1 ~ugust1964 - 1 ~ugust196~)" - No. of Total No. Subject Ty?e of course or training Duration and location Categories of trainees - courses cf tralneee APGHANISTAN

Malaria Basic training - Malaria 2 weeks Junior malaria inspectors 5 48 eradication techniques, Kunduz , Pulikhumri entomology and parasitology Mazar-1-sharif

Refresher training in 2 - 4 weeks Entomological technicians 4 20 entomology Jalalabad, Kandahar and (field staff) Kunduz

Advanced training for field 2 weeks Field supervisors 1 7 supsrvisors Kabul

II Refresher training in 1 week Microscopists 1 7 parasitology Kabul

Smallpox Refresher course 3 weeks Vaccinators and sanitarian- 3 180 Public Health Institute, supervisors Kabul

Refresher course for 2 weeks Vaccinators 2 130 vaccinators Institute of Public Health, Kabul

Rural Health Orientation training in Repeated courses of Medical students, nursing 11 111 rural health 1 month and midwifery students Rural Health Project

h he figures in this table have been obtained from WO field staff in respect of their training activities. Because of possible omissions in or duplication of reporting, they cannot be regarded as being completely accurate. Ragular acadmlc courses in medical and nursing colleges and training activities Whlch form the main object of WHO-assisted projects have not been included. SEAhCl8h Page 225 Annex 9 No. of Total No. subject Type of course or training Duration and location Categories of trainees courses ,f trainee I Health education Basic training One semester Teachers 7 210 and school 1 Faculty of Education, health Kabul and Higher Teacher. Training College, Kabul

Health education In-service training 3 WE~~S, Smallpox vaccinators and 2 160 Institute cf Public supervisors Health, Kabul I Basic training Continuous Sanitarian students 2 70 Institute cf Public Health, Kabul

Nursing and Basic nursing and midwifery 3-4 years Student nurses and midwives Continuous 154 midwifery Aliabad, Snararah, education Avicena and Mastoorat Hospitals

Basic nursing 1 year Midwives 1 4 Shararah, Avicena and Mastoorat Hospitals

First aid Lectures and practical work 1 week Village level workers 1 75 I Gulzar Training Centre

Environmental Basic training on water 1 academic year Civil engineering students 1 20 sanitation supply and sewerage Faculty of Engineering, Kabul Wliversity SEA~CIB~ Page 226 Annex 9 No. of Total No. Subject TYPe of Course or training Duration and locatlor. Categories sf trainees courses of trainees Preparatory course for 3 months Medical auxiliaries 11 admission as medical Faculty of Medicine, students Kabul

In-service training 3 months Laborztory assistants and 8 Institute of Public laboratory attendants Health. Kabul

Tuberculosis Refresher course 2 weeks lady health visitors 63 control Union Tuberculosis Institute. Rangoon

Training in census taking 2 weeks Medical officers. 10 and statistics Union Tuberculosis statistical assistants Institute, Rangoon and clerks

Leprosy Basic training 3 months Junior leprosy workers 20 Special Skin Clinic, Mandalay

Refresher course 4 ueeks Medical officers, leprosy 46 Special Skin Clinic, inspectors and Junior Rangoon leprosy workers

Nursing Refresher course in ward 3 months Senior graduate nurses 15 administration Rangoon General Hospital SEAhc18h Page 227 SEAhCl8h Page 228 Annex 9 NO. Of Total No. Type of course or training Duration and location Categories of trainees I Subject I I I courses of trainees

Malaria Basic training in 4 weeks laboratory technicians, 1 20 I Iparasitology and laboratory Regional Co-ordinating surveillance inspectors, techniques Organizaticn, Lucknow malaria inspectors and supervisors

Refresher course in 10 days /Laboratory technicians 7 115 parasitology and laboratory Regional Co-ordinating techniques Organization, Lucknow

Tuberculosis Orientation seminar 10 days Medical officers and 1 32 I National Tuberculosis teachers Institute. Bangalore

Post-graduate training in 3 months Medical officers 1 65 organization National Tuberculosis Institute. Bangalore

Post-basic training in 3 months Health vlsitors,X-ray and 1 220 treatment and case-finding National Tuberculosis laboratory technicians I " I Institute, Bangalore Post-basic training in 3 months Statistical assistants 1 61 statistical aspects National Tuberculosis Institute, Bangalore

BCG vaccination programme 2 months BCG team leaders 3 40 National Tuberculosis I Institute. Bangalore SEA/RCl8/2 Page 229 Annex 9 I Subject Type of course or training Duratisn and location Categcries of trainees NO. Of Total No. cowses of trainees BCG vaccination Reorientation training 6 weeks Vaccinators ir 46 Tuberculosis Demonstra- tlon and Training Centre, Bangalore

Cholera Refresher course 4 weeks Physicians 9 School cf Tropical Medicine, Calcutta

Leprosy Basic course 6 months Leprosy auxiliary workers 18 Karuan Training Centre, Hyder?.bad

Basic course 6 months Leprosy auxiliary workers 16 Leprosy Control Project, Pogiri

Refresher course 1 week Leprosy auxiliary workers 36 Leprosy Control Project Pogiri

Special training 3 months Senior 3uxiliary workcr 5 Leprosy Control Project, trainees Pogiri

Rural health Post-graduate course in 1 month B.Sc. students 10 rural health administration Indo-Norwegian Health Project. Quilon SEA/FLC18/2 Page 230 Annex 9

Subject Type of course or training Duration and location

Rural health, Undergraduate training 1 month I Social and 1 Indo-Norwegian Health preventive Project, Quilon medicine

Epidemiology Refresher training 5 months and health National Institute of statistics Communicable Diseases, Delhi

-do 3 months National Institute of of Communicable Diseases Delhi

Nursing Refresher course 1-2 weeks Health visitors, auxiliary 3 31 education Aliabada, Bhanvad and midwives and midwives Khamb'nalia

Post-basic course in nursin 9-12 months Graduate nurses and Continuous 28 education, administration, Hadras, Bangalore and midwives 1 and in public health Ahnedabad

Post-basic course in ward 3 months Graduate nurses 4 55 administration Bangalore

/ 2-4 weeks Nursing superintendents, 12 239 1 Hadras and Chandlgarh matrons and ward sisters SEA/llcl8/2 Page 231 Annex 9

No. of Subject Rrpe of course or training Duration and location Categ~riesof trainees courses

Nursing Short-term course 8 weeks Nurse tutors 2 education Ahmedabad

Auxiliary nurse-midwife 2 years Nursing students Cont inuc training Margoa

Supplementary ccurses in 1 month Nursing students 1 basic nursing Margoa

Basic Training in rural 1-4 weeks Student nurses Continuc health nursing and school Indo-Norwegian Health health Project, Quilon

Post-basic training in 6 weeks Public health nurses Yearly rural health nursing Indo-Norwegian Health Project. Quilon

School health Orientation course 2 weeks Teachers of middle and 1 New Delhi secondary schools

Environiental In-service trlining 2 weeks Sanitary inspectors 1 Sanitation Rural Health Training Centre, Aliabada

Surgery Post-graduate course Continuous Post-graduate students Continu< Medical College, Baroda

Clinical Theoretical and practical 10 months Biochemists and laboratory 1 chemistry training Medical College, Baroda technicians SEA/RCIB/Z Page 232 Annex 9 No. of Total No. Subject WPe of course or training Duration and. location Categories of trainees courses of trainee$; Clinical Theoretical 2 months Staff and post-graduate 1 20 chemistry Medical College, Baroda students

Introductory lictures 2 months Nursing staff 1 25 S.S.G. Hospital, Baroda

Academic lectures 2 months Undergraduate and post- 1 40 Department of Bio- graduate students chemistry, University of Baroda

Internal Post-graduate course Continuous Post-graduate students Continuous 8 medicine Medical College, Baroda

INDONESIA

Tuberculosis Training in field work 3-4 weeks Health auxiliaries 2 9 control Headquarters of Tuberculosis Control , Project, Bangakok

Leprosy Basic training 1 month Medical undergraduates 1 37 Central Leprosy Institute Djakarta

-do- 4 weeks Auxiliary staff 6 60 Provincial Leprosy Headquarters and Leprosy Institutes SEA/RCl8/2 Page 233 Annex 9 NO. Of Subject Type of Course or training Duration and locatisn Categories of trainees Total No. courses of trainee:

Leprosy Training in leprosy control 12 months Leprosy Nurses 2 42 Leprosy Training Centre Tangeranghest Java

Physiotherapy Basic academic training 3 years Student physiotherapists 2 40 Rehabilitation Centre, and student assistant Solo physiotherapists

Basic and post-graduate 2 years Students and graduate 2 60 training Rehabilitation Centre. physical educationists SO10

Post-graduate upgrading 6 months Assistant physiotherapists 1 18 Rehabilitlatlon Centre SO10

MALDIVE ISLANDS

Malaria Basic training in nalar~lo- 3 months Health assistants 1 6 lc~j,p.trLisitilcgy, Male microscopy and entomology

Public health Basic training 2 years Health assistants 1 5 Male

Nursing Basic nurse-aide training 1 year Nurse-aides 2 21 Male

Midwifery Basic training 4 months Indigenous midwives 1 8 Male SEA/RC~~/; Page 234 Annex 9 NO. of subject Type of course or training Duration and location Categories of trainees Total NO. courses of tralnet -

MONGOLIA

Brucellosis Basic training 2 weeks Medical officers 1 25 I Ulan Bator I Field training in epizooti- 1 month Medical officers and 1 8 cal and epidemiological Central Aimak technicians methods

Refresher training in 2 months Medlcal officer 1 1 laboratory techniques Ulan Bator

Epidemiology Training in home visiting 2 weeks Medical officers and 1 4 and case-finding Ulan Bator Itechnicians Bacteriology Orientation in diagnostic Intermittent Medical officers Continuous 7 procedures Ulan Bator

Malaria Basic training in 5-11 weeks Microscopists, surveillance 9 287 malariology , entomology, Kathmandu, Birganj and superintendents, inspectors parasitology and microscopy Biratnagar and visitors

1 Basic training in geographi- 1-6 weeks Operations and surveillance 7 345 cal reconnaissance Hitaura, Kathmandu inspectors, surveillance Biratnagar and Nepalganj superintendents, inspectors supervisors and other field Iworkers Subject Type of course or tralning Duration and location categories' of trainees

Malaria Basic training in surveil- 1-3 weeks Operations and surveillance lance activitles Kzthmandu, Birganj inspectors, surveillance Hitaura and Biratnagar superintendents, inspector: supervisors and other field I workers Basic training in spraying 1-2 weeks -do- I I Kathmandu. Biratnagar I Birganj and different arca headquarters

Refresher courses in 2-4 weeks Entomological field entomology Kathmandu and Biratnagar assistants and technicians

Refresher courses in 2 weeks Inspectors, supervisors spraying operations Biratnagar. Nepalganj and foremen and Birganj

I Tuberc~ilosis I Basic training in BCG 1 8 weeks I BCG technician trainees control vaccination Central Chest Clinic, I Kathmandu 1 Nursing Post-diploma Course in 3 months Graduate nurses I I ward administration I Rural health Basic trainlng 2 years A&xiliary health workers Auxiliary Health Workers (clinical assistants) School, Kathmandu SEA/hCl8/2 Page 236 Annex 9 No. of Total No. Subject Type sf course or training Duration and location Categories of trainees courses of tmiuees

THAILAND

Malaria Basic training in malaria 1 year Sector chief trainees 2 150 eradication and public healtt Malaria training centres, Prabudhabat and Chiengmai

Basic training in malaria 1-4 weeks Sector chiefs, assistant 123 7 269 eradication spraying, evalu- Regional and Zonal sector chiefs, squad ation, health education and Headquarters and Bangkok chiefs, health educators, surveillance house visitors and spraymen

Basic training in microscopy 2 months Microscopists 17 I66 Regional Headquarters and Bangkok

Basic training in entomology 10 days Entomological assistants 1 30 Bangkok

Refresher course in malaria 1 week Zone chiefs, assistant zone 3 100 eradication and evaluation Bangkok and Regional chiefs and medical officers Headquarters

Refresher course in micro- 10 days Microscopists 12 475 SooPY Bangkok and Regional Headquarters

Refresher course in 7 days Sector chiefs, assistant 102 3 433 surveillance Bangkok and Regional sector chiefs,squad chiefs Headquarters and house visitors Sub jeot Type of course or training Duration and location Categories of trainees I Malaria Refresher course in 7 days Entomological assistants entomology Bangkok and regional Headquarters

Leprosy Bzsic training 6 months Leprosy auxiliaries Leprosy Control Project

Refresher course 1 week Leprosy auxiliaries Bangkok and Sakol Nakhon

Refresher course 2 weeks Leprosy auxiliaries and Bangkok Laboratory workers

Training in the diagnosis I 2 months Sanitarians and Junior trachoma Trachoma Control Project health workers Korat

Practical training in 3 weeks Auxiliary trachoma workers control work Trachoma Control Project Korat and Provincial Health Office, Khonkaen

Public health Gn-the-spot training in 1 month "Tambol" health workers I basic health service Pitsanuloke Province Gn-the-spot training in 3 weeks Health officers, a public oase-finding and drug distl Bangkok and Korat health nurse and sanitarian bution programme SEAfiC18/2 Page 238 Annex 9

Subject Type of course or trainin8 Duration and location Categories of trainees

I I Laboratory Advanced training 4 months Senior laboratory techniques Bangkok Central I technicians Laboratory

Medical record: Basic course 10 months Medical records officers Siriraj Hospital, Dhonburi and various Bangkok hospitals

Radiography Refresher course in X-my 2 months X-ray sperators, nurses, technology Feculty of Medical medical officers, and Technology, Bangkok engineers