SEA~RCI112 WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR SOUTH EAST ASIA TENTH ANNUAL REPORT OF THE REGIONAL DIRECTOR TO THE REGIONAL COMMITTEE FOR SOUTH EAST ASIA AUGUST 1957 - JULY 1958 TABLE OF CONTENTS Introduction PART I - GENERAL STAT-T OF ACTIVITIES IN TEIE REGION Publio Health Administration Strengthening of National Health Servioes Community Development Maternal and Child Health Nursing Health Eduoation of the Publio Nutrition Mental Health Sooial and Oooupational Health Dental Health Environmental Sanitation Eduoation and Training Mreot Assietanoe to Eduoational Institutions Fellowships Communicable Diseases Malaria and Other Insect-Borne Diseases Tubemulosis Venereal Diseases and Treponematoses Other Communicable Diseases Epidemiology Health Statistics Assistanoe to Research Publio Health Laboratories and Vaooine Produotion Publio Health Laboratories Vaooine Produotion Curative Servioes Sooio-Eoonomio Aspeots of WHO'S Programme Atomic Energy in Relation to Health PART 11 - GENERAL Regional Committee Organization and Administration Organizational Structure Personnel Staff (Relfare Aooommodation of the Regional Office Legal and Constitutional Matters Implementation of Projects by Governments Proourement of Equipment and Suppliea Reports and Documents Collaboration with Other Agencies 43 United Nations 43 Specialieed Agencies 44 BiJateral Agencies 45 Non-Governmental Organi~ations 45 Other Agencies 45 Public Information 46 PART I11 - ACTIVITIES UNDERTAKEN BY GOVERNMENTS WITH THE HELP OF WEIO Afghanis tan 49 Burma 62 . Ceylon 71 India 77 India - Former French Settlements 108 Indonesia 109 Maldive Islands 119 Nepal 120 Portuguese India 122 Thailand 123 . Inter-Cow try 131 ' ANNEXES 1. Organizational chart 2. Geographical distribution of international ataff assigned to South East Asia Region as of jl July ;'. 1958 . 3. Conferences and.me.etings oalled by the United, . Nations and specialized agencies at which WHO was represented 4. Conferenoes and meetings of governmental, non- governmental and other organizations at which WHO wae represented . .. 5. Tables showing fellowships. awarded by WO by . .; : ,:. source of funds, type of fellowship, and distri- .. ., ' bution by subjeot of study and by 0o~ntqY ' ' .. , . 6. Training aotivities oarried oyt by governments, , . ). with the assistanoe'of WHO ataff.'fto be issued .. separately) SEA/RC~~/~ INTRODUCTION This year has seen a slight setback in the steady expansion of public health services, which has been a feature of the past ten years in South East Asia. This setback has been part of a general though slight reduction in the expansion of socio-economic develop ment in at least five countrfes in the Region. Perhaps it is just as well to have a slight reduction in the tempo of these aotivities, as they were beginning to develop a little too rapidly and were not having sufficient time to take deep enough roots. Nationkl resources, which were already slender, were being spread so widely and so rapid- ly that numerous programmes could ill afford to stand the strain of subsequent development. Such a temporery halt is, therefore, useful if it is.exploited for consolidation of existing programmes and for better planning of future activities. That this halt is temporary I have no doubt. The forward march to material progress is too well established to be shaken off by anytbing short of a major world tragedy. People all over South-East Asia now realize the benefits of modern public health services well enough to insist on having for themselves a bigger and better share of them. This is certainly true of the population of rural areas, which forms the bulk of the popula- tion of the Region and which has had, hitherto, the somewhat un- deserved reputation of being resistant to scientific medicine. This so-called "resistancev has in fact been our own inability to adjust modern medicine to the needs of the villagers of South East Asia. There are, admittedly, still many maladjustments to rectify, but the road is now clear and future scientific progress ensured. In addition to the setback mentioned above, the usual head- aohes of public health programmes have remained unaltered. Departments of health have continued to be harrassed by ministries of finance, aa usual. Shortages of trained and even semi-trained personnel have re- mained as mute as ever, and training programmes are still neither well plenned nor well executed. Counterparts for WHO field staff remeln as elusive as before. Investment in brick and mortar still takes precedence over investment in human beings. It is indeed a major misfortune of public health services in this region that build- ings for hospitals, laboratories, health centres and training insti- tutes eat up such large funds that far too little is loft for hiring adequate personnel to do the job for which these buildings are intended. Administrative delays, better known as red tape, still remain a formidable barrier. The willingness to accept responsibility, among junior workers, and the unwillingness to share responsibility, among senior workers, are &ti14 too evident. A number of old projects, where technical assistance has terminated, still continue to show signs of deterioration, not so much from any lack of ability or desire for progress but from gradual disappearance of locel facilities and resources which had been made available during the period of WHO assistance. I quote from a recent report of a WHO expert on laboratoriesc "In practically no instance has the original standard been maintained or improved, mainly because of lack of staff and materials (to be provided by governments). Break- down and delay in the repair of equipment are a common feature of a nunber of laboratories. I wish to put on record my disappointment with the majority of the labor& baries visited to-date". It must not be inferred from the preceding remarks that all is not well with public health programmes in South East Asia. This is far from the truth. In fact, very considerable progress has been made in spite of all these handicaps, which, after all, are insepar- able from such a rapid process of growth. When looked at in re- trospect, the developma'nte during the past ten years have indeed been remarkable, as will be seen from a document which I am presenting to the Regipnal Committee separately under the title "Ten-Year Review r WHO'S Activities in the South East Asia Region." I give below some of the highlights of the programme. Dur- ing the period under review 136 projects have been assisted. On 31 July 1958 there wore 116 professional staff members in the field. A number of posts were not filled8 recruitment for certain categories still continues to be difficult. The total flnanclal responsibility for programmes in the Region in which the Organization is partioipqb ing amounted to over seven million dollars in the current year, inclusive of "Other Extra Budgetary Fundsu. The main fields of assistance remain, as before, the control of communicable diseases, the promotion of rural health services and the training of all categories of health personnel. The state of environmental sanitation throughout the Region continues to remain highly unsatisfactory, partly from lack of fund8 and partly from lack of driving force to improve existing conditions. A more detailed assessment of the sanitation situation appears in a separate document, SEA/RCII/I~, to which I draw the Committee's special attention. Among the programmes for the control of communicable diseases the most dramatic is the ambitious programme for malaria eradioation, details of which appear elsewhere. There has been no major advance in tuberculosis control, ainoe the largest single programme, which is for 'India, still awaits approval by the Government, and the chemo- therapy research project in Madras has not yet put forward its report. Projects in leprosy control have made good progress, which has been remarkable in the case of Thailand. Yaws control has not yet made the expected progress towards eradication, and the programme in Thailand has, in fact, needed some further strengthening. we still have no adequate answer to the problem of filariasis, especially in r'wal areas. The two pilot projects in trachoma in India and Indo- nesia, have shown good rekults, but the proposed expansion of the programme, especially in India, has not yet obtained government approval. In rural health tho most notable feature has been the very successful regional conference on that subject which was held in October 1957 in New Delhi. The recommendations of this conference will undoubtedly form an important milestone in the development of rural health servlces in this region. Individual rural health pro- c jects h~vomade considerable progress in India through the community development programme; ten subsidiary etate plans of operations have I been drawn up during the year, and basic criteria completed for rural training areas and demonstration districts. Schemes for the expansion of rural health serviceb in Indonesia and Thailand have been under consideration. The rural health project in Chaurassia, Afghanistan, is now well staffed and well equippbd. In maternal and child health activities we have continued the emphasis on improving standards of paediatrics both by providing medical and nursing aediatric teachers and by holding a paediatric teaching conference (n June 1958). A report of this conference appears separately. The integration of maternal and health services into general public health services continues. An attempt to promote some urban health centres for demonstration purpose8 has not yet been successful. Training activities have as usual been the main feature of WBO assistance in this region. Projects for assistance to medical schools and nurses'training institutions have been successfully conti- nued. The school for sanitarians in Kabul and the school for health assistants in Kathmandu have both made very good progress and have become a permanent feature of the national health services in Afghan- istan anb Nepal. A detailed enumeration of the extensive training activities which have been assisted during the year appears in Awex 6, to be issued separately.