Nineteenth annual report of the Regional Director to the Regional Committee for the Western Pacific covering the period, 1 July 1968 - 30 June 1969

WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC NINETEENTH ANNUAL REPORT (1 July 1968 - 30 June 1969) OF THE REGIONAL DIRECTOR TO THE REGIONAL COMMITTEE FOR THE WESTERN PACIFIC TWENTIETH SESSION WPR/RC20/3 THE WORK OF WHO IN THE WESTERN PACIFIC REGION NINETEENTH ANNUAL REPORT OF THE REGIONAL DIRECTOR oro THE REGIONAL CCM1I'lTEE FOR THE WESTERN PACIFIC Covering the period, 1 July 1968 - 30 June 1969 World Health Organization Regional Office for the Western Pacific Manila, Philippines July 1969 The following abbreviations are used in this report: ECAFE FAO IAEA ILO UNDESA UNDP UNESCO UNICEF US/PHS WFP Economic Commission for Asia and the Far East Food and Agriculture Organization of the United Nations International Atomic Energy Agency International Labour Organisation Uni ted Nations Department of Economic and Social Affairs United Nations Development Programme United Nations Educational, Scientific and Cultural Organization United Nations Children's Fund United States Public Health Service World Food Programme -ii- ,/ .' ~. ". ~- -..: ... • "r- CONTENTS I!l'l'R.ODtJC'I':[ON III III III III III III III III III III III III III III III III • III III III • III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III vii 1 2 PARr I. GENERAL STATEMENT OF ACTIVITIES IN THE REGION MA.IARIA III III III III III III III III III III III III III III III III III III III III III " III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III .. 1.1 Introcluction III III III III ,. III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III • 1.2 Important aohievements in the promotion of 1.3 malaria erad.1catlon III III III III III III III III III III III • III III III III III III III III III III • III III III III III III III III III III " III Progress of work in the malaria projeots •••••••••••••••• 1.3.1 1.3.2 1.3.3 Countries belonging to the Northern Zane ••••••••• Countries belonging to the Central Malaria Zone •• Countries belonging to the Australasian 3 3 7 7 8 r.1a.lar1 cus Zone III III III III III III III • III III III III III III III III III III III III III III III III III III III III III III III III III 12 1.4 Inter-country activities •..•..•.•....•.....•...........• 14 1.4.1 1.4.2 1.4.3 The International Malaria Eradioation Training Centre in Manila (MEre) ••••••••••••••• Independent assessment teams ••••••••••••••••••••• Inter-regional team for the study of teohnioal problems in malaria eradication •••••••••••••••• C~ICABI.E DISEASES III III .. III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III 2.1 2.2 2.3 2.4 2.6 2.7 Epidemiological Surveillance and Quarantine III III III III III III III III III III III III III Smallpox Eradication III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III III • Virus Diseases ......................................... . 2.3.1 2.3.2 2.3.3 2.3.4 2.3.5 Poliomyelitis .................................... Influenza .......................................• Japa.nese enceplla.li tis ........................... . Dengue-haemorrhagic fever ....................... . rrx-aohoma ••• '. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Paras! tic Diseases ........................•............. 2.4.1 Schistosomiasis ................................. . 2.4.2 F':llariasls ...................................... . Venereal Diseases and Treponematoses .................... En.demic Treponematoses ••.••.•.••••••••••••••••••• Venereal infections .............................. 'I'u.berculosls •......•........................•........... I.eprosy •••••..•••••••••.••••..••••••...••.•••••••••••••••• -11i- 14 15 15 15 15 16 16 16 17 17 18 18 19 19 19 20 21 21 21 25 2.8 Bacterial Diseases ••••••••••••••••••••••••••••••• 'I •••••• 2.8.1 2.8.2 Cholera Plague • • • • • • • • • • • • • • • • • • • • • • • 41 •••••••••••••• ' •••• · ......................................... . 3 HEALTH PROTECTION AND PROMOTION ••••••••••••••...••••••••••.•• 4 5 6 7 1 2 3 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Callcer .......................•....•.............. ' ....... . Cardiovascular Diseases Dental Health •••••••.•••••• ............... .................... Mental Health · ............. " ............................ . Nutrition · .......................................... . Radiation Health •••••• Occupational Health ................................. ••••••••••••••••••••••••• '0' •••••• PUBLIC HEALTH SERVICES ••••••••••••••••••••••••••••••••••••• 'II • 4.1 4.2 4.3 4.4 4.5 4.6 4.7 National Health Rlanning •••••••••.• Community Health Services •••••••••• . .................. . . ................. . Organization of Medical Care Health Laboratory Services ............................. ............................ Nursing ........................................................... Development or improvement in nursing services Development or improvement of nursing education •• Health Education ••••••••.••• Maternal and Child Health ••• .. .. .. . .. . .. . . .. . . . . .. . .. . .. . ' ........ . .. .. .. . . .. . . . .. .. . .. . .. . .. .. . . . . . .. . . . . ENVIRONMENTAL HEALTH •...•......•.•....••.•••. I ......... ' ........... .. HEALTH S~TISTICS .................................................. - ........... . EDUCATION AND TRAINING Medical Education ••••• Public Health Training .. ' .................................... -................ . Other Activities ....................................................... Fellowships ••••• . .................................................. . Educational Meetings and Courses ................................... PART II. CO-OPERATION WITH OTHER ORGANIZATIONS CO-OPERATION WITH UNITED NATIONS AND REIATED AGENCIES INTERGOVERNMENTAL ORGANIZATIONS ••.••••••••••••••••••••••••••• WIlli OTHER OR<JA.NIZA.TIONS ................................................. . South Pacific C0tml1ssion ................................ 4. .............. . Other Joint Work ..................................................... -iv- 26 26 27 27 27 27 28 29 29 32 33 34 34 36 38 40 41 41 42 46 47 50 57 59 60 63 66 66 68 73 75 76 76 76 ' . .... t • " . .,. - , ',. r 4 1 2 3 4 5 6 1 2 NON-OOVERNMENTAL ORGANIZATIONS IN OFFICIAL REIATIONS Wlm wo •••• "" ••• """"""""""" •• """"""""""""""""",, •• ,, 78 PART III. PUBLIC INFORMATION TWENTIETH A~Y •••••••••••••••••••••••••••••••••••••••• FtJBI..ICATIONS """""""""""""""""".""""""""" •. """"""."",, .. ,,",, .• ,,. WORID lmA.L'nI Ill\. Y """"".".""""""""""" •• "." .• """."".,,"",, ••• ,, .. ,, '. , RADIO COVERA.GE "."" .. """.""""""".".""""."",, •• ,,""""",,.,,.,,.,,""""" FIIJ.1S ""."."""""""""" .•• "." •. """""."."" ••• ,, ••. ,,""""""",, .. ,,"'"'' VISI'1'ORS .".""""""...."""""""."""."""" •••• ,,.""",,.,,..,,"",,.,,""" '" PART IV. CONSTITUTIONAL AND AmINISTRATIVE DEVELOPMENTS TIiE REGIONAL C~ITrEE ••• """""""." ••••• "" .. """""""""" •• " •• ",,.,, REGIONAL OF'F'ICE .""" •• ""." ... """".,,"""""""""""""""""",,.,,",, .. ,,""" 2.1 Organizational Structure ...... ""." .. "."."" .... """"""".".".,, 81 82 82 82 87 89 89 2.1.1 Regional nfrice staff............................ 89 2.1.2 WHO Representatives -.............................. 89 2.1.3 Proj ect staff .................................... 9C> 2.2 Salaries and Allowanoes ................................. 90 2.2.1 2.2.2 Staff in the professional category ••••••••••••••• Staff in the general service category •••••••.•••• 90 90 2.3 Regional Off! ce BuIlding ................................ 90 rrtle Conference Hall .•............•..•..•......... Repairs and maintenance ............. " ........... . 2.4 Regional Obligations and Expenditures ••••••••••••••.•••• PART V. SUMMARY OF A COMPIETED LONG-TERM PROJEaI' 90 94 91 SCHOOL HEALTH EDUCATION, PHILIPPINES •••••••••••••••••••••••••••••• -v- PART VI. PROJECT LIST PROJECTS IN OPERATION FROM 1 JULY 1968 TO 30 JUNE 1969 •••••••••••• 102 TABLES DETAIIBD STATUS OF MAIARIA ERADICATION IN THE WESTERN PACIFIC REGION AS AT 31 DECEMBER 1967 DETAILED STATUS OF MAIARIA ERADICATION IN THE ............. ' ....... . 4 WESTERN PACIFIC REGION AS AT 31 DECEMBER 1968 ••••••••••••••••••••• 5 TABLE OF OBLIGATIONS INCURRED BY THE WORLD HEALTH ORGANIZATION WESTERN PACIFIC REGION, 1950-1968 •••••••••••••••••••• 93 GRAPH OBLIGATIONS INCURRED BY THE WORm HFAmH ORGANIZATION WESTERN PACIFIC REGION, 1950-1968 .•••.•.•••...•.•.••.•.•..•••••••• 92 -vi- -' ... . , • '" • .. .r , , MANILA At a reception given on I October 1968 in honour of WHO's twen- tieth anniversary, H. E. President Ferdinand E. Marcos of the Philippines ' .. , '? ,At, I ,'u welcomes WHO Director-General Dr. M. G. Candau and Dr. Francisco J. Dy, Regional Director of WHO for the Western Pacific Region. "----- . ..:- , ... • r_~_ .. IN'.IRODUCTION The health situation in the Western Pacific Region is essentially the same as in' past years, although certain trends can be noted which will have an effect on the long-term regional health policy. While the communicable diseases still predominate as causes of mortality and morbidity in most developing countries, cardiovascular diseases, cancer and accidents are assuming increasing importance as causes of death. The rapid urbanization taking place is accompanied by problems - such as slums, poor housing and delinquency - and where industrial growth is more active, there has been a rise in accidents, water and air pollution. All these developments are important from the health point of view. In some countries in the Region where there are problems of internal security, services have been so disrupted that it 1s d1fficul t to maintain the levels of health established, and. in some instances • certain diseases, such as malaria, have broken out in epidemic form. The increasing expectation and demand for health care are shown by requests for more health centres and hospitals, health insuranoe and social security schemes. community water supply and sewerage systems. WHO's approach to technical assistance in the Region has followed the framework of the resolution adopted by the Regional Conmittee in 19681 and covers: (a) Major problem areas 1n the provision of health services, viz •• (i) organization and administration; (11) education and training: (11i) selected progr8lJlDeS such as cOJlJl'JUn1cable disease control, organization of medical care, environ- mental health and health promotion with particular attention to child health. ~esolut1on WPR/RC19.R6, WPR Handbook of Resolutions and DeCiSions, 1969. 6th ed., section 1.1.2, page 8. -v11- (b) Joint studies which may be pursued by Member States that are of particular interest to groups of countries, lc) Assistance to Member States taking steps to formulate national health plans and to determine priorities and goals within the framework of national socio-economic development plans. Planning, organization and administration of the health senvices , There is a need in many countries for more flexibil1 ty in staffing patterns and more coverage of the population by ImU ti- PUrpose health workers. Health practice research has started in one country in the Region. WHO is assisting in a study of the current patterns of the organization and administration of the local health services and in a review and assessment of the exist- ing methods and practices used in the delivery of such services in the 'light of present and fUture demands. The resource ~equire­ ments which would be appropriate in number and quality for the efficient fUnctioning of the local health services and the content and scope of training for the various categories of health personnel needed are also being determined. It is hoped that this approach will enable the health authorities to plan services which will meet specifiC demands and will be, at the same time, suitable for financing from locally available resources. The results of these stUdies will also be usefUl in the formulation of a national health plan. Education and training There is an increasing demand for more and better trained personnel. It is, however, important to ensure that training is in accordance with the individual needs of countries and their ability to absorb the persons trained. The continuing manpower drain appears to show that insufficient attention is being given to this aspect. Health authorities are, therefore, being encouraged to undertake manpower studies. There also appears to be a need for teaching institutions to establish curricula better adapted to national health -v111- #- . ~ • • "--- .... : • problems and needs. M:1n1stries of health are being enoouraged to set up institutes of publio health which will provide a multi-disoiplinary training programme for all public health workers. The WHO staff assigned to suoh oountries will work olosely with these 1nsti tutes so that training oan be planned in aocordance with needs and the ablli ty of the oountry to find positions for the staff trained. Plans are now being made to set up an institute of this type in Viet-Nam. Communioable diseases WHO staff are trying to evolve a strategy for the simultaneous development of malaria and basio health servioes, as the laok of an infrastructure is one of the reasons why some countries have failed to achieve eradication within the time originally planned. Studies on technical problems confronting malaria eradication have been intensified. particular attention has been given to chloroquine- resistant strains of f. falciparum. Attention has also been called to the danger of the spread of malaria in development schemes, suoh as that in the wwer Mekong Basin. The organization of oentral epidemiologioal and health statistioal servioes with the ultimate aim of establiShing a disease intelligence network throughout the country is a need in all developing oountries. The assistanoe provided by the Organization to countries undertaking suoh projects inoludes the planning and conduot of epidemiological surveys, the routine collection and analysis of health statistical data, and the strengthening of public health laboratory services. Cholera oontinued to be endemic in the Philippines and the Republic of Viet-Nam. Small outbreaks were reported in Cambodia and West Malaysia and a few cases in Singapore. The Organization met requests from Cambodia and Malaysia for cholera vaccine. Studies oarried out by the WHO inter-regional team in the Philippines, working in collaboration with the Governments of the Philippines and Japan, showed that treatment of close contacts with tetracycline resulted in a significant reduction in the number of vibrio excretors among them. FUrther trials on a larger scale are planned. -ix- An interesting projeot in the field of tuberculosis is that recently started in Singapore where a survey is being made of treated cases to assess the problems of initial drug resistance bnd the results of twelve months of treatment. 'The findings should be of interest to all oountries undertaking mass tuberculosis campaigns. Organization of medioal care Hospitals are expensive to build and to operate and the money devoted to them consumes a large part of the natiOJlal budget. '!heir role in a prograrmne of comprehensive medical care is not always under- stood. '!he regional1zation of the hospital system and the establiSh- ment of referral links with the health centres are strongly recommended as a means to achieve integration of preventive and curative medicine and to promote a oomprehensive health service which will be more accessible to, and provide more coverage of, the population being served. This concept is being emphasized in all WHO-assisted projects which have as their objectives the development of basic health services. Environmental health In the field of environmental health, the two large pre-investment studies for sewerage systems which have been carried out with Special FUnd assistance in Greater Manila and Greater Taipei, and the feasi- bility studies in sewerage and sewage treatment and solid wastes management undertaken in Fiji, Malaysia and the Philippines are of particular interest. The Greater Manila project has progressed to a point at which a government decision on the amount of investment for construction will be needed shortly. '!he Greater Taipei project has only recently been establiShed, but the need has already become apparent for government action to expedite the estabUshlqent of the co-ordinating,!advisory cOlllllittee which is to be the main liaison organ between the Government and the project. Important projects planned include two on sewerage and sewage treatment for Singapore, a Special Fund-assisted project on water supply for Sihanoukville, Cambodia, and consultant assistance in sewerage planning for Kaohsiung, China (Taiwan). -x- - .' • .< I r _ ,- Maternal and child health Continuous efforts are being made by cOWltries in the Region to provide health care to an increasing number of children. This is being achieved through the expansion of the basic health services, into which the maternal and child health services are being integrated, by increasing the provision of health care facilities for children in day-care centres and in the schools, and by preparing health personnel for their role in maternal and child health. 'lhese efforts should have a signifioant effect on the health of children. I am happy to report that an increasing number of cOWltries in the Region are beooming convinoed that family planning activities should be an essential component of maternal and child health services and are requesting WHO to advise them on this aspect of their programme. This approach is welcomed and it is hoped that it will expedite the development of basic health services. Joint studies A number of cOWltries which have cOOlllon problems and neighbouring borders are increasing their co-operative efforts towards regional developnent. A WHO team has made a survey of the problem of schisto- somiasis in Cambodia and Laos. This work 1s particularly important in view of the large-scale development project being Wldertaken by the Mekong COIlIII1ttee in that area. '!he fourth inter-territorial malaria conference for the South-West Pacific, held in Papua and New Guinea in May. and the technical meeting on malaria for the riparian countries involved in the Lower Mekong Basin Development Scheme, held in Laos in June, are two other examples of co-operative efforts. .Special studies are being Wldertaken on Japanese encephal1 tis in China (Taiwan) and the Republic of Korea, and on filariasis in the South Pacific. -xi- National health planni~ Acti vi ties connected with national health planning correspond closely to the approach agreed upon during the technical discussions held in connexion with the last session of the Regional Colllllittee. This consists of: (a) advisory services to governm~nts, (b) training, ...... - and (c) developing through research and/or adopting suitable techniques which can be used by the developing countries. The successful course in national health planning :organized for WHO senior staff in the latter part of 1968 heralded tlle beginning of a joint prograDllle between WHO and the University of the PhilippineS. This course was the first of a planned annual series designed to acquaint national health administrators in the Region with the general principles of national health planning within the framework of overall socio-economic development planning. Orientation/tra1qfng courses at i the country level for national health personnel involved in the health planning process are envisaged as one of the post-training activities of the participants in the international course. Heal th practice research will be conducted in a pilot demonstration area with a view to developing and testing health planning techniques which will be of use to the developing countries in the Region. Al though we are still unable to control some of the problems which have been with us for many years and ~new problems arise daily, I believe that considerable progress has been made in a number of fields during the period under review. I look forward with interest to the results of the more systematic approach to the organization, administration and integration of health services which 1s now being tried out in a number of countries. T,~(LA~ Reg10~ /D1:;tr -xii- . . ~ .. PART I. GENERAL STATEMENT OF ACTIVITIES IN THE REGION , ,- . -.. . --~- • 1. MAIARIA 1.1 Introduction WPR/RC20/3 page 3 Malaria still exists in eleven of the forty-three countries and territories in the Western Pacific Region.* These countries and terri- tories belong to different climatic and topographical malaria zones, where more than 53 million people still live under malaria risk. These zones and the malarious countries can be divided as follows: (a) Northern Zone - Republic of Korea, rural Hong Kong - population at risk: 10.16 million (b) Central Zone - Brunei, Malaysia and the Philippines - population at risk: 19.62 million (c) Western Zone - Cambodia, laos, Republic of Viet-Nam - population at risk: 20.6 million (d) Australasian Zone - British Solomon Islands, Papua and New Guinea, New Hebrides and Timor population at risk: 2.98 million Apart from the natural absence of malaria - due to the absence of a vector - in the twenty-two Pacific Island groups with anllstimated population of 4.08 million, malaria has been eradicated from seven countries where 24 million people used to live under malaria risk. These include China (Taiwan), the northern tip of Australia, urban Hong Kong, Japan, Macao, the Ryukyus and Singapore. 1.2 Important achievements in the promotion of malaria eradication The training of national personnel in the methodology of malaria eradication and the orientation of key public health personnel on the role that medical establishments - especially those attached to the rural health services - can play in the eradication operations, have received high priority in the regional malaria eradication efforts. * Mainland China, North Korea, and North Viet-Nam, on which very scanty information is available, are excluded. TABLE 1. DETAILED STATUS OF MALARIA ERADICATION IN THE WEST~ PACIFIC REGION AS A T 31 DECEMBER 1967 1---.... --·-··-·.·· .. · .... ·· .. · ................ -... ....... ...... .... .. .......... _-_ ............ __ ... __ ................. -............... - ........ _ .......................................... _ ................... -......... - ................................. , ............... _ ........... _...... .. ...................... ,,_.... . '." ...... --.... .. I I Population in thousands I ! ···-·---.. · ....r-~~;;~~~;~·· 'T" ... - .. · .. ·-............ l···~~~~~-...... ·: .......... · .. ;;; .. ·;;:di~;;~~ .. ~~~;;~~~i~ .. ;~~~ .. ·-.. · ........ r .... ·- ................. .. I I I never Indigenous I Of I malaria r· .. · .. ·_ .. · .. · .... _ ...... ·'t ....................... , ......................... "T'" ...... _- Whele I Or..tntry or territory 1 Total I or disappeared ! o:iginal ! eradication I In the I In the I In tbe I Total etadicadon I I, without specific I malarious 1 claimed eonsollda- attack I pteparat«y ; programme I } I anttmalaria I areas ~maintenanee! tion phase \' phase! phase I I not yet I I! measures! i phase) I" 'i started i i: , t! i I 1 ................. w· ... _ .. • .... 11t--··_· .. -········ .. · ........ ·· 1 ' ..... ··.,{,2.t ............ ~ ...... _ ..... ~m .. " .. __ ...... · __ t ......... .<4.L .. ··.· ..... _·I ............ @. .................. !{§) .. · ..... J11 .. _··tl .... CB.1 ...... ·l .... (~...·· ..... ".U.().L f ! i!! ,i I ! Australfa . 11 890 I 11 657 i 233 i 233 1 I' I 1 British Solomon Islands I 144 I I 144 i' ! i 144 ! Brunei I 127· 81 I 46 46 'I 46 ! ! Cambodia I 6 569 I 3 665 I 2 904 I 2 904 I China (Taiwan) ! 13 431 .. ! 13 431 13 431 .. I I Hong Kong I 3 908 3 908 3 204 I '704 ! Japan I 100 353 96 682 3 771 3 7'11 i ! Korea (Republic of) ! 29 942 20 287 9 656 I 9 656 I Laos i 2 7'11 2 7'11 ) 2 771 I Macau l 297 7 290 290 l j Malaysia I i West Malaysia 1 8 68'7 8 687 ; Sabah, East Malaysia ; 680 67 523 Sarawak, East Malaysia I 895 147 748 246 309 325 2'77 114 400 400 523 439 New Hebrides I 78 78 Papua and New Guinea I 2 259 2 259 938 244 1182 Philippines ! 35 152 25 814 9 338 8 000 1 338 b 9 338 8 287 78 1 077 Portuguese Timor ,'573 116 457 457 , kyu I I I 1 Ryu Islands i 964 85, 879 \ 879 - '\' - I - . - ; - I' , I I ' " ! I Singapore . 2 001! - ; 2 001 I 2 001: - I -; - : - I - ! i Viet-Nam ! 17 320 i 2793 i 14 527 ~ - ! - i -: - ! - j 14527 J r--"'" ...... " ........ ' ............ '... .. ........... - ..... · .. i .. _ ...... ,-.. .. "... ..... .. ...... ".. .. ........ _.-.... j- ........ _ ........ " ....... ;. . " ... - ........................... -.- .. _ ... -+ ... _ .. -.. ---1------.... ,--..j..-._.-... ..-... -----.. ! Total for countries with!! . I I I ! i ~_~!B!.~! .. ~ ... ~~!~!.~~~ .. ~.~_~ ........ _.4 ... _~:_ .. ~: ......... L __ 16129: __ .. "_ ........ \ .. _~6 .~~ .. O ....... L ._ 24 ~.~_._ ............ S.~.7 ... J ... 9 .. 3~~ .. : ... _ .. =.~.~~ ...... _ .. L_._~=-~~ ... "40 ~" .. J i TWenty-two eounttie.s in whichl 1 ! i malaria was never lDdigenous)! I r·;!!;~;;~··-··"··· ...... ··· .. · .. - .. ··I· .. ··-;: .. ;:;;· .. + .... ·-" 16: :::." ........... " ........... " .... N~_ ....... "_.~ .......... ~_,." ___ ..... ~."_ .......... MI ......... _ ....... " .• _ •• _ .. , ........ .l ................... " .... _ .... ~ ... _ ........ -... .: a Excluding China (Mainland). North Korea and North Viet-Nam. ~ Feuding reclaSSification • .., J' .. ~ . 'd~ ~~ .f=2 S ~ , • • 1--"' ; ( ~. I TABLE 2. DETAILED STATUS OF MALARIA ERADICATION IN THE WESTERN PACIFIC REGION AS AT 31 DECEMBER 1968 ~ ,. Country or territory ......... m ......... . ; Australia i British Solomon Islands Brunei Cambodia China (Taiwan) Hong Kong Japan Korea (Republic of) : Laos Macao Malaysia West Malaysia Sabah, East Malaysia Sarawak, East Malaysia New Hebrides Papua and New Guinea Philippines Timor Ryukyu Islands Singapore Viet-Nam : Total for countries with 1-·' ...................... , ........ , .• Where malaria never indigenous Total or disappeared without specific antimalaria measures (2) . (3) ................. ~" ........ !", ......... ,." .. " ....... , ..... ~ ..................... . 12088 148 151 6690 13733 3966 101419 30946 2874 297· 8966 622 945 84 2283 36475 583 968 2029 17635 242839 11851 105 3697 97 608 21494 81 27460 118 85 2844 165343 Of original malarious areas (4) 237 148 46 2930 13733 3966 3811 9452 2874 297 8966 541 945 84 2283 9 015 465 883 2029 14791 77 496 .... " ........ ~ ..... -. . .......... , .... - ..... -~ ... -.-.. -............ " .. ".-•. --., ........................ -. ................................ __ ._".,·· •.. _~.w ..... . .. ~~!'.':I~.lI:~?~ .. !.~ ... ~<:l.~.~.Il:~~ .... _ ............ . ." ........................... H •• n.N' ... ' ...... W ••• ' .. ~ ............ " .............. , .............. T ......... " .......... _ ... " ................... ! Where Where eradication programmes in progress , malaria ...............................•... , ···········-············r········_···_········_·········:····_· __ ·········_·····1 eradication, In the ,In the . In the . i i claimed !consolidation i attack preparatory Total ·(maintenance i phase i phase ! phase . phase) , i . Where eradication i programme Other malaria eradication projects not yet started ! in operation (5) i (6) l (7) . (8) i (9) ! (10) (11) '''''''f ... " .................... ····· .. ··· .. ·r···w ..... •••••• .. •••••••• .... ·t .. ·· .. · ...... · ..········ ... · .... ··,·· ...... t .... ··· .. w ...... • ...... •• .. • .. ••• .. t .. ·· .. · .. · .. · ...... ······· ···· .... ~··-r .. ···· .... ··_·M_ ...... _ ....... -........... ~ . 237 18 733 3252 3811 297 883 2029 24 242 46 246 269 561 46 590- 1285" 1875 195 541 676 945 1154 1154 9015 9015 148 2930 714 9452 2874 7091 84 1129 465 14 791 .. -......... f.. . ........................... "'! ................. " ......... . 11730 1285 13576 39678 PEP PEP PEP METe - METC(2) PEP : originally malarious areas . i·-·········~··~··· .. ··,···,·"····-···,-.. ··.·,, ... , ......... ""............ . ........... .; ......... . : Twenty-two island groups- ' • ............. \ .......................................... __ •• _ .......... ~ ..... _ ........... n ....... _ ••••• _ ............ _ ........... M ......... _._ .. _.l .............................. _ ...__ .. _~ ........... _ .... _ .......... i . .......... _ ............................ ~................ .. ...... -. .. 1 ..",. ......... _ ..... _ ........ _ .. 1.. __ ._ .. _ ....... _ .......... _ ..... _ ..1 i in which malaria was never 4079 4079 i indigenous '''j ......... . j .. ,,, : Regional total 246 918! 169 422 ; ...... " ..... " ................ , ................... " .................... ~ ..... _ .. _ ............ i ... , ......... ~.' .. _~ ... N .. ' ...... -! ...... M.M." •••••• " ............. _ ..... _ ... w ............. ··, NO DATA ON CHINA (MAINLAND), NORTH KOREA AND NORTH VIET-NAM. ~timate, no details available, "'"Including 268 in attack and 327 in preparatory phase in urban areas covered by antimalarial measures. -American Samoa, Bonin, Canton & Enderbury, Christmas ISland, Cocos Island, Cook Islands, Fiji, French Polyuesia, Gilbert and Ellice Islands, Guam, Midway Island, Nauru, New Caledonia, New Zealand, Niue, Norfolk Island, Pacific Islands, Pitcairn, Tokelau, Tonga, Wake Islands, Western Samoa. -Expanding MEP without WHO assistance. i~ U1~ ~ \.>I WPR/RC20/3 page 6 The contributions of the international malaria eradication training centre (METC) in the Philippines and the two WHO-assisted national METes in the Philippines and Malaysia to these efforts is fully recognized. Inter-country co-ordination of antimalaria efforts has been prompted through the promotion of technical malaria meetings. The convening of the Fourth Inter-territorial Malaria Conference for the South-West Pacific in Kundiawa, Papua and New Guinea, 1n May 1969, and the Technical Meeting on Malaria for the riparian countries of the Lower Mekong Developnent Scheme held in Vientiane, Laos, in June 1969. contributed to the exchange of information among neighbouring countries and to the co-ordinated plarming and implementation of antimalaria activities. The convening of the Sixth Asian Malaria Conference in Malaysia in October 1969 will be a historical one, as it is expected that the new WHO strategy of global malaria eradica- tion, as recommended by the Twenty-second World Health Assembly, will be presented to the participants. Studies on technical problems confronting malaria eradication prograumes in the Region have been intensified. The occurrence of chloroquine-resistant strains of R. falciparum in the countries belong- ing to the Western Zone, in West Malaysia and, recently, in the Philippines, has prompted studies on the distribution of these strains and trials on the effectiveness of new antimalaria drugs or quinine salts in clearing the parasitaemia. With the current emphaSis on health planning, and the preparation of master plans of operation to promote the development of the general health services required before a malaria eradication programme can be launched, the antimalaria services in a number of countries have been reorganized so that there may be a co-ordinated effort to proteot the rural population against malaria. It is becoming apparent that the execution of extensive irrigation proJeots will prove most difficult in the face of the malaria problems generated by these schemes. This has been noted in some of the t '- r __ WPR!RC20/3 page 7 engineeriDs projeots connected with the development of the Lower Mekong River Basin. '!be need for expert technical guidanoe and inoreased finan- c1al support of the antimalarial efforts connected with these irrigation proJeots 18 evident. Malaria epidemics and the immobilization of the labour foroes by a high morbidity could upset the sohedule of work and even result in its abandonment. It is believed that the budgets of these development schemes should include adequate finanoial proviSion to minimize this risk. 1.3 Prosress of work in the malaria projeots 1.3.1 Countries belonging to the Northern Zone 1.3.1.1 Republio of Korea The prospects of conduoting a malaria eradication programme appear at present remote because of financial restrictions and the need to await the development of the rural health services. Pre-eradication activities were co~ined to the development of a pilot study area with an estimated population of 100 000. Malaria-oriented health staff have been assigned to a main health oentre and its satellites. The delimitation of malarious areas has continued. It is now apparent that endemicity in the Republic of Korea is confined to the four north-eastern mountainous provinces where an estimated 9.2 million people live under malaria risk. During 1968, health establishments and voluntary collaborators collected 40 375 blood speoimens, 20 049 of which proved to be positive (all f. vivax). 1.3.1.2 China (Taiwan) Since the certification of achieved malaria eradication in 1905, malaria vigilanoe aotivities have been continued by the health establish- ments under the technical guidance of a malaria vigilance unit attached to the Taiwan Malaria Research Institute. During 1968, fourteen malaria oases were detected (2 indigenous, 2 induoed, and 10 imported from abroad) in 285 000 slides oolleoted from vulnerable groups and from populatiOns living in highly receptive areas. Financial restrictions are reported to be affecting the activities of the malaria vigilance unit. wPR/RC2ol, page 8 1.'.1.' The Ryukyus All the three main groups of islands have been in the maintenance phase since 1966 and no cases of malaria have been detected among the indigenous population. The Administration has requested WHO certifica- tion of achieved eradication and a report on the findings has been sub- mitted for consideration of the Expert Canm1ttee on Malaria, in accord- ance with the new procedure. 1.,.1.4 Hong KOng While malaria has been eradicated from the urban part, antima1aria measures are oontinuing in the New Territories. 1.,.2 Countries belOnging to the Central Malaria Zone 1.3.2.1 Brunei The eradication programme oovering a total population of 105 000 is in the third year of the consolidation phase and is px:ogressing smoothly. Only nine cases of malaria were recorded during 1968 (seven imported from abroad and two induoed). As the oompletion of roads oonneoting remote vUlages and of the rural health network will take some time, it is considered essential to oontinue finanoing the consolidation phase (surveillance act! vi ties), until the rural health structure is fully organized. 1.,.2.2 East Malaysia (Sabah) '!be Government is g1 ving a high priority to this progrBllllle, whioh is proteoting 581 000 people living under malaria risk. Following a oomprehensive review of the results obtained with respect to the goal of eradioation, it has become apparent that the type of terrain and the laok of cOlllllUllication in the sparsely populated hinterland preclude the application of an eradication methodology. A new approach has, there- fore, been evolved, to protect the population through a less stringent antimalaria programme. '!be eradication methodology, however, is being applied in densely populated areas on the coast where more than three- ~-' WPR/RC20/3 page 9 quarters of the populatioh live and where a network of rural health servioes is developing. Certain improvements were made in the programme following the 1967 epidemic. Refresher courses were given to all field personnel and the number of supervisory personnel was inoreased with a view to raising the standard of performance. UNICEF's deoision to discontinue its assistance to this programme beyond 1970 has not affected the determination of the Government to continue its antimalaria efforts, as it is convinced of the health and socio-eoonomic benefits derived from this endeavour. The magnitude of the problem in the absence of this programme is evident, as despite the relentless efforts being made to control the disease, 11 517 malaria cases were reported in 1968 (i.e., an annual malaria parasite incidence of 20 per thousand population) • 1.3.2.3 East Malaysia (Sarawak) The eradication programme covers a population of 945 000 who live in the five administrative divisions of the country, but are mostly concentrated in Divisions 1 and 2. The programme is characterized by the fact that planning, supervision and evaluation are the responsibility of the national malaria eradication service, while the implementation of the various field operations is the responsibility of the five medical divisions of the general health services. This arrangement has resulted in excellent co-ordination of activities. The rural health services are progressively developing but it will take some time, and substantial financing, to implement this programme, especially in the sparsely populated, underdeveloped mountainous areas, which lack roads and effective means of communications. The antimalaria efforts have suc- ceeded in keeping the incidence of the disease at a low level (1718 cases detected during 1968). Although the discontinuation of UNICEF assistance beyond 1970 will throw a financial burden on the health budget, which is already strained, the Government is determined to maintain its antimalaria efforts, without which implementation of economic development schemes will be retarded indefinitely. WPR/RC20/3 page 10 1.3.2.4 West Malaysia The malaria eradication programme was planned to be cOlllpleted in stages over a period of eleven years in all the malarious Sfeas which are inhabited by 9 million people. The Government had expected some international financial assistance to help provide the inseoticides and vehioles. required. As this did not materialize, an eqUllvalent amount has been included in the Second Five-Year Development Plan starting in 1971. In the meantime, a malaria eradication law has been prOlllUlgated and the administrative machinery has been strengthened. It is considered that this programme will progress smoothly once the financial problem is solved. The 1968 activities included the establishment of a central malaria eradication diVision in the directorate of health services, the organi- zation of one malaria zone and its sectors in the first stage area, comprising Perlis and some districts in Kedah and Penang, as well as the training of various categories of malaria personnel. 'lbe first cycle of spraying started in August 1968. and covered a population of half a million. It was preceded by geographical reconnaissance and an intensive health education campaign. Blood sampling from indicator villages made prior to spraying showed an 11 % slide positivity rate (2535 positives in 22 321 slides taken). The active participation of the network of rural health units - which have a good coverage in the areas under operation - in malaria passive case detection and treatment promises well for the implementation of a satisfactory surveillance mechanism in the late attack phase. 1.3.2.5 Philippines The Government is according a high priority to the malaria eradica- tion programme, and has allocated in its FY 1969 budget an anlount of uS$2.58 million, which is supplemented by uS$1.28 million from the United States Agency for International Development (AID) for the pro- vision of commodities. • .. ' . • PHILIPPINES Fifteen years ago malaria forced the farmers out of this fertile plain. Settlers have been coming back regularly as a MALAYSIA Teams such as these go all over the malarious areas in Sabah to spray with DDT all the villages, hamlets, and scat- tered huts. The teams' equipment is provided in part by result of a systematic malaria eradication campaign by the national team assisted by WHO. UNICEF which, with the World Health Organization, aids the Malaysian Government in its programme to eradicate the disease. -WPR/RC20/3 page 11 n"e administrative maohinery responsible for the management of this programme in the 39 field malaria units distributed over many islands is becoming progressively stronger. Improvements have been noted in the field of logistios, an effeotive reporting system is being developed and training aotivities expanded. The monthly meetings held under the chairmanship of the Secretary of Health to review the progress of work and to take action·on the various operational problems encountered, have been of great help. The 1968 delimitation stUdies of the malarious areas showed that the number of population under malaria risk is about 9 million. Although the level of endemicity in most areas is low (below 2 % prevalenoe rate in 334 indioator villages and between 2 and 12 % in 336 others), certain local1 ties in Mindoro, northern Illzon, Palawan, and Sulu Archipelago are still highly malarious. These areas are located in remote areas in the folds of hills or in places where effective supervision cannot be maintained due to transport difficulties. Because of logistic problems experienoed early in 1968 and the delayed arrival of insecticides, the start of the first cycle of spray- ing in 1968 was delayed until April. The second cycle of spraying, which consequently started late in the year, was confined to highly malarious localities inhabited by an estimated population of one million. Analysis of the spraying data showed a missed-house rate of 15 %, mostly due to the occupants refusing to accept spraying. '!his fact led to the training and assignment of one assistant health educator to each unit, and the utilization of the services of some 23 United States Peace Corps Volunteers by the Department of Health. The epidemiological evaluation of this programme has been strengthened through the assignment of senior professional staff and senior laboratory technologists to the six area offices. A monthly reporting system has been developed to record the number of slides taken from each locality and the results obtained. Active case detection started in 1969 and is covering an estimated population of wPRjRC20/;; page 12 ~. ( four million. Pass1.ve case detection through medical establishments has progressively increased in all malarious areas. Some areas inhabited by an estimated 2.9 million population are being projected for entry into the consolidation phase in 1970. The WHO-assisted national malaria training centre in Tala was strengthened by the assignment of an additional number of professional and senior sub-professional staff of various disciplines. The decision of the Department of Health to attach the Tala malaria unit to this centre and to use it as a field training area is a very constructive one. The centre is also undertakiI".g the training of malaria sub- professional personnel and WHO fellows from other countries in the Region. During 1968, the participants in the various courses numbered sixty. 1·;;.3 Countries belOnging to the Australasian Malarious Zone 1.3.3.1 British Solomon Islands The Government has decided to implement a national malaria eradication programme, starting in 1970, which has the dual purpose of eradicating malaria and at the same time expanding and strengthening the basic health services. The WHO independent assessment team, which visited the Islands in 1968, stated that rapid development of the rural health services is more likely to be achieved through the impact of a malaria eradication programme. It stressed the mutual interdependence of these programmes and the urgency of developing both services simultaneously. The authorities, aware of the requisites of a time-exacting national eradication programme, have meticulously planned the marine logistic support needed to carry out operations in the various islands according to schedule. As 85 % of the population lives along the coast, the operations rely heavily on sea transportation. GeograPhical recon- naissance is progressing satisfactorily. The DIJr-spraying programme in the western group of islands and in Guadalcanal is now protecting about 54 700 inhabitants, about ",. ' -~ / , ~ WPR/RC20/3 • page 13 one-third of the estimated total population. The future spraying programme is planned to cover progressively over a period of five years the rest of the islands where malaria is hyperendemic. Refusal to accept spraying is minimal. The quality of performance could be improved by the training and assignment of senior supervisory staff. The decision of the authorities to involve the district officers in assuring the total coverage of all the villages by DDT-spraying should improve this aspect. Active case detection carried out by malaria canvassers in the western group of islands is progressing. During 1968, the number of microscopically confirmed cases in 36 004 slides collected in the sprayed areas was 3739 (i.e., 10.4 % slide positivity rate). Most of these cases were imported from the neighbouring malaria hyperendemic islands. The development of the rural health services is progreSSing, but the target of establishing 60 rural health units is behind schedule. So far 34 such units exist although the majority are still under-staffed. There are hospitals and dispensaries in most ,t:,f the islands supported by religious missions. Their contribution to the passive case detection mechanism shows the same co-operative approach as that of government district hospitals and rural health units. 1.3.3.2 Papua and New Guinea The Government is according a high priority to the malaria programme, which is now covering with DDl'-spraying 1.15 million of the total population of 2.5 million living under malaria risk. The Department of Health has allocated about 10 % of its budget to the antima1aria programme, which gives protection against the disease at a cost of A$1.10 per capita per year. This programme is regarded as a vital one in the context of overall socio-economic development in Papua and New Guinea, as the hyperendemic malaria Situation, which approaches holoendemicity in certain areas (where 58.8 % of the infants have malaria parasites), will preclude the WPR/RC20/3 page 14 smooth and economical implementation of the various developnerrt schemes. The training of the national malaria staff at the Kund1awa centre and the award of fellowships for attendance at the METC/Man;1la have been intensified in preparation for the expected extension of the pro- gramme. No active case detection mechanism exists, but progressive efforts are being made to promote the participation of the general health ser- vices in passive case detection. 1.3.3.8 New Hebrides No ant1malaria programme exists and protection against malaria is mainly based on drug administration. During 1968 some 6710 malaria cases were diagnosed clinically among a total population of 84 000, all of whom are living under malaria risk. A request for WHO assistance in conducting a malaria and filariasis survey is included in the 1970 regional budget. 1.3.3.4 Timor No special ant1malaria programme exists and the proteotion against malaria is based mainly on drug administrat1.on. The number of popula- tion living under malaria risk is 436 000 out of a total population of 583 000. 1.4 Inter-country activities 1.4.1 The International Malaria Eradication Training Centre in Manila (METe) The Centre is a joint project of WHO, the United States Public Health Service (US/PH~) and the Government of the Philippines. It offered seven courses during the period under review, which were attended by 147 participants - mostly senior professional personnel - from countries in the Western PacifiC, South-East Asia and Eastern Mediterranean Regions, as well as by the staff of WHO, the. US/PHS, - ~ b .. • WPR/RC20/3 page 15 the United States Peace Corps Volunteers. The organizationof.a special course to demonstrate to senior instructors how modern methods of teach- ing and the use of audio-visual aids could enhance the efficacy and speed of training in malaria eradication was particularly successful. The group educational activity arranged once a year for key public health personnel with a view to promoting their participation in the malaria eradication effort, was extended from two to over three weeks to include seminars on health planning, manpower studies and health economics. 1.4.2 Independent assessment teams One such team, consisting of a public health administrator and a malariologist, was recruited during 1968 to assess the programme in the British Solomon Islands. 1.4.3 Inter-regional team for the study of technical problems in malaria eradication This inter-regional team, consisting of an epidemiologist and an entomologist, was assigned to the Region early in 1968. It is carrying out studies and investigations on special problems, particular attention being given to the problem of ~. balabacensis. It is also assisting in the co-ordination of the various epidemiological studies connected with this problem being carried out in Cambodia, Laos, Malaysia, Thailand and the Republic of Viet-Nam. 2. COMMUNICABLE DISEASES 2.1 Epidemiological Surveillance and Quarantine Several countries are developing and strengthening their national epidemiological services, particular attention being given to communicable disease intelligence surveys. A WHO epidemiologist and a statistician are aSSisting the Government of Cambodia to establish an epidemiological and health statistical service which will be responsible for planning and guiding national disease control programmes. The local epidemio- logical patterns of prevailing causes of morbidity and mortality are vlPR/RC20/3 page 16 being studied as a basis for the formulation of such progranrnes. A similar project has started in the Republic of Korea. WHO microbiologists are working in China (Taiwan) and Gilbert and Ellice Islands where the laboratory diagnostic services required to conduct epidemiological surveys are being developed. The assistance given to the Republic of Viet-Nam in the promotion of port sanitation and quarantine practices has continued. Sport-term fellowships were awarded to health officials from Laos and the Republics of Korea and Viet-Nam to observe quarantine practices in China (Taiwan). Hong Kong, India, Japan and the Philippines. The importance of inter- national quarantine practices being considered a part of epidemiological surveillance is being stressed. 2.2 Smallpox Eradication No case of smallpox has been reported in the Region since 1966. However, active mass immunization and surveillance programmes are being continued in most countries. WHO has supported the programmes in Cambodia and Laos by providing freeze-dried vaccines. WHO will provide conSUltants and fellowships to the Republic of Korea, Philippines, and the Republic of Viet-Nam as soon as the UNICEF- donated vaccine prOduction units are installed. A WHO consultant will advise Malaysia on the planning and choice of the site and equipment for a smallpox production unit. During the period under review. China (Taiwan) donated 200 000 doses and the Philippines, 250 000 doses of freeze-dried smallpox vaccine to the WHO Smallpox Special Account. 2.3 Virus Diseases 2.3.1 Poliomyelitis There is evidence to show that the virus isolated from poliomyelitis cases belongs almost solely to type I and III. This will have to be taken· into consid~ration when selecting - . - . "- PHILIPPINES QUARANTINE Sorting out and dissecting the day's harvest at the Quarantine Service. CHINA (TAIWAN) TRACHOMA Education is one of the weapons used against trachoma. For many years to come, large scale treatment programmes will be necessary. To date, progress re- ports are satisfactory. L wPR/RC20/3 page 17 the type of vaccines to be given as a first dose, in view of possible interference in the take of the type II virus. The advantage of g1 ving repeated vaccine over a number of years has been demonstrated by the experience in Singapore. A WHO virologist continued to assist the Government of China in the strengthening of diagnostic services in the virus laboratory of the Communicable Disease Control Centre and in the laboratory studies carl'ied out in cormexion with the poliomyelitis campaign which has received material assistance from UNICEF~ 2.3.2 Influenza During July 1968, a major outbreak of influenza was reported in Hong Kong with an estimated 300 000 cases. Since then, reports received by WHO have shown that the spread was rapid. In mid-August, Singapore was attacked and by the end of the month, outbreaks began in China (Taiwan), Malaysia, the Republic of Viet-Nam and the Philippines. By February 1969, the disease had reached Japan and further east of the Philippines to the Pacific Islands, including Fiji. The strain of influenza virus designated as A2/Hong Kong/68 has been consistently isolated in all outbreaks except that in Fiji, where, in addition, strains of para-influenza 1 and 3 were also isolated. 2.3.3 Japanese encephalitis The endemicity of this disease in the Region is confined to China (Taiwan), Japan, the Republic of Korea and, to a lesser extent, the Ryukyu Islands. Although the situation in Japan seems to have improved as a result of active immunization programmes, it must not be forgotten that in the last two decades there has been an increase in incidence every three to four years. In China (Taiwan), 610 cases with 131 deaths were reported in 1968.1 A WHO adviser has assisted in the laboratory diagnosis of this disease and in the production of vaccine. 1 Information based on Government reports. WPIVRC20/3 page 18 In the Republic of Korea, there were 1226 cases and 396 deaths. 1 WHO is assistil"lg the Government in a field trial. Japanes~ encephalitis vaccine is beil"lg given to 100 000 first-grade schoolchildren in the highly endemic province of Cholla Pukdo and it is planned to vaccinate another group of about 50 000 children entering the schools in 1970. A WHO-sponsored Japanese encephalitis vector biology and control research unit has been established in Seoul, Republic of KOrea, with a sub-unit in Taipei, China (Taiwan). 2.3.4 Dengue-haemorrhagic fever Only a few countries have submitted reports to WHO on the incidence of dengue-haemorrhagic fever. The cases reported from the Philippines, however, indicate that they still cause an epidemic during the period July to September. A WHO consultant will assist the Government in the clinical and viral studies which will be carried out during this period in 1969. The epidemiology, laboratory and clinical diagnosis of the disease and the vector and its control will be fully discussed in the regional seminar on mosquito-borne virus diseases which will be held in Manila in October. 2.3.5 Trachoma In China (Taiwan). the annual school mass trachoma treatment campaign successfully concluded its seventh year. The results showed that active trachoma had consistently decreased. The per¢entage of active trachoma among some two million pupils examined annually was as follows: 1 1962/63 1963/64 1964/65 1965/66 15.6 % 14.4 % 12.4 % 9.4 % 1966/67 1967/68 1968/69 Information based on Government reports. 8.8 % 7.4 % 4.8 % .' WPR/RC20!3 page 19 WHO consultants assisted the Government to formulate a future policy. '!he Institute of Medical and Veterinary Science, Australia, and WHO are assisting the Government of Western Samoa in a survey, including immunofluorescence studies of the conjunctival smears, which is being_ carried out among first-grade schoolchildren in Western Samoa. 2.4 Parasitic Diseases 2.4.1 Schistosomiasis The control of this disease in Japan continued to be effective. In the Philippines, a large-scale control programme is being planned in view of the number of new cases recently reported. A WHO team, conSisting of a paraSitologist and a malacologist, continued to survey the areas along the Mekong Hi ver covering Vientiane, Pakse and Khong in Laos, and Stung Trang, Kratie, Kompong Cbam and Bassac in Cambodia. Dogs in these areas \'(ere found to harbour the adult parasite. Prel1minary findings showed the presence of the disease along the sectors between Khong and Kratie. There was no evidence of infection in Vientiane and Kompong Cham. The only three cases found in Pakse were in emigrants from Khong and the only case found in Bassac was in an emigrant from Battambang near Tonle Sap (the great lake), an area not yet surveyed. A more intensive survey on the extent and geographical distribution of this disease is necessary. The search for the intennediate host is being continued. 2.4.2 Filariasis In Western Samoa, the assessment of the first round of mass drug administration with diethylcarbamazine was completed and the index for dosage coverage determined. Although the majority of the population took at least 12 doses, only 21 % of them took the full 18. Results obtained to date indicate that the objectives of the pilot project have not yet been achieved because of natural and technical difficulties, for example the hurricane which took place in 1967 and changes in personnel. WPR/RC20/3 page 20 It is planned to undertake a second round of mass drug administration and UNICEF has agreed to continue to provide the drugs required. A consultant was assigned to West Malaysia to assist in compiling and analyzing data on filariasis, particularly as regards the progress of survey and control work, and in asseSSing the programme. It appears that the 1nitial mass treatment of the population has reduced filariasis infection with Brugia malayi to a low level, As this has been supple- mented by adequate follow-up surveys, with treatment of those found infected, the reduction in microfilarial rate has persisted for almost ten years. Tlielve participants from ten countries and territories in the South Pacific area and four observers attended the seminar on filariasis which was held in Western Samoa in August 1968.under the joint auspices of the South Pacific Commission and the Organization. The situation as regards filariasis and its control in the South Pacific, with special reference to the project in Western Samoa, was reviewed. Emphasis was laid on the 1mportance of ensuring that an adequate dose of diethylcarbamazine was taken in mass drug campaigns and it was suggested that the total amotmt given should not be less than 72 mgjkg body weight.. The seminar recommended that ;1.fa significant number of positive cases - either recurrences, new infections, or newly- imported cases - are observed in follow-up surveys after a complete round of treatment, repeated mass treatment should be considered. 2.5 Venereal Diseases and Treponematoses 2.5.1 Endemic Treponematoses Reports of yaws from countries in the Region indicate that its incidence has remained low even in the originally endemic areas. In 1968, only 118 cases were fotmd in 559 339 persons examined in West Malaysia. l A WHO consultant assessed the programme in Cambodia to which UNICEF is giving drugs and supplies. 1 Information extracted from the monthly reports rece;1.ved from the Government. '. j. · --- ., FILARIASIS WESTERN SAMOA In co-operation with the Government of Western Samoa, WHO and UNICEF are taking part in a pilot project for the TUBERCULOSIS-HONG KONG Part of anti-tuberculosis campaign. control of filariasis, a disease caused by tiny worms blocking the lymph vessels. Children wait for the skin test. Il _ 2.5.2 Venereal infections WPR!RC20/3 page 21 The second regional seminar on venereal disease control was held in December 1968. '!here were 19 partiCipants from 15 countries in the Region. During the seminar, it was revealed that the frequency of syphilis has increased in some oountries, has remained stationary in others, and shows a downward trend in some. Gonorrhoea has shown a oonsiderable increase throughout the Region and in some countries it has almost reached epidemic proportions in certain segments of the population. ChancrOid, lymphogranuloma venereum and granuloma inguinale appear to be of limited importanoe while non-gonococcal urethritis is being encountered more frequently in some areas. A WHO team, consisting of a venereologist and a public health nurse, is assisting the Republic of Viet-Nam to develop a national venereal disease control programme and to train staff. WHO consultants will visit China (Taiwan) and Singapore later this year. 2.6 Tuberculosis Fifteen countries and territories in the Region have received assistance from WHO in their tuberculosis control efforts. Partioular attention has been given to BCG vaccination, case-finding and treat- ment. The underlying concept in all these programmes is the establish- ment of country-wide and permanent services and their integration into the general health services. Experience has shown that the tuberculosiS problem in a country cannot be solved by services restricted to urban areas or to a few selected, so-called high-risk, population groups. Longitudinal surveys have demonstrated clearly that the problem lies mainly in the group of people who are already infected with virulent tubercle bacilli. Any short-lived campaign, no matter how intensive it is, cannot change this fact owing to the inherent l1m1 tations of existing technical and opera- tional control measures. wPR/RC20/3 page 22 Recent sociological and epidemiological studies have shown that the majority of infectious cases of pulmonary tuberculosis develop symptoms and, when the disease is confinned, are much more co-operative in following the prescribed treatment. It is, therefore, important that control measures are directed to these symptomatic cases first before any active case-finding is introduced in a community. In most of the developing countries in this region, especially those in the northern sector, the problem is roughly five times greater than that in the economically advanced countries, yet the amount they can afford to spend is only one,..hundredth of that spent by the affluent countries. If they try to repeat the traditional, practices adopted by the developed countries, it will take many years before a tuberculosis control programme on a national scale can be organized. The failure of many tuberculosis demonstration centres, BeG campaigns, mass miniature radiophotography services, tuberculosis hospitals, and rehabilitation centres, illustrates this point. The main reason for this situation is that the requirements for such activities on a nation- wide scale are out of proportion to available resources. There is, therefore, no prospect of expanding and maintaining these activities. These experiences have led WHO to promote tuberculosis programmes in which simple and economical methods can be applied to a large segment of the total population, within a short period of time, through the active involvement of auxiliaries working at the peripheral level. Standardized techniques for vaccination, case-finding and chemotherapy, which can be applied in any community and safely entrusted to auxiliary workers after a short period of training, are now available. This approach is perhaps the real breakthrough 1n tuberculosis oontrol for the developing countries, one that is much more important than the discovery of a wonder drug to heal the disease. This approach is now well accepted and is being used in most of the countries and territories in this region. BeG vaccination is still considered the most effective tool to achieve a reduction in the tuberculosis problem in developing countries ,... ' from the cost/benefit point of view. WP.R/RC20/3 page 23 Its effectiveness is in direct proportion to the type of vaccine applied. the percentage of the susceptible population in the oonmunity, and the coverage of the pro- gramme. As nowadays the vaccine used in many countries comes from the same source, or is locally produced from a seed lot periodically supplied from the WHO International Reference Centre, and the preva- lence of infection in a community cannot be changed wi thin a short time, the main factor affecting the success of a BeG vaccination programme is its coverage. WHO recommends that in areas where BCG vaccination is indicated. there are no economic or operational justi- fications for not keeping at least 75 % of the eligible population protected. A number of island territories in the South PaCific, such as the British Solomon Islands. Fiji. New Hebrides and Western Samoa, have achieVed this goal. In larger countries, if emphasis is placed on specific age-groups, such as newborn babies. infants under one year or school-entrants, an effective and persistent coverage of these groups for many years will also make a significant impact. 'Ibis has been done for a number of years in Hong Kong and Singapore. In China (Taiwan) over 80 % of infants aged three to nine months have been vaccinated simultaneously with smallpox and BCG. In many other countries, the number of BCG vaccinations performed during 1968 has shown a Significant increase as a result of the introduction of direct BeG vaccination in the younger age group. Por example, in 1968 a total of 2 935 933 children were vaccinated in the Republic of Korea (2 163 151 in 1967); 108 690 in Malaysia (Sarawak) (29 138 in 1967); and 885 638 in the Philippines (526 396 in 1967). In Cambodia, 261 239 children were vaccinated during the five-month period beginning 1 October 1968, while the total number vaccinated in the three-year period starting July 1965 was only 308 185. Trials were made in the Republics of Korea and Viet-Nam with jet injection equipment with the aim of introducing a simpler and speedier method of BCG vaccination which could be applied by auxiliary workers after a brief period of training. The trials showed that the instrument WPR/RC20/3 page 24 still required certain improvements in order to provide a more even depth of injection and a more consistent quantity of vaccine. Once these defects are overcome, the new equipment will proQably replace the intradermal method of injection. The trials on chemotherapeutic regimens that provide maximum benefits for the minimum expenditure in personnel, time and money, have been continued in many projects. It appears that an initial period of daily chemotherapy with two or three first-line drugs, including isoniazid and streptomycin, for as short a period as twb or three weeks, followed by the use of streptomycin and isoniazid under direct supervision twice weekly, is a very practical, economical yet effective and acceptable regimen for mass use in many countries. This has been recommended for wider use in all WHO/UNICEF-assisted tuberculosis projects in the Region. In areas without injection facilities the alternative regimen would be daily isoniazid with thiacetazone as the companion drug. This is as effective as any other dual~drug regimen and costs only one-tenth of the combination of isoniazid and PAS. Thiacetazone has a relatively narrow safety margin but toxicity, when this occurs, usually appears during the first two months of administra- tion. It is therefore advisable to see the patients once a week to watch for toxic reactions during the first two months of treatment. Tablets can be issued once every month for a period of twelve months to those who have not shown any untoward reaction. The number of tuberculosis patients under chemotherapy at the end of 1968 has shown an increase in almost every project receiving WHO/UNICEF assistance. In January 1969 a tuberculosis treatment survey was initiated in Singapore aiming at the assessment of the prevalence of initial drug resistance and the evaluation of the results of twelve months of treatment. Operational studies on the integration of tuberculosis control activities into the general health service has been continued in a number of countries. These have shovln that microscopic examination I WPR/RC20/3 page 25 of sputum from persons with prolonged cough can unearth a high propor- tion of positive results, and that auxil1ary personnel attached to the peripheral health un1 ts can reasonably be expected to undertake such a job in addition to their routine activities. Experience gained in the past decade has also demonstrated clearly that defaults among patients receiving domiciliary treatment are considerably less than among those with X-ray evidence of the disease. Sputum examination as the primary tool for tuberculosis case-finding is now adopted by every WHO/tJNICEF- assisted project in the Region. In the Republic of Korea, a total of 23 781 infectious cases of tuberculosis were discovered during 1968 through the examination of m 743 sputum specimens. Every one of the 191 health centres in the country participated. In China (Taiwan) 8604 cases were found through the examination of 142 125 specimens at 365 health stations. In Cambodia, the same technique has been started in ten provincial hospitals and six health centres. Regional training activities have continued to expand during the year. '!he third. regional tuberculosis course jointly sponsored by the Japanese Government and WHO took place in Tokyo during the period 6 May to 5 September 1968. The possibility of setting up a demonstra- tion area near Tokyo which would provide field practice for partici- pants attending the course is under discussion. A joint refresher course on tuberculosis and leprosy organized by the South Pacific Com- mission and WHO was held in Noumea, New caledOnia, from 17 March to 12 April 1969. Three senior medical officers from Laos, the Philippines and Singapore attended the inter-regional tuberculosis training course in Europe. 2.7 ~prosy In China (Taiwan), a WHO adviser is assisting to broaden the rehabilitation programme for the prevention and oorrection of WPR/RC20/3 page 26 disabilities into a case-finding, contact tracing and domiciliary treatment programme. In the Republic of Korea, the activities of the national leprosy mobile teams have been decentralized from national to provincial level. Administrative difficulties have been experienced as a result of this decentralization, but steps are being taken to correct this situation. It is hoped that with the continuation of advisory assistance from WHO and material assistance from voluntary agencies such as the Order of Malta, Deutsches Aussaetzigen Hilfswerk Wuerzburg (DAHW), the Korean Leprosy Association and UNICEF, the programme will be able to continue as planned. 2.8 Bacterial Diseases 2.8.1 Cholera Cholera El Tor continued to be endemiC in the Philippines and the Republic of Viet-Nam. Small outbreaks in Cambodia and West Malaysia and a few cases from Singapore were also reported. Cholera vaccines were supplied to Cambodia and Malaysia under the WHO Special Account. These countries were able to control the spread of the diSease through the imposition of sanitary measures and vaccination programme. WHO continued to participate in the bacteriological, epidemio- logical and clinical studies being carried out in the Philippines. Treatment of 366 household contacts with oral tetracycline· - 250 mg three times a day for three days for adults and 150 mg three times a day for three days for children - showed a significant reduction in the number of vibrio excretors among them four days after initial medication. Those who did not receive chemoprophylaxis continued to excrete vibrios even longer than ten days. Trials on a larger scale are planned. ... ' '. KOREA Happy reunion: A cured leper meets her daughter. -~ '- -. 2.8.2 Plague WPR/RC20/3 page Z7 Plague has been reported solely from the Republic of Viet-Nam. In 1968, a total of 3786 cases (554 confirmed) were reported from twenty-seven provinces with an estimated population of over ten million. In 1967, 5616 cases were reported from 25 provinces. The nwnber of deaths reported fell from 282 in 1967 to 206 in 1968.1 A WHO adviser continued to assist the Government in deratting and flea control in the ports of Saigon and Danang. A national plague control programme started late in 1968. 3. HEALTH PROTEC'l'ION AND PROMCYl'ION 3.1 Cancer Cancer is asswning increasing importance among the causes of death in practically all countries in the Region. Although there have to date been few requests for WHO assistance in this field, the interest of health authorities in undertaking progranmes, particularly in con- nexion with the early detection and registration of twnours, is growing. Two consultants, an epidemiologist and an oncologist, were provided to the pilot project on camnmity canoer control in the PhilippineS in aocordance with the established plans for this activity. One of them paid two brief visits to China (Taiwan), where a canoer registry and possibly a cancer centre are to be established in Taipei. Consultant services in connexion with a feasibility study on the establishment of a cancer registry have been requested by Malaysia. 3.2 Cardiovascular Diseases A seminar on the prevention and oontrol of cardiovascular diseases due to infections, particularly rheumatio heart disease, was held in Manila in November. '!he regional situation l·lith regard to some non- infectious diseases of the heart and the resources in the Region for 1 Information provided by the Department of Communicable Disease Control, Ministry of Public Health. WPR/RC20/3 page 28 ... the prevention of these conditions were reviewed. Preventive measures appropriate to conditions in the Region were suggested. The report on the proceedings was issued in February. 3.3 Dental Health The regional dental health programme is developing smoothly, from both the country and inter-country points of view. Consultant services were provided early in 1969 to the'~chool dental health programme in China (Taiwan) and to the Republic of Viet-Nam. A consultant has recently started a six-month assignment in the Philippines. Another will be assigned to the South Pacific area to meet the needs of the British Solomon Islands Protectorate, Fiji. Gilbert and Ellice Islands, Tonga and Western Samoa. A request for assistance in water fluorida- tion has been received from French Polynesia. Country programmes are being developed wi thin the general scope of the regional programme so that each contributes to this more comprehensive aspect of· dental health. Most of the countries participating in the inter-oountry training courses on the epidemiology of dental disease have completed the col- lection of data on their own surveys. The report on the survey in Fiji was issued early in 1969. Out of the few countries w~oh have not yet submitted a report, Singapore will most probably do so within 1969. The oonsultant who will be assigned to the South !,acific terri- tories will also spend adequate time in the Regional Offic~ to analyse the data submitted and consolidate them into individual reports. Another consultant will follow up this activity through visits to the northern part of the Region later in the year. Once the various survey reports are available, it will be possible to draw an interesting pioture of the epidemiology of dental disease in the Region. This should assist health administrations to make plans for further action and will provide the Regional Office with an idea of what assistance might be required in the future. - ( • 3.4 Mental Health Wl'R/RC20/.3 page 29 Assistance to the mental health project in China (Taiwan) was completed at the end of 1968. This successful activity has led to the strengthening of the Department of Neurology and Psychiatry of the National Taiwan University, which is now a very efficient teaching and ... research institution, and which has recently taken finn leadership in the plans to extend mental health services to the whole of Taiwan. Long-tenn advisory services continue to be provided to the Philippines. The tenns of reference of the WHO adviser are being studied with a view to adapting them to fit the changing needs of the programme. 3.5 Nutrition Applied nutrition activities and programmes are now under way in several countries - Cambodia, Malaysia, Philippines, Republic of Korea and the South Pacific. These programmes involve the Ministries of Health, Education, Agriculture and ColllllUIl1ty Develo}Dent. Following a definition of the nutritional problems in a pilot area, \'l8.YS of improving the situation are developed. These include nutrition educa- tion, supplementary feeding for vulnerable groups, the production of protective foods, and nutrition training for the personnel involved. The Philippine programme is the longest established. In the latter part of 1968, following recommendations made by FAO, WHO and UNICEF, a comprehensive evaluation of the impact of the programme and of its various phases of activ1 ty was undertaken by government agencies. The programme is being expanded through all the government teacher training colleges. A national training centre on applied nutrition is functioning actively at Bayambang. A number of courses have been held for personnel involved in the implementation of field activities in various parts of the country - fourteen provinces are now involved. This programme is regarded by the UNICEF country office as its most effectively-used assistance in the country. WPR/RC20/3 page 30 In Cambodia and Malaysia, applied nutrition projects lare in an earlier stage. In Cambodia, baseline surveys on health aspects were completed in the first pilot area and two mobile multi-disciplinary teams have been trained for field activities. The Ministry of Health has given good support to this project and activities are now being expanded to a second area. Nutrition education activities have begun and are to be intensified in the coming year. The WHO team consists of a medical nutritionist and a nutrition biochemist. The services of the latter are also being used to study and strengthen the health laboratory services of the whole country. In Malaysia, after extensive preliminary planning, survey forms have been pre-tested for use in the comprehensive surveys which are planned for the latter part of 1969. Nutrition training is being developed in the South Pacific through the activities of an inter-country team based at the Fiji School of Medicine. The team comprises a medical nutritionist and a public health nutritionist. During the period under review, the nutrition component was strengthened within the framework land curri- culum of existing courses for nurses, medical students and medical practitioners. Some surveys have been undertaken in Fiji within this context and are helping to define more accurately some of the nutri- tional problems, such as protein-calorie malnutrition and growth retardation, nutritional anaemias and endemic goitre. Va~ious special studies in such fields as maternal and child health, nutrition and infection are being undertaken in colloboration with the Fiji School of Medicine. Preliminary visits were made to the Britis.1-J. Solomon Islands Protectorate, New Caledonia, Papua and New Guinea, Tonga and Western Samoa. Plans were prepared for the development of courses on applied nutrition for health and other personnel in all of these territories, with activities in 1969 being concentrated on Papua and New Guinea, Tonga and Western Samoa. These courses are within the existing framework of activities of training institutions in these countries. At the same time, plans are being made and training will , , . - wPR/RC20/3 page 31 be conducted, to enable school and/or pre-school feeding activities to be established or strengthened, where appropriate. The activities of this project are thus being decentralized and nutrition training is being developed within each country suitable to its own needs and condi- tions, and within institutions where counterpart personnel can continue the activities and training. There seems to be & more general awareness of the need for nutrition activities both within the maternal and ohild health and basic health services framework, and as an inter-disciplinary and inter-agency concern. Some countries have well-developed nutrition programmes such as China (Taiwan) and Japan. WHO staff have also been assigned to French Polynesia, Laos and Singapore. All the projects have been planned jOintly with FAO but the arrival of FAO staff has in all cases been delayed because of the insufficient priority given to the project by the government or the United Nations Development Programme (UNDP). This has hampered balanced project development. Efforts are being made to integrate nutrition into national health plans and into overall socio-economic develOpllent plans. Some developments of interest have been in the following special areas: (a) (b) (c) Malnutrition wards have been established in the Philippines, with UNICEF aSSistance, and serve to focus attention and action on the actual nutrition problems. Consultants to strengthen nutrition teaChing for medical personnel have been requested by some countries. Nutritional anaemias are to be studied wi thin the global framework of a collaborative prograrmne of WHO and the United states Public Health Service. (d) Endemic goitre affects considerable areas in nearly all countries in the Region. It is associated with a raised wPR/RC20/3 page 32 prevalence of endemic cretinism (deaf-mutism, d~arfism, mental defects and/or other abnormalities) and some countries have requested consultants 1n this field. The Philippine goitre control project was launched in two pilot areas during the period under review. General efforts to strengthen nutrition work in the Region include the publication of a monograph on nutrition in maternal and child health in the September 1968 issue of the Journal of Tropical Paediatrics. In addition, a more comprehensive manual on the "Health Aspe9ts of Food and Nutritionlf for use in the developing countries of the :Region, has been printed and is to be distributed in the latter part 9f 1969. 3.6 Radiation Health Regional activities in this area have been carried out under an inter-regional project. The WHO medical officer assigned to this project has been stationed at the Regional Office since December 1968. His services are shared with the South-East Asia Regional Office. Several countries have been visited with the purpose of gathering I information on radiation health programmes - in particular those directed to radiation protection - on training activities, legislation and administrative structures. Advisory services were provided to Fiji on the feasibility of establishing a radiotherapy departm~nt. In the other countries visited, advice was given on specific technical aspects and the administrative structure of a radiation protection service. Assistance is also being given to the Department of Health in the Philippines, where a radiation protection unit is being set up. Although it may be too early to draw any general con¢lusion from the visits completed so far, it appears that ,radiation health consti- tutes an important problem in most countries because of the growing (and little controlled) use of diagnostic and, to a lesser extent, therapeutic equipment. The industrial use of X-rays and !isotopes is also increasing and this problem requires more attention from the health authorities. "'"--- , , WPR/RC20/3 page 33 '!he inter-country adviser on training in the maintenance of X-ray equipnent has spent some time in the Philippines and is now working in Malaysia. Prior to reporting for duty, he visited the United states of America and Japan to familiarize himself with the most recent develop- ments in testing and technical equipment. 3.7 Occupational Health A number of countries in the Region are becoming rapidly industrialized and are being faced rather abruptly with the health problems that such a process entails. As national and technical experience requires a reasonably long time to develop, requests for international assistance in the field of occupational health have increased recently and more can be reasonably expected. '!he industrial health project in China (Taiwan) benefitted from the visit of a WHO consultant late in 1968 and another, in industrial hygiene, will be provided later in 1969. ILO is planning to join WHO's efforts by covering the field of safety. In the Philippines, a government request has been submitted to the UNDP for funding of a joint lLO/WHO project in occupational health. The progranme, which is to start later in 1969, is one of wide scope and involves the Health Department, Labour Department and Institute of Hygiene, UniverSity of the Philippines. WHO's participation consists of an industrial hygienist and fellowships in related fields. In April, Malaysia submitted a request for a consultant on industrial hygiene to advise the occupational health unit recently established at the Labour Department wi th the participation of the Ministry of Health. The Republic of Korea is planning to request Special FUnd assistance for the establishment of an institute of occupational health, with joint ILO/WHO participation. WI'lVRC20!3 page 34 4. PUBLIC HEALTH SERVICES 4.1 National Health Planning As an initial step in promoting systematic health pl~ng in the Region, WHO, with the assistance of the Institute of Hygiene, University of the Philippines, has made plans to organize an annual series of COurses in national health planning. The first of these wa$ held in September and October 1968 for senior WHO staff. Startu1g in 1969. three-month courses will be offered to senior national staff from countries and territories within the Region. Three phases are envisaged ! for this programne. The first (1968-70) will be under the auspices of WHO with assistance from the University; the second (1971-70) will be under the auspices of the University with technical and material assistance from the Organization; and the third (1977- ) ",1.11 be a continuation of the programme after international assistance has tenninated. Training is designed to prepare senior health staff to undertake systematic health planning and to organize orientation/training courses at the country level for national health personnel involved in the health planning process. The course consists of a review of the basic disciplines essential to overall national planning (economics, demo- graphy and statistics, public administration, operational research); general planning (physical, social, economic development); and health planning (theoretical and practical, including health manpower planning and a review of contempora~J methodologies). During the 1968 course, a consultant from the Pan American Health Organization gave. lectures on health planning methodology, and one from the Asian Institute for Economic Development and Planning conducted the lecture-discussions on social planning. The University of the Philippines provided lecturers in the basic disciplines, economic development planning and physical planning. '. I -. . WPR/RC20/3 page 35 It will be recalled that participants in the technical discussions on "Health Planning as an Administrative Tool" haldin connex1on with the nineteenth session of the Regional Committee, suggested that WHO should provide advisory or consultant services, if requested, to countries and territories in the Region undertaking health planning, assist in the training of personnel and, through research, in developing or adapting suitable planning procedures which could be used by the developing countries in the Region. In 1968, a WHO consultant had exploratory discussions with the Ministry of Health in Cambodia on the formulation of general public health administration measures which would facilitate systematic health planning in tha future. The Ministry intends to establish a co-ordination com- mittee for this purpose. In recent months, a team consisting of national health personnel and WHO staff assigned to Cambodia has been surveying and assessing the health services and manpower resources. The informa- tion that is rapidly accumulating from this effort should be very useful to the co-ordination committee. In the latter part of 1968 and in early 1969, a consultant assisted the Ministry of Health in the Republic of Korea to assess its health manpower resources. Later in 1969, a long-term adviser will be assigned to work with the National Health Planning Unit on the preparation of the material required in connexion with the drafting of health planning proposals for incorporation in the Third Five-Year Economic Plan. UNICEF has given material assistance to the Unit. The Government of the Republic of Viet-Nam, following a preliminary survey undertaken under bilateral arrangement, is ready to start overall national planning this year. The Ten-Year Plan being made is intended to cover the present emergency and the reconstruction phase which will follow. A national health planning unit has already been established. The Ministry has overall responsibility for both health and social affairs and this should result in better co-ordination in planning in these two areas. A WHO consultant will be appointed to assist the WPR/RC20/3 page 36 national health planning unit:in the initial phases of organization and the assessment of problems. The inter-country advisory services project will start in July when the adviser reports to Manila. This project will enable consultant services to be provided to countries and territories at relatively short notice, While long-term assistance will continue to be provided under the country programmes. Although health practice research is not part of the health plan- ning exercise, E~' the work being done in pilot and delllonstration areas to find out how the effectiveness of the delivery of !health services can be improved and the cost of such services min;lm1zed, repre- sents a useful adjunct to health planning. This activity is important not only as a means of testing the efficacy of administratIve procedures but as one for developing norms and standards. WHO is assisting in the , development of three pilot demonstration areas of this kind in Malaysia. Republic of Korea and Western Samoa, and plans are being made to establish another in the Philippines, where health planning techniques will be developed and tested. It will also serve as a field practice area for the international courses on national health planning. 4.2 Community Health Services The creation or strengthening of basic health services is still a priority goal in the Region. In many developing countriE/s the best means of providing medical facilities for the population and of ensuring maximum coverage is to meet the most urgent health needs. The principle is to make a start wherever feasible under existing conditions, gradually adding facilities, increasing coverage, strengthening supervision and building up logistic support. The essential basic health services are medical care. the prevention and control of diseases, maternal and child health, environmental health, public health nursing, health education and the collection and recording of health stati$tics. Assistance in planning and implementing projects for the develop- ment of basic health services was provided during the period under • , --, "1; ~ WPR/RC20/3 page 37 review to six countries. A major need in most of these countries is the establishment of a more flexible staffing pattern adapted to local resources and requirements. It is, therefore, essential to know more about the health demands of the population and the use that is being made of existing health services. Once this information is obtained, - it will be easier to determine the steps required to achieve objectives. In order to assist governments in building up comprehensive health services, WHO is emphasizing the follcwing approach: (a) The adoption of master plans of operation for general health services develOpment into which all WHO-assisted projects in the country are articulated and their activities co-ordinated Plans of operation of this type have been negotiated with the British Solomon Islands Protectorate, Laos, New Hebrides and western Samoa. Their immediate objectives are to develop amd strengthen the national health administration and services at all levels; to plan and execute programmes for health staff developnent; to conduct surveys and assessments of health cond.1 tions and programnes; and to undertake health practice research as a basis for the further development of the health services. (b) The undertaking of health practice research, primarily in pilot areas In the Republic of Korea, for example, this is aimed at the development and promotion of antimalaria aotivities as an integral activity of the local health services. In Malaysia, the relationships between health demands and the services provided are being examined quantitatively and in depth. The results of this study should provide a guideline for the establishment of a suitable organization and staff- ing pattern which should result in the more effeotive delivery of health services oompatible with population demands. (c) The need for closer operational relationships between health centres and hospitals with a view to developing a two-way referral system Further stUdies will be carried out in pilot areas to determine WPR/RC20/3 page 38 whether the methods used elsewhere have resulted in better coverage at a lower cost. (d) Zonal co-operation In the Lower Mekong River area. zonal co-operation is being promoted by a WHO public health administrator with a view ~o under- taking a concerted attack on common health problems which do not recognize national boundaries. The pooling of limited national resources against, for example, malaria and schistosomiasis, should result in their more effective use. (e) Evaluation Increasing attention is being given to the provision of a built-in evaluation framework in the plans of work of projects. ~s will permit annual evaluation exercises to be undertaken and on the basis of the information thus obtained programmes can be more rationally formulated. It is too early to report on the progress being made in countries where this new approach to the development of community health services is being undertaken. It is believed, however, that by next year the studies now going on will provide the ministries of healthi concerned with a more realistic basis for planning their future programmes and determining their health manpower needs. 4.3 Organization of Medical Care The increasing number of people who understand the benefits of medical care and advances in medicine are contributing to an increased demand for health care which many governments cannot satisfy. WHO has tried to assist governments to deal with this problem by show- ing how available facilities can be used to achieve a better coverage of the population. The hospital is an essential component of the general health services, which are intended to provide facilities for the personal health care of the population at a level and cost compatiQle with the resources available. Hospitals are expensive to build and ... - -.. r REHABILITATION - JAPAN The speech therapist is rewarded by a child's smile in the Crippled Children's Hospital of Japan. Assistance is pro- vided by UNICEF and WHO. Registration at the Handicapped Children's Center. '. WPR!RC20/3 page 39 operate. '!he initial outlay is high while the annual running costs, besides being considerable, continue to rise each year. To Justify this high cost, hospitals should be able to increase their patient in-take but in view of the acute shortage of hospital beds in many countries this would mean a high rate of turnover. This step would only be warranted if there were other services available to handle ambulatory cases and to provide domiciliary care to recently discharged patients. Domiciliary care services can, however, be provided by the peripheral health units (health centres) if their staff are oriented to take over this responsibility. The services these units provide can also contri- bute materially to the prevention of diseases, particularly the com- municable diseases which, at present, are the major causes of hospital admissions. Regionalization of the hospital system is, therefore, recommended so that relatively minor cases which can be handled by less speoialized physioians can be accommodated in small outlying hospitals. Cases needing special care can be referred to or received at the larger hospitals which serve a region and where more sophisticated facilities are obtainable. 'Ihis would require the establishment of referral links between hospitals and health centres. '!he comp:rehensive approach to community health envisaged under the master plans of operation already accepted by some governments affords the means for emphasizing the importance of the integration of preventive and curative services and endeavours to show how the regionalization of medical care services can be accomplished. In some countries, the health authorities are considering the possibility of broadening ,social security benefits by establishing health insurance schemes with the patients themselves sharing the medical care cost. In the Republic of Korea, for example, steps are being taken Jointly by ILO and WHO to develop a health insurance scheme within the Government's expanded social security system. Hospital management is another aspect of medical care which governments are trying to improve. Consultants have been assigned to China (Taiwan) and Laos for this purpose. wPR/RC20/3 page 40 Advisory services in medical rehabilitation are being provided to China (Taiwan) I Japan and Laos, where assistance is being given in the particular fields of physical and occupational therapy. 4.4 Health Laboratory Services Eight countries and territories received assistance in the plan- ning and establishment of public health laboratory services and in the training of various categories of laboratory personnel. A WHO technical officer was assigned to Cambodia in September 1968 to assist in the training of laboratory technicians at the Institute of Biology. A WHO adviser is assisting the Gilbert and Ellice Islands to strengthen its laboratory services. In Laos, assistance is being given in the further development of public health laboratory services in accordance with the five-year plan for the organization and development of a national laboratory service. A laboratory technician, whose main duty is the training of laboratory workers, was added to the project in November 1968. The development of a public health laboratory service in Western Samoa is progressing smoothly with the assistance of a WHO adviser. Laboratory space has been expanded to approximately double the previous area. The laboratory, which was formerly a unit of the Apia General Hospital, has been reorganized and strengthened and now serves as the National Health Laboratory. Plans are now being made to establish regional laboratory services. WHO consultants advised the Governments of the Philippines and the Republic of Viet-Nam on the management and administration of their health laboratory services and a consultant visited China (Taiwan), the Philippines and the Republic of Korea to review the DPT vaccine pro- duction laboratories. With the arrival of the regional adviser on health laboratory services, the Regional Office will be better able to meet 'requests from governments for advice in this field. REHABILITA TlON LAOS _ J In co-operation with the United Na- tions development Programme, WHO is helping to plan and operate rehabilita- tion facilities and to train staff. A phy- siotherapist helps exercising a little girl's leg crippled by polio. ,", VIENTIANE Amputees carry out physical exercises before fitting of their artificial legs. 4.5 Nursing WPR/RC20/3 page 41 As nursing activities are influenoed by many faotors - the level of nursing development wi thin a country, existing patterns of services, cultural and economic factors, resources and needs - the emphasis given to the nursing programme has differed in the various countries of the Region. The main objectives of the regional programme have been to assist governments in the improvement or development of nursing services and of educational and training programmes to prepare personnel to provide these services. 4.5.1 Development or improvement in nursing services Public health has often been the area in which technical assistance in nursing is first requested, as many developing countries have selected as a primary goal the establishment of a network of health oentres as a way to achieve better health care for their people. In programmes directed to this end, technical assistance in nursing has been provided as part of an integrated programme of health assistance within a country calling for the joint efforts of doctors, nurses, sanitary engineers, health educators, etc. The need for assistance in the development of safe hospital nursing services has been brought to the attention of the WHO nurses when they are confronted with the hospital situation in which nursing students receive their nursing practice. With the continuing efforts being made to improve nursing education, the need for attention to hospital nursing services has been increaSingly recognized. Assistance in these two areas of service - public health and hospital nursing - has generally been combined with the development or improvement of education and training programmes for nursing and midwifery staff. WPR/RC20/3 page 42 4.5.2 Developnent or improvement of nursing education (a) Basic nursing education The goal has been to recruit candidates who have a broad general educational baokground upon which to build a professional nursing education programme. Candidates with this qualification are difficult to find in oountries where educational opportunities, espeoially for women, are limited. WHO efforts have been direoted toward establishing a level which will not rule out too many applicants and yet will provide a sound educational basis upon which a nursing programne may be built. (b) Auxiliary nursing schools In almost every country of the Region, there is some type of auxiliary health worker. The pattern of auxiliary nursing is variable as it is dependent on the practice already existing in the country and is based on its particular needs. Assistance has been givl3n to the development of suitable educational programmes for these groups and in the prepration of nursing teaching staff. A need still. unmet in many countries is to establish a system of nursing education flexible enough to penn1t auxiliary nursing personnel, who meet the general educational requirement set up for schools of basic nursing education in the country and who have the potential for further development, to complete their studies to become a fully qualified nurse and/or midwife. (c) Educational programmes for special groups of health service personnel - midwives, auxiliary midwives, health aides, MCH workers, etc. In recognition of the essential role of the midwives in the provision of health services, attempts have been made to upgrade midwifery education. Emphasis on nurse-midwifery appears to be increasing in some countries and territories LAustralia, British Solomon Islands Protectorate, China (Taiwan), Gilbert and Ellice Islands, Japan, Malaysia, New Zealand, Philippines, and R!;!public of Koreij, where the advantage of combining both nursing-midwifery training and service is a matter of discussion and action at policy wPR/RC20/3 page 43 level. This type of programne seems more economical as 1 t permits a better use of limited teaching personnel and facilities, and facilitates movement from one group to another. In the Republic of Korea, WHO nurses are assisting in a progr8lmJe to prepare mUlti-purpose health aides. This includes theory and super- vised practice in both nursing and midwifery. In several countries, WHO has also ass1sted in teaching the trad1tional b1rth attendants Simple techniques of oleanliness and some- what safer delivery praotices. (d) Post-basic and/or graduate educational programmes Assistance has also been provided to more specialized or advanced programmes as dictated by the situation in the indiVidual country. Post- basic courses 1n public health nursing, teaching, administration and clinical specialties are being developed in Australia, Japan, Malaysia, New Zealand, the Philippines, the Republic of Korea and Singapore. Assistance in the establishment of a nursing unit at the levels of the Ministry of Health and/or Ministry of Education through the oreation of a centralized authority for nurs1ng This has been acoomplished, through direct assistance from WHO, 1n Cambodia, MalaYSia, the Republic of Korea, Singapore and Western Samoa. In other oountries - Australia, FiJ1, Japan, New Zealand, Republic of Viet-Nam - direct action has been taken by the national nurses themselves or with the assistance of bilateral agencies working in the oountry. The establishment of these nursing units has made it possible to plan for nursing on a broader basis and to set up standards for appropriate legislative activities for the control and advancement of nursing wi thin the country. Factors influencing nursing development One of the principal limiting factors in the development of nursing in several countries in the Region and which, to a great WPR/RC20/3 page 44 extent, explains the "brain drain" and the difficulties found in the recruitment of suitable candidates into nursing, is the limited financial resources of the country. One of the concerns of the WHO nurses has been to find out what type of personnel at what level of training is feasible and suitable for financing from locally available resources. Sometimes, WHO's standard has had to be modified in order to meet the most urgent needs of the largest number of people. WHO nursing advisory services and fellowships programme The technical assistance programmes in nursing are being imple- mented mainly through the prOvision of long- and short-term advisory services and the award of fellowships. The advisory services provided by WHO nurses assigned to a particular country have been a key factor in the development of nursing programmes. WHO nurses are participating in twenty-eight projects in the Region. In countries where nursing schools are of a very sub-standard level, young people have been brought to another country for basic nursing preparation (British Solomon Islands Protectorate, Gilbert and Ellice Islands, New Hebrides, etc.). National nurses who have had basic training in their own countries have been sent for advanced study abroad. Some have earned baccalaureate, Master's or even post- Master's degrees. Many others have had educational programmes tailored to their individual needs, combining study and observation in education and service institutions. Although it is difficult to evaluate the nursing activities as a whole in the Region or to establish cause-effect relationships, it may be said that there is not a single country in the Region which " r WPR/RC20/3 page 45 has rece1 ved WHO assistance and which has failed to experience some aooeleration in its nursing development and improvement in its nursing services. With years of international experienoe, many lessons have been learned, among which the following are mentioned: (1) For all oategories of nursing, midwifery and other health personnel, training must be related to their ~ funotion in the partioular country. (2) To ensure oontinuing progress in nursing education or nursing servioes, provision must be made for a con- tinuing supply of qualified teaohers and supervisors. Termination of WHO assistance before the oountry oan develop its own post-basic training programmes may result in a slowing down of the progress made during the period of WHO assistance. (3) More progress has been made in countries Where a recognized nursing authority has been established at governmental level. (4) More progress has also been made in countries Where two or three levels of nursing have been established and definitions of functions and quali- fications for each category have been formulated and implemented at all levels of health services. Many things still remain to be done. Research and field trials to develop and test new methods in nursing eduoation and services are vi tal if nursing is to be reliable and able to adapt itself to the rapidly changing oiroumstances of modern times. Preparation of national nurses in researoh methodology through regional seminars and fellowships abroad has been, and will continue to be, one of the concerns of the nUrsing programne in the Region. Increased co-ordination of nursing with other disciplines of the health team wPR/RC20/3 page 46 is also required in connexion with overall planning as well as at the practipal working level. 4.6 Health Education Support continues to be directed to the development of qualified health education leaders for health education service and training programmes, and for school health education programmes. A WHO adviser completed an eighteen-month assignment in Fiji in connexion with a project to develop training in health education for medical personnel, health workers and school-teachers. TWo counter- parts received WHO fellowships and have now assumed responsibility for the health education training activities. The five-year assignment of a health educator with the local health services project in the Republic of Korea was completed. As a result of the assistance provided, a health education service was established in the demonstration province and two counterparts have been professionally prepared in health education. A seven-year programme of assistance to school health education was completed in the Philippines. Three WHO advisers have assisted the Government to strengthen teacher preparation in health education and school-community health education programmes. The project established a nation-wide in-service education programme :1:n school health education for teachers and health personnel, pre-service courses in health education in all of the teacher training institu- tions of the country, post-graduate programmes in school health education in the leading teacher training colleges, training and demonstration centres, and curriculum development activities that resulted in the preparation of health instruction guides for school- teachers. The Philippine Government has also carried out follow-up seminars in connexion with the national seminar on research and evaluation in health education which was assisted by WHO last year. .,.' -, WPlVRC20/3 page 47 Assistance was. withdrawn from the project in Singapore. Two counterparts are now receiving training abroad and two health educa- tion posts have been established for them in the Ministry of.Health. A short-term consUltant's assignment to Malaysia emphasized the importance of relating health education in the schools with community health endeavours. WHO has. provided a fellowship for the new Director of School Health Education in the Ministry of Education whose post has been approved for establishment in 1969 when he returns from his fellow- ship. A policy has been established separating physical education and health education on the school time-table. A Joint school health education committee, with representation from the Ministries of Health and Education and the Malayan Medical Association, has set priorities for school health, made an inventory of health facilities available to schools, prepared health materials, pupil cards and environmental health inspection forms, initiated school broadcasts on health educa- tion and a demonstration school health service. State school health committees are being established and health education has been included as a required course for teacher trainees at the University of Malaya. The Malaysian Government has appointed a WHO fellow as full-time assistant director of medical services in-charge of the Health Educa- tion Division in the Ministry of Health. It has also appointed another WHO fellow as officer-in-charge of health education at the Institute of Public Health. The South Pacific Commission sponsored a seminar on the adminis- tration of health education services in Port Moresby in April 1969 as a follow-up of WHO's regional seminar on health education which was held in Manila in 1966. Planning is under way for the second regional seminar on health education which will concentrate its attention on the preparation of teachers for school health education. 4.7 Maternal and Child Health The available statistics in the Region show a gradual reduction in the number of deaths among mothers and children. Important factors WPR/RC20/3 page 48 contributing to this improvedsi tuation are: economic develolDent, education, and the expanding care provided to mothers and children by the health services. 'lb1s reduction, however, does not give a true picture of the present and future health situation as far as mothers and children are concerned. The continuing high fertil1 ty rate in many countries places an increasing burden of care on the families and, in particular, on the women. The continuous cycle of pregnancy, childbirth and child- rearing often limits the possibil1ty of giving adequate care to each child. Childbirth at an early age or late in the fert::Lle period, at short intervals and with a high frequency, reduces the bhances of mothers and children enjoying optimal health and leads to foetal wastage. This is incompletely reflected in available statistics. There is, however, a growing awareness that fertility regulation as well as assistance to unfertile families, can contribute considerably to their mental and physical health. In the developing countries in the Western Pacific Region deaths during the first month after birth account for the greater part of 1nfant mortality and are more difficult to prevent than those occurring between one month and one year of age and in the pre-school age group. Predominant problems from six months of age onwards aremalnutri tion preceded or complicated by communicable diseases and paras1tism. As development progresses, accidents, hered1tary and mal1gn8.nt d1seases, mental health problems and the care of hand1capped children come to the foreground. Maternal health is threatened by anaem1~, toxaemia, haemorrhages and other complications of pregnancy and Childbirth. Mothers an,d children represent up to half of the population, and deaths under the age of five years account for 40 % or more of all deaths in a number of countries. In view of the size of ' the problem, continuous planning and evaluation are needed to make the best poss1ble use of available resources. Efforts are being made to integrate maternal and child health services with the general health services and to combine preventive and curative care. .< WPR/RC20/3 page 49 The coverage of mothers and children by the health servioes is still a matter of concern in a number of countries. WHO is emphasizing the part that private physicians and voluntary assooiations and indivi- duals can play in improving ooverage and how day-oare nurseries and schools can be used to reach "organized" groups. It also believes that high-risk groups, suoh as mothers with more than an average problem during pregnancy and children threatened by malnutrition, need to be identified and given priority. WHO assistance was given to a number of countries to strengthen the integration of maternal and child health services into the general health services. To this end, short-term consultants visited Cambodia and the Philippines. In China (Taiwan), preparations have been completed for a project providing health care to children attending day-care nurseries in rural areas. Public health nurses of the health stations will make regular visits to the nurseries, supervise the health of the children, give 1IIJnunizations if needed and try and reach the mothers and their other children. During 1969 and 19rO, the prograllllle will cover 157 day-care centres. It is also intended to expand and upgrade family planning services by intensified public information and education and increased home visiting and supervision. UNICEF is providing equiIJllent and supplies and WHO technical advice to this pilot project. In Laos, the WHO public health nurse educators attached to the maternal and child health project have continued to give assistanoe in the training of rural midwives and in the expansion of maternal and child health clinics since the departure of the WHO medical officer. The team works closely with the WHO-assisted project for the develop- ment of health services In the Republic of Korea, a WHO maternal and child health adviser is assisting in the expansion and integration of maternal and child health and family planning services in the basic health services. Special attention is being given to supervision, the in-service training of staff and the upgrading of training areas. WPR/RC20/3 page 50 A plan of operation for a maternal and ohild health servioes and family planning project in Singapore was ooncluded at the end of 1968. The immediate objectives are to expand family planning servioeswithin the oontext of the maternal and ohild health programme, to assess the effeotiveness of the family planning services provided, and to train staff in family planning within the oontext of maternal and child health. UNICEF is providing supplies and equipnent in connexion with the education of the public and the evaluation centre. WHO is providing technical advice. The activities of the maternal and child health team in the South Pacific area were continued with visits paid to the British Solomon Islands Proteotorate, Cook Islands, and Western Samoa. A follow-up of the paediatric education seminar held in 1967 will be conducted by two consultants in the latter part of 1969. WHO oontinued to advise on the health aspects of social welfare projects assisted by UNICEF in the Philippines and by the United Nations Department of Economic and Social Affairs (UNDESA) and UNICEF in the Republics of Korea and Viet-Name 5. ENVIRONMENTAL HEALTH In general, efforts are being directed to the establishment and strengthening of national environmental health divisions. Two new WHO-assisted projects with this objeotive were started and two others are under planning. Emphasis continued to be placed on the promo- tional, supervisory and controlling roles to be exercised by the Ministry of Health through its environmental health organization on all matters affecting the environment. Some degree of sucoess in this respect was aohieved through the presence of long-term WHO publio health engineering advisers. The lack of uniformity in the qualifi- cations and training ourricula of environmental health personnel, not only among different countries in the Region but also within the same WPR/RC20/3 page 51 country, and the relatively unattractive advencement opportunities for publ1c health engineers make effective staffing a <:l1ff1Cult 1lJlde1ttaJ.d.n. Assistance to specific schemes, such as rural water supply or municipal sewerage systems or to specific activities, such as water pollution control, solid waste management and food san1tation, was gi ven to several countries. '!he concepts of financial and adm1nistra- tive feasibility were also introduced in several studies, especially those in the fields of sewerage and solid wastes. Arrangements are being pursued for the involvement of ministries of health and WHO advisers in the development projects of the Lower Mekong River Basin. In the rural areas, the establishment of an integrated approach to the development of public health services has been instrumeDtal in linking environmental health activities to overall development pro- grammes, both from the public health and economic development stand- pOints. The same approach has been more difficult to apply in the urban context, although there are indications that in the future more development plans will take into account some of the needs of the larger muniCipalities for water and sewerage. During the year under review the programme had twenty-one projects in operation. These consisted of eight long-term projects in environ- mental health, four in which environmental health staff are partici- pating in comprehensive public health activities, and nine consisting of short-term consultants. There has been a significant increase in the provision of assistance to countries to appraise the engineering, economic and financial aspects dealing with the development of major urban sewerage schemes. In Cambodia, a new advisory services project was established and some of the short-range objectives, such as the creation of a division of environmental health, the definition of its programmes and activities and the designation of a division head, have already wPR/RC20/3 page 52 been reached. WHO assistance to short- and long-term planning for water supply for the city of Sihanoukville is being considered. In China (Taiwan), a previous project on water supply and sewerage was transformed into a more general environmental health advisory services project. Its activities are varied and include among others advice on: water and sewerage progra.mroes, w~ter and air pollution control programmes, rural environmental santtation, environmental health aspects of physical planning, and thf training of environmental health personnel. The Greater Taipei area sanitary sewerage project, operated by the Government through the Council for International Economic Cooperation and Development with UNDP/Special Fund assistance and with WHO as the executing agency, became operational at the beginning of 1969 with the arrival of the WHO project manager and representatives of the consulting engineering firm which will undertake the two-year study. A work plan was prepared for the project activities. WHO participated with the United Nations in an interim assessment of the environmental sanitation improvements directly motivated or stimulated by assistance from the World Food Programme. The request of the Government of Japan for consultant assistance in air pollution control was postponed until the end of 1969. In Laos, under a comprehensive plan for the development of health services, a WHO sanitarian is adviSing on training and the setting-up and operation of demonstration centres. Active planning for a new environmental health advisory services project was initiated. In Malaysia, the WHO adviser assigned to Sarawak has provided assistance to the Health Department in the training of rural sanitation staff and the planning and construction of rural water supply schemes. The water supply development programme has gradually gained momentum and the scale of the programme was significantly enlarged~ when the Sarawak District Development Programme provided additional local funds. --- r· . .. ' ENVIRONMENTAL HEALTH Peaceful "Torpedo" A bathy thermograph is used in the Ma- nila Bay to determine temperature at dif- ferent depths. The Philippine Government, United Nations Development Programme and WHO are working together on the Greater Manila Sewerage System in order to improve health conditions in a fast grow- ing metropolitan city. Hygienic latrine construction is one of the first steps in rub- lic hygiene. It is also one 0 the cheapest. .'- ,- -,,_/ WPR/RC20/3 page 53 Twenty-eight rural water supply schemes were either completed or are under construction. This represents an investment ofM$51 850,1 exclusive of the local contribution in labour. In early 1969, WHO agreed to provide an additional sanitary engineer to advise and assist the Ministry in developing a unit in public health engineering at the central level in Kuala Lumpur. In late 1968, a WHO mission assisted the Ooverrunent 1n reviewing ani evaluating sewerage schemes for lpoh (population 250 000) and Kuala Lumpur (population 450 000). WHO is now in the process of arranging for a mission to advise the Government on major questions dealing with national water supply planning and policies. A consultant was assigned for a month to West Malaysia to advise on fly control in the Cameron Highlands. His recommendations on research and trials on substitute fertilizers, on the organization of a fly con- trol campaign and the personnel required, were sulxDitted to the Govern- ment. '!he sanitary engineer attached to the inter-country advisory services project on water and sewerage programmes undertook a three- week visit to Sarawak to prepare an outline sewerage plan and estimates for Kuching, to make recommandations for sewerage generally, and to prepare the way for a proposed sewerage administration and finance consultant. In the Philippines, WHO, as executing agency for the Special FUnd component of the UNDP. has been assisting in the preparation of a master plan for a sewerage system for the metropolitan area of Manila. The project will prepare a phased programme for the develop- ment of sewerage facilities (present population 3 000 000). The estimated cost of this planning exercise is U8$l 112 000. WHO hopes to submit an interim report in August 1969 which will cover the recommended first phase construction programme and recommendations on the organization and management of sewerage utility. ~1.00 = U8$0.33 WPR/RC20/3 page 54 A WHO sanitarian oonsultant was assigned to the Department of Health for three months in early 1969 to advise on the n~tional food sanitation programme whioh was previously initiated with WHO assistance. During this time, an assessment was also made of the UNICEF-assisted environmental health training project. WHO has continued to provide advisory services in cQnnexion with the project whioh is receiving material assistance from UNICEF for the construction of water supplies for hospitals and health oentres. Under planning for implementation in 1969 is a long-term project to provide advisory services in the field of water suppl~ to the National Waterworks and Sewerage Authority. Assistance will be given in reviewing plans and programmes for the improvement and construction of provincial waterworks and advice provided on their administration. The ltJHO adviser is expected to take up his assignment in September 1969. A consultant made a study on the administrative and technical feasibility of establishing a oentral authority for the management of solid waste in the Greater Manila area. His oonclusions were that, at present, an authority could be established to cover only part of the area but that its disposal and, to a more limited extent, col- lection facilities could be made available, upon request, to the entire area. This is the first step which can later on be developed, with proper legislation, to cover the entire metropolitan area. In the Republic of Korea, planning was started for WHO assistance to a national water supply and sewerage project for urban and rural areas. Two WHO sanitarians assigned to multi-disciplinary projeots are providing the same type of assistance as the one assigned to Laos. WHO participation in the Special Fund-assisted project on a pre- investment survey of the Naktong River Basin started in April with the assignment of a WHO sanitary engineer. In Singapore, a oonsul tant advised the Ministry of Health on various aspects of environmental health, including the organizational , .~ WP1!/RC20/3 page 55 structure. WHO is oontinuing negotiations ldth UNDESA on the prov1sion of a sanitary engineering consu,l tant to participate in the urban renewal and development projeot. which is financed under the Special Fund component of the UNDP. Under planning for implementation in 1969 are three projects: (a) A long-term proJeot financed under the Teohnioal Assistance component of the UNDP, consisting of a sanitary engineer to assist the Public Works Depart- ment in the preparat10n of short- and long-range plans for the development of sewerage facilities for the whole of Singapore and the control and/or elimination of water pollution. This large projected sewerage development programme will amount to 8$70.41 million. (b) A one-year project financed under the Teohnical Assistance component of the UNDP consisting of a consultant to advise and assist the Public Works Department on the management and operation of large oomplex sewage treatment plants and the training of nationals in the operation of these r, plants. (c) Three short-term consultants to advise the Ministry of Health on various aspects of environmental health programmes, including new problems arising from rapid urbanization and industrialization, and on vector control and waste disposal. In the Republic of Vlet-Nam. assistance continued to be given on specific aspects, such as munioipal garbage collection and disposal and disinfeotion of small commercial water supplies. Engineers were assigned to Da Nang and Can-tho for the entire.reporting period. 1 The post in Saigon was vacant for the major part of the period, but another engineer was assigned there in June 1969 and will be engaged 1 8$1.00 = u8$3.03 WPR/RC20!3 page 56 in overall planning, especially in respect of eventual UNlCEF assist- ance. Environmental health participat;:ion in the ne"l proj~ct of WHO assistance to the National Public Health Institute has been planned, with the assignment of a public health engineer and a sanitarian. In the South Pacific area, an inter-country team consisting of two sanitary engineers is based in Suva. The project has continued to give assistance to the participating countries in the planning, technical appraisal and supervision of construction of piped water supplies built with central and local government funds and UNICEF assistance. Operations continued in the British Solomon Islands Protectorate, Fiji, Gilbert and Ellice Islands, Niue, Tonga and Western Samoa, and plans are being made to start activities in the Condominium of New Hebrides. A consultant was provided to Fiji to advise on the feasibility of setting-up a water and sewerage authority covering either the Suva area or the whole country. A consultant assisted the authorities in Papua and New Guinea to review the training programme for health inspectors and to take part in a conference on their utilization and training. The inter-country water supply and sewerage project provided assistance on several stUdies, especially in the field of urban sewerage. Firm and tentative commitments were made for further assistance in the years to come, and the objectives of the project were expanded to include other environmental health interests. Despite the inevitable obstacles to the successful implement- ation of WHO-assisted projects and of national programmes, a good measure of success has been achieved. As previously reported, governments continued to attach a satisfactory priority to environ. mental health programmes and projects. In the two large ~rojects consisting of pre-investment studies for sewerage, the test will come when financing of the construction for the first phase is decided upon. , . r' , 6. HEALTH STATISTICS WPR/RC20/3 page 57 No health administration can plan, implement and evaluate its activities properly without the support of statistical data. The lack of this information in a number of developing countries in the Region poses an important problem. Reliable statistics can only be obtained if the basic statistical data are accurate and complete. The initial activities of WHO-assisted projects have been centred, therefore, on the improvement of basic data and the training of staff. The medical records department of hospitals, health centres, dispensaries and similar institutions are· areas of special interest. A WHO adviser on vital and health statistics and a WHO statisti- cian terminated their assignments with the University of Malaya at the end of 1968. The WHO adviser on vital and health statistics aSSisted in plan- ning, organizing and implementing training programmes in biostatistics offered for students, faculty and other staff. He actively partici- pated in the conduct of courses and in special studies conducted by the Faculty. A national counterpart, who later took over most of the lectures. was trained. The f~llowing are the most important recommend- ations he made on completion of his assignment: that the curriculum of the school should be revised to include the teaching of biostatistics as an elementary course early in the medical career, in order to pro- vide students with knowledge that would be needed throughout their medical training; that a unit in medical statistics, under the direction of an experienced senior statistician, should be established to fill the need for research work and to advise on the design of experiments and the analysis of data; that training in statistics should be extended to health workers I)utside of the Faculty of Medicine to meet the general shortage of health statisticians throughout the country. The WHO statistician assisted in the organization of a modern medical records unit in the un1versityhospital and in training medical records personnel for their participation in the teaching activities of WPRjl\C20 /3 page 58 the Medioal School, partioularly in the fields of medical records and hospital statistics. Methods and procedures for medical reoords work in hospitals were developed, tried out. and revised as necessary. A consultant/statistician has been assigned to Cambodia since May 1968. The organization of the medical records units of the Kbmero- sovietic Hospital and the Takhmau Health Centre have been improved and guidelines established for similar activities in dispensaries and other medical care establishments. Partioular attention has been given to the civil registration of vital events and the collection and analysis of national mortality statistics. He has worked closely with a United Nations demographer and, as a result of their joint aotivities, a speoial committee for the establishment of a national vital and health statistics system is being created. The next step will be the transformation of this committee into a national committee on vital and health statistics. In Laos, WHO has assisted in the organization of a medical records and statistics unit in the Mahosot Hospital, which is intended to serve as a model for other hospitals. New forms to record, consolidate and control data were designed and tried out. A system of registration of health statistics for health centres and dispensaries was tested on a large scale at the Sikhay Health Centre, which also serves as a work- shop for the staff of the Statistical Services. Record forms were introduced on a trial basis and, if t.hese prove to be successful, they will be introduced in all health centres. The WHO adviser has also given statistical assistance to the nutrition and development of health services projects. In view of delays in the completion of the new hospital in Tonga, the Government agreed to the temporary reassignment of the WHO medical records officer to Western Samoa. Assistance is now being given in the establishment of a medical records system in the Gener~l Hospital of Apia and in the district health centres and hospitals. 'Training in medical records for local personnel is being developed. I . ' . - WPR/RC20!3 page 59 Upon the request of the Government of Singapore, the WHO adviser on biostatistics assigned to Kuala Lumpur paid a short visit in November 1968 to see whether the assignment of a WHO statistical adviser would be useful to the Ministry of Health in setting up a statistical unit to co-ordinate and supervise the collection of health statistics, and to compile and analyze the data collected. As a result of his findings, a consultant in statistics is now being recruited. In January 1969, a WHO adviser was again assigned to the Republic of Viet-Nam. It is intended to set up a pilot medical records system at the Cho-ray General Hospital. Plans have been made for courses for medical records officers. A detailed study of the civil registration law and other statutes relating to vital and health statistics is in progress. Close relations have been established with the National Institute of Statistics and other bilateral agencies so that there will be a concerted effort to develop and improve national vital and health statistics. In the Republic of Korea, a central epidemiological service, with statistical support, is being organized and developed within the Preventive Medicine Section of the Bureau of Public Health, Ministry of Health and Social Affairs. The statistical basis for epidemiological activities will be strengthened and a disease intelligence network established. Important causes of morbidity and morta11 ty will be studied. 7. EDUCATION AND WINING The demand for more and better trained health personnel remains great in countries throughout the Region. In an attempt to meet this need, closer attention is being directed to the development of educa- tion and training programmes. In the same context, greater emphasis is being placed on the importance of careful health manpower planning as an integral part of national health planning. WPR!RC20!3 page 60 It is to be regretted that the so-called "brain drain" continues, causing shortages of health personnel, especially doctors and nurses, in the more rapidly developing countries. An education and training component is included in all WHO- assisted projects. In addition, the faculties of medical schools, schools of public health and institutes of public health are being strengthened through the provision of visiting lecturers, either on a long-term or consultant basis, and the award of fellowships for study abroad. The fellowship programme remains a major activity in the education and training field, accounting for apprOximately 20 % of the regional budget for the calendar year 1968. An evaluation of the programme by a WHO consultant, which will take six months to complete, was begun in February 1969. 7.1 Medical Education Medical educational facilities in the Region came under review during the nineteenth session of the Regional Committee when further consideration was given to a proposal originating in 1967 from a Member government to establish a WHO medical school in the Region. The proposal did not obtain support from the Regional Committee, which recommended instead that WHO should continue to assist in the strengthen- ing of national medical schools within the Region. A WHO travelling seminar on medical education was held from 30 April to 15 May 1969. This was attended by fourteen participants, most of them deans of medical schools in the Western Pacific Region, and one from Thailand. The seminar began in Manila, after which it visited Australia, where sessions were held in Sydney and Perth. The final session was held in Singapore. The travelling seminar was the first WHO meeting on medical education held in the Region since the 1963 conference of deans of medical schools. It afforded a unique opportunity for participants " . ~ . • • < . MEDICAL EDUCATION MANILA · , , Venereal diseases are on the upsurge especially ;n countries with large move- ments of populations or extensive urbanization. WHO convened the Second Regional Seminar on Venereal Disease Control in Manila between 3 to 12 Decem- ber 1968 in order to review the nature and extent of venereal disease problem in the Region and review the possible methods of treatment of venereal disease. The Chairman was Dr. Gabino V. Balbin, Regional Health Director of the Phil- ippines. ." •• .i. _ .. WPR/RC20/3 page 61 to exchange information on medical education programmes in their countries, to consider new trends and their applicability to programmes in the Region, and to discuss mutual problems. It emerged that several problems were common to many countries. These included: (a) the "brain drain", with both permanent loss of graduates overseas and temporary loss in the post-registration or residency period; (b) the mal-distribution of physicians with concen- tration in the cities (ltinternal brain drain"); (c) the difficulty of evolving a curriculum appropriate to the country's needs; (d) the shortage of teachers, particularly in the basic and pre-clinical sciences; ( e) the inadequa. te pay for faculty staff. A major topic dealt with was that of co-operation and collabora- tion between schools. This included a discussion on the opportunity for student and faculty exchange and the possible establishment of national and regional associations of medical schools. The most significant development coming from the seminar was the appointment of a Steering Committee to examine the feasibility of establishing a regional association. There was strong support for this suggestion among the travelling participants as well as those in the places visited. The Steering Committee has been asked to report on its study within one year, and aim, if at all possible and feasible, towards the establishment of a regional association within two years. Although the Organization has continued to experience difficulty in recruiting French-speaking lecturers to assist the teaching pro- gramme in the Royal School of Medicine in Laos, the position this year has somewhat improved. A full-time lecturer in pathology was appointed to the School in October 1968 and a senior consultant in the teaching of social and preventive medicine spent one month in WPRjRC20!3 page 62 Laos in November-December. However, full-time lecturer posts in social and preventive medicine and physiology still remain vacant. The assistance to the Faculty of Medicine, University of Malaya, Kuala Lumpur, has developed satisfactorily and the first group of students from the School are graduating this year. With the expansion of teaching in the Medical School and the opening of the teaching hospital (756 beds) in August 1968, the resources of the tl:)aching faculty and the administrative hospital staff have been heavily taxed. During the year, two WHO nurse educators (full-time) I!emained with the project. One of these was primarily concerned with the organiza- tion of post-basic courses for nursing tutors and the other has assisted principally in strengthening the public health component of the basic nursing course. The WHO biostatistician, who stayed twenty-one months with the project, and the medical records officer, whose term covered twenty-eight months, completed their assignments at the end of 1968 (see Section 6). A consultant lecturer in internal medicine, who spent six months at the School, completed his assignment in November 1968. A WHO visiting lecturer in social and preventive medioine spent four months at the University of Singapore, assisting the Department of Social and Preventive Medicine and Public Health in rev:J.ew1ng and strengthening its teaching programme, both for medical students and for post-graduate students taking the Diploma of Public He~lth course. Although the Organization has had budgetary proviSion to supply advisory services to the Medical Faculty of Hue, Viet-Nam, in 1968 and 1969, the project could not be implemented following the severe damage inflicted on the school buildings in the Tet offensive of 1968. The school has been transferred temporarily to Saigon where classes are being given in the premises of the Faculty of Medicine, University of Saigon. WHO continues to send several fellows from surrounding countries and territories to the Fiji School of Medicine for undergraduate 4. . . \ ~ WPRjRC20/3 .' page 63 medical training. In 1969, eleven undergraduate students were enrolled on WHO fellowships. Two of those who graduated in 1968 were WHO fellows. 7.2 Public Health Training As a follow-up of the conference of directors of schools of public health from the African, Eastern Mediterranean, South-East Asia and Western Pacific Regions of WHO held in Manila in 1967, a further conference, to which directors of schools of public health in the same four regions are being invited, will be held in Alexandria in October 1969. It is anticipated that an Association of Schools of Public Health in the four regions, the concept of which emerged from the Manila meeting, will be inaugurated during the conference in Alexandria. An important landmark in the field of public health training for various categories of health workers in the Republic of Viet-Nam was the signing on 24 November 1968 of the plan of operation for the establishment of the National Institute of Public Health in Saigon. Donations of $1 million from the Government of the United States of America and $0.5 million from the Government of the Netherlands have been made to the project through the Voluntary Fund for Health Promo- tion. WHO is also providing assistance under its regular budget. Planning for this major project has entailed numerous meetings and discussion between government officials, representatives of the AID in the Republic of Viet-Nam and WHO staff. '!he decree proclaiming the establishment of the Institute was signed on 27 March 1969, following which a site has been secured by the Ministry of Health for the building. '!he Co-ordination Committee, which will lay down the broad lines of policy of the project's development, held its first meeting in Saigon on 16 May 1969 under the chairmanship of the Minister of Health. A WHO consultant on education and training spent six weeks in Laos late in 1968 to advise the Government on the planning and establish- ment of the Institute of Public Health, which is designed to co-ordinate, direct and standardize the training of various categories of health WPRjl\C20!3 page 64 personnel, particularly at the auxiliary level. It is intetlded that the Institute's training activities will be closely linked ~th the demonstration health centre being set up under the development of health services project. Although post-graduate training facilities for physicians in public health have existed for some time in the School of Public Health, Seoul National University, relatively few physicians have taken the Master of Public Health course. The principal reason for this has been finan- cial, as the few fellowships available for such training have carried very low stipends and have therefore been financially unattractive. To improve the situation, a WHO study grant was made to the School during the year. This, along t'1ith a grant from the Government, is being used by the School to establish a fellowship fund which will provide physicians wishing to take the Master of Public Health course on a full-time basis with reasonable stipends. Recipients of the fellowships are required to give at least three years of government service after completion of the course. It is hoped that these better terms and conditions will encourage more physicians, particularly those employed in health centres throughout the country, to take the course. A full-time WHO public health administrator has assisted the Dean and the Faculty to review and reorganize the curriculum for the Master of Public Health course and to plan the new school building, which is being constructed from funds given by the China Medical Board and Seoul National University. WHO assistance to the training of public health workers in the National Institute of Health, Republic of Korea, continued throughout the year with the posting of two full-time advisers - a public health nurse educator and a sanitarian tutor. In the nursing field, the two main programmes assisted were the ten-week course for nurses in public health and the course for health aides, which has been extended from six to nine months to include midwifery instruction. Some problems occurred in the programme early in 1969 because of a government decision to change the training centres from schools of nursing (under the , , WPR/llC20!3 page 65 Ministry of Education) to health centres and hospitals which are under the Ministry of Health. However, an evaluation carried out by the WHO public health nurse educator and staff from the Institute has indicated that the overall programme is operating quite successfully. Approxi- mately 488 health aides completed their training during the year and have been assigned to health centres and sub-centres throughout the country. Considerable progress was made in the training of sanitarians wi th the establishment of two courses, one of six months I duration in Wook Suk University for new trainees and the other a four-month course in the Institute for employees who have already had some basic training. However, the shortage of qualified and experienced instructors and the lack of budgetary support have seriously handicapped the scheme. Amalgamation of the two education and training projects in the Republic of Korea (School of Public Health, Seoul National University, and National Institute of Health) into a consolidated project (assist- ance to education and training of health and medical workers) has now been effected. WHO staff from the two projects - a public health administrator, a public health nurse educator and a sanitarian tutor - will work in the future as a team giving assistance in four principal areas: the School of Public Health, National Institute of Health, medical and nursing schools. Improvement in the planning and co-ordination of various training activities is hoped for under the new project. The Organization continued to offer short-term fellowships to senior faculty members of schools of public health to provide them with an opportunity to visit other schools of public health, health training institutions and countries in the Region, which send them students for training. One fellowship of this type was awarded during the period under review and two more are planned for the coming year. WPR/RC20!3 page 66 7.3 Other Activities A Danish anaesthesiology team, accompanied by the Chief. Staff Training. WHO Headquarters, visited the Region for one month at the end of 1968 as part of an evaluation of the training courses given at the Copenhagen Anaesthesiology Centre. Visits were made to most of the countries in the Region which have sent fellows to Deztlmark for training. The team had an opportunity to meet the majority of the 1 former fellows in their working situation. Since 1952. fifty-two fellows from the Region have attended this course. '!he team also looked into the feasibility of establishing a \r/HO- assisted regional anaesthesiology training centre in Manila. The Government of the Philippines has shown interest in the project and the matter is being studied further. The Danish Government and the World Federation of Societies of Anaesthesiologists have indicated their support of the proposal. Until such time as a regional centre may be established, fellows will continue to be sent to Copenhagen for training. 7.4 Fellowships During the period under review, a total of 275 individual regional fellowships, including 53 for training at the Malaria Eradi- cation Training Centre, Manila. were awarded. While this figure is 11 % less than the number reported last year, the extensions and repeat awards processed numbered around 30. In addition, there were a number of felloi'l'Ship cancellations and transfer-awards. Not included in the total are ai'/'ards from inter-country and inter-regional funds for participation in educational meetings, seminars and courses, which are listed under section 7.5. ~nCluding seven who took the refresher course. - - . . . -. .. MEDICAL EDUCA nON WHO Fellows Mr. Sea Baik Lee of Korea, Miss Su Luan Ho of China (Taiwan) and Dr. lakopo Esera of Western Samoa are attend- ing a one year course at the Institute of Hygiene, University Malaria Eradication Training Centre, Manila In Tala, Phifappines, a demonstration hut is used to show Malaria eradication technicians all over the world the resting of the Philippines, Manila. Miss Ho & Mr. Lee are taking CPH course and Dr. &era is taking a masters degree in public health. places of the disease carrying vectors and the surfaces to be sprayed with insecticides. WPR/RC20/3 page 67 Some other aspects of the regional fellowships awarded are analyzed below: Profession of Fellows Physician Nurse Sanitarian others Fields of Activity Medical and health services Teaching Undergraduate study Types of Studies Arranged Individual studies WHO-sponsored courses Other courses Place of Study In countries within the Region only In other regions and not in the Western Pacific Region In the Western Pacific Region and other regions 113 (41 %) 37 (13.5 %) 8 (3 %) 117 (42.5 %) 243 (88 %) 24 (9 %) 8 (3 %) 207 (75 %) 49 (18 %) 19 (7 %) 135 (49 %) 120 (44 %) 20 (7 %) A total of fifty-six fellows from other regions were accepted for lang- and short-term study in the Western Pacific Region. The breakdown by region of origin is as follows: Regional Office for the Americas Regional Office for the Eastern Mediterranean Regional Office for Europe Regional Office for South-East Asia 2 19 (17) 1 The figures in brackets refer to fellowships in malaria eradication undertaken at the METe in Manila. WPR/RC20/3 page 68 The World Health Organization gratefully acknowledges the splendid co-operation and willingness of countries in the Region to receive fellows for academic courses as well as observation visits. 7.5 Educational Meetings and Courses The inter-country educational meetings and courses held during the year are listed in Part VI. WHO financed the attendance of forty- seven participants at these meetings. A total of twenty-two participants from the Region took part in ten inter-regional seminars and courses of less than a month's duration. These are listed below: (a) Course on Methods of Epidemiologioal Surveillance, Karlovy Vary (Czechoslovakia) and Geneva, 12-30 August 1968; (b) Travelling Seminar on the Disinfection of Dr1nking- water, Union of Soviet Socialist Republics, 2-24 September 1968; (c) Seminar on Teaching MethodS and Teaching Aids, Ankara, 9-14 September 1968; (d) Travelling Seminar on the Organization of Refresher Courses for Medical Staff, Union of Soviet Socialist Republics, 8-31 October 1968; (e) Workshops on Cellular and Molecular BaSis of the Immune Response, New Delhi, 14 October - 23 November 1968;1 (f) Course for Coding Instructors, New Delhi, 11-20 November 1968;1 (g) IABA Regional Seminar for Asia and the Far East on Radiation Protection Monitoring, Bombay, 9-13 December 1968; (h) Seminar on the Organization of Medical r-are, Union of Soviet Socialist Republics, 9-30 April 1969; lFUnded from WPRO 0114. 4. , - , ' (i) Course on Cholera Control, Calcutta, Hong Kong, Philippines, 19 May - 6 June 1969: (J) Refresher Course on Anaesthesiology, Copenhagen, 1-21 June 1969. Twenty-four fellowships were also awarded to enable participants from the Region to attend the following long-tem (more than one month IS duration) ,inter-regional courses: (a) FAO/WHO Training Centre on Abattoir Management and Operation, R,rSskllde, Derunark: Fourth Course, 5 August - 14 September 1968; (b) Course for Clinical Instructors in Physical Therapy, Copenhagen, 2 September - 29 November 1968: (c) Advanced Course in Paediatrics, Warsaw, 12 September - 25 October 1968: (d) (e) (f) (g) (h) Course on Human Genetics for Teachers in Medical Schools, Copenhagen, 3 September - 31 December 1968: Course on Occupational Health in Agriculture, IXmdee, Scotland, 1 October - 8 November 1968: Advanced Course in Diagnosis, Treatment and Prevention of Major Cardiovascular Diseases, Copenhagen, 1 November 1968 - 15 June 1969: Anaesthesiology Course, Copenhagen, 13 January - 12 December 1969: Course on the Epidemiology and Control of Tuberculosis, Rome, 15 February - 31 May 1969: (i) Course on the Application of Basic Medical Sciences to Surgery, Copenhagen, 9 April - 30 May 1969; (J) Course on the Epidemiology and Control of Tuberculosis, Prague, 17 April - 17 July 1969; (k) Course on Methods and Techniques for Parasitic Disease Surveys, Bangkok, 5 May - 14 June 1969: (1) Joint USSR/WHO Seminar on Vector Biology, Union of Soviet Socialist Republics, 19 May - 29 June 1969. PARr II. CO-OPERATION Wl'lH OTHER ORGANIZATIONS ' .. ·-.- ,- . " CO-OPERATION WITH OTHER ORGANIZATIONS 30 October 19b8 - Meeting of representatives of all bilateral and multilateral aid programmes operating in the Philippines in the field of food and agriculture. Photo shows (from left) Mr. Andrew J. Joseph, Resident VIET-NAM On 24 November 1968, agreement was reached between the Government of Viet-Nam and the World Health Organi- zation for the foundation of the National Institute of Public Health in Saigon. More than one million dollars will be spent on buildings, teaching assistance and research facilities as the result of a special contribution by the United States of Amer- Representative of the United Nations Development Pro- gramme in the Philippines; Dr. A. H. Boerma, Director-Gen- eral, FAO; Dr. Francisco J. Dy, WHO Regional Director, Dr. D. R. Thomson, Director of Health Services, WPRO. ica and of the Netherlands. Photo shows (from left) Dr. Ngu- yen Van Thieu, Special Technical Assistant to the Minister of Health, Viet-Nam, Major J. Faircloth, Executive Assistant - A.D.fP.H., USAID, Saigon, Dr. Tran Lu Y, Minister of Health, Social Welfare and Relief to the Homeless and Dr. Francisco J. Dy, Director of WHO's Western Pacific Region. ," • 1. CO-OPERATION WITH UNITED NATIONS AND RELATED A~IES WPR/RC20/3 page 73 WHO continued to co-operate with individual organizations on matters of common interest. United Nations Members of the Joint Inspection Unit, which was established by the Secretary-General of the United Nations to make on the spot inquiries and investigations in any of the services of the diffe- rent organizations of the United Nations family, visited Cambodia, East and West Malaysia, and Singapore during the period under review. Economic Commission for Asia and the Far East (ECAFE) A WHO adviser is assisting in implementing the general recom- mendations in the summary report on the WlI) health survey in the Lower Mekong Basin, which was adopted by the Committee for the Co- ordination of Investigations of the Lower Mekong Basin. He is also advising on the health protection of the labour forces enga!ed in the Committee's projects. The importance of the Mekong Committee secretariat making provision for the cost of such services for in- clusion in the overall cost estimates of construction projects has been stressed. The WHO public health administrator is wonting closely with the WEn staff assigned to Cambodia, Laos and the Republic of Viet-Nam in their efforts to plan and develop general health services in areas covered by Mekong Committee projects. The Asian Institute for Economic Develnpment and Planning in Bangkok second.ed a staff member to conduct the lecture-discussions on social planning during the course on national health planning organized for senior WHO staff last year. United Nations DevelOpment Programme (UNDP) Close relations have continued with the Resident Representatives of the UNDP. WPR/RC20,0 page 74 WHO is the executing agency for two projects finanoed from the Special FUnd component of the UNDP: the first relating to the deve- lopment of a master plan for the sewerage system for the Greater Manila area, which went into operation in December 1966; the second, the Greater Taipei area sanitary sewerage project, which started in January 1969. The Organization is also a participating agency with FAO in a Special Fund-assisted project in the Republic of Korea, where a pre-investment survey is being made of the Naktdng River Basin. Negotiations are still going on in connexion with the participation of WHO in a Special FUnd-assisted urban renewal and development project in Singapore. Special mention should be made of the very considerable help WHO receives from the UNDP office in Sydney in connexion with the WHO fellowship programme. United Nations Children's Fund (UNICEF) As in previous years, there has been close co-operation and continuous consultation with UNICEF in the planning, imple- mentation and evaluation of projects receiving UNICEF supplies and equipment. The assistance provided covers many fields, inoluding maternal and child health, nursing, rural health, en- vironmental health and communicable diseases. The material assistance provided by UNICEF represents a valuable contribution to health programmes in the Region. World Food Programme (WFP) The health aspects of several WFP projects were studied by technical units in the Regional Office and by WHO officers at the country level. In October 1968 a headquarters consultamt visited the Region and had discussions in depth about health programmes which could be assisted by the Programme. A projeot of particular interest to WHO is that on environmental sanitation in China (Taiwan). WHO participated with the United Nations in an interim assessment of the environmental sanitation improvements directly motivated or stimulated by WFP assistance. f , J .. , ,. .. WPR/RC20/3 page 75 A considerable expansion of WFP activities in the Region is anticipated. Food and Agriculture Organization (FAO) Several nutrition projects were planned jointly with FAD (see Part I, section 3.5). Collaboration with FAD has also been developed in matters of veterinar,r public health, rodent control and river basin development. A joint FAO/WHOjUNEScOjUNICEF consultant on nutrition education in schools visited the Philippines in the period under review. International Labour Organisation (IIO) Close contact is being maintained with the ILO Regional Adviser in Occupational Health. A number of joint projects are planned. Part I, section 3.7 contains further information. Meetings Attended Representatives from the Regional Office attended the following meetings: (a) ECAFE: Thirty-eighth (plenar,r) session of the Committee for Co-ordination of Investigations of the Lower Mekong Basin, Saigon, 22-ZT Januar,r 1969: (b) IAEA: Visiting Seminar on Food Irradiation, Singapore, Manila, Taipei, Seoul, 24 Januar,r - 7 Februar,r 1969: (c) Regional Meeting of United Nations Development ,.' Programme Resident Representatives in Asia and the Far East, Manila, 9-19 Februar,r 1969. 2. INI'ERGOVERNMENl'AL ORGANIZATIONS Informal liaison and friendly relations are maintained with the Asian Development Bank which is situated in Manila. Regional office staff are available to discuss health and other conditions WPR/RC20/3 page 76 in countries with members of the Bank's missions before they visit countries in the Region. 3. WITH OTHER ORGANIZATIONS 3.1 South Pacific Commission The seminar on filariasis control held in Apia from 6-12 August 1968 and the tuberculosis and leprosy course held in Noumea from 17 March - 9 April 1969 were jointly sponsored by the Commission and WHO. The Commission sent a representative to the nineteenth session of the Regional Committee. Meetings Attend.ed Representatives from the Regional Office attended the following meetings: (a) Eighth South Pacific Conference, Noumea, 2-11 October 1968; (b) Thirty-first session of the South Pacific Commission, Noumea, 14-20 October 1968; (c) Seminar on the Administration of Health Educatllon Services, Port Moresby, 17-28 March 1969. 3.2 other Joint Work The South Pacific Health Service has continued to work closely with the Organization in connexion with WHO-aSSisted projects in the South Pacific. A number of projects in the Region have received assis- tance from the Colombo Plan, China Medical Board and the United States Agency for International Development. A number of govern- ments have also reported that Peace Corps workers are now assigned to health projects in their countries. MeetingS Attended Representatives from the Regional Office attended the following meetings: • • • .. • •• .. - • (a) Third Congress of' the Asia-Pacific Academy of' Ophthalmology, Singapore, 5 August 1968; (b) United States/Japan Co-operative Medical Science Committees, Fourth Meeting, Tokyo, 5-9 August 1968; WPR/RC20/3 page 77 (c) Third Asian COnf'erence on Work f'or the Blind (spon- sored by the American Foundation f'or Overseas Blind, Inc., the Royal Commonwealth Society f'or the Blind with co-sponsorship by the Bureau of' Public Schools, Department of' Education, Philippines), Manila, 26-31 August 1968: (d) Eighth International Congress on Tropical Medicine and Malaria, Teheran, 7-15 September 1968: (e) Symposium on Human Growth (sponsored by the Eighth International Congress of' Anthropological and Ethno- logical Sciences), Ky~to, 9 September 1968; (f') Third General Assembly of' the Federation of' Asian Phannaceutical Associations and the Second Asian Congress of' Pharmaceutical Sciences, Seoul, 16-21 September 1968: (g) First Seminar on Japanese Encephalitis in East Asia (sponsored by the Japanese Government and the Overseas Technical Co-operation Agency), Tokyo, 29-30 November 1968: (h) Joint Philippines/Japan/WHO Cholera Research Meeting, Manila, 21-22 January 1969: (i) Fburth Regional SeminarjLaboratory Meeting on Parasitology and Tropical Medicine, Schistosomiasis and Other Snail-Transmitted Helminthiasis (sponsored by the Control Co-ordination Board f'or Tropical Medicine of' South-East Asian Ministers of' Education Council), Manila, 24-27 February 1969: WPR,/RC20/3 page 78 (J) Group Training Course in Waterworics Engineering (sponsored by the Japanese Government under the Colombo Plan scheme), Tokyo, 17-18 April 1969; (k) Ninth Japan .conference on Radioisotopes (sponsored by the Japan Radioisotope Association, Inc., and the Atomic Energy Society of Japan), Tokyo, 13-15 May 1969. 4. NON-OOVEmlw1ENI'AL ORGANIZATIONS IN OFFICIAL RELATIONS WITH WHO Representatives from the Regional Office attended. the following meetings: (a) World Medical Association: 22nd General Assembly, Sydney, 5-10 August 1968; (b) Fourth Pan-Pacific Rehabilitation Conference of the International Society for Rehabilitation of the Disabled, Hong Kong, 2-8 September 1968; (0) Fourth Regional Seminar of the International planned Parenthood Federation, Seoul, 15-16 October 1968; (d) International Union Against Tuberculosis, Sixth Eastern Regional Tuberculosis Conference, Kuala Lumpur, 11-15 November 1968. • .. • ., '. PART III. PUBLIC INFORMATION .. 1. ~20/3 page 81 The twentieth anniversary of WHO was celebrated on 1 October 1968, the opening date of the nineteenth session of the Regional Committee. This coincided with the celebration of World Health lay in the Philippines. The Philippine Medical Association joined the celebration by inviting WHO guest speakers and distributing WHO information material ~n a very wide scale throughout the country (7000 information items). A special sub- committee of the Philippine National Committee was set up to deal with press, radio and television coverage. In addition, circulars were sent by the Department of Health to all the directors of health regions, by the Department of Education to the Director of Public Schools, Private SchQols and Vocational Education, and by the National Waterwnrks and Sewerage Authority and the Manila City Health Department to their staff. A special feature, "WHO in the Philippines", was issued on the occasion and widely distributed in advance with the Regional Director's message (written and recorded) for World Health !By, and copies of the regional publication prepared for the twentieth anniversary. The opening ceremony, which was attended by President Ferdinand E. Marcos of the Philippines and the Director-General, was covered by numerous press reporters, photographers, radio networks and television crews. Special programmes were set up in co-operation with the Public Information Unit by several radio stations. Forty dubbings of the Regional Director's message were distributed to provincial radio stations throughout the Philippines along with the special "kit". The Regional Director himself gave several interviews. All in all, WHO's Twentieth Anniversary in the Philippines resulted in the publication of forty-four press items and eight features in six magazines in Manila only. WPR/RC20/3 page 82 The United States Information Service printed a poster in honour of WHO. In all, about 20 000 items of vlHO information material were distributed in the Philippines on this occasion. 2. PUBLICATIONS The regional publication issued to commemorate the twentieth anniversary met with great success and a new edition had to be printed. A total of 100 000 copies were prepared and 89 000 have already been distributed. Hundreds of back issues of the magazine ''World Health" devoted to specific subjects have been distributed to visitors, teachers and students throughout the Region. 3. WORLD HEALTH DAY A thousand copies of the ''kit'' in English and French were distributed throughout the Region and sets of photographs were sent to newspapers. The response, judged by articles published in the press, was very satisfactory. One interesting aspect of the celebration of World Health Day in Taipei was the decision that no charge would be made for babies delivered on that day. A permanent photographic exhibit on the theme has been. put up in the Public Information Office. 4. RADIO COVERAGE Radio and television reporters from various stations in the Philippines came to the Regional Office to film and inter- view participants in the first regional seminar on the prevention and control of cardiovascular diseases due to infection, .1 , .. WPR/RC20/3 page 83/84 particularly rheumatic heart disease, and the second regional seminar on venereal disease control. 5. FILMS A team from the United Nations Film Division visited the Public Information Office to prepare the ground for shooting a film on mental health. Their project was completed with the help of the Philippine Mental Health Association and the WHO medical officer assigned to the mental health project. Thirty-eight films were loaned to various official organ- izations in the Region. 6. VISrroRS Some 800 teachers and students visited the WHO Building during United Nations week. A log-book for visitors was opened on 1 March 1969. To date, 119 people have visited the office and have been given booklets and details of the work of WHO in the Region. • , . .' PART rv. CONSTI'ruTIONAL AND AIlIIINISTRATIVE DEVELOPMENl'S • .,'\ REGIONAL COMMITIEE Manila, 1·8 October 1968. 19th session of the Regional Committee for the Western Pacific Region. The Chairman ""'!'- - , , I, \ was Dr. Clemente S. Gatmaitan, Undersecretary of Health of the Philippines. J WPRjRC20/3 page 87 1. THE REGIONAL C<MIII'ITEE The nineteenth session of the Regional Committee for the Western Pacific was held in Manila from 1 to 8 October 1968. The session was attended by representatives of all Member States in the Region, and ~ , • by representatives of Member States responsible for territories in the Region. Representatives of the United Nations, the United Nations Development Programme, UNICEF, the International Committee of Military Medicine and Pharmacy, the South Pacific Commission and eleven non- governmental organizations in official relations with WHO were also present. The Director-General and an Assistant Director-General attended the session The afternoon of the first day was devoted to the celebration of the twentieth anniversary of \iHO. The Committee examined the report of the Regional Director for the period 1 July 1967 to 30 June 1968. Considerable attention was paid to the problem of communicable disease control and the continued threat of the spread of quarantinable diseases. Representatives of several countries emphasized the need to under- take more work in connexion with Japanese encephalitis - in particular, to carry out field trials - and also suggested that more attention should be given to leprosy. A summary of recent findings in the Joint Ph11ippines/Japan/WH0 cholera study project was presented to the Committee. The Committee approved the proposed programme and budget estimates for the Region for 1970 for transmission to the Director-General. After reviewing the proposal made by one Member government regarding the establishment of a WHO medical school in the Region, the Committee decided that, since the proposal had not obtained support from Member States, no further action was required; it recommended that, instead, WHO should continue to assist in strengthening national medical schools within the Region. WPR/RC20/} page 88 The Committee reviewed a report summarizing information received from Member states regarding assistance provided by voluntary organiza- tions in the field of health, and recommended that national health administrations should make full use of the information collected, with a view to utilizing these resources more effectively. With regard to long-term planning and evaluation, the Committee recommended that the next general programme of work for a specific period be bull t up in three successive steps - national, regional and global; emphasis should be placed on organization and administration (including the extension of health services to the periphery and improvement in their management); education and training; and selected programmes such as communicable disease control, the organization of medical care, environmental health, and health promotion, with parti- cular attention to child health. The Committee also noted with interest the proposal that Member countries might wish to pursue joint studies on selected subjects of particular interest to groups of oountries - for example, haemorrhagic fever, Japanese encephalitis and filariasis. The conoept of biennial programming was endorsed by the Committee, which suggested that budgetary data for the current year - i. e., the year in which the programme and budget proposals were prepared - should be retained, so that a four-year cycle would be presented. The Committee expressed its appreciation of the initiative taken in planning for 1970 a course on the health aspects of population dynamics, and the hope that regional activities in this field would be expanded. After reviewing the question of the cost of regional committee sessions held away from regional headquarters, the Committee reaffirmed the principle approved at its fourth session: namely, that any extra costs over and above those normally incurred when a regional committee session was held at regional headquarters should be borne by the host government. It considered, further, that the extra costs borne by the host government should be offset by any savings aCCruing to the Regional Office allocation for the Regional Committee for the finanCial year concerned. '. }' .. WPR/RC20/3 page 89 "Health planning as an administrative tool" was the subject of the technical discussions. National health planning was recognized as an important administrative tool for strengthening the health services and ensuring co-ordination of health activities with general socio-economic development, and stress was laid on the importance of the training of medical and other staff 1n this f1eld. "The planning and organization of a national epidemiological service" was selected as the theme for the technical discussions in The Committee decided that its twentieth and twenty-first sessions should be held at the regional headquarters in Manila, unless invita- tions were received for them to be held elsewhere. 2. REGIONAL OFFICE 2.1 Organizational Structure Following a study of the distribution of responsibilities in the Bureau of Health Services, the co-ordinativeresponsibilities of the Assistant Directors of Health Services were strengthened and certain operational responsibilities were transferred from them to the Regional Advisers. 2.1.1 Regional office staff Recruitment was completed during this period for the posts of assistant director of health services, finance officer, public informa- tion officer, nursing adviser, budget officer and administrative ser- vices officer. In some cases, recruitment resulted from the Organiza- tion's policy of reassigning staff at intervals to assure the best use of available experience as well as to infuse new ideas. 2.1.2 WHO Representatives. A representative was appointed to Cambodia in October 1968. WPR/RC20/3 page 90 '!he WHO Representatl ves attended programme planning and country review meetings in Manila in November 1968 and again in April 1969. Advantage was taken of their presence to discuss administ~tlve matters of mutual interest. 2.1.3 Project staff During the period under review, forty-three project posts were filled either by recruitment or reassignment. A total of 145 selection committees were held between July 1968 and May 1969. Seventy-four short-term consultants were recruited. The total period of their assignments was 98 man-months. 2.2 Salaries and Allowances 2.2.1 Staff in the professional category In accordance with recommendations made by the International Clv11 Service Advisory Board, professional and higher level gross salary scales were increased by 5 % on 1 January 1969. Post (cost-of-living) adjustments were increased in Cambodia and Fiji. 2.2.2 Staff in the general service category Salary scales for general service staff were increased in Cambodia, Fiji and the Republic of Korea. 2.3 Regional Office BUilding 2.3.1 The Conference Hall The Conference Hall was used for seven conferences and seminars. These were either sponsored by WHO or were of an international character and met the established criteria for such meetings. 2.3.2 Repairs and maintenance The ground and second floors of the WHO building werE! repainted and revarnished. Rooms on the second, third and fourth floors were • ... • WPR/RC20/3 page 91 repartitioned to provide an additional twelve rooms. Three units of the evaporative oondensers of the air-oonditioning system were desoaled. 2.4 Regional Obligations and Expenditures Pages 92-93 of this report oontain a graphio presentation and a finanoial table of the obligation totals for the Region for the period 1950 to 1968. A comparison of implementation in relation to funds budgeted under the regular budget for the fisoal years 1967 and 1968 shows a 97.4 % implementation in 1967 and a 95.4% L~plementat1on in 1968. As far as the Teohnioal Assistance oomponent of the UNDP is oonoerned, the implementation percentage during the biennium 1967/1968 was 98.3 %. M!1lions GRAPH OF OBLIGA TIONS INCURRED BY THE WORLD HEALTH ORGANIZA nON WESTERN PACIFIC REGION~/ of US$ 1950-1968 6.00 r (Expressed in Millions of US Dollars) 5 00 L LEGEND: . r t I REGULAR BUDGET '!:/ I UNDP/TA AND SF Y --- TOTAL BUDGET 4.00 J.- ,. /' ------____ "_' ____ . --.-.. -~.-----,-- .---.--~.---~- / c .... ",. ~ , 3.00 ~ .' r , .• 7 ' ,. 2 00 r . ..-----.•.. - . ~ ~- 7 , .. ' , .. r ..... " ,. .... ' e" ,'- , ,,' , .. , , , , .- • " .- ,.' , , 1. 00 I _ __ ~::~:=>::~:~~r~~~~::/~====::==~---=~====~~:/~~--~~~ ". , .' .............. -_ .... " .;' .. ---_.----_ .... -- - ... . , ........ y_---- . ...__-. • .--__________ /.~...-"_ > , J --e-___ // -.---- .r 1 0' ~ --~1i"om5]0---,.19~-~1--~~-~-----o 19;)2 1953 19:54 195:) 19f,G 195'7 l~:)g 19G9 10GO 1%1 1i):32 1963 19&1 1965 19M 1907 19i;5 .!/ F .Lgun:$ extrac.ted frorn ~Cficif},l_~~_ No:~ . ) 34. 41, 4'i . .')4. 62. 70 7&. 85, 93 f 101. 109, 117, 126. 134 142, 150. 159. 167 and rn: ~ (Financial Reports and He ports of the Exte.rnal AuJi':or to t!le \\'orld Health As:-etnbly). 2/ Irl<_~lildes Volumary fund for 1:':~'3lr!; Pronwrioo. FUD.us-i:-:-Trust anli P.dr;,bL!:.sable ;'~unJ$. _. . ~/In.~~~ludc5 the ~;NDP/SF con1poncn.l oi:1ilgation ()f $1728 in l~GG_ $GG 41'l tn 19Cr::' a:-::d $287 073 in 1968~ ! ~ ~ " , • 'ell!: ~~ 'S2 ~ 'vi •• WPR/RC20!3 page 93/94 TABLE OF OBLIGATIONS INCURRED BY THE WORLD HEALTH ORGANIZATION WESTERN PACIFIC REGIO~ 1950-1968 \~?l:':.~_~:~~.r."~~l~ions of US Dollars) : .................. _ .................................. " ................. , ............... -" Year r····· .. · .. · .. ····· .. ·····,,····,· 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 0.32 0.39 0.46 0.60 0.62 0.74 0·75 l.05 1.54 1.94 2.15 2.19 2.44 2·59 2.84 3.14 3.58 4.05 4.39 OBLIGATIONS 0.10 0.48 0.47 0·53 0.58 0.54 0·57 0.69 0.62 0.60 0.54 0.84 0.74 0.90 0.81 1.06 -y 0.75 .0/ 1.13 21 0.32 0.49 0.94 1.07 1.15 1.32 1.29 1.62 2.23 2.56 2.75 2.73 3.28 3.33 3.74 3.95 4.64 4.80 5.52 1fFigures extracted from Official Reoords Nos. 34, 41, 47, 54, 62, 70, 78, 85, 93, 101, 109, 117. 126, 134, 142, 150, 159. 167 and 175 (Financial Reports and Reports of the External Auditor to the World Health Assembly). S1Includes Voluntary Fund for Health Promotion, Funds- in-trust and Reimbursable Funds. ~Includes the UNDP/SF component obligation of $1728 • .o/Includes the UNDP/SF component obligation of $56 417. 2!Includes the UNDP/SF component obligation of $287 073. , I SCHOOL HEALTH EDUCATION, PHILIPPINES WPR/RC20/3 page 97 1. Description and area of project In 1963, a project funded partly under the Technical Assistance component of the UNDP was formulated between the Government, UNICEF and WHO to help meet the health needs of children and youth by promoting an expanded and strengthened school health education programmu. Inter- national assistance extended from the period October 1963 to July 1968. A study made of the qualifications, teaching interests and needs of school health personnel showed the meagre health education back- ground of teachers of health. As the health of the children and youth of the country could be impaired as the result of poor nutrition and various unsafe aspects of the environment, school officials considered the health instruction of boys and girls to be imperative. Basic to the aims of the training programme in school health education was the assumption that during the formative years of the child'S 11fe, health understandings, attitudes and practices can be developed through the provision of: (1) (2) (3) (4) well-trained teachers in health education; the services of a professional health staff; a satisfactory educational programme for the child; and close co-operation and assistance from the parents and the community. In view of the foregoing situation, the project initiated a train- ing programme in school health education with the Department of Health, the Department of Education, the Institute of Hygiene and the Graduate School of the University of the Philippines, the Philippine Normal College and other agencies concerned with improving the physical, mental and social well-being of schoolchildren. The primary objective of the programme was to intensify the Government's efforts to mobilize the services of the Department of Health and Department of Education, school wPR/RC20;' page 98 administrators and olassroom teaohers through in-servioe. pre-service and post-graduate training in sohool health eduoation while the immediate objectives were the improvement and development of health instruction materials and aids and the promotion of a more effective collaborative effort between government agencies, training institutions and community groups. 2. Methods WHO provided the services of two advisers and a short-term consultant in school health educati~n. These advisers assisted the Department of Education in establishing and strengthening organ1zationa~ units in all three of its bureaus, in the creation of an inter-departmental advisory committee oomposed of representatives of the Health and Education Depart- ments to plan, implement, supervise and evaluate the ongoing school health education programme; and in developing training for school administrators, teachers and health personnel. Assistance was also given in the prepara- tion of school health education teaching materials and aids through a nationally-convened school health curriculum workshop that developed a series of twelve health instruction guides for teachers to use in elementary and seoondary sohools and colleges. WHO and UNICEF assisted with the establishment of health education training laboratory facilities at the University of the Philippines. These were designed to train health teachers to make their own health teaching aids using readily available and inexpensive local materials. Seven WHO fellows made up of health instructors of teacher training institutions and national-level administrators of school health education undertook advanced studies abroad. UNICEF supported the training of school and health personnel through undergraduate and graduate programmes, regional workshops, sUDIDer insti- tutes, extension courses, and the establishment of library and teaching laboratory facilities and pilot schools, by providing stipends, honoraria, equi}Xllent, supplies and other subSidies amounting to a total of $108 200 for the seven-year period. ... WPR/RC20/3 page 99 Techniques employed in training activities for school administrators, teachers and health personnel included an analysis of health problems and needs found in local communities where these personnel worked; securing the participation of schoolchildren, parents and the community in plan- ning and carrying out action programmes designed to overcome identified problems; the integration of health concepts and content throughout the curriculum of schools; special health classes and other activities for promoting understanding and the personal and communal action necessary to improve health. 3. Work accomplished School health education service units staffed by qualified personnel have been established and are now engaged in implementing the school health education programme in the Bureaus of Public, Private and Voca- tional Schools of the Department of Education. Over 3500 school and health personnel from all parts of the country received speCial training under the seven-year programme. Health educa- tion is now established as a required course in all teacher training institutions. Programmes of study in which school health education is a major or minor subject are now offered at undergraduate and graduate levels in the leading teacher training colleges. The Government has established an inter-departmental 'committee to co-ordinate the efforts of the Departments of Education and Health so that their combined resources may make a full impact on the health status of children and youth, through improved and expanded school sanitary faci- lities, health services, health instruction in the classroom and school- community co-operation for community health development. The project has developed health instruction guides for teachers for elementary, secondary and college levels. These will soon be avail- able to some 200 000 school teachers who serve the 8 000 000 school- children and youth of the country. One of the dimensions introduced into the school health programme has been school-community co-operation for health. This is an endeavour WPR/RC20/3 pagelOO of the sohool to work closely with parents and community agencies, both official and voluntary, for the improvement of the health of pupils. This co-operation (or co-ordination) has been implemented by the forma- tion of school health councils in the schools where health needs and problems are identified, priorities set and action programmes formulated and implemented. The Government has progressively taken over full responsibility for the activities initiated with WHO/UNICEF assistance and e:ll1pansion is in progress. The national programme is designed to mobilize the resources of the over 3500 persons who received special training under this project, over 7000 qualified public health staff of the Department of Health and over 200 000 school teachers, who, along wit!! parents, and community, leaders, have joined together' as a massive "school health team". to take'con- certed action in overcoming the extensive health problems of children and youth. 4. Suggestions for follow-up In view of the extensive resources the Government has put into this project, with assistance from WHO, UNDP and UNICEF, it would be useful to determine the future progress and impact of the programme by making a continuing assessment of the directing and implementing machinery respon- sible for carrying on and developing further this important activity. In addition, periodic reviews of the evidence of progress, using such indices as the number of schools with trained school-health teachers and the distribution and degree of utilization of health instruction guides and materials, should be considered. Finally, it would be most useful to obtain a picture of the continuing impact of the programme, through the application of its school-community action programme philosophy, by making a long-term periodic follow-up of select and representative communities where school-community health programmes have been inaugu- rated with a baseline study, and where there has been extensive school and community participation in identifYing and solving community health problems through action programmes. • •• .. • .. ., PART VI. PROJECT LIST ~ .. WPR;RC20/J page 102 PROJECTS m OPERATION TlUs part of the Report contains a list of the projects - country and inter-country - that were in operation during the Whole or part of the period from 1 July 1968 to 30 June 1969. Continuing projects for which the only assistance given during the period was technical advice from the Regional Office are not shown. In country projects, the purpose for which the g~vernment under- took the project is stated. Under the heading "Fellowships" are shown those fellowships awarded during the same period that do not form part Of assistance to a larger project. The starting date of each project is shown, between brackets, after its title, the finishing date being also shown tor completed projects and, where possible, for uncompleted projects. Names of co-operating agencies, whether or not they have contributed funds, are given, between brackets, after the source of funds. The abbreviations used include the following: R - regular budget; UNDP/TA - Technical Assistance component of the United Nations Development Programme; UNDP/SF - Special Fund component of the United Nations Development Programme; AID - United States Agency for International Development. other abbreviations are explained in the list on page ii. .. WPR/RC20!3 page 103 Australia 0200 Fellowships R: Child health and child health services. (eleven months), health statistics (three months), occupa- tional health - L:dustrial medical services and ergonomics (seven months), teacrung and research (three months), public health administration - use of the computer in total hospital and medical services management (three months), venereal disease control (three months) • British Solomon Islands Protectorate 0003 Education Nov. 1959 - Aug. 1 8 R UNICEF Pacific Commission) The aim was to develop training programmes to prepare nursing personnel for hospital and health services in the Protectorate. I-lHO provided a nurse educator and three fellowships. The project was implemented in two phases. During the first phase, from 1959 to 1966, a basic programme of general nursing for nurses and medical assistants at protectorate registration level was established and developed; it included clinical and public health experience adapted to the conditions in the islands. Beginning in 1959, post-basic, supplementary and refresher courses were held for nursing and midwifery personnel and medical assistants; in 1965 responsibility for such courses was transferred to the rural health services project (British Solomon Islands Protectorate 0007). A Nursing and Midwives Board was established, with responsibility for setting standards for nurse training, approving curricula for nursing and mid- wifery education, setting qualifying examinations and registering qualified personnel. Nursing services in hospitals were improved. During the second phase, 1967-1968, emphasiS vms placed on the integ- ration of public health into the basic curriculum and the development of field demonstration and practice areas for students. Forty-three nurses and fifty medical assistants completed the basic nursing course during the period of the project, and seventy- six stUdents were in training \~hen it ended in 1968. A larger enrol- ment is required to meet future needs for nursing personnel. The WPR!RC20/3· pagel04 developnent of the training programme has been retard.e9. bY financial difficulties and by several other factors, but the recent ;expansion of hospital and health service facilities should improve the situation as regards practical training. Bd tish Solomon Islands Protectorate 0200 Fellowships R: Basic nursing (t\'lelve months), general nursing (twelve months). To develop the operational, technical and administrative facili- ties of the malaria and public health services, so that a country-wide malaria eradication programme can be implemented later. This programme supersides a malaria eradication pilot project carried out from 1961 to 1964. British Solomon Islands Protectorate 0 02 Rural Health Services Oct. 1965 - 1969) UNDP/!,A UNICEF To expand and strengthen the network of local health services and train auxiliary health personnel. Brunei 0003 Malaria Eradication Programme (Jan. 1966 - 1970) R To eradicate malaria from the country. This follows the malaria pre-eradication programme started in 1962. Since December 1967, WHO assistance has been lim1 te<ll to fello,",- ships and technical advice from the Regional Office. Brunei 0200 Fellowships R: Mental health - practical aspects of psychiatry (three months). WPR,fflC20/, page lOS Cambodia and Paramedioal WHO provided a consultant to evaluate the existing courses and training programmes in preventive medicine and public health in the Royal Faculty of Medicine and to assist the faculty authorities in developing a teaching programme in this field. Tb survey and evaluate training resources, and prepare short- term and long-term plans for meeting the nursing needs of the health services; to organize and improve nursing services and education pro- grammes throughout the country; and to review nursing legislation, personnel policies, and terms of service. Cambodia 0024 Environmental Health AdviSOry Services (Sept. 1968 - 197') R To establish a public health- engineering unit in the Ministry of Public Health and co-ordinate its work with the work of other units of the Ministry; and to draw up and implement country-wide environmental health programmes. Cambodia 0200 Fellowships R: months). Public health administration (twelve ent To build up administrative and operational facilities to the level required for the implementation of a full malaria eradication programme; to complete an epidemiological survey of malaria; and to train national technical staff for the eradication programme. The pre-eradication programme continues the antimalaria operatiOns with which WHO has been assisting (under project number Cambodia 0001) since October 1950. WPR/RC20/3 page 106 R UNICEF To set up the nucleus of a national tuberculosis control service with emphasis on preventive and public health work: and to carry out an effective control programme, so as to reduce, and finally to eliminate, tuberculosis as a major public health problem. WHO provided a consultant to review the existing treponematoses control service, including the facilities for laboratory ~xamination, and to make an assessment of the progress of the yaws control project, which was assisted by vlHO between 1959 and 1964, particularly as regards its integration into the basic health services. Cambodia 0505 Epidemiology and Health Statistics (March 1966 - 1972) R To establish in the Ministry of Public Health an epidemiological and health statistical service which will be responsible for planning and guiding national disease control programmes; to study local epidemiological patterns of prevailing causes of morbidity and mortality as a basis for the formulation of such programmes; to reorganize the health statistics systems in hospitals, health centres, dispensaries and other institutions providing health care; and to train personnel of the health services in epidemiology and health statistics. Cambodia 0507 Health Laboratory DevelOpment (Sept. 1968 - 1971) UNDPjrA To improve the organization and technical services of the pro- vincial laboratories and to train staff. To organize a system of public health nursing and midwifery WPR/RC20/3 page leY7 administration and services to meet the changing health needs and resources of the country. Cambodia 0509 Maternal and Child Health Advisory Services (First phase: Jan. - May 1960; Second phase: May 1962 - Aug. 1966; Third phase: Oct. - Nov. 1968) R UNICEF WHO provided a consultant for three weeks to help to evaluate the project, which was assisted by WHO between 1952 and 1960 and again between 1962 and 1966 (under the number Cambodia 0004), and to advise on its future development. (FAO) To improve nutritional levels in the community; to study the etiology and epidemiology of nutritional diseases and deficiencies affecting the population; to establish patterns for practical nutrition progrannnes that can be adapted to any part of the country; and to train national staff for their implementation and evaluation. China 0020 Mental Health Programme, Taiwan (First phase: Oct. 1955 - Dec. 1964; Second phase: March- May 1965; Third phase: Dec. 1966 - Dec. 1968) R (AID) (Asia Foundation) The aims \'lere to make a survey of mental health needs and facili- ties; to establish a mental health progrannne, with special emphasis on child guidance and community mental hospitals; to carry out research; and to train local professional and auxiliary personnel. Between October 1955 and December 1968, six WHO consultants in psychiatric nursing, psychiatric epidemiology and statistics, child development, psychiatric research and psychiatric social work, were provided from one to two months. A 1'lli0 psychiatric nurse was provided from January 1960 to December 1964 and a WHO psychiatric social worker from December 1966 to December 1968. Twenty-five fellowships were awarded and technical literature was supplied. WPR/RC20/3 page loB The project was based in the Department of Psychiatry and Neuro- logy of the National Taiwan University, Taipei. An epidemiological survey of mental disorders in connnunities \'las made and a children's mental health centre was set up in Taipei. Teaching and research were carried out among patients in hospitals attached to the Depart- ment and to this centre. As more staff became available, teaching of undergraduate medical and nursing students was extended to a medical school and schools of nursing in other parts of Taiwan. Pilot studies on problems that can be handled by mental health counselling were made in a primary school in Taipei, and teachers from the school were trained at the Taipei centre as school counsellors in mental health. Similar training of teachers of another school was started in 1964. Psychiatric nursing has been included in nursing training progrannnes. The most successful result of the project was the strengthening of the Department of Neurology and Psychiatry, which is now a very efficient teaching and research institution, knOl~ and accepted inter- nationally because of the high standard of its faculty and scientific work. Among other activities, the Department participates in the international study of schizophrenia, sponsored by WHO. In recent years the need has become obvious for an extension of mental health services to the community. In this phase of develQpment the Department of Neurology and Psychiatry has given and is still giving valuable leadership. At present it is aSSisting the Provincial Health Administration and city muniCipalities in the establishment of departments of psychiatry in the provincial general hospitals, which are located in each county throughout the island, and in city general hospitals. For this purpose, two mental health committees were appointed in the autumn of 1967, the first by the Provincial Health Administration, and the second by the ~1unicipal City of Taipei. The committees are concerned with the planning and establishment of addi- tional mental health facilities throughout the island over the next ten years. • WPRjliC20/3 page 109 To strengthen the training at the Institute of Public Health, particularly in epidemiology and public health practice. To carry out an island-wide study of the prevalence, distribution and relative gravity of trachoma, and of environmental and other factors influencing the transmission of the disease; to develop a com- prehensive control programme based on existing health services with the objective of reducing trachoma to a level at which it will no longer be a major public health problem, and of preventing disabling complications and sequelae. UNICEF To follow up the recommendations made in 1961 by a WHO team of water supply consultants in connexion with the improvement of commu- nity water supply and sewerage; to review and amend as necessary national and provincial legislation pertaining to community water supplies; to develop techniques for financing and administering water supply and sewerage programmes, so as to make the programmes self- supporting; to stimulate regional planning of water supply schemes; to i~~tiate training programmes; and to co-ordinate activities relating to community water supply with other sectors of the nation's economy (industry, agriculture, etc.) which are directly concerned with the use and allocation of water resources. China 0045 Leprosy Control, Tahlan (Nov. 1965 - July 1970) R To establish a training and demonstration pilot project for rehabilitation of leprosy patients, and to prepare a plan for a national leprosy control programme. WPRjliC20!3 page 110 China 0046 Conummicable Disease Control Centre, Taiwan (July 1965 - 1971) R To set up in the Provincial Department of Health an epidemio- logical service that will include laboratory facilities: to study local epidemiological patterns of prevailing causes of morbidity and mortality, in order to establish a basis for planning specific disease control programmes: and to develop procedures, suited to local con- ditions, for the investigation, diagnosis, control and prevention of the most prevalent communicable diseases. China 0049 ~sical and Occupational Therapy, Taiwan (Dec. 1 - 1972) R To organize at the National Taiwan University colle~ate courses for training physical therapists and occupational therapi!sts and to improve professional standards. China 0050 Taiwan Provincial Junior College of Nursing (June - Sept. 1969) R WHO provided a consultant to assist the Faculty to s~udy and appraise the five-year educational curriculum of the Jun;Lor College of Nursing and Midwifery with special emphasis on the midwifery aspects of the curriculum; to appraise the clinical and public health fields utilized by the students in the practice of midwifery; and to formulate a plan of action aimed at the strengthening of nursing and midwifery education and practice. China 0052 Virus Laboratory Services, Taiwan (Sept. 1967 - June 1969) R The aim of the project was to develop the virus diagnostic laboratory services in the communicable disease control centre and to strengthen the services in the peripheral laboratorie$; to promote surveys and other related studies in order to assess the prevalence and nature of virus infections, especially among children, so as to enable the health authorities to establish a basis for formulating WPR,lEC20/3 page III specific disease control programmes; and to assist in the training of local personnel in virus laboratory work. WHO provided a virologist, a consultant in Japanese encephalitis vaccine production, two fellow- ships and supplies and equipment. Particular attention was given to the building up of diagnostic services in relation to enteroviruses, such as poliomyelitis, and arboviruses, such as Japanese encephalitis. The laboratory services were improved, advice was given in connexion with the virological and serological surveys being carried out by the Provincial Health Depart- ment and epidemiological information gathered on these two diseases. National personnel were trained in various aspects of virus laboratory work, including the production and quality control of Japanese encephalitis vaccine. As a result of the assistance given, the Taiwan Vaccine and Serum Laboratory can now produce Japanese encephalitis vaccine on a limited scale. The diagnostic virus laboratory service for poliomyelitis and Japanese encephalitis is now well organized and operating satisfactorily. In June 1969, the assistance provided tnder this project was amalgamated with that given to the Communicable Disease Control Centre (China 0046) and the WHO virologist was trans- ferred to the combined project. To strengthen the Nursing Division of the Provincial Department of Health and increase its participation in the development of health programmes; to improve nursing organization, administration and super- vision; to carry out studies in nursing practice; and, in collaboration with the education authorities, to improve the programmes and the practical training facilities for student nurses. WHO provided two consultants (in hospital administration and medical care), each for three months, to study the hospital administra- tion system and related needs and to assist in preparing plans for further development. WPR/RC20/3 page 112 China 0057 Cheng Hsin Rehabilitation Centre, Taiwan (Nov. 1968 - April 1969) R WHO provided a consultant who assisted the Director ~f the Cheng Hsin Rehabilitation Centre in the establishment of occupational therapy services and in the in-service training of occupational therapy staff for the centre. Advisory services were also provided to the National Taiwan University Hospital in connexion w~th the , planning of a training programme for occupational therapists at the School of Allied Medical Professions. June - Nov. 1 WHO provided a consultant to assist in determining the nature and extent of occupational health and industrial hygiene problems and the factors responsible for them, assessing the facilities and resources for their control, reviewing the relevant legislation and! regulations, strengthening the occupational health and safety services, and examining problems of air and water pollution caused by industry. Consultant services were previously provided under this pI'oJect in 1965-66 and 1967, and further assistance is planned. China 0061 School Dental Health, Taiwan (Jan. - April 1969) R WHO provided a consultant who, in co-operation with his national counterpart, made an evaluation of the progress of the school dental health progranJl1e. which is receiving supplies and equipnent from UNICEF. China 0064 Urban Environmental Planning and Control, Taiwan (Jan. - Dec. 1969) UNDP!M To assist in planning a programme in the environmental sanitation aspects of urban development and in promoting liaison between the various national agencies having competence and/or jurisd1ction in this field; to assist in co-ordinating and directing activities in all • • WPR/RC20/3 page 113 aspects of comm\IDity environmental engineering, including public water supply, sanitary sewerage, surface-water drainage, solid wastes collection and disposal, and air and water pollution control; and to advise on programming, formulation of planning and design criteria, individual training, management, financing, administration, legisla- tion and other relevant matters. for the Greater Taipei Area To assist (i) in the preparation of a master plan for sanitary sewerage for the Greater Taipei area, including interim, first stage and long-term proposals, so as to facilitate the provision of sanitary sewers and sui table means of sewage disposal in appropriate stages; (ii) in the training of local personnel in planning, design, construc- tion supervision and management, operation and maintenance of the sewerage system; and (iii) in the preparation of related legal, organizational, managerial and financial bases for the operation of the system. China 0200 Fellowships R: Food hygiene and inspection (twelve months), hospital administration (three for three months), industrial waste disposal ( twelve months), nurSing education (ttolel ve months), public health nursing administration (twelve months). Cook Islands 0200 Fellowshi~s R: General paediatrics and medicine (six months), medical course leading to a Diploma in Surgery and Medicine (one for tl'1elve months, two for twelve months - extension of previous awardS), medicine (twelve months - extension of previous award), nursing (two for twelve months), surgery (six months). WPR,lRC20/3 page 114 The aims were to improve health education work in the health services and teaching institutions and to develop the health education aspects of training programmes in the school of medicine, the schools of nursing and other institutions. WHO provided a health education adviser, two fellowships and some literature. At all stages of the project, the health education section of the Medical Department was represented by a trained health educator. Health education training needs at the Fiji School ot: Medicine, the Nuffield Department of Preventive and Social Medicine, the Nuffield Department of Environmental Hygiene, the Nursing School, the Public Health Nursing School and the Nasinu Teachers' Training College in Suva were studied and assistance given in planning andideveloping the curricula •. Health surveys, studies and research were carried out with a view to establishing the SCientific basis for developing health education training. Special courses of study in health education and the related social science disciplines were developed. Health educa- tion demonstration and training activities, in which methods and tech- niques could be developed and tried out and where practical field experience could be provided for the trainees, were established. The WHO adviser gave lectures in health education at the Fiji; School of MediCine, the Central Nursing School, the Teachers' Training. College and the South Pacific Training Centre. Teaching aimed to convey the background of health education in the wider context of rural and community development and dealt with some of the PI'9blems of developing countries - such as the relation between population increase and food production, the role of public health and the place of health education in general and special pro- grammes - the role of communication, programme planning with people, evaluation and the learning process. Visual aids, to a necessarily limited extent, and group discussion methods ~lere also used. An important objective was to make the content easily understandable, • • I -~ WPR/RC20/' page 115 as well as interesting, for the very different academic levels of participants. The health education section of the Medical Department, at the termination of WHO assistance, was only slightly better off than at its beginning. The extra asset is a health educator who, while in position at the Directorate of Education, has taken over health educa- tion activities at the Teachers' Training College, Nasinu, and has given excellent co-operation wherever possible. This reduces consider- ably the teaching load of the health education section of the Medical Department. There is, however, need for an additional post if the training plans of the Government are to be realized. A further posi- tive achievement is that health education would seem to be firmly accepted by all institutions in which it is taught and there is a growing tendency to provide even more time for it in the curriculum. Fiji 0200 Fellowships R: Environmental health (six months), nurSing administration (twelve months), physiotherapy (twelve months - exten- sion of previous award), public health administration (nine months), food inspection, hygiene and handling (six mothhs). French Polynesia 0004 Nutrition and Dental Health Education (March - Nov. 1968) R UNICEF WHO provided a consultant for eight months to assist in strengthen- ing the nutrition work of the health services, especially the maternal and child health and dental health services. Studies were made of food patterns and of socio-cultural and other factors affecting the nutri- tional state of the population, as well as of nutritional factors affecting dental health, and recommendations submitted on nutrition measures that would help to preserve dental health. Assistance was also given in nutrition education and training work and in promoting co-ordination among various governmental and non-governmental agencies concerned with nutrition. Consultant services were previously provided under this project in 1960, 1963-64 and further assistance is planned. WPR/RC20/3 page 116 French Polypesia 0200 Fellowships R: Environmental health (twelve months) • Nurs Education UNICEF To develop training programmes for preparing nursin~ and midwifery personnel for the hospital and health services and to strengthen the public health nursing aspects of the basic curricula of the School of Nursing attached to the Central Colony Hospital, Tarawa. Gilbert and Ellice Islands 0008 Communicable Diseases - General Activities: Advisory Services (Dec. 1968 - 1971) R To study the epidemiology of the main communicable diseases, particularly diarrhoeal diseases, with the end in view of determin- ing the most appropriate measures for their control. Hong Kong 0200 Fellowships R: Operating theatre and nursing tech- nology for open heart surgery (six months). Japan 0023 Medical Rehabilitation (Oct. 1962 - Aug. 1963; May 1964 - 19(9) R To raise the standard of teaching at the physical and occupa- tional therapy school set up in 1963; to give in-service training to physical and occupational therapy personnel; to train a nucleus of senior phySical and occupational therapists, in conformity with inter- nationally accepted standards, for teaching posts in other similar schools to be established in the future; to modify procedures for the admission and classification of patients at rehabilitation centres to enable rehabilitation measures to be undertaken more quickly. Japan 0200 Fellowships R: Automation in hospital management (three months). community treatment plants for the disposal of sewage and nightsoi1 (three months), control of addiction-producing drugs (three __ .r • WPR/RC20/3 page 117 months), development and improvement of prosthetic appliances (three months), health laboratory services (three months), health promOtion and development of physical fitness in the younger generation (three months), health services for the aged (t~1O months), management and operation of cerebro- and cardiovascular disease hospitals (three months), maternal and child health (three months), medical rehabilita- tion nursing (twelve months), medical specialist system (three months), mental health (one for three months, one for four months), procedures for the manufacturing or importation of drugs (tlu.'ee months), nursing education (one-and-a-half months), organization of visiting nurse services (three months), prevention and control of cerebro- and cardio- vascular diseases (three months), production and use of measles vaccine in mass immunization programme (three months), public health adminis- tration (two for twelve months), public health aspects of housing (three months), quality control of biological products (three months), role of the community organization in maternal and child health services (three months), role of health insurance in national health programmes (three months), statistics on perinatal death (three months), vital and health statistics (six months). Korea 0003 Maternal and Child Health Advisory Services (Feb. 1968 - 1973) R UNICEF To develop a national programme to strengthen maternal and child health services throughout the country as part of the general health services and to integrate family planning into the programme; also to train health personnel in maternal and child health. Korea 0004 Leprosy Control (First phase: Nov. 1961 Dec. 1966; Third phase: (Order of Malta) (DAm-I) _ June 1966; Second phase: Oct.- April - Aug. 1968) UNDP/l'A UNICEF To expand the leprosy control programme. WPR,fflC20/3 page 118 Malaria Pre-eradication Pro ramme 1962 - Dec. 19fO R To survey the malaria situation, organize a national malaria service and train staff, so as to enable an eradication programme to be planned and implemented. This programme follows the pre-eradication survey that began in June 1959. To strengthen the Department of Training and Sunveys of the National Institute of Health (formerly the Natimlal Institute for Public Health Training) which trains staff for the looal health services. Korea 0019 Tuberculosis Control (First phase: March 1962 - Dec. 1966; Second phase: March- Oct. 1967; Third phase: Aug. 1968 - 1972) UND.t>/l'A UNICEF To develop an effective and comprehensive national tuberculosis control programme, so as to reduce, and finally to eliminate, the disease as a public health problem. Korea 0021 NurSing Education (Aug. 1968 - 19(2) R To develop a nursing section in the Ministry of Education; and to formulate and implemant short-term and long-term plans for strengthening and developing nursing education. Korea 0025 Local Health Services (March 1963 - 1973) R UNICEF To develop the public health services in the demonstration province (Chungchong Namdo) and the local health services in other provinces; and to train local health personnel at the Division of Training of the National Institute of Heal tho • WPR/RC20!3 page 119 To develop and strengthen the teaching faculty of the School of Public Health, Seoul National University. and Statistics Adviso Services R Tb organize and develop a central epidemiological service and a disease intelligence net~lork in the Ministry of Health and 30cial Affairs; to improve the collection, recording and utilization of health statistics; and to co-ordinate health laboratory services with the epidemiological services. Korea 0034 National Health Plannj.ng (Sept. 1966 - Feb. 1967; Aug. - Dec. 1968; April - May 1969) R WHO provided a consultant to assist the Ministry of Health and Social Affairs in making a general appraisal of the total health man- power resources available, including their deployment and utilization, and the adequacy and needs of all institutions and facilities avail- able for the education and training of health personnel. This followS the visit of a consultant in 1966 and 1967 to help in formulating a national health plan. Korea 0041 Assistance to Education and Tl'aini of Health and Medical Workers Jan. 1969 - 1973) R Tb provide a consolidated programme of assistance in the educa- tion and training of health and medical workers Lpreviously provided under projects Korea 0027 (School of Public Health, Seoul National University) and Korea 0015 (National Institute of Health.27, including assistance to basic and post-basic training for physicians, nurses, sani tarians and other health ,,/orkers. WPR/RC20/3 page 120 Korea 0044 Pre-investment Surv of the Nakto April 1969 - March 1970 UNDP /SF (FAO) River Basin WHO is providing a sanitary engineer who is serving as adviser to this FAO-assisted project. He is assisting the project on all matters pertaining to the provision of environmental health services and a sanitary infrastructure for resettlement scheme~. Attention is also being given to the question of stream pollution and the alloca- tion of resources to cover the sanitary aspects of the project. Korea 0200 Fellowships R: Dental health administration (five months), dental public health (twelve months), DPT vaccine production (one for three months, two for t~lelve months), health education (twelve months), industrial and occupational health (two months), quarantine services (three for three months). Laos 0012 NurSing Education (March 1962 - 1976) UNDP/l'A UNICEF (AID) (Asia Foundation) (Colombo Plan) To set up a school of nurSing and midwifery for training personnel for the country's hospital and health services, which are to be extended and improved. 1 School of Medicine 7; Sept. 1 - 1978) R To strengthen the faculty of the Royal School of iMedicine. Laos 0018 Rehabilitation of the Physically Handicapped (Oct. 1967 - 1972) UNDP/!,A (Bureau of Technical Assistance Operations) To assess the extent of the problem of the physic~lly handicapped; plan and operate rehabilitation facilities and train staff for them , and review legislation dealing with the physically handicapped. Laos 0502 Institute of Public Health (Oct. - Dec. 1968) R WPR/RC20/3 page 121 WHO provided a consultant who assessed health manpower needs and resources for training health personnel and advised on the possibility of establishing an institute of public health. Laos 0503 Development of Health Services (Nov. 1968 - 1978) UNDPj'rA To plan and develop the general health services at provincial and district levels, wi th particular attention to the Province of Vientiane which will serve as a pilot area; and to assess the health manpower requirements for the pilot area and plan measures for meeting them. Laos 0504 Malaria Control (Jan. 1969 - 1978) R To build up the administrative and operational facilities of the Central Malaria Service to the level required with a view to carrying out an antimalaria programme, in the first place, in the Vientiane Plain. Or anization of Medical Care - Aug. 1969) R WHO provided a consultant to prepare a draft plan for the provision of medical care through hospital and out-patient care services and to advise the Government in establishing rural and urban hospitals as an integral component of the comprehensive health services being established by the development of health services project (Laos 0503); to study the hospital legislation now in effect and the possibility of establishing a system of hospital regionalization; and to recommend the type of hospital standards, facilities and personnel required to carry out such a programme. WPR/RC20/3 page 122 ~P/l'A. UNICEF To establish a public health laboratory service and train labora- tory personnel. Laos 0511 Nutrition Advisory Services (Dec. 1968 - 1971) R UNICEF (FAO) To improve nutritional levels in the community and to co-ordinate. under a national nutrition policy. all food and nutrition activities carried out by international and national governmental and non- governmental agencies. Laos 0 12 Vital and Health Statistics Adviso Services (March 1968 - 1978 R To establish a vital and health statistics service in the Ministry of Public Health and to train staff. Laos Foundation) To ascertain the principal maternal and child health needs in Laos and set up training programmes; to expand and improve maternal and child health serVices as an integral part of the general health programme. Mala~ia 0020 Malaria Eradication Programme, West Malaysia July 1967 - 1979) R To eradicate malaria from the country. 'Ihis follows the malaria pre-eradication programme started in July 1964. Oct. - Dec. 1968) WHO provided a consultant to assist in assessing the school health education programme and in planning for its further develop- ment. with special attention to health education in teacher training • WPR/RC20/3 page 123 and in-service training for education and health personnel responsible for school health, and its incorporation in the curriculum of schools a t all levels. r-1al~;ysia 00.35 Streng;thening of Health Services and Traiw: of Health Personnel (First phase: Jan. 1964 - Aug. 1 ; Second phase: Sept. 1968 - 1978) R UNICEF First phase: To strengthen and expand the rural health services in East and West Malaysia and to train personnel according to a con- solidated plan, which includes phasing of expansion and developnent of uniform standards throughout the country. Second phase: To undertake health practice research with a view to developing suitable methods and practices for the efficient orgar.iza- tion and administration of the local health services. From the know- ledge and experience gained, to formulate suitable recommendations for the establishment of a health policy and programme for local health services development under the Second Five-Year Development Plan. Malaysia 0040 University of Malaya - (Sept. 1965 - 1973) R To strengthen the teaching staff of the Faculty of Medicine of the University of Malaya, particularly in the fields of preventive medicine, public health, nursing and medical recording. Malaysia 0041 Environmental Health Advisory Services, East ~ysia (Jan. 19bb-l97l) R UNICEF To improve the general level of community sanitation and personal hygiene in the rural areas of East Malaysia; to develop sanitary facili- ties suitable for villages and small rural communities, including sanitary latrines and water supply systems; and to train village workers in sanitation techniques, with emphasis on rural water supplies, excreta disposal, vector control and food sanitation. WPR/RC20/3 page 124 To eradicate malaria from Sabah. The eradication programme follows antimalaria operations for which vmo has provided assistance since July 1955. To eradicate malaria from Sarawak. This follows the malaria pilot project started in 1952. Malaysia 0055 Applied Nutrition (First phase: Nov. - Dec. 1967; Second phase: Sept. 1968 - 1973) R To plan and carry out nutritional surveys in a pilot area where an applied nutrition programme is being launched, develop nutrition education and supplementary feeding programmes, and train the person- nel needed for implementing and evaluating the health aspects of the programme. Malaysia 0070 Tuberculosis Control (Feb. 1968 - 1971) R UNICEF To develop a practical, comprehensive and integrated tuberculosis control service within the general public health services in all states; to train various categories of personnel for the service; to study the epidemiological patterns of tuberculosis in the country; and to continue field trials in order to find more effective methods, applicable to local conditions, for the public health control of the disease. ur, WHO provided a team consisting of a sanitary engtLneering consul- tant and an administrative and financial consultant tp review and assess sewerage schemes for Greater Kuala Lumpur and Ipoh. The proposal for a master plan for regional sewerage development in Greater Kuala Lumpur ". WPR/RC20/3 page 125 was analyzed and a report submitted setting forth technical details and a justification for a pre-investment study to produce a Master Plan. The objectives of the pre-investment studies were defined and appropriate terms of reference established. The cost of the pre- investment studies was also estimated and a plan of action and time- table of work recommended. In Ipoh, the technical aspects and costing of the sewerage scheme design, and the method, feasibility and adequacy of municipal revenues for financing the construction of the scheme were reviewed. Malaysia 0200 Fellowships R: months) • Nursing school administration (twelve New Hebrides 0004 Tuberculosis Control (June 1964 - Aug. 1968) tlNDP/'I'A UNICEF The aim was to expand and improve the tuberculosis control servi.ce; to carry out a systematic tuberculosis testing and BeG vaccina- tion campaign throughout the Condominium; to treat all cases, mainly at home, under supervision; to take measures to protect the healthy; and to co-ordinate the BeG vaccination campaign with other programmes, such as those of vaccination against diphtheria, pertussis and tetanus. vlHO provided a medical officer and a public health nurse. The initial phase of the project included systematic tuberculin testing of the whole population, BCG vaccination of Mantoux-negative individuals, microscopic examination of sputum for acid-fast bacilli from tuberculin reactors with productive cough, and hospitalized treat- ment of the infectious cases discovered. During this period a total of 61 623 persons were seen; 32.3% of the 52 613 \~hose tests were read had a positive reaction. Annual visits have been made by a mobile team to each village in the territorY since July 1965. Direct BeG vaccination was given to newborn infants and persons under 25 years of age who WPR/RC20;:' page 126 were absent during the case-finding campaign. Those per~onswi th a productive cough were microscopically examined. During the second annual review, which began in 1967, the mobile team also gave immunizations against other communicable diseases. During the four years of the project, a total of 52 389 persons were vaccinated with BeG. This represents a 67% coverage of the population or almost 90% coverage of the susceptibles. During the same period, a total of 76 bacillary cases were discovered, 59 of whom had not been known previously. Up to August 1968, 80% of the population had been vaccinated against smallpox, more than 75% of the pre-school children had received triple antigen, 90% of the school- children and nearly 65% of the women between 15 and 45 years of age had been vaccinated against tetanus. The project was redefined in September 1968 into a general health services project. The experience gained confirms the practicability of employing a disease control campaign as a spearhead for the develop- ment of basic health services. It also shows that a fairly effective tuberculosis control service can be organized without sophisticated equipment, such as a mobile X-ray unit, provided properly trained auxiliary workers and some funds are available. The annual expenditure for the operation of this project is estimated to have been US$o.24 per capita. New Hebrides 0007 NurSing Education (Feb. - May 1969) R vlHO provided a consultant to assist in assembling and analyzing data and information as a basis for assessing nursing educational requirements in the Condominium, and in formulating the objectives and developing the curriculum of the nursing school attached to the hospital under the jurisdiction of the British authorities. New Hebrides 0200 Fellowships R: Post-graduate studies in surgery (twelve months). f .... -""':,- New Hebrides 0500 Development of Health Services (Jan. 1969 - 1973) R WPR/RC20/3 page 127 To plan and develop the general health services, with particular attention to the peripheral health services; to establish sui table methods and practices for the efficient operation of the rural health programme with particular reference to its involvement in maternal and child health, tuberculosis control, antimalaria activities and environ- mental sanitation; to plan and carry out in-service training for para- medical and auxiliary personnel; and to establish field practice areas for the training of undergraduate paramedical staff. New Zealand 0200 Fellowships R: Dental public health administration (four months), medical care services (four months), nursing administra- tion (four months), pharmacology and therapeutics (four months), public health control of drugs and poisons (four months), public health nursing (four months). Niue 0200 Fellowships R: Obstetrics and g-;naecology (six months), surgery (six months). Papua and New Guinea 0200 Fellowships R: Adminietration of health services in rural areas (two for three weeks), ohild ~alth (six months), environmental sanitation (five months), malaria eradi- cation (four for three weeks and two for eight weeks), maternal and child health (four months), medical auxiliary training (six months), tuberculosis control (two months). Phili UNDPjTA The aim was to develop and strengthen the training of school health and educational personnel, and to supply the necessary materials so that teachers and health specialists might together provide adequate health education for young children and adolescents. (See page 97.) WPR/RC20!3 page 128 Philippines 0075 Social Paediatrics (Aug. 1963 - Feb. 1967; Dec. 1968 - Jan. 1969) R WHO provided two consultants (in maternal and child hea~th and public health nursing) to assess the development of the maternal and child health services since the previous visit of a WHO consultant in 1966 j. and to advise on the further development of materna,l and child health care at central, provincial and local level. Philippines 0076 Laboratory Management and Administration (First phase: Feb. - April 1962; Second phase: June - Aug. 1964; Third phase: Dec. 1966 - Sept. 1967; Fourth phase: Nov. 1968 - Jan. 1969) UNDP/!,A UNICEF WHO provided a consultant to review the progress made in the organization and administration of the Bureau of Researc~ and Labora- tories, and to submit recommendations on the technical and administra- tive requirements of the central and regional health laboratories, and on a system for providing consultative and reference services to the laboratories of the local health and medical services. Consultant services and fellowships were provided under this project between 1962 and 1967. Philippines 0087 Food Sanitation (March 1967 - April 1968; Jan. - April 1969) R To improve food sanitation, including food processing, prepara- tion, handling and dispensing. Philippines 0093 Cancer Control (Dec. 1967 - Jan. 1968; April - July 1968; March oj May 1969) R WHO provided two consultants who advised the Department of Health on the development of a co-ordinated cancer control programme for the country and on the setting up of a cancer control programme in the eight health regions, beginning with a pilot demonstrati~n project in a province near Manila. They also made recommendations ~n the staff and resources needed and on training requirements. on the operation of -, • WPR/RC20~ page 129 a national tumour registry, and on the use of cytological cancer detection techniques, with particular attention to the detection. of cancer of the female genital tract. Philippines 0095 National Seminar on Urban Health Mministration (7-15 Nov. 1968) R WHO provided consultants in public health administration, occupational health and environmental health for a national seminar which made a review of modern concepts and practices in urban health administration, particularly as regards programme planning and the management and methods employed in public health practice, discussed the problems encountered in administering health services in urban centres, and considered how improvements could be effected. Philippines 0101 Dental Health Advisory Services (June - Oct. 1969) R WHO provided a consultant to make an evaluation of the progress of the dental health programme, for which consultant services were provided in 1966-1967; and to assist the Department of Health in organizing a course for dental health workers. olitan Area WHO provided a consultant for three months to advise the Government, in consultation and co-operation with national administrative and tech- nical committees,on refuse collection and disposal, on the establishment of a metropolitan district for the management of solid wastes in the Greater Manila area. Philippines 0111 Master Plan for a Sewerage System for the Manila Metropolitan Area (Dec. 1966 - 1970) UNDP/SF To prepare a master plan for a sewerage system for the Manila metropolitan area and a phased sewerage-development programme to meet the present and future requirements of the metropolitan population. WPR/RC20!3 page 130 The work includes the preparation of detailed financial and engineering studies for the first phase of development, which involves the construc- tion of the most urgently needed works. Philippines 0200 Fellowships R: Virology (twelve months). Philippines 0503 Malaria Eradication Programme (Aug. 1958 - 1976) R (AID) To eradicate malaria from the country and prevent its re- establishment. Philippines 0504 Tuberculosis Control (Oct. - Dec. 1963; Jan. 1964 - 1971) R UNICEF To examine whether existing plans to control tuberculosis, based on available data, are practical and efficient under local conditions; to examine the practicability, acceptability and economic implications of standardized tuberculosis control methods compriSing preventive, diagnostic and curative components; to provide facilities for training of various categories of health personnel and to obtain data on which sound planning of the integration of tuberculosis control activities into general health services could be based. Philippines 9506 Mental Health Advisory Services (Nov. 1949 - Jan. 1950; Jan. 1953; Feb. 1957 - Dec. 1960; Sept. 1963 - 1972) R To develop a mental health programme for the whole country. Ryukyu Islands 0200 Fellowships R: Biostatistics (twelve months), enVironmental sanitation (twelve months), public health nurSing (three for twelve months), sanitary engineering (twelve months). Singapore 0003 Nursing Education (June 1952 - Dec. 1968) UNDP/I'A The aim was to assess and to improve the standards of nursing education and nursing services. WHO provided four nurse educators and awarded fellowships. WPR,tRC20/3 page 131 In the first phase of the project assistance was given in the development of an organized midwifery teaching programme. In 1957, the WHO team consisted of one senior nurse educator assigned to assist the Principal Matron at the ministry of health level and three nurse educa- tors who aSsisted in the clinical fields: psychiatric, paediatric, and medical-surgical nursing. In 1962, assistance was strengthened when activities were combined with those of tHO other projects receiving assistance - nursing administration and practice (Singapore 0004) and midwifery education (Singapore 0006). The basic nursing education curriculum vIas evaluated and revised. Through the development of a programme of clinical teaching and selec- tive learning experiences in the classroom, and field practice under guidance and supervision, it was possible to reduce its length while improving the quality of nursing education. The revised curriculum provides a broader training with an introduction to psychiatric and public health nursing and better correlation to theory and practice. The curriculum of the assistant nurSing training course was also revised and the total training period reduced to two years. The revised curri- culum was approved by the NurSing Board in 1963. The trained assistant nurses are taking their place in the nursing team \'1ith credit. The students who have completed the ward administration course since 1965, in all about seventy, have greatly contributed to the imprOVement of nursing services and consequently to the better development of clinical experience for nursing students. The development of psychiatric nursing has been beset ~nth many problems. However, there has been some progress in this field. The inclusion of psychiatric nursing experience in the revised curriculum for general nursing training has contributed to breaking do\'/Il the prejudice to work in this field. In 1968, twenty-seven students entered the post-basic psychiatric nursing course and twenty- five assistant nurses were trained in psychiatric nursing. Full responsibility for the post-basic course in paediatriC nursing was assumed by Singapore nurses in 1967. Thirty-seven nurses have qualified WPR/RC20!3 page 132 in this field. Forty-nine sisters and staff nurses have pbtained post- basic operating theatre certificates. Most of them are working in the operating theatres in the various hospitals so that uniform standards are maintained. Assistance was also given in the field of legislation for the control of nursing education and practice. 'Ihe revision of the Nurses I Ordinance has been completed and rules for training and the conduct of examinations revised. There is a progressive outlook for the nursing profession in Singapore. The senior nurses are aware of their responsibility and the need for continuing education. Nursing studies have greatly contributed to the development of this leadership. Through attendance at WHO- sponsored seminars, training programmes of in-service education and a programme of fellowships for advanced education abroad, the status of the nursing profession has gradually been enhanced. The development of educational opportunities for senior nurses at university level in Singapore which was envisaged has not as yet materialized. It is doubtful whether the country's resources will permit this in the next decade. In the meantime, educational standards are being raised, supervision in the nursing field has improved, better teaching is being carried out. Much remains to be done, but it is believed that the momentum contributed by the combined efforts of national and international personnel will carry the profession forward to further development. Singaeore 0004 NurSing Administration and Practice (Jan. 1956 - 1970) R UNICEF , To develop programmes to prepare nursing personnel for administra- tive posts in hospital and public health services and to improve the quality of nursing practice, patient care and clinical teaching. .. 1 • Singapore 0011 University of Singapore (Dec. 1968 - April 1969) R WPR/RC20/3 page 133 WHO provided a consultant to assi.st in strengthening the teaching programmes in the Department of Preventive and Social Medicine, to give lectures as required, and to assist in the training of staff. Consultant services and fellowships were provided under this pro- Ject between 1962 and 1966, and further assistance is planned. Singapore 0012 Health Education Advisory Services (Aug. 1965 - Nov. 1968) R UNICEF The aim was to evaluate the health education programme, and to plan and carry out an expanded programme, particularly in schools, maternal and child health centres, teacher training centres and insti- tutions, and centres for the training of health and medical workers. WHO provided a health education adviser and awarded three fellowships. The WHO adviser worked closely with the Senior Health Officer- in-Charge of the Training, Health Education and Special Services Branch of the Public Health Division of the Ministry of Health and with the services and programmes 'directly assisted by that Branch. As programme activities developed, the technical area was extended to include working relationships with pertinent officials and staff of the Ministry of Education, particularly those in the Teachers' Training College and the Educational Television Unit. Advisory services were provided in con- nexion with active programmes in cleansing and community sanitation, on school health, educational procedures and process in motivation for family planning, and the development of educational and campaign materials prepared by the Training, Health Education and Special Services Branch. Teaching materials and scripts on personal and community health were also prepared for the educational television programme of the Ministry of Education. Lectures were given as part of the established training programmes for public health nurses, public health inspectors, public health assistants and also to groups of school teachers designated by the Ministry of Education to acquire WPR;Rc20/,3 page 1:;4 intensive information on community health and san~tation. i Particular attention was given to the development of professionally t~ained health education specialists. T.his is being achieved throUgh the award of WHO fellowships for post-graduate health education. The Ministry of Health has two such posts which wUl be fUled' by WHO fellows. Every encouragement has been given to the acceptance of health education training as a part of in-service staff development. The project has contributed to increased awareness that education is a continuing process and that the ways in which information is im- parted are significant to the acceptance of facts and subsequent action on such facts. There is evidence of a growing interest in in-service training of staff in health education and more attention is being given to the incorporation of health education in school curricula. Further assistance in the form of consultants to evaluate the progress made is planned. Singapore 001,3 Radiation Health Advisory Services (June - Sept. 1968; Aug. - Sept. 1969) R WHO provided a consultant to advise the Radiotherapy Department of the General Hospital on the physical facilities of the radiotherapy service, the training of physicists and technicians engaged in the service, the calibration and maintenance of equipment and the organiza- tion of an isotope service. Singapore 0015 Tuberculosis Control (May 1968 - July 1971) R To conduct field trials on problems involved in case-~inding, treatment and prevention of tuberculosis; to study the epidemiological pattern of tuberculosis in the country; to introduce a comprehensive tuberculosis control programme integrated into the general: public health programme~·and to provide facilities for training various categories of public health workers in tuberculosis contro~ work. ... --~- S a ore 0016 Medical Statistics and Hos ital Records (Oct. 1967 - Feb. 19 June - Dec. 1969) R WPR/RC20/3 page 135 WHO provided a consultant to review the progress made in the further development of the central office of statistics of the Ministry of Health; and to advise on training and on the general organization of hospital and health centre statistics. Singapore 0017 Nutrition Advisory Services (Aug. - Oct. 1968) R WHO provided a consultant to carry out studies on the etiology and epidemiology of nutritional disorders and their effects on health, recommend measures for implementation through health or other channels, and assist in improving the general food and nutritional situation in the community. Singapore 0018 Environmental Health Advisory Services (July - Sept. 1968) R WHO provided a consultant to review the environmental sanitation work and programmes of the Ministry of Health, and to recommend short- term and long-term programmes for the Public Health Engineering Unit, with emphasis on co-ordination between the Ministry of Health and the ministries and agencies having jurisdiction over internationally assisted municipal projects. Singapore 0200 Fellowships R: Medical rehabilitation (twelve months). Tonga 0009 Hospital Administration (Feb. 1968 - 1973) R To establish a medical records department, with a statistical unit, at the new general hospital in NUku'alofa and a medical records system that can be extended to all the hospitals in the country; to train medical records personnel; and to improve hospital administration, particularly of the general hospital. WPR;RC20!3 pagel,36 Tonga 0010 Nursing Education (Jan. 1969 - 1973) R To strengthen the basic nursing c~riculum of the Qu~en Salota School of Nursing; to improve the quality and quantity of nursing and midwifery personnel needed to meet the demands of the, expanding health services; and to evolve a body of nursing legislation suitable for the Kingdom. Tonga 0200 Fellowships R: Medical officers'course (two for twelve months), public health and industrial health (twelve months). Trust Territory of the Pacific Islands 0200 Fellowships R: Public health nursing (three for twelve months). Viet-Nam 00 TUberculosis Control (Jan. 1958 - 1975) UNDP TA UNICEF To set up the nucleus of a national tuberculosis control service, with emphasis on measures to be integl'ated into general public health services; to complete a national tUberculosis centre in Saigon and to integrate it in the existing facilities; to continue the UNICEF/WHO- assisted BeG vaccination project and integrate it in the national tuberculosis control service. Viet-Nam 0011 Vital and Health Statistics Advisory Services (Dec. 1960 - Dec. 1963; Sept. 1966 - Feb. 1967: Jan. 1969 - 1972) R . To organize an efficient and up-to-date system of COllecting and recording vital and health statistical data so as to produce vital and health statistics which will meet national and inter- national needs; and to train national personnel in the adlninistration and operation of a national health statistical service. • Viet-Nam 0016 Malaria Pre-eradication Programme (March 1959 - ) R (AID) WPR/RC20/3 page 137 To train national staff and make preparations for the implementa- tion of a malaria eradication programme. Since March 1967, WHO assistance has been limited to fellowships. Viet-Nam 0018 Health Laboratory Services (First phase: Feb. - June 1962; Second phase: Nov. 1964 ~ 1974) R To establish a central health laboratory service and to train health laboratory workers; later, to organize regional and peripheral health laboratory services. Viet-Nam 0026 Venereal Disease Control (June 1966 - 1972) R To reduce the incidence of the venereal diseases, demonstrate modern methods of venereal disease control, and strengthen and improve the syphilis serological work carried out in the laboratories. Viet-Nam 0033 Environmental Health Advisory Services (April 1966 - 1974) R To strengthen the environmental sanitation service in the Ministry of Health and introduce improvements in public water supply, human excreta disposal, refuse disposal, food hygiene and vector control in urban and rural areas. Viet-Nam 0035 Dental Health Advisory Services (April - July 1969) R WHO provided a consultant who reviewed the dental health and school dental health services; examined the staff, equipment and supplies available for dental health programmes; and advised on their utilization and on future requirements. He also recommended suitable training schemes for dental health personnel. WPR/RC20/3 page 1,38 Viet-MaID 0036 International Quarantine Advisory Services (First phase: Nov. - Dec. 1966; Second phase: Sept. - Dec. 1967; Third phase: Aug. 1968 - 19(9) R . To develop and strengthen the service responsible for the quarantinable diseases and train national staff. Viet-NaID 0041 Food and Drug Control (Dec. 1967 - 19(9) UNDP/TA To develop and maintain the work of the national food. and drug control laboratories. Viet-NaID 0200 Fellowships R: Hospital statistics and medical records (twelve months). Western Samoa 0200 Fellowships R: Medical officers' course (two for twelve months and three for twelve months - extensions of pre- vious awards), nursing (five months), public health administration (two for twelve months). Western Samoa 0500 National Health Services Development (Oct. 1967 - 1972) R To develop and strengthen the organization and operation of the general health services, particularly at district and local levels; to improve the operation of the rural health programme; to organize in- service training for medical and paramedical personnel; to conduct epidemiological studies on the most important causes of morbidity and mortality in the country; and to plan disease control programmes as part of the general health services. Western Samoa 9501 Filariasis Control (July 1965 - 1970) R UNICEF To determine, by a pilot project, the best way of controlling filariasis, mainly by drug treatment, in Western Samoa; to prepare a filariasis control programme for the whole country. based on the results of the pilot project; and to train staff in filariasis survey and control techniques. .... Western Samoa 9504 Public Health Labo~atory Services (Aug. - Dec. 1967: March 1968 - 1972) R WPR;Rc20/3 page 139 To develop and strengthen the health laborato~ services. WPRO 0035 Fifth Joint WHO/South Pacific Commission Course: Tuberculosis and Leprosy, Noumea (17 March - 9 April 19(9) R (South Pacific Commission) The course provided the participants with an intensive review of tuberculosis and leprosy as problems in community health, with special emphasis on prevention, case-finding and treatment. Practical and realistic methods of control which were appropriate to the social and economic situation in the area were discussed. The part of the course related to tuberculosis consisted of theoretical instruction in epidemiology, case-finding and diagnosis, treatment, biological and chemical prophylaxis, rehabilitation, health eduoation, training and the planning and organization of a oontrol programme, with speoial reference to the availability of WHO/UNICEF assistance. Practical training was given in tuberculin testing, BeG vaccination techniques, bacteriological techniques, and mass X-ray examination of populations .. The section on leprosy covered classification, pathology, clinical aspects and diagnosis, deformities, epidemiology, chemoprophylaxis, the lepromin reaction, the role of BCG vaccination, treatment and control. The South Pacific Commission and WHO each provided two consul- tants and staff from their own offices. There were fifteen partici- pants from American Samoa, British Solomon Islands Protectorate, Cook Islands, Fiji, Gilbert and Ellice Islands, Nauru, New Caledonia (3), Papua and New Guinea (2), Tonga, Trust Territory of the Pacific Islands, Wallis and Futuna, and Western Samoa. WHO provided the cost of attendance of eight participants. Staff from the East-West Centre and the. National Communicable Diseases Centre, Hawaii, served as resource personnel. The health services from New Caledonia sent two observers. WPR/RC20/3 page 140 WPRO 0072 Malaria Eradication Training Centre, Manila . (April 1959 - June 1961; Sept. 1963 - 1973) R (AIQ) To provide training in the theory and techniques of malaria eradication for various categories of personnel needed by countries of the Western Pacific Region and other regions. WPRO 0075 Regional TUberculosis Advisory Team (July 1961 - 1975) R UNICEF To assist countries of the Region in assessing their tuberculosis programmes. During the period under review, individual members of the team visited Cambodia, China (Taiwan), Hong Kong, East Malaysia (Sabah and Sarawak), Philippines, Republic of Korea, Singapore and Tonga. WPRO 0979 Advisory Services (1961 - ) R To meet requests from countries of the Region for advisory services in connexion with the planning of long-term projects or with specific problems. The following assistance was provided to West Malaysia during the period under review; Filariasis Control. A consultant for three months from May to August 1968 to assist in compiling and analyzing data on filariasis, parti- cularly as regards the progress of survey and control work, and in assessing the filariasis control programme; and to advise ,on the further development of the programme, including its research aspects. Environmental and Chemical Control. A consultant from August to September 1968 to investigate the problems of fly infestation in the Cameron Highlands and to recommend a control programme inoorporating chemical and environmental control measures, with concurrent field evaluation. Radiation Protection Legislation. A consultant for three months from October to December 1968 to assess the extent to whioh radio- active substances and radiation equipment are used in West Malaysia, ... . . WPR/RC20/3 page 141 the Jurisdiction of different agencies in this field, and the avaU- ability of specialized personnel, laboratories and monitoring services, and to assist the government in reviewing legislation for radiation protection. WPRO 0080 Mekong River Schistosomiasis Survey (Nov. 1968 - ) R WHO provided a parasitologist and a malacologist to make surveys in the Vientiane, Pakse and Khong districts of Laos and in the Stung Treng, Kratie, Kompong Cham and Bassac-Lower Mekong districts of Cambodia, in order to ascertain whether there are endemic foci of schistosomiasis and whether a snail host exists. Assistance with previous surveys in Laos was provided under this projeot in 1960, 1961 and 1966-1967. The survey in 1960 also covered Cambodia. WPRO 0083 Maternal and Child Health Advisory Services, South Pacific (April 1962 - Aug. 1963; Sept. 1965 - 1972) UNDP/TA UNICEF (South Pacific Commission) A maternal and child health team, based in Fiji, to conduct in- service and refresher courses for maternal and child health staff, as required, in territories of the South Pacific area. During the period under review, individual members of the team visited the British Solomon Islands Protectorate, Cook Islands and Western Samoa. WPRO 0102 Nursing Advisory Services (First phase: Dec. 1967 - June 1968) R WHO provided two nurse consultants who visited certain countries in the Region to advise governments on the implementation and follow- up of field studies of staffing patterns for nursing servioes. WPRO 0199 Schools of Public Health (1966 - ) R The following fell~wship was provided: Republic of Korea - public health education and training (ten weeks). WPR/RC20/3 page 142 WPRO 0114 Participation in Educational Meetings (1964 - ) R The following fellowships were awarded for partic:l.pation in educational meetings; (i) for the course for coding instructors, New Delhi - two-week fellowships to candidates from Japan, New Zealand and Papua and New Guinea; (ii) for the workshop on cellular and molecular basis of the immune response, New Delhi - a three- week fellowship to a candidate from Singapore; (iii) for the groundwater development course at the University of Minnesota, Minneapolis - a two-and-a-half-month fellOWShip to a candidate from Fiji; (iv) for visits to laboratory animal breeding centres in Europe - a one-half-month fellowship to a candidate trom Australia. WPRO 0125 - Thi.rd Regional Tuberculosis Course, Tokyo (6 May - 6 Septo 1968) R The course, which was the third course on tuberculosis held in the Region, was sponsored by the Government of Japan anP WHO. Its purpose was to provide assistance in training national workers in the application of modern methods of tuberculosis control. It was also designed to stimulate the proviSion of practical training and demonstration in national institutions. There were ten participants from China (Taiwan), India, Indonesia, Laos, Malaysia, Philippines, Republic of Korea, ~~ Thailand. WHO provided six lecturers, the cost of attendance of four participants, and reference material. The fourth course started in May 1969. WPRO 0135 Environmental Health Advisory Services, South Pacific Area (Oct. 1965 - 1972) UNDP/TA To assist countries and territories in the South pacific area to improve community water supplies and environmental sanitation in general. During the period under review, visits were made to the British Solomon Islands Protectorate, Fiji, Gilbert and Ellice !slands, Niue, Tonga and Western Samoa. ..~ WPRO 0137 Communicable Diseases Advisory Team (Aug. 1967 - 1973) R WPR!RC20j'j page 143 To assist the governments of countries and territories in the Region in assessing the general situation regarding the communicable diseases, in planning epidemiological and laboratory surveys of the most important of them, in planning and organizing control and preven- tive measures, and in strengthening epidemiological and laboratory services. During the period under review, visits were made to Cambodia, Laos, Philippines, Republic of Korea and Republic of Viet-Nam. WPRO 0138 Public Health Nursing, South Pacific (Oct. 1967 - 1972) R To assist countries and territories in the South Pacific area to develop public health nursing services as a part of the general health services. During the period under review, visits were made to the British Solomon Islands Protectorate, Gilbert and Ellice Islands, Nauru, New Hebrides, New Zealand, Papua and New Guinea, Tonga and Western Samoa. WPRO 0141 First Regional Seminar on the Prevention and Control of Cardiovascular Diseases due to Infections, Particularly Rheumatic Heart Disease, Manila (5-12 Nov. 1968) R The purposes of the seminar were to assess the problem of prevent- able heart diseases in the Region, with particular emphasis on rheumatic heart disease; to review the regional situation with regard to some non- infectious diseases of the heart; to review resources in the Region for the prevention of the above conditions; and to suggest preventive measures appropriate to conditions in the Region. There were sixteen participants from Australia, Brunei, China (Taiwan), Fiji, French Polynesia, Gilbert and Ellice Islands, Japa.."l, Malaysia, Nauru, New Caledonia, New Zealand, Philippines, Republic of Korea, Republic of Viet-Nam, Tonga and Western Samoa, and observers from the Philippine College of Physicians and the Department of Health. WPR,tRC20/3 page 144 WHO provided four consultants, the cost of attendance of fifteen participants, and the services of two staff members. Theparticipant from Nauru was sponsored by the South Pacific Commission. WPRO 0143 Malaria Eradication Assessment Team (Feb. 1967 - ) R To make independent appraisals of the status of malaria eradica- tion and of any special aspects of the malaria programmes in the Region. During the period under review, an assessment was made of the programme in the British Solomon Islands Protectorate. WPRO 0144 Second Regional Seminar on Venereal Disease Control, Manila (3-12 Dec. 1968) R The purpose of the seminar was to review the nature and extent of the venereal disease problem in the Region and the recent develop- ments in the epidemiology, diagnosis and treatment of venereal diseases; to discuss the control measures undertaken, with special emphasis on the organization and administration of venereal disease control pro- grammes, and the role played by social services in venereal disease control. The importance of co-ordination and the exchange of infonna- tion between countries and the role played by private praotitioners in venereal disease control were also considered. There were nineteen participants from Australia, China (Taiwan) (2), French Polynesia, Fiji, Hong Kong, Japan, New Caledonia, New Zealand, Papua and New Guinea, Philippines (2), Republic of Korea, Republic of Viet-Nam (3), Singapore, Trust Terri tory of the Pacific Islands and Western Samoa. Seven observers from the Philippines and one from UNICEF, Manila, also attended. WHO provided three oonsultants and the cost of attendance of the participants. .. • > • WPRjRC20/) page 145 WPRO 0145 Second WHO/South Pacific Commission Joint Seminar on Filariasis, Apia (6-12 Aug. 1968) R The purpose of the seminar was to assess the situation as regards filariasis and its control in the South Pacific, with special reference to the pilot project in Western Samoa (see Western Samoa 0501 above). There were twelve participants from American Samoa, Australia, Cook Islands, Fiji, French Polynesia, Gilbert and Ellice Islands, Nauru, New Hebrides, Tonga and Western Samoa, and observers from American Samoa and the United States Peace Corps. They made recommendations on studies of the bionomics of the vector, on control measures, and on drug treatment • WHO provided a temporary adviser, the cost of attendance of ten participants, and the services of four s·t;aff members. The South Pacific Commission provided a consultant, the cost of attendance of two participants, the services of a staff member, and interpretation services. WPRO 0148 Applied Nutrition, Education and Training, South Pacific (March 1968 - 1971) R UNICEF (FAO) (South Pacific Commission) To conduct nutrition courses (in-service) and/or to strengthen the teaching of nutrition in the basic training of pUblic health and other workers in South Pacific Island territories, and to undertake surveys where necessary in this framework. The team is based in Suva and makes visits as required to other territories. WPRO 0149 Environmental Health AdVisory Services (Sept. - Dec. 1968) R Fiji. A consultant was provided in November and December 1968 to advise on the feasibility of setting up a water and sewerage authority covering either the Suva area or the whole country; on the legal administrative and financial arrangements to ensure the effectiveness of any such authority and to facilitate the provision of sanitary WPR/RC20/3 page 146 sewerage for the Suva area, and on the measures to be taken to ensure sound administration of urban water supply and sew~rage throughout the country. Papua and New Guinea. A consultant was provided for six weeks in September and October 1968 to review the training programme for health inspectors and to take part in a conference on their utilization &ld training. WPRO 0156 Trainil16 in Maintenance of X-ray Equipment (April - Dec. 1969) R To assist governments in assessing the needs for the mainte- nance of radiological equipment; to advise on the organization of maintenance services as part of the Government's technical services to health and medical institutions; to assist in organizing, directing and supervising the training of selected X-ray operators in the installation, testing, calibration, servicing and maintenance of X-ray equipment, and in the proper use of radiographic and photo- fluorographic equipment. WPRO 015 Vaccine Production Dec. 1968 - Feb. 1969) R WHO provided a consultant to review the DPT vacoine produotion oentresin China (Taiwan). the Philippines and Republio of Korea, and to advise on how diffioulties encountered in the proquction of a safe and potent vaooine could be overcome. WPRO 0159 First Regional Course on National ije!1thPlanning, Manila (2 Sept. - 31 Oot. 1968) R The oourse was the· first of a planned annual series designed to acquaint national health administrators from countries of the Region with the general principles of national planning for sooio- eoonomic development and to familiarize them with the principles and methods of national health planning within the framework of sucll --' ..... - ;-, : • , WPR;RC20/3 page 147 development planning and as an integral part of health administra- tion. It is intended that these courses, which will be arranged by WHO until 1970, should be taken over as from 1971 by the Institute of Hygiene, University of the Philippines, with assistance from the Organization. The 1968 course was attended only by WHO representatives and regional office staff. It consisted of lectures and discussions on basic disciplines (economics, demography and statistics, sociology, operational research), general planning (physical, social, economic development) and health planning (historical review, health man- power, national health planning methodology). The subjects were introduced by staff members from the University of the Philippines, one from the Asian Institute for Economic Development and Planning, Bangkok, the Chief of the Training Division, Pan American Programme for Health Planning, Santiago, Chile, and a WHO consultant. An evaluation made by the participants at the end of the course resulted in recommendations that will be taken into account in future courses. WPRO 0160 Dental Health Advisory Services (July - Sept. 1969) R WHO provided a consultant to follow up the findings of the dental epidemiological survey carried out in a number of territories in the South Pacific area in 1966; to assist the health authorities in assessing broadly the dental health situation and activities in pro- gress; and to make recommendations for the development and improvement of public health dental services and programmes, with particular attention to school dental health programmes, dental health education, the introduction of anti-caries measures such as the use of fluorine, and the staff, including auxiliary staff, required. WPR/RC20!3 page 148 WPRO 0161 Second Regional Seminar on Education and Training: Travelling Seminar on Medical Education, Manila, Sydney, Perth, Singapore (30 April - 15 May 1969) R The purpose of the seminar was to exchange information on the organization and programmes of the various medical schools in the Region; to consider new trends in the field of medical education and their applicability to medical education programmes in the Region; to discuss the major problems related to medical education in the Region and to consider how these might be solved; and to explore possible avenues of co-operation and collaboration between the various schools. Sessions were held in Manila, Sydney, Perth and Singapore. The topics selected for the programme were the assessment of medical manpower requirements; general objectives of the medical undergraduate curriculum; the need to relate medical education pro- grammes to community health needs; the development of a medical curriculum - the role of faculty and students; requirements for admission of students to medical schools; evaluation of student performance; teaching methods in medical schools; utilization of community health resources in medical undergraduate education; desir- ability of a preliminary degree course in medicine; research and electives in medical education; training for general practice (under- graduate and graduate aspects); co-operation and collaboration between medical schools. Four or five topics were discussed in each location. The participants were given the opportunity to visit medical colleges, faculties or hospitals in the countries visited. The participants decided to set up a Steering Committee, consist- ing of four members, to examine the feasibility of establtshing a regional association of medical schools. A preliminary report, with recommendations, will be submitted within a year and the participants who attended the seminar, as well as medical schools in the Region, will be kept fUlly informed of developments. J ( --,"*--- --::--' WPR/RC20!3 page 149 There were fourteen participants from Australia, Cambodia, China (Taiwan) (2), Fiji, Laos, New Zealand, Papua and New Guinea, Philippines (2). Republic of Korea (2), Republic of Viet-Nam and Thailand. WHO provided two consultants and the cost of attendance of the partiCipants. WPRO 0163 Evaluation of WHO Fellowships Programme (Feb. - July 1969) R WHO provided a consultant who is visiting selected countries in the Region for the purpose of making an evaluation of the WHO fellowship programme. The following aspects are covered in the study: planning of the programme; the selection and preparation of candidates for fellowships; whether the programmes and itineraries are arranged to meet training needs; utilization of fellows after their return; and the effects of fellowships on national health pro- grammes. The information collected will provide guidance to govern- ments and to the Organization on how this programme can be improved. WPRO 0164 Advisory Services on National Health Planning (Oct. - Nov. 1968; July 1969 - 1977) To advise on the planning and co-ordination of national health programmes as part of development plans. WPRO 0169 Advisory Services on Water and Sewerage Programmes (Jan. 1968 - 1972) R To assist governments in carrying out studies on water supply and sewerage programmes and on other environmental health activities, and in developing the programmes. During the period under review, visits were made to China (Taiwan), Fiji, Laos, East and West Malaysia, and the Republic of Korea. WPR/RC20/3 page 150 WPRO 0188 Public Health Adviso£TServices: Mekong Committee (Sept. 1968 - Sept. 1969) R To assist in implementing the general recommendations in the summary report on the health survey in the Lower Mekong Basin adopted by the Committee for the Co-ordination of Investigations of the Lower Mekong Basin; to advise on the health protection of the labour forces engaged in the Committee's projects; to assess the health implications of such projects and make recommendations on measures for disease prevention and on the organization of basic health services in new development areas; to assist the Mekong Committee secretariat in making estimates of the cost of such services for inclusion in the overall cost estimates of construc- tion projects; to study the pattern of environmental factors in relation to health; to make recommendations on measures to prevent the spread of water-borne diseases in the development areaS; and to advise the WHO staff who are assisting the governments in the four riparian countries to plan and develop general health services in areas covered by Mekong Committee projects. !.

. t ~ l WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTE REGIONAL COMMrl'I'EE Twentieth Session Manila REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL 23-30 September 1969 ND.JETEENTH ANNUAL HEPOR!' OF THE REG IONAL DIRECTOR TO THE WPR/.RC20!3 Corro1 23 September 1969 ORIGINAL: ENGLISH REGIONAL COMMITl'EE FOR THE WESTERN PACIFIC Corrigendum Page 47 second paragraph, fourth sentence: Please delete "A joint school health education committee" and replace by "A joint school health committee" 0 third paragraph, last sentence: Please delete and replace by lilt has also appointed another WHO fellow as Director of the Inst1 tute of Public Heal tho"