WORLD HEALTH ORGANIZAnOM • ORGANISATION MONDIALE DE LA SANTE REGIONAL COMMITTEE Ninth Session Manila REGIONAL OFFICE FOR THE WESTERN PACIfIC BUREAU REGIONAL DU PACIFIOUE OCCIDENTAL 26 September - 2 October 1958 ANNUAL REPORT OF THE REG roNAL DIRECTOR Corrigendum Page 29, paragraph 4, WP /RC9 /2 Corr.l 18 September 1958 ORIGINAL: ENGLISH delete the two sentences referring to Japanese vaccine, and insert the following text: "The dry vaccine used in Japan, and recently made more heat- resistant by the use of a new adjuvant, has been tested in several laboratories in other parts of the world. These tests, arranged with the assistance of the Organization, suggest that the vaccine may be extremely valuable in future years."
WORLD HEALTH ORGANIZATION Regional Office for the Western Pacific .: WP/RC9/2 , ORGANISATION MONDIALE DE LA SANTE EIGHTH ANNUAL REPORT OF THE REGIONAL DIRECTOR (1 JULY 1957 - 30 JUNE 1958) TO THE Bureau regional du Pacifique occidental REGIONAL COMMITTEE FOR THE WESTERN PACIFIC NINTH SESSION R£TURN TO WHO LIBRARY, MANfLA 1. 2. 4. 6. 1. 2. CONTENTS PART I. GENERAL IN'l'RODUCTION •••••••••••••••• ' ••••••••••••••••••••••••••••••••••••• THE .REXlIONA.L CO~TTEE ••••••••••••••••••••••••••••••••••••••••••• REXlIONA.L OF'FICE .................................................. . 3 .1 General ••••••••••••••••••••••••••••••••••••••••••••••••••••• 3.2 Organizational structure and. area representatives ••••••••••• 3.3 Regional office staff ••••••••••••••••••••••••••••••••••••••• 3.4 Project staff ••••••••••••••••••••••••••••••••••••••••••••••• AGREEMENTS WITH GOVERNMENTS •••••••••••••••••••••••••••••••••••••• CO-ORDINATION OF WORK WITH OTHER ORGANIZATIONS ••••••••••••••••••• Uni ted. Nations and the specialized agencies ••••••••••••••••• With other intergovernmental organizations •••••••••••••••••• South Pacific Commission ••••••••••••••••••••••••••••• 5.3 Other joint work •••••••••••••••••••••••••••••••••••••••••••• PUBIJ:C INF'O~TION ••••••••••••••••••••••••• ., ••••••••••••••••••••• PART II. GENERAL STATEMENT OF ACTIVITIES IN THE RIDlON PUBI..IC-HF.A.LTH SE:FtVICES ••••••••••••••••••••••••••••••••.••••••••••• 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Assistance to governments in developing and strengthening their health services ••••••••••••••••••••• Maternal and. Child Health ••••••••••••••••••••••••••••••••••• N1J.rsing ••••••••••••••••••••••••••••••••••••••••••••••••••••• Environmental Sanitation •••••••••••••••••••••••••••••••••••• Health Education •••••••••••••••••••••••••••••••••••••••••••• Mental Health ••••••••••••••••••••••••••••••••••••••••••••••• Statistics .................................................. EI>UCATION AND 'rRA.INING ••••••••••••••••••••••••••••••••••••••••••• 2.1 2.2 2.3 Assistance to Educational Institutions ...................... .................................................. Fellowships Educational Meetings ........................................ 1 5 6 6 6 6 7 7 7 7 8 8 8 9 11 II 14 16 17 19 20 21 23 24 26 ~. CONTENTS COMMUNICABLE DISFASES ............................................ Ma.laria ••••••••••••••••••••••••••••••••••••••••••••••••••••• Tuberculosis and. BeG •••••••••••••••••• ~ ••••••••••••••• ~ ••••• Venereal Diseases and. Treponematoses " ••••••••••• " ••••••• '.'." •• 27 27 28 ~ 3.3.1 Yaws ••••••••••••••••••••••••••••••••••••••••••••••••• 30 ~.~.2 Venereal Diseases •••••••••••••••••••••••••••••••••••• 31 3.4 Other Communicable Diseases ••••••••••••••••••••••••••••••••• ~~ Leprosy ••••••••••••••••.•••••••••••••••••••••••••••••• Poliomyelitis •••••••••••••••••••••••••••••••••••••••• Trachoma ••••••••••••••••••••••••••••••••••••••••••••• 4. ACTIVITIES OF THE EPIDEMIOLOGICAL INTELLIGENCE STATION ••••• "..... ~5 PART III. PROJECT LIST Proj ets in Operation fram 1 July 1957 to ~ June 1958 ••••••••••••••• ~9 1. 2. 4. LIST OF REGIONAL OFFICE POSTS •••••••••••••••••••••••••••••••••••• CONSULTANTS EMPLOYED DURING THE YEAR ••••••••••••••••••••••••••••• PROJECT AND RIDIONAL OFFICE INTERNATIONAL STAFF H'I.DYE:D AS OF 30 JtJN'E 1958 •••••••••••••••••••••••••••••••••• " •••• GEDGRAHlICAL DISTRIBUTION OF INTERNATIONAL STAFF ••••••••••••••••• LIST OF SUPPLEMENTARY AGREEMENTS SIGNED WITH MEMBER COUNTRIES DURING THE PERIOD 1 JULY 1957 TO 30 JUNE 1958 •••••••••••••••••••• 6. FELLOWSHIP AWARDS .. 1 JULY 1957 TO ~ JUNE 1958 .. 81 87 91 ACCORDING TO FIEIJ)S OF STUDY AND COUNTRIES OF ORIGIN ••••••••••••• 93 7. DISTRIBUTION OF VISITS IN ACCORDA.NCE WITH COUNTRY OF STUDY AND R.E.XlIONS •••••••••••••••••••••••••••••••••••••••••••••••• 99 8. PLANNING INDIVIDUAL FELLOWSHIPS •••••••••••••••••••••••••••••••••• lOl PART I. GENERAL 1. INTRODUCTION wp/RC9/2 page 1 As in previous years, assistance to governments bas been adjusted. to the particular needs and existing resources of the countries concerned.. Visits of regional office staff to countries and territories bave revealed. an ever- increasing awareness of the importance of health planning. Interest in comprehensive rather than specialized, programmes is slowly growing and progress towards improved health services continues to be steady. The appointment of area representatives bas resulted in closer contact with the governments concerned. and bas enabled the Organization to determine more clearly their most urgent needs, to approach the problem of assistance in the planning of public- health services in a more realistic manner and has facilitated. the co-ordination of aid. received from different agencies. It has also provided, a more reliable basis for the determination of priorities when government requests cannot all be fitted. into the regular budget. Although the shortage of trained. medical and auxiliary staff still remains one of the greatest handicaps to rapid, progress, more and. more it is being realized that local counterparts must be trained to staff the projects Which are being developed with assistance from WHO. This is vi tal to the integration of individual projects into the national health services and. the continuing success of such projects rests to a very great extent in the hands of the national counterparts. That governments are in accord. with WHO I s policy in this respect is confirmed, by the increasing number of requests for fellowships for the training of local personnel at undergraduate and post-graduate levels in medical" health, nursing and para-medical services. I wish, however, to stress a danger which may arise as a result of increasing demands for all categories of personnel and. that is the possibility that the candidates selected, for field. training may not have the necessary basic educational background. and tbat too many trainees may be recruited. The number of trainees must be in proportion to the number of teachers and teaching facilities available otherwise it will not be possible to maintain and improve standards. As great a handicap to progress as lack of trained. personnel would be the filling of posts in health services, hospitals, clinics, and teaching institutions with inadequately trained personnel as this might well result in loss of confidence on the part of the peoples it is our aim to help. Progress we all wish" but progress must be adjusted. to available resources and of far greater value is a long-term training programme at the end of Which governments will have well-qualified. staff capable of taking on the duties and. responsibilities dema.nded of them. The :Regional Office is ever exploring and a.ssessing additional 1'scili ties within the Region where candidates selected. for fellowships may receive training. A number of governments in the Region have received. WHO fellows for training and advanced study in special health fields at universities, colleges, research institutes, health departments and laboratories. The Western Pacific Region is most fortunate in having such facilities at its disposal and I wish to take this opportunity of placing on record our appreciation of the continued assistance rendered by Member States to our fellowship programme. /The trend. towards ••• WP/RC9/'2 page '2 The trend towards integrated public-health services is gradually receiving more attention. In many parts of the Region the need for closer co-operation between doctors, nurses, midwives and. other personnel is being acknowledged. although there is still need for further recognition of the importance of co-ordinated preventive and curative services. In the field. of maternal and child health, for example, programmes in same countries and territories would become more effective if this could be achieved. Another trend, which is a matter of satisfactionl is the fact that project personnel in some countries are being increasingly consulted in connexion with the general administration of the service concerned. It is hoped that this development will extend to other countries. In the field of communicable disease control continued emphasis has been pl$ced. on malaria programmes and. governments have been encouraged to intensify th$ir ant1ma.laria programmes with a view to changing the objective from control to eradication. As a result of the funds available from the Malaria Eradication Special Account greatly expanded activities are envisaged in the future and plans are being drawn up to give assistance to all countries in the Region where a malaria problem still exists. Considerable progress is being made towards the co-ordination of antimalaria programmes being carriid out on both sides of inter- national frontiers. The Borneo Malaria Conferences are now receiving full support from the Govermnent of Indonesia and the activities of the AntimaJaria Co-ordination Board2 will be expanded. through the appointment of a secretary 'Who will be financed out of the Malaria Eradication Special Account. The inter-country yaws team in the South Pacific has continued. its activities according to plan. In Fijil West New Guinea and. Western Samoa the fall in the incidence of yaws resulting from the mass campaigns has been maintained and in certain areas the goal of eradication has apparently almost been achieved. A problem which may now arise is the possibility that interest may be lost owing to the fall in prevalence of yaws and I would. emphasize the great importance of rural health services being developed. and following up the mass campaign as part of their routine activities in order that the gains so far made may not be lost. In the field. of tuberculosis control the concepts of integration and consolidation have gained. greater acceptance during the year and. their practical realization made progress, especially in China and. the Philippines. The zonal seminars in environmental sanitation have been amongst the most successful inter-country programmes. Considerable interest was aroused among the participants in problems of environmental sanitation and it is evident from post-seminar follow-up that the meetings had a very stimulating effect upon participants. I should also like to draw attention to the stimulus which has been provided to the training of enviromnental sanitation workers by Japanl 'Where undergraduate courses in sanitary engineering have been established at Hokkaido and. Kyoto Universities and plans for post-graduate courses are also under consideration. A post-graduate course leading to the degree of Master of Public Health Engineering was also initiated. at the Institute of Hygiene, Phi Ji ppine s • iComposed. of representatives from Brunei, Indonesia, North Borneo and Sarawak '2 Composed of representatives from Burma, Cambodia, Laos, Federation of Malaya, Thailand. and Viet Nam wp/RC9/2 page 3 A new activity during the period under review was the Public Health Conference and. Study Tour of Japan and Taiwan. Arranged. as it was immediately following the Regional Committee meeting in Hong Kong, this proved a most interesting and economical inter-country project. The arrangements made by the Host Governments were excellent and I should. like to take this opportunity of thanking the Governments of Japan and. China for all they did to ensure the success of a project which was the first of its kind in the Region. Programme analysis and. evaluation is a new activity which has only recently been developed by the Organization and. much attention has been paid to this during the past year. In some projects evaluation has shown that work is progressing to the point where it may soon be possible to withdraw international personnel. National staff can then proceed. on their own and. assistance from the Organization might then take the form of visits of short. term consultants or Regional Office staff to advise the government on particular aspects of the programme. When this stage is reached funds will then be released. for the introduction of new fields of activity where the need is great but where aid has not been possible in view of the number of continuing projects. As requested by the Regional Committee a number of evaluation reports have been distributed, with the agreement of the government concerned, to other countries in the Region wi th similar problems. Apart from the evaluation of country projects undertaken periodically by project sta~f in collaboration with their national counterparts, the Regional Office has systematically evaluated. a number of completed. projects and carried out an analysis of all fellowships awarded in the Region during th period. 1950-1956. The inter-country projects Which have taken place since the last meeting of the Regional Committee have also been evaluated.. The experience gained. in this field will form the basis for planning and operation of future programmes and it is hoped that in this way some of the early mistakes will not be repeated. The services of the Regional Statistician and. Programme Evaluator are available to the national health administrations who might wish to receive assistance in the evaluation of their national health programmes. A serious long-term problem of the future is the financing of government programmes if these are to develop as envisaged.. In general the global plans for development in the health field, whether these be on a national or inter- national basis, are such as to require rapidly increasing capital investment as well as running costs. Although it is hoped that the increasing interest of governments in health work may result in an increase in national funds, it will obviously not be possible for governments to continue to finance programmes from central funds to the exclusion of other sources. Much more attention and. encouragement will need., therefore, to be given to local participation if growth is not to be handicapped. by lack of money in the years to come. * * * * * * A pleasing event to record in the period. under review was the achievement of independence by the Federation of Malaya and the fact that it is now a Member of WHO. We look forward to a continuation of the good. working relationships we have had. with this country. * * * * * * / A further event ••• WP/RC9/2 pe.ge 4 A fUrther event of interest to us all is the establishment of our new r gional head.quarters in Manila and. I should like to express the warm thanks of myself and my staff for the generosity of Member States and Territories in the Region 'Which has made this possible. * * * * * * In Part II will be found. a general statement of activities in the Region during the period. under review where the points I have touched on are described. in further detail. /' .I . / V····/ ') ) /, 7'./ I:::~. (t· ( '<1' , Regi~nai Director~ / /2. THE RIDIONAL COMMITTEE 2. THE RIDIONAL COMMITrEE WP/RC9/2 page 5 The eignth session of the Regional Committee for the Western Pacific was held in Hong Kong, from 5 to lO September 1957. The meeting was attended by representatives from all Member States in the Region, and of the Governments of France, the Netherlands, Portugal, the United Kingdom of Great Britain and Northern Ireland, and the United States of America, responsible for territories in the Region. Representatives from the United Nations Children f s Fund, the United Nations Technical Assistance Board, the South Pacific Commission and from eleven non-governmental organizations in official relations with WHO were present. The Federation of Malaya. and the Un1 ted States International Co-operation Administration sent observers. The Committee reviewed the progress made in the Region and noted the closer co-operation with Member Countries that had followed. the appointment of area representatives. It is considered that in the regioIl8.l programme more attention should in the future be paid to the medical uses of radioactive substances. It emphasized the importance of a proper evaluation of past experience and ask d that evaluation reports should be distributed throughout the Region, subject to the consent of the governments concerned. The Committee recommended that malaria training courses should. be organized in view of the great and urgent need for trained staff tor malaria control work, that the courses should be held in rotation in the countries of the Region where adequate facilities were available and malaria control projects were in operation, so that the training might be both theoretical and practical. The Ccmn1ttee asked the Regional Director to give full priority to the inter-regional symposium on insect resistance, planned for 1958. The programme and budget proposals for the Western Pacific Region in 1959 were reviewed in detail by a sub-committee; the Committee endorsed them and authorized. the Regional Director to follow the priorities already approved, if the proposed effective working budget should. be revised. The Committee recommended. that two inter-country projects, proposed to be financed from Technical Assistance funds in 1959, should be approved, by the Technical Assistance Board and the TeChnical Assistance Committee. The Committee considered the resolution of the World Health Assembly on Assembly procedures for examining the programme and budget estimates; the maJority of the members thought that the present system for the establiShment ot~riorities had. proved satisfactory and should be continued. The Committee endbrsed. the view of the World Health Assembly that the ten per cent. limitation for regional and inter-country projects placed by the Technical Assistance Committee on the planning figure for projects was detrimental to assistance to governments in health work, when such assistance could best take the form of a programme serving a group of countries. The procedures for planning country programmes under the Expanded Programme of Technical Assistance were reviewed; it was considered. that they had so far proved to be satisfactory and should be continued for a further trial period. The Committee accepted the view of the Executive Board. and the World. Health Assembly that governments snould be relieved from contributions to the local SUbsistence expenses of international staff financed under the Technical Assistance Programme. /The method of ••• wp/RC9/2 page 6 The method, of appointing regional dir ctors was discussed at same length, with particular reference to the New Zealand proposal. l Same representativ s thought that the proposal would be a return to centralization and that the present procedure should be retained. Others considered that the Executive Board should take more part in the selection of the regional directors and should not be presented with a single nomination only. The Committee was unable to reach agreement on this matter and, it was therefore agreed, that the minutes of the discussion should be transmitted, to the Executive Board. During the session of the Regional Committee, technical discussions were held on the subject of leprosy control and included, a visit to a leprosarium on the island of Hay Ling Chau, some miles west of Hong Kong. The Committee selected, "Malaria control and, eradication" as its topic for 1958. 3. REnIONAL OFFICE 3.1 General The Administration in the year under review has been carrying a heavier load than normally with the extra work in connexion with the new office building, especially in the preparation of supply lists, negotiations with the Government and suppliers, and the accounting and control of funds. It has also been necessary to devote many hours to meetings with the Architect and, Contractor. It is hoped, the fruit of these labours will soon be evident. 3.2 Organizational structure and area representatives There has been no change in the organizational structure in the Regional Office or in the number of area representatives as approved for 1958. However, it was decided, to contract the services of a Protection Agency to guard the premises. This has worked well and will be continued. 3.3 Regional office staff The filling of the vacant posts of third public-health administrator and, reports and, liaison officer have greatly facilitated the work in the Bureau of Health Services. The expanded, activities financed by the Malaria Eradication Special Account resulted in an increase of work for the Regional Office but this has been compensated, by additional posts financed from the Special Account. Activities concerned with the malaria eradication programme are not separated fram the rest of the work in the Regional Office but are integrated with its routine activities so that there is no special unit in the Administration devoted, entirely to this programme. As thi s programme is just getting underway" it is difficult to assess the increased workload at the time of reporting, but it is believed that we have adequate staff to deal with this. /There have been ••• 101'1'. Rec. Wld, Hlth Org. 1.§." 143 wp/RC9/2 page 7 There have been some changes in personnel in the Bureau of Health Services due to the resignation of the Director of Health Services. This resulted in the promotion of the Regional Adviser in Malaria to the post of director of health services and the filling of the malaria ~dviser post by promoting a team leader. The post of reports and liaison officer was also filled by the promotion of a regional office staff member. 3.4 Project staff As of 1 January 1958, project staff were included, in the new system of salaries and allownces. This has resulted in a uniform system for both regional office and project staff, a step in the direction of sound administration. The problem of accommodation for project staff is still of paramount importance in some countries and, can be shown by the fact that one country requested that no additional personnel should be recruited as there was no housing available. This means that it is difficult to make firm offers of employment to candidates and, that project personnel in the field have sometimes to work with under-staffed teams. Annexes 1 .. 4 give details of the staffing pattern in the Region. 4. AGREFHENTS WITH GOVERNMENTS Supplementary agreements relating to plans of operation for twenty-nine projects were signed during the period under review. Fourteen of these were projects for which assistance in the form of equipment and supplies is being given by UNICEF. A list of the agreements is given in Annex 5. 5. CO .. ORDINATION OF WOBK WITH OTHER ORGANIZATIONS 5.1 United Nations and the Specialized agenCies Good relationships with other organizations, both international and bilateral, have continued,. The close partnership with UNICEF in many projects has been maintained. The project summaries in Part III of the report give some indication of the scope of UNICEF assistance to national projects in maternal and child health and communicable disease control. In addition, sixteen national programmes in which WHO gave technical adVice, also received, supplies and equip.. ment from UNICEF. The UNICEF offices in Bangkok, Manila, Taipei and, Sydney have worked, closely with the Regional Office in all matters related to Joint projects. Working relations with representatives of the Technical Assistance Board in Bangkok and the Hlilippines continued to be good,. Meetings have been held 'When- ever possible to discuss matters of mutual interest and to resolve problems. Certain difficulties arose in connexion with the planning of the 1958 Technical Assistance progratmne which underlined, the importance of agency sub-totals. In same cases, governments reduced their health estimates below the tentative agency sub .. totals, whereas in others, programme requests were greater than the money allocated,. This latter action has resulted, in enforced delays as far as recrui tment and. implementation of programmes are concern d as there was insufficient money to cover all requests. The United, Nations Technical Assistance Board. Office in Sydney has assisted, in the travel arr~nts for the increasing number of fellows who have undertaken specialized training in Australia and New Zealand. /WHO project staff ••• WP/RC9/2 page 8 WHO project staff are working closely with the UNESCO Fundamental Education project in Cambodia, Where regular lectures on first-aid and. personal hygiene are being given to the students, and close co-operation has continued. with UNESCO in Viet Nam. In the Philippines an administrative committee, composed of representatives from the United. Nations, UNICEF, the Technical Assistance Board and WHO, meets regularly to discuss and solve jOint problems. In agreement with the Regional Office for South-East Asia, observers were sent to the Third. Regional Technical Conference on Water Resources sponsored by ECAFE and held. in Manila; the United. Nations Seminar on the Protection of Human Rights in Criminal Law and. Procedure, held in Bagu1o; the fourteenth session of ECAFE held in Kuala Lumpur; and the second session of the Regional Association for the South-West Pacific of the World Meteorological Association h ld. in Manila. 5.2 With other intergovernmental organizations 5.2.1 South Pacific Commission An observer from the South Pacific Commission attended. the last session of the Regional Committee following which direct conversations were held on matters concerning both the South Pacific Commission and the Organization. The Acting Secretary-General of the Commission visited the Regional Office in December 1957 when points of mutual interest were discussed. The first joint project, the Health Education Training Course, was concluded successfully in Noumea in August 1957. Fellowship awards were given to partici- pants from American Samoa, British Solomon Islands Protectorate, Cook Islands, Fiji, French Polynesia, Guam, Nauru, New Caledonia, New Hebrides, Niue, Northern Territory of Australia, Papua and New Guinea, Tonga, United States Trust Territories of the Pacific, Wallis Islands, West New Guinea and Western Samoa. A WHO health education specialist assigned. to the Commission has since then made follow-up visits to trainees in a number of island territories and the reports on his visits have been submitted by the Commission to the governments of the territories concerned. 5.3 Other jOint work Cordial relationships have continued with the United. States International Co-operation Administration (ICA) officials in Cambodia, China, Korea, Laos, the Philippines and Viet Nam. ICA is supporting a number of WHO-assisted projects in these countries and a closer technical contact is being developed., particularly in Cambodia and Viet Nam where increasing use is being made of WHO technical guidance. In malaria projects, particularly, the aid has enabled. the work to advance more rapidly from one stage to the next. Country missions of ICA also sent observers to the Public Health Conference and Study Tour held. in China (Taiwan), the Environmental Sanitation Seminars held in Singapore and Port Moresby, the second meeting of the AntjrnaJaria Co-ordination Board. in Bangkok, and. the fifth and. sixth Borneo Malaria Conferences. /There has been ••• wp/aC9/2 page 9 There has been increasing co-operation with the Colombo Plan authorities in Cambodia, Laos and Viet Nam. A WHO fellowship provided an opportunity for a Canadian professor to visit the three countries with a view to developing closer contact between Canada and the institutions in the countries concerned. Plans are now under consideration for a co-ordinated fellowship programme in which Canada will integrate its programmes with WHO projects. Relationships with French Economic and. Cultural Aid. continue to be good. This agency is assisting the maternal and child. health programmes in Viet Nam with a professor of paediatrics until such time as WHO can find a suitable incumbent for the post. In Viet Nam informal meetings of all agencies interested in work in the fi Id of health have been initiated by the WHO area office and have proved. useful. In China and the Philippines, WHO has continued to take an active part in the work of the national public-health co-ordination committees. The importance of establishing such committees cannot be over-emphasized, particularly in countries where a number of outside agencies are assisting the government. They enable the various agencies to obtain a clearer picture of the health needs of the countries concerned and to plan assistance in such a way that the aid given will be complementary and not duplicated.. They also fac111 tate the function of the Organization lito act as the directing and. co-ordinating authority on international health work". The Rockefeller Foundation, the China Medical Board. and the Asia Foundation have maintained their interest in a number of WHO-assisted projects and have contributed. to progress in the field. of education and. training through the award. of fellowships. The Organization sent observers to the Pan-Pacific Conference on Rehabilitation sponsored. by the International SOCiety for the Welfare of Children and held. in Sydney, and the First Asian Regional Paediatric Congress held in Singapore. It also accepted. an invitation to send an observer to the Conference of Deans of Medical Schools in Australasia, which was held. in Melbourne. 6. PUBLIC INFORMATION A development in public information work during the year was the int rest of government health departments, information offices as well as accredited correspondents, reporters and free-lance writers in giving wider information coverage to health and health activities in their own countries. A review of the year will show that the press and radio have exerted efforts to disseminate information material and. to acquaint the people with what is being done for them. On their own initiative many newspapers and radio stations produced articles and prepared broadcasts encouraging mass support of health work in their countri s. To encourage this trend the Regional Office has devoted much time to the maintenance of good relations with the press and other media of mass camnunication. A mailing list of over 2000 addresses covers a reg1on.-wide distribution of material, and a fairly high percentage of the material produced in the Regional. Office is used in the newsletters, pamphlets, booklets and. other material distributed by Headquarters. /While WHO field ••• WP/RC9/2 page 10 While WHO field personnel remained a good source of material for public information, visits by the Public Information Officer and his assistant to WHO. assisted field projects, interviews of staff members and stories taken from field reports were responsible for the bulk of articles, stories and photographs that were sent out by the office. Efforts are being exerted to encoura~ more staff members to contribute stories that would. depict their experience in the field .• The Regional Office has also co-operated. closely with Headquarters in a number of projects. As a result of a visit by Mr. Pierre Gascar, noted French writer who came to the Philippines in 1956, several chapters on the work of WHO in the Philippines and WHO assistance in the Schistosomiasis Control Pilot Project in Leyte were incorporated in an excellent book IIVoyage Chez les Vivants" which was published recently. The Regional Office gave assistance to Mr. Gascar during his sojourn in the Philippines. In collaboration with Mr. Alfred. Wagg, the motion picture documentary producer, who was engaged by Headquarters to do a film on the WHO-assisted work in th Philippines, the office prepared. a script for a film on the Schistosomiasis Control Pilot Project in Leyte. Full supervision of the filming and liaison work between the film crew and Geneva. was undertaken by the Regional Office staff. The film is to be shown in television in the Un! ted States of America and a short documentary film, in colour, will be given world~wide distribution. Press cuttings and. reports from the area representatives showed that the monthly publication "FEATURESII , wich was first issued a year ago, is very well received by newspapers and magazines. A fairly good number of the articles in this publication have been widely reprinted. The Regional Office also inaugurated another series for the press of the Region -- a monthly "Review of WHO Publications" The WPRO pamphlet, which is widely distributed, has been revised and brought up to date so that new projects are now included. The increasing interest in health work is vividly supported. by the reports on 1958 World Health Day observance in the Region. While World Health Day articles distributed by the office were reproduced by newspapers and magazines of many countries, the main emphasis has been on the presentation of national health activities. Special articles, scripts for radio broadcasts and. unique cel brations indicated that there was individual planning. It also showed that Member Governments are doing their best to stimulate wider public support for their health programmes by adapting the theme of World Health Day to their own local conditions. Special exhibits were set up in Manila during the celebration of united Nations Week, 16-24 October 1951, in Hong Kong, for the E1ghth Regional Committee Meeting and in Tokyo, during the first Regional Venereal-Disease Control Seminar held fran 17 to 29 March 1958. The office also sent photographs for exhibit purposes at the First Asian Paediatric Congress which was held in Singapore from 26 to 30 May 1958. The Tenth Anniversary picture pamphlet - Pictures of World Health - was widely distributed to health departments, newspapers, magazines and. radio stations. /PARr I!. •• PART II. GENERAL STATEMENT OF ACTIVITIES IN THE RmION 1. PUBLIC-HEALTH SERVICES WP/RC9/2 page II 1.1 Assistance to governments in developing and. strengthenin~ their health services Regional activities d:uring the period. under review included., among others, four factors of health planning, namely, ascertaining the problems, considering what is being done, what should. be done and what can be done. Visits undertaken by public-health administrators, regional advisers and the work of area representatives were closely connected with the study of the health needs of the countries visited, the evaluation of existing projects and assistance in planning improved programmes. The Region presents fairly wide divergent patterns of health administration and. assistance must, therefore, be adapted to the particular needs and. existing resources of the country concerned. As reported on previous occasions, the main factors Which still hamper progress in many countries of the Region are the shortage of medical and. auxiliary staff and. budgetary limitations. However, in a number of countries a more definite pattern of health administration is emerging and short-term objectives are being defined. in a more positive manner. There also appears to be a growing understanding on the part of governments of the role that outside help can play and of its limitations. In the past a number of governments have shown a preference for projects with well-defined. limits for which one can expect visible results in the relatively near future. A recent trend. which is becoming more apparent is the sign that governments are not only more aware of the acute need for improvement of their central administrations but are also more willing to seek advice in these fields. Comprehensive and long-term planning of country health programmes, which is a fundamental objective of WHO's work in the Region, is being developed. gradually. The most distinct change in the pattern of a national health administration is that authorized by the Government of the Philippines. The emphasis to be placed. on decentralized health services under eight regional directors will ensure that the health needs in the rural areas are taken care of and. that specialized mass campaign work will be integrated. into the work of the rural health units. In Viet Nam the planned. reorganization of the Ministry of Public Health, with the assistance of Michigan State University, is yet another step forward in the government plans to develop and modernize the health administration. A joint study is now being undertaken by the University, the United States Inter- national Co-operation Administration (ICA) and WHO in regard to the administrative and organizational problems of the Ministry. In Viet Nam assistance has been given to the central services in maternal and child. health work and environmental sanitation through the WHO projects. Plans have also been drawn up for an / extensive progra.mme of ••• WP/RC9/2 page 12 an extensive progl'atmne of rural health services in which lCA is assisting. Emphasis is being placed on the prevention of diseases, field teams will be established first, following which the organizational and administrative aspects of health services from national to local level will be developed .• The shorta~e of man-power is being tackled by engaging physicians from other countries (Philippines) and. by a long-range plan to expand. and, modernize the medical school facilities in Saigon. The five-year development plan of the Government of Laos also envisages the expansion of health services. The trend. towards integrated public-health services has gradually gained impetus. There is a move from individual or isolated demonstration projects towards the integl'ation of projects into co-ordinated. public-health services. As an example of this trend., the Government of Cambodia decided, in spite of the difficulties, to set up a rural health training and demonstration centre as a nucleus from which the various programmes assisted. by WHO might be integrated into a comprehensive scheme. The Rural Health Training Centre in Ji tra, Federation of Malaya, is developing a curative and preventive service for the local government area of Kubang Pasu. The Government plans to establish ninety district health units within fifteen years, each community will have a district centre, four sub-centres and. quarters for midwives who will work from the centres and sub-centres. Programmes are being developed, for medical care, out-patient clinics, maternal and child health services, school-health services, dental services, health education, environmental sanitation and communicable disease control. The area is also being use for the training of auxiliary teams from allover Malaya who will eventually staff the centres and sub-centres throughout the rural areas, under medical and nursing supervision. Four training courses have so far been held and. a fifth is in progress.· In Fiji, follow-up services in connexion with the yaws control progl'e.mme are now being carried out by the rural health services, while in Laos plans are under consideration for expansion of the yaws control project into a rural health service demonstration project. In the Philippines also, follow-up work in connexion with the leprosy, BCG and yaws control programmes is now to a very large extent included in the routine activities of the rural health services. In Singapore, 14 May 1958 marked the official opening of the Institute of Health, which is a co-operative venture of the Government of Singapore, the Singapore City Council and the University of Malaya. It provides headquarters for the Pre-school and School Health Service of the Singapore Government, houses the Maternity and. Infant Welfare Centre of the City Council and, the Department of Social Medicine and Public Health of the University. The Health Education Centre and Public Health Museum are situated there and a small section is reserved for social welfare and voluntary agencies. Thus, in one centre, phYSicians, medical students, nurses, midwives and sanitary inspectors can all obtain training and practical experience. As stated in the introduction, the Federation of Malaya became a Member State during the past year. Under the Malaya.n1zation of Public Service Scheme more and more local men have been given responsible posts following the departure of expatriate officers. There is, however, a need of international assistance in training local officers for greater responsibilities, such as for example, / training in -ward, ••• VlP/RC9/2 page 13 training in ward administration for staff nurses who were selected for promotion to nursing sisters. The Government is making a heroic effort to train persons locally and has a long-term programme in view. Because of the assistance available first from the Korean Civilian Assistance Command (KCAC) and. then from the Un1 ted. Nations Korean Rehabilitation Administration (UNKRA), Korea has until now only requested WHO fellowships to give additional training to selected candidates. WHO has also provided technical advice especially in connexion with the UNICEF-assisted midwives' refresher training programmes. With the termination of UNKRA activities, WHO has been requested to take over some of its work and to continue aid to some of the projects. Last year, regional office technical staff and short.term consultants visited Korea to survey and. to advise on health education, physical rehabilitation and. leprosy control. In August 1958 a malaria team composed of a malariologist, an entomologist and two laboratory technicians will assist the Government in carrying out a malaria survey and. arrangements have been made for a short-term consultant to carry out a survey of the clonorchiasis situation. The Government has now requested. an international expert in 1960 to assist the national public. health demonstration and training centre, where a programme designed to train sufficient personnel to permit the upgrading of the public-health dispensaries into health centres, is being carried out. One of the new activities during the period was the Public Health Conference and Study Tour of Japan and Taiwan, which started immediately after the meeting of the Regional Committee in Hong Kong. Invi tations were extended for a senior health officer from each of the Member States represented at the Regional Committee, and their territories, to participate. The Host Governments made funds available to meet the local costs and. established preparatory committees. Local organization was extremely efficient, the schedule was closely adhered to and the timing was very good. The topic of the conference was "Comprehensive Health Planning" which included. en mmuni ty development. The participants had an opportunity to see projects assisted by WHO, UNICEF and/or bilateral agencies. The group visited over twenty. seven institutions, programmes and projects embracing research laboratories, medical schools, institutes of public health, nursing education projects, vital and health statistical services, environmental sanitation projects, health centres and. stations, maternal and child health services, crippled children services, hospitals and. programmes for the control of communicable diseases, such as malaria, tuberculosis, venereal diseases, trachoma and leprosy. While preparing to receive the group, the workers in the institutions and on programmes and projects to be visited had an opportunity to re.evaluate their work. Reports received indicate that the presence of the group stimulated interest in health in official circles and among the general population; it is also believed. that the workers in the countries visited benefitted. greatly from the ex~ of views and experiences with the visitors. It is difficult to say how much of the follOwing can be credited to the Public Health Conference and. Study Tour, but in one of the host countries, negotiations for a practice area for the Institute of Public Health have been resumed, plans are underway for regionalization of health services and for the affiliation of provincial service hospitals with the teaching hospitals of medical schools. II mentioned in ••• WP/RC9/2 page 14 I mentioned. in my last report and. should like to repeat again the importance of an established civil service system. Lack of security of tenure and the rather low.salary scale have resulted. in certain areas in a sizable turnover in government key personnel. Those who remain often have to resort to private practice after government office hours in order to supplement their income. As a result, efficiency is not at its optimum and national health programmes consequently suffer. Although there are certain difficulties of a fairly constant nature, such as the prOvision of counterparts, the lack of trained medical and auxiliary personnel, this situation is slowly improving. In general, counterparts are now being provided. although the situation is not always as completely satisfactory as one would wish, too many changes resulting in delays. Progress would be more rapid. if governments were able to improve the numbers and. in some cases the quality of counterpart personnel on Whom the success of the programme very largely rests. The recruitment of medical and. auxiliary personnel has, however, been accelerated in a number of countries and, as previously stated, an increasing number of requests are being received. for fellowships for the training of local personnel at undergraduate and post-graduate level. There is also a slow but definite move towards improved. co-ordination between the various teaching programmes, a development Which it is hoped. will increase in impetus in the coming year. 1.2 Maternal and. Child Health The need. for special measures to protect the health of mothers and children is recognized in all countries and territories of the Region and, as in previous years, efforts have been continued to assist governments in strengthening various aspects of their maternal and child health programmes. Since the range of pro- blems and needs encountered in the Region is extensive, activities in programmes assisted. by the Organization cover a broad field. WHO project staff have continued to assist the Qovernments of China, Malaya and. Viet Nam in programmes Which are primarily concerned With improving and extending basic public-health and medical care services for mothers and children and with training of professional and. auxiliary medical nursing and. midwifery personnel for this purpose. In Cambodia, WHO staff have continued to assist the Government in developing the school-health programme. In addition to these field. activities, fellowships have been awarded. to doctors, nurses and midwives from a number of countries and territories to enable them to obtain further training and. experience abroad .• In 1952, WHO provided. a medical consultant to advise the Government of Japan on the organization of a programme for the rehabilitation of handicapped. children, subsequent assistance included. the advisory services of a consultant on physiotherapy and the award of fellowships. The programme has expanded steadily and hospital-schools for crippled children have now been established in thirty-nine prefectures. At the request of the Government, provision was made for the medical consultant to return to Japan for a period. of one month to evaluate the programme and. make recommendations for future developments. /The Government of ••• Maternal and Child. Health The Government of Cambodia is receiving WHO assistance in its ef- forts to integrate maternal 'Inn child health services into the healt.h services of the country. Photo shows health workers in the Satheavong Health Centre. A vast programme of short-terlll training of hilots (traditional birth attendants) has been organized by the Philippine Governmpnt with the help of WHO and UNICEF. Hert', a hilot assists a young mother at childbirth. wp/RC9/2 page 15 The Government of Malaya, is continuing investigations on the problem of protein malnutrition in children. Following the surveys carried, out by two consultants provided by WHO in 1956, further studies were considered necessary and a social anthropologist has recently been assigned by WHO to assist the Govermnent in this work. It is expected that the results of these investigations will make a valuable contribution to the development of a practical and effective programme to improve child nutrition. An important development in China has been the establishment of the Institute of Maternal and, Child, Health which was opened in Taichung early in 1958. This institute is to serve as the administrative unit for the maternal and child health programme in Taiwan and its activities will also include teaching and research. The WHO consultant wo visited, Taiw.n in 1957 submitted a very compre- hensive and valuable report, one result of which has been that increased attention is being given to problems of malnutrition in pregnant women and young children. A committee has been set up to investigate the possibilities of using locally available protein-rich food for supplementary feeding of mothers and young children. At the Government I s request, two fellowships have been provided for a doctor and a nurse to study infant nutrition; these fellowships are to replace the services of the medical consultant originally requested for 1958. The maternal and, child. health programme in Viet Nam continues to make steady progress. The main activities during the year have been concerned with improving and extending services and, training programmes in the Children's Hospital and in the Tu-Du Matern! ty Hospital in Saigon, which have been designated as teaching and demonstration centres. Recruitment difficulties have unfortunately delayed appointment of the paediatrician requested, by the Government from WHO, but there is reason to hope that this post will be filled, before the end of 1958. In Malaya" the Government's rural health services scheme is being gradually implemented. Training courses for auxiliary level nurses, midwives and sanitarians have been continued at the Rural Health Training Centre in Ji tra, to prepar the staff for service in the new health centres. The present shortage of doctors, nurses and midwives for supervisory duties does, however, present a serious problem for which a solution has yet to be found. In many parts of the Region, there are signs of increasing a~eness of the need for closer co-operation between doctors, nurses, midwives and, other personnel engaged in maternal and, child. health work. There is, however, less evidenc that the necessity to integrate, or at least, to co-ordinate preventive and curative services has been given due recognition, with the result that maternal and child health programmes in same countries and territories are less effective than they might be. There is a real need for more attention to be gf ven to this problem and the ways in which it might be solved. As in previous years, UNICEF has made a major contribution to maternal and child work in many countries and territories of the Region and has provided assistance to most of the maternal and child health projects in wich the Organization is concerned .• /1.3 Nursing WP/RC9/2 page 16 1.; Nursing As health services throughout the Region develop and expand, there is evidence of an increasing awareness of the role of the nurse in health programmes. The demand. for nursing service in the general and. special fields is in most instances beyond 'Wha.t present educational facilities can supply. During the period. under review, the Organization has provided assistance to a number of Member Countries for the improvement and development of nursing and midWifery services. This has included. continued. assistance in expanding and strengthening basic schools of nursing and. midwifery; improving facilities for clinical experience in hospitals and health agencies; post-basic education for public-health nurses, midwives, clinical teachers and nursing service personnel; providing technical advice and assistance in the study of needs and resources of nursing personnel, evaluation of existing education programmes and. formulation of immediate and. long-range plans to meet present and. future needs, study and revision of existing nursing and midwifery legislation and drafting of new legislation to improve standards and protect the public and the profession. In addition, fellowships have been awarded. to prepare national nurses for positions of responsibility in national health programmes. The need. for integration of the social and. preventive aspects of health into the basic edUcation programme in schools of nursing is receiving attention in all WHO-assisted programmes. In some countries, this is being accomplished through inclusion of public health and the social sciences in the basic curriculum, relating tie se concepts in clinical nursing care, and increasing the students' contact with the community and. the preventive health services through planned. experience in public-health agencies. Several schools of nursing have appointed a qualified public-health nurse to their teaching staff and many public-health agenci s DOW have organized education programmes for various categories of personnel. Shortage of' qualified. teaching staff and the use of student nurses to supply the bulk of hospital nursing service is a delaying factor in some countries. Assistance is being given in the field. of mental health and. psychiatric nursing in Taiwan and a training programme for psychiatric nurses has been established. in Singapore. The great need. for assistance in this field is recognized in all countries and requests are expected. to increase for advisory services and. fellowships. In several countries, nursing education committees, nursing associations and other national bodies with nursing representation are studying nursing and midwifery curricula. and. training programmes, evaluation and examination procedures, legislation, needs and resources of nursing personnel and staffing patterns for hospitals, schools of nursing and. health services as a basis for programme planning. The development of formal post-basic courses and in-service education programmes at national level for the various categories of nursing and midwifery personnel has continued.. Post-basic courses for public-health nurses, psychiatric nurses and ward. sisters have been established in Singapore during the past year. /Seven countries are ••• A WHO senior Nurse Educator ]s helping the Government of the Fe- deration of Malaya to improve the standard of nursing education· and the quality of the nursing practice. N'ursing Student nurses at the General Hospital in Singapore being given a practical demonstration by a WHO Nurse-Educator who is assisting the Government of SingaDore to raise the standard of nursing education. Seven countries are receiving assistance with midwifery education. wp/RC9/2 page 17 Significant progress has been made in the strengthening of midwifery education and. improved. midwifery practice including domiciliary midwifery. A nursing consultant was provided. for a three-month period. to study the nursing education programme in Taiwan and to ad~se on future assistance in basic and post-graduate nursing education. There are many problems which continue to be of major concern in the Region. Shortage of well-prepared personnel for leadership positions continues to limit the proe,ress which can be made in all fields of nursing. The increasing demands for nursing service has in some instances resulted in an increase in recruitment of all categories of personnel often without the necessary increase of teaching personnel and facilities to maintain and improve standards. In many countries where nursing has not reached professional status because of unavailability of candidates with the required education or because of lack of recogniti~n of the nurse as a professional worker, standards of nursing care and development of nursing services leave much to be done. The expansion in the numbers and categories of auxiliary level workers, in many instances with l1m1 ted training, and. the lack of availabill ty of trained. professional personnel to provide adequate supervision and. guidance for them is a serious problem. In addition to the critical shortage of nurses prepared for teaching, administration and supervision, there is an acute shortage of nurses with adequate preparation in special fields such as psychiatric nursing and mental health, paediatric nursing, public"health and. industrial nursing, surgical specialties and tuberculosis. There is a great need for development of advanced programmes locally or regionally to prepare personnel for these fields. Overs as fellowships could then be utilized for preparation for leadership positions. Teaching aids and. equipment provided. by UNICEF, WHO, the United States International Co-operation Administration and other international and bilateral agencies have helped inmeasurably. Teaching materials prepared. locally in the language used. by the people and related. to local situations are still in very short supply. Finally, there is a need for further study and. help to define the role of the nurse in national health administration, nursing service and nursing education administration and as a professional member of the health team, and. to plan with administrative bodies for the development of nursing as an integral part of the health services with adequate support (b~tary or other) for the development of programmes for the education and training of all categories of nursing personnel. 1.4 Environmental Sanitation There has been an increased. awareness of the importance of factors in the environment affecting the public health in countries of the Western Pacific Region dur.ing the past year. This awareness has been reflected in long-range /p1anning for environmental ••• WP/RC9/2 page 18 planning for environmental sanitation programmes, initiation of training and field programmes, interest in and. attendance at WHO-sponsored. environmental sanitation seminars and in requests received. in the Regional Office for assistance in this field .• The current year saw the completion of the series of three zonal semi nars in environmental sanitation. The first seminar held. in Taiwan late in 1956 had. as its general subject "The Collection, Disposal and Utilization of Organic Wastes". The second zonal seminar w.s held. in Singapore during the period 2 to 19 December 1957 and. concerned itself with rural w.ter supplies. The third zonal seminar Which w.s held in Port Moresby, Territory of Papua and New Guinea from the period 5 to 23 May 1958 had. as its general subject "Environmental Sa.ni tation of the South Pacific Islands". These seminars were extremely successfUl in stimulating interest in problems of environmental sanitation and in providing for exchange of information between technical workers in the countries participating in these meetings. The seminars were attended by a varied group including public-health administrators, public-health engineers, sanitarians, public-works engineers, teachers and laboratory workers. The seminars included a total of fifty participants and. twenty-five official observers from twenty-eight countries and territories. These meetings obtained. wide publicity both in the popular press and in technical journals. It is evident from post-seminar follow-ups that the meetings had a very stimulating effect upon the countries participating. Most of the countries of this region have a very marked shortage of trained workers in the field. of environmental sanitation. The need for more and better- trained personnel has been recognized by a number of governments in instituting new programmes for training of these workers. In Japan, the newly-established undergraduate course in sanitary engineering at Hokkaido University has now been joined by a similar course at Kyoto University. It is planned that eventually a graduate course in sanitary engineering will be instituted at the latter university and a third. national university in Tokyo is presently planning for specialized teaching in this field. A post-graduate course leading to the degree of Master of Public Health Engineering w.s initiated this year at the Institute of HygLene of the University of the Philippines. Continued. emphasis is being placed. by Member CO'lmtries on basic programmes for provision of safe w.ter supplies and sanitary disposal of human excreta. Water-borne sewerage systems previously planned and designed with the assistance of WHO are being constructed in urban communities of North Borneo. WHO is also assisting the capital of Taiwan, Taipei, in the design of a w.ter.borne sewerage system which will serve this community of approximately 700 000 people. Problems arising through the use of septic tanks or other household devices for disposal of household wastes have been of great interest to technicians of Member CO'lmtries. It is anticipated. that this will be an increaSing problem, especially in those countries where urbanization is occurring at ever-accelerating rates. The interest in composting of organic w.stes, including night-soil, continues in the Region. There are presently operating in Japan three fUll-scale prototype high-rate camposting plants. The full-scale prototype plant for the community of Ping-tung, Taiwan, w.s recently completed based on studies made in the operation of a pilot plant. The City of Taipei, assisted. by the TaiWdn Institute /of Environmental Sanitation ••• Environmental Sanitation A group of sanitary agent trainee~·, inspecting a chemical feed device for treating water at Bien Hoa in Viet N am. WHO has provided a public health engineer to help Viet Nam strengthen the national and local environmental sanitation services. Health. Education of the Public A lady health educator conduct- ing a health education study in connection with the WHO-assisted Schistosomiasis Control Pilot Pro- ject in Leyte, Philippines. The stu- dy seeks to demonstrate how ba'li(~ health education principles can bc- applied to the control of a specific disease. wp/RC9/2 page 19 of Environmental Sanitation, is also making studies to determine the most effective method. for compo sting of the City's wastes. A pilot camposting plant has been designed and will shortly be constructed for the City of Manila. A . successful anti-littering campaign for the City of Manila had widespread repercussions throughout the Philippines and has been copied by a number of other cities in the country. Stimulation has been given by WHO to the formation of environmental sani tation technical associations in the various Member Countries. It is hoped that these will eventually be joined. in an Asian a.ssociation which may hold annual meetings and. possibly publish a technical journal for this part of the world. For the future, it is expected. that the WHO Regional Office will continue to emphasize training aspects in order that countries may be assisted in the provision of trained workers , both professional and non-professional, in the field of environmental sanitation. Continued emphasis will be placed on stimulating countries to develop national long-range environmental sanitation plans. It is also expected that a considerable amount of effort will be made to determine further approaches to acceptance by the public of environmental sanitation programmes, especially in rural areas. It is hoped that these approaches will be developed through collaboration with social anthropologists and SOCiologists. It is hoped that these efforts, with the assistance 'Which may be offered in solving specific and. immediate problems by the use of projects or consultants in individual countries and by awarding fellowships, will accelerate the tempo in the improvement of the environment in the Western Pacific. 1.5 Health Education With the accumulation of an ever-increasing body of scientific knowledge, the public-health profession today is faced with the problem of translating this knowledge into practices 'Which will be understood, accepted and. utilized. by the people. Such practices frequently run contrary to the traditional customs and beliefs of the people as well as those practices formerly advocated by health personnel themselves. This means that the educational process whereby the people are influenced. to alter their health attitudes and behaviOur, both individually and. collectively, becomes even more important if these new develop- ments are to benefit the people. Running parallel with the developnent in the fields of health and. medicine are the rapid strides being made in the behavioural sciences 'Which have demonstrated. more effective ways of influencing people as well as pointing up the 11m! tations of many of the long-established educational methods and. techniques. As yet there is no short cut to health education by any programme of universal application. Each government finds that it has to design plans and approaches best sui ted to its background. and. the attitude of its people. It is the aim of the health education programme of the Western Pacific Regional Office to assist governments in this endeavour with emphasis on the training of all types of health workers in the understanding and application of these recent social science findings as an integral part of their day-to-day health activities. /The outstanding activity ••• WP/RC9/2 page 20 The outstanding activity of the year 'Was the holding of the eight-weeks joint WHO/SPC Health Education Training Course for forty island education and health workers at the Headquarters of the South Pacific Commission in Noumea, New Caledonia. The faculty of this training course rated it a success and in addition to the expressions of satisfaction on the part of the trainees there have been numerous favourable reports from territorial administrations in terms of its benefits to their trainees. Since the training course, the WHO health education specialist assigned. to the Commission for follow-up work has visited the majority of the trainees giving them guidance and advising the territorial departments of health and. education on their health education problems and needs. The Regional Adviser was also able to visit all the course trainees from the Trust Territory of the Pacific Islands, Guam and. Saipan during a field visit to these territories in December 1957. Through the interest stimulated by this course, the Government of Guam is planning to sponsor a similar training course in late 1958 for its health and. education workers and those from the surrounding United. States island territories. In addition, the Organization has received health education fellowship requests from Fiji and West New Guinea. Plans have been completed for a health education conference of WHO field personnel and their counterparts in Tai'WB.n. This will be held in July. The main purpose of the conference is to clarify the major health education problems involved. in WHO project operations, to consider improved approaches to these problems based. on modern health education concepts and to explore the resources Which can be brought to bear on the health education aspects of these projects. It is planned that this meeting will be the first of a series of health education conferences to be held in other countries in the Region where there are a sufficient number of WHO field personnel employed. During the period. under review fellows ftom New Zealand, Territory of Papua and New Guinea (2) and. Korea (2) pursued. twelve-month overseas fellowship studies in health education and. the health education supervisor with the Department of H alth in the Philippines was granted. a ten-month etudy travel fellowship in health education administration and. supervision. Observation and. study programmes in health education were also arranged for two fellows from other regions. Other health education activities have included advisory services in the planning phase of a number of country and inter-country projects. 1.6 Mental Health While the interest of public-health authorities and the public in mental health in several countries of the Region is great, there is a considerable shortage of trained. mental health workers of all kinds which means that activities in this field continue to be limited. Since last year's report there were no very significant changes in the Region, with the exception of the Philippine~where plans for a mental hygi ne division under the proposed Bureau of Disease Control are now under consideration. Administrative and. clinical improvements took place in the National Mental Hospital in Manila and these were strengthened. fUrther by extensive in-service training and a fellowship programme. Two psychiatrists and. two psychiatric nurses of the National Mental Hospital have been avm.rded WHO fellowships for four-months study of mental health work in Australia. Plans for a new admission and. diagnostic / centre in Manila ••• Mental Health A WHO consultant is helping the Government of the Philippines modernize its mental health services. Education and Training WHO is assisting the University of Malaya in Singapore to develop the teaching of preventive and social medicine and to establish a post-graduate school of public health. A WHO lecturer is shown with a group of medical students. wp/RC9/2 page 21 centre in Manila, centralizing medico-social and. voluntary agencies' work, were advanced with an appropriate budgetary provision. The Government of the Philippines has requested continuation of WHO assistance in the mental health field througn 1959 as a high priority. On the recommendation of a WHO consultant, a child guidance clinic ~s established in Taipei, China, and an expanded. programme of demonstration and. training ~s launched. in 1957 after the Associate Professor returned from a WHO fellowship. Growing interest in this field was expressed. by the Government whiCh requested fellowships in psychiatry and psychiatric social work. Training in psychiatric nurSing is being undertaken at the Collegiate School of Nursing, National Taiwan University and WHO is assisting by the provision of a psyChiatric nurse educator. China, Hong Kong, Japan and. the Philippines received fellowship a~ds in the period of review; these a~ds covered. the following fields: child psychiatry, clinical psychology, preventive drug addiction (mental health), organization and administration of mental health clinics and practice in these clinics, diagnostic and. guidance techniques with particular reference to variDus methDds Df testing children, and Drientation and. training in the administration of a psychiatric hospital, organization, treatment and rehabilitation of psychiatric cases. The pDor quality Df teaching in psychological medicine given in many medical SChODls of the RegiDn and the failure tD give this discipline a prDper place in the curriculum are responsible to a large extent for the shDrtage Df persDnnel in this field. Progress can be achieved by sending overseas suitable natiDnal candidates WhD, on return, will prDvide leadership and promDte interest in th field. of mental health. It appears that the visits tD the cDuntries by a shDrt- term consultant may also do much tD promote the development Df the service and influence governments to attract the persDnnel of the quality needed .• To promDte mental health activities wi thin the Region further, WHO is sponsoring an Asian Seminar Dn Family Life and. Mental Health in late 1958. The seminar is being Drganized. by the Philippine Mental Health Association with ~ the co-operation of the World. FederatiDn of Mental Health, the Asia_Foundation ~~ and the Government Df the Philippines. o ~ 1.7 Statistics <.!J il The vital and. health statistical services of many cDuntries and territDri s in the RegiDn are as yet not sufficiently well-develDped to provide the necessary statistical basis for planning realistic long-term public-health programmes fDr the area concerned. The need to strengthen such services has been a matter of concern tD the Regional Office for some time and it is therefDre encouraging to . find. that governments are showing increasing interest in this field. as evidenced. b~ the growing number Df requests for advisory services. Assistance bas been provided in several ways; through visits of the Regional Statistician, through the award of fellowships and. by advisory services to governments. Field activities are as yet limited. In Singapore, however, the hos~i tal records project is being broadened into a medical statistics project /Which has as ••• WP/RC9/2 page 22 which has as its objective the improvement of vital and. health statistics throughout Singapore. In the Philippines the Government is in the process of establishing a committee on vital and health statistics, while in Viet Nam a vital and. health statistics project, which is designed. to reorganize and. strengthen the Central Statistics Bureau, is planned for 1960. A statistician specialist has been assigned. to the tuberculosis control project in Taiwan and a visiting professor of vital and health statistics was assigned. to the Institute of Hygiene, University of the Philippines, to assist in the training of public- health personnel and. provide technical advice to the Government. The training of personnel is, of course, essential for the improvement of statistical services and. in the past twelve fellowships have been awarded to enable national statistical personnel to go abroad. on advanced training. Plans for 1960 include a regional seminar on vital and health statistics,which has as its objective the provision of additional training for workers in national statistical services, and many governments have expressed interest in sending partiCipants. This will be the second vital and health statistics s~minar to be held in the Region and it is hoped. that the stimulus it will provide will result in an increased a~eness of the important role improved statistical services can play in national development. In areas where the vital and health statistical service is not sufficiently well-developed, a broadening of statistical information can be obtained by means of national health surveys and. the Regional Office is in a position to furnish technical assistance in the planning and operation of such surveys by the less expensive and. more efficient method of sampling. Of considerable importance too is the organization of national committees on vital and health statistics in order to co-ordinate the activities and. functions of different agencies, thus avoiding wasteful overlapping of effort, fulfilling national needs and attaining uniformity and comparability. To the extent that it is available, statistical information on the health and. socio-economic conditions of countries and territories in the Region is being regularly collected and classified at the Regional Office in order to permit a better understanding of the specific health problems to be solved. and. to serve as a possible basis for programme planning in the countries concerned. The epidemiological returns from countries containing a large number of communicable and non-communicable diseases are also summarized. weekly at the Regional Office in order to provide a general picture of the current health situation. It is hoped. that governments will continue to stress the importance of vital and health statistics and. that full use will be made of the advisory services in the Regional Office so that in the not too distant future progress will have been made to a point where the services available will fulfill national needs and. eventually attain international uniformity and comparability. /2. EDUCATION AND TRAINING 2. EDUCATION AND TRAINING 2.1 Assistance to Educational Institutions wp/RC9/2 page 23 During the year, the PUblic-Health Administrators or the Adviser on Education and. Training visited all educational institutions where assistance is being given. Assistance from the Organization has taken the form of visiting lecturers, fellowships, consultants and, grants. In Cambodia, WHO continued to support the Royal School of Medicine, by providing lecturers in the fields of ophthalmology, radiology and physiology and, financial assistance to a proportion of the annual enrolment of Cambodian students. Laotian students, three of whom are on WHO fellowships: are also being trained, in this school. A WHO-sponsored lecturer in social medicine has been assisting the University nf Malaya on the exchange programme between this university and, the London School of Hygiene and Tropical Medicine and a fellowship was awarded, to his counterpart for further training at the London School. WHO sent 1:'-rD fellows from Hong Kong and one from Japan to the 1957-58 course for the diploma in public health. The Regional Committee has, on a number of occasions, emphasized the importance of intr~regional education and. training facilities and the course for the diploma of public health at the University of M3laya is particularly commended. to its attention. It is hoped, that continued. support will be given to the course by countries in the Region, particularly those countries without national training facilities. WHO lecturers in physiology and biology continued, their lecturing activities at the Central Medical School, Suva. Students on thre~-year WHO fellowships in biology and physiology are being trained overseas while fellowships for ovel'seas stud;y in anatomy and physics were awarded, by the China Medical Board in order to train an assistant medical practitioner and a local student respectively for junior lectureships in the medical and basic sciences. Arrangements for the China Medical Board fellowships were made through WHO. Assistance to the Institute of Public Health, Tokyo, has continued. with the provision of a senior nursing educator, the assignment of a short-term consultant in the training of sanitarians, fellowship awards and supplies. The Institute has offered its facilities as a training centre and Japanese-speaking fellows from Taiwan bave already benefited, from this. The exchange programme between the Institute of Hygiene of the University of the Philippines and the Johns Hopkins School of HYeiene end Public Health bas progressed according to plan, a short-term consultant and, a lecturer in maternal and child, health, as well as a lecturer in biostatistical methods and. a short-term consultant in mental health, being provided, in the period. The Institute of Hygiene is playing an important role as a training centre for WHO fellowship students in addition to its other facilities, a post-graduate course leading to the degree of Master of Public Health Engineering. An evaluation report covering the period, 1953-1957 was prepared, by the Regional Programme Evaluator. This reveals that sixty-four out of the sixty-nine recommendations made by visiting staff since the project started have been implemented.; the recommendations made were classified, into "more" and "less" important. All the recommendations in the first category have been put into ~ffect. /2.2 Fellowships ... wp/RC9/2 page 24 2.2 Fell.owships During the period under review, eighty fellowships (including one granted under Headquarters' "Exchange of Scientific Workers - Ma.1aria Eradication Progra.zm:ne ll ) were awarded. by the Regional Office under its regular and Technical Assistance programmes. This number includes one eighteen-month, one twenty-one month, and. three twenty-four-menth awards but does not include second. or third. year aw.rds fer which funds had been obligated. bef.ore the period.. Nei ther does it include ten grants given in application of the principles embodied in reselution WHA6.35 (whereby assistance is given to candidates attending national training courses) nor two fellowships for study in New Zealand financed by the China Medical Board of New York, I~c. The fellowship menths for the 80 fellowships total 673.5. The distribution of the fellowships according to fields of study and countries of origin is shown in Annex g" Of the 80 fellewships, 39 or 48.7% were awarded for study within the Western Pacific Region (intra-regional) while 11 were for study partly in the Region with visits to other countries outside the Region (inter-regional). This year's percentage of intra-regional fellowships (48.7%) shows a marked. increase over that reperted last year (30%). Of the 80 fellowships awarded., 7 were for less than three months in duration, 13 were for three to five months, 24 were fer six to eight months, 31 were for nine to twelve months, and 5 were fer more than twelve months. The possibility of more fellows. training wholly within the Region is continueusly under study and governments are urged. to agree to sending their candidates to ceuntries within the Regien for study or observation whenever adequate training facilities in the desired field. of study are available. During the period. under review, placement for study within the Regien was alse arranged. for a number of candidates from outside the Region. The distribution of fellows from other regions who actually arrived in the Region during the period was as follows: Africa - 3; Americas - 2; Eastern Mediterranean - 3; and. South-East Asia - 11. Annex T gives the distribution of visits to this region by countries of study and region of origin. As in previous years, a number of candidates n.ominated were without adequate preparation in the language of the proposed country of study resulting in delays in placement arrangements and/or deferment .of the commencement of their training schedules. Receiving institutions are unanimous in their insistence on adequate language preparation and it is to comply with this all-important requirement and to ensure that the fellows benefit fully from their fellowships that governments are once more asked to ensure that only qualified candidates are nominated.. It should. be pointed out that a candidate whose English proficiency is found to be inadequate during the period .of the fellowship is usually required. t.o underg.o intensive language tuition if pursuing an academic course of study, and that this not only adds to the candidate's already heavy schedule, affecting his progress ad¥ersely, but also causes unnecessary inconvenience to the teaching staff. /All candidates from ••• WP/RC9/2 page 25 All candidates from non-English speaking areas nominated for study or observati on in the United States of America and English-speaking Canada are now required. to submit an English proficiency test conducted. by the Michigan University Language Institute and administered. through its proctor or examiner in the country of origin, prior to their being given an award for study in these areas. This scheme was evolved. to solve the ever-recurring problem of fellows assessed. as proficient in English in a local examination but turning out to be sadly unprepared. for study in an English-speaking country. It is also to meet the increasing resistance on the part of teaching institutions to accepting candidates for training without an additional safeguard. The Michigan test does not mean the discontinuation of the English proficiency tests at present conducted by national testing agencie~as it would be advisable to continue with the existing system of language testing thus eliminating candidates whose knowledge of English is quite inadequate. Those who, from a general point of view and from the language point of view (tested with the existing procedure), are acceptable to this office, would then be subject to the Michigan testing. It should be pointed. out that interpretation of the knowledge of fellows going on an observation or travel tour is on a more lenient basis than for those who will attend academic courses of study. Candidates nominated for study or observation in the United. Kingd.om are normally tested for the1r English proficiency by the British Council representative in the country of origin at the request of the United Kingdom Ministry of Health. The attention of governments is called. again to the diagram representing fellowship planning procedures as shown in Annex S which must be followed. if placement arrangements are to be made and awards issued before the end of the fiscal year. In this connexion, I should like to stress once more the need for applications of candidates proposed for study in schools of public health and nursing in the United. States of America and. Canada to be accompanied by complete documentation, i.e. photostat copy of diploma and certified transcript of academic records showing grades and an English proficiency certificate, as without these placement cannot be made. Also, in the case of candidates nominated f or study in Australia and New Zealand, it is essential that applications are accompanied by the chest ~ray films and recent medical examination certificates, as until this information is available applications for entry visas cannot be considered by the Australian and New Zealand authorities. An analysis and evaluation of WHO fellowships awarded during the period 1950-1956 was undertaken in the period under review and. the report prepared distributed to governments. Although the assessment scheme (evaluation of returned fellows) was tentative and is being improved on a trial and. error basis, it is gratifying to note the interest shown in it by a number of governments. To enable the Organization to continue with its evaluation of the fellowship programme, it is important that the required. follow-up reports of fellows and statements by governments should be submitted on the dates they are due. /2.3 Educational Meetings WP/RC9/2 page 26 2.3 Educational Meetings The foliowing meetings were held in the year under review: 1) Joint SPC/WHO-sponsored. Health Education Training Course, Noumea, New Caledonia - 1 July - 21 August 1957 2) Public Health Conference and Study Tour, Japan and Taiwan - 13-30 September 1957 3) Study Group on Social and Preventive Medicine, Manila - 16-29 October 1957 4) Regional Venereal Disease Control Seminar, Tokyo, Japan - 17-29 March 1958 5) Zone II Environmental Sanitation Seminar on Water Supplies, Singapore - 2-20 December 1957 6) Zone III Environmental Sanitation Seminar of the South Pacific Islands, Port Moresby, Papua and. New Guinea - 5-23 May 1958 Details of the se meetings may be found in Part III of the report. In addition to the above, members of the Secretariat attended. various educational meetings organized by Headquarters or other regions such as: 1) Regional Malaria Advisers Meeting, 12 July - 14 August 1957 - Geneva 2) Meeting of Headquarters/Regional Medical Officers dealing with fellowships, 1-15 February 1958 - Geneva 3) Regional Malaria Advisers Meeting - 8-14 May 1958 - Geneva and by other organizations or countries such as: 1) Second Meeting of the Antima1aria Co-ordination Board., 11-13 December 1957 - Bangkok, Thailand 2) Fifth Borneo Malaria Conference, 26-28 November 1957 - Labuan, North Borneo 3) Sixth Borneo Malaria Conference, 3-7 June 1958 - Sibu, Sarawak Also, one participant fram the Region attended the Seminar on Rehabilitation held in Solo, Indonesia, w,ich was organized by the United Nations (UNTAA) and the Government of Indonesia, in co-operation 'With lLO, WHO, International Society for the Welfare of Cripples and the World. Veterans Federation. /3. COMMUNICABLE DISFASES Education and Training A WHO medical officer and bis counterpart undertaking nutrition stu- dies in the course of a health SUl'vey of Gau island in the Fiji Islands group. The survey was conducted by stu- dents of the Central Medical School. Fiji. Cotntntlnicable Diseases MALARIA A phase of the anti malaria cam- paign in Sarawak showing DDT being carried to a spraying area in the jungles. Governments of 13 countries are receiving WHO assist- ance in their antimalaria efforts. ;. COMMUNICABLE DISFASES ;.1 Malaria WP/RC9/2 page 27 As in the previous year, technical assistance has been provided. to malaria programmes, and. governments have been encouraged to intensify their antima1aria programmes with a view to changing their objective from control to eradication. Fellowships in the field of malaria have been awarded to strengthen malaria services, and recent technical information on malaria has been distributed to ant1ma 1aria workers in the Region. Emphasis has been given to inter-country co-ordination and. co-operation, especially among countries with common borders. The Antimalaria Co-ordination Board, held. its second meeting in Bangkok in December 1957, attended by representatives of the Governments of Federation of Malaya, Burma, Cambodia, Laos, Thailand and. Viet Nam, as well as representatives of the United States International Co-operation Administration (ICA) in the last four countries; plans are being made to hold the third meeting of the Board. in Rangoon next December. Borneo Ma.1a.ria Conferences were held in Labuan in November 1957 and in Sibu, Sarawak, in J'lme 1958. The seventh meeting will be held. in Kuching in December 1958. Representatives from Kalimantan, Indonesia,and from SEARO attended these meetings both in November 1957 and. in June 1958; considerable progress was made towards the co-ordination of antima.1aria programmes that are being carried. out on both sides of the international frontiers. These conferences afford. an opportunity for neighbouring malaria workers to discuss problems, to share experiences, and to co-ordinate plans and. operations. WHO malaria project staff have been assisting the Governments of Cambodia, North Borneo and Sarawak. Malaria Advisory Team No.4 worked in the Philippines from June to December 1957 and Malaria Advisory Team No. ; in North Borneo from February to April 1958; these teams assessed the eradication programmes, provided technical ad~ice and made recommendations for the development and future conduct of the campaigns. Advisory Team No. ; proceeded. to Cambodia in April 1958. Technical advice has also been given througn the visits of the Regional Malaria Adviser to a number of countries, including North Borneo, Sarawak, China (Taiwan) and the Philippines. Following the assessment of the advisory team which worked in China. (Taiwan) from January to March 1957, a surveillance programme has been worked out in co-operation with the Government and lCA. This programme partly financed under the Malaria Eradication Special Account (MESA) is due to start on 1 July 1958. Action against residual foci of transmission continues. In the Philippines spraying has been discontinued in many previously malarious areas, and efforts are being made by the Government, assisted by lCA, to stop residual transmission in the rest of the country; following the recommendations of the advisory team an extensive surveillance system has b en planned in co-operation with the Government and. lCA. This will be assisted by MESA and. is due to start on 1 July 1958. In Cambodia transmission has been stopped in most of the malarious areas but some difficulty has been encountered among the indigenous population in the mountainous regions. Residual spraying is being supplemented by antimalarial / drugs and addi ti onal ••• WP/RC9/2 page 28 drugs and additional international staff are being provided. under MESA. The use of medicated salt (table salt with antimalarial drugs) to help stop mo.lo.rio. transmission in the mountainous regions of Cambodia is planned under MESA for th later part of 1958. The Sarawak malaria project has been expanded. to cover the greater part of the malarious popul.a.tion; transmission has been interrupted in most areas. Solutions are being sought to the problems raised. by nomadic tribes and by the discovery of a secondary vector. At the time of the visit of the malaria advisory team to North Borneo in 1958, spraying twice a year and the administration of antimalarial drugs had not yet stopped malaria transmission, but the prospects of so doing were favourable. The visit of a malaria consultant to Japan and. a pre~eradication malaria survey in Korea have been planned for the last six months of 1958 under MESA. At the seventh and eighth sessions of the Regional Committee resolutions were adopted stressing the importance of organizing an inter-regional malaria training course in order to improve training facilities for malaria eradication workers in the Region. I am glad to report that it is proposed to provide courses for international students at the Malaria Institute at Tala. The courses will be run by the Philippine Division of Malariology, supported. by lCA and WHO in co-operation. Assistance has already been given to the training of malaria workers in neighbouring countries where special facilities were available. A seminar on resistance of insects to insecticides was held in New Delhi in March 1958 and. eighteen participants from seven countries in this region and forty-three from countries outside the Region attended the meeting. A book containing translations of thirty-eight papers on insect resistance by Japanese workers has been published. and 373 copies have already been distributed to workers in this field. Copies are still available in the Western Pacific Regional Office. One consultant visited China (Taiwan) and another both parts of New Guinea; in neither case was resistance of anophelines to insecticides detected. Investigations have been continued. by WHO staff members and government workers in other countries in the Region. No case of resistance of anophelines in this region has been detected; careful observations have shown that the increase in tolerance of A. leucosphyrUS balabacensis detected last year in North Borneol has not devel~d into true resistance. As in the previous years, assistance from UNICEF and lCA has been of considerable help in developing and expanding the ant1ma1aria activities in a number of countries in the Region. 3.2 Tuberculosis and BOG Tuberculosis campaigns carried. out during the year by governments with the assistance of the Organization gave considerable emphasis to BCG vaccination. /Those in active ••• lunpUblished document WP/RC8/7 WP/RC9/2 page 29 Those in active operation and still receiving international assistance were in Cambodia, China, the Philippines, Viet Nam and West New Guinea. The objectives were to test and vaccinate the sections of the population specified. in the plans of operation and the cumulative totals for all campaigns assisted by WHO and UNICEF up to 31 March 1958 were: Tested Vaccinated 18 265 974 8 482 679 There was an increased acceptance of BOG, and. a greater confidence in its safety and effectiveness allover the world, including the countries of the Region. The concepts of integration and consolidation gained greater acceptance during the year and their practical realization made progress especially in China and the Philippines. The four BCG vaccine production laboratories approved. by the Organization continued their work on the highest scientific level. The fame~ la~gratgry ill Japan pl'oEl:aeea. an elt;pel'lmeftt61 stl'aill of Beat l'eeist&&t Ell'y ¥&QQ;1B8 ,Rasa International assistance has ceased in respect of the BCG campaigns in Brunei, the Federation of Malaya, Hong Kong, Sarawak and Singapore and the work is being carried on by the Governments. Regional office staff, however, visited. the countries concerned and gave technical advice. The statistics are still sent to the Tuberculosis Research Office in Copenhagen and appear in the official reports Which have a worl~wide distribution. There has been increasing emphasis on tuberculosis control projects designed to use every available control method and. to approach the problem fram the public-health or preventive aspect. It is the Organization's policy to develop and recommend simple, cheap and effective methods of controlling tuberculosis on a large scale, and this approach finds more and more support in the Member States. There is less emphasis on beds and the construction of costly institutions and more emphasis on case-finding and. domiciliary treatment. The expanding tuberculosis control project in China continued to show excellent progress and. received from the Organization fellowships, equipment and supplies, and the services of a senior adviser, a statistician and an :x;..ray engineer consultant. The prevalence surveys carried out as an integral part of the programme have been most successful. In Viet Nam,. the Organization provided a senior adviser during the year to the tuberculosis control project, into Which the BeG work was integrated. /Research bas continued ••• WP/RC9/2 page 30 Research has continued during the year on a number of outstanding questions including the best drugs or combination of drugs to use in domiciliary chemo- therapy programmes, and, effective methods of supervision. Exploratory conversations were held with a number of governments about the possibility of doing prevalence surveys of the type recommended. by the UNICEF/WHO Joint Committee on Health Policy. 3.3 Venereal Diseases and Trepon~toses The activities during the past year continued to be concerned with assisting the governments of yaws-endemic areas to survey their yaws problems, to plan and establish appropriate control programmes or to continue effectively already established control projects. The immediate objective of these activities was to achieve the control of yaws and eventually, its eradication. An ultimate objective was the encouragement of the governments and. the people, through development of the necessary post campaign follow-up activities, to establish as effective a rural health service as the available resources will permit. The Organization continued to give technical assistance to the yaws control projects already established. in Laos, Federation of Malaya, West New Guinea, the Philippines, the Pacific Islands Territories of the British Solamon Islands Protectorate, Fiji, the Gilbert and. Ellice Islands Colony and Western Samoa. Full-time WHO personnel were assigned to the projects in Laos and in the Pacific Islands Territories. The yaws problems in Cambodia, the Cook Islands, the Condominium of the New Hebrides, the Kingdom of Tonga and Niue were also discussed, with the Governments. Negotiations were successfully completed concerning a yaws control project for the New Hebrides which commenced. in June 1958 and the Kingdom of Tonga has agreed, in principle to undertaking a similar project planned to start in 1959. Unfortunately, the proposed yaws control project for Cambodia, accepted. in principle by the Government, could not be started as anticipated. For the Cook Islands and Niue, the Governments were recommended to consider the assistance of WHO for an evaluation of the yaws control work, being carried out by the national personnel, sometime in the future. In Laos, Fiji, West New Guinea and Western Samoa, the results of the very complete re-surveys carried out indicated that the dramatic fall in the occurrence of yaws resulting from the mass campaigns has been maintained and that in certain areas the goal of eradication of the disease has apparently been almost achieved. 'rbe post campaign follow-up activities organized, were no doubt responsible for this achievement and they varied with the problems in the different areas. In Western Samoa, the re-survey.integration work very successfully established the pattern for the follow-up control activities, Which have been fully integrated, into those of the rural health services. It is planned that a. complete re-survey of the population will be carried out annually during a "Yaws Week", utilizing all rural health personnel. Fiji has tried out a similar plan in the limited, area. /In Laos, where ••• TUBERCULOSIS The Government of Viet Nam has carried out a BeG vaccination prog- ramme with WHO assi,stance. /\ Vietnamese member of a BeG team is shown at work. VENEREAL DISEASES A phase of the venereal diseases survey on the island of Hsi Yu located off the coast of Taiwan, which ~as undertaken with WHO assistance. WP/RC9/2 page 31 In Laos, where the prevalence of yaws was initially not high, now that the disease has been brought well under control, the possibilities are being explor d, with the agreement of the Government, of redefining the project to provide for the establishment of a rural health service utilizing mobile health teams in a pilot area. This is an interesting and logical developnent following on the yaws control work in the villages, in view of the need for an effective rural health service. In West New Guinea, there is the special problem of the prevention of the reintroduction of infection from the areas not yet under government control. The Government has commenced yaws control activities, so far as this is possible, in the adjoining parts of these areas, but there will be need for continued. vigilance on the part of the health personnel. In the Philippines, the extensive rural health units programme was further developed. and. the integration of the yaws control activities into those of the rural health units continued. to make smooth progress. Provinces in which the prevalence of yaws bas been reduced to a low level are being handed over to the rural health services for continuation of follow-up activities. The initial treatment surveys of the British Solomon Islands Protectorate were completed during the year. In the British Solomon Islands, plans are being considered by the Government for integrating the follow-up yaws control activiti s into those of the reorganized. rural health service which may be based. on mobile health teams. The Gilbert and Ellice Islands are due to carry out the first re-surveys later this year. The Federation of Malaya is now interested in expanding the yaws control project, at present confined to Kelantan and Trengganu, into a national control programme. Thus the projects in the major yaws endemic areas of the Region have continued to make progress in achieVing the complete control of the disease and in the remaining areas, control projects were started. or planned, except for French Polynesia where preliminary surveys are not expected. to start until 1959. The emphasis has been placed. on eradication of the disease as the ultimate goal coupled. with an improved. rural health service. A major difficulty in some areas is likely to be the diminished interest in the continuation of follow-up activities with the fall in the prevalence of yaws. The continued. assistance of the United States International Co-operation Administration to the project in Laos and of UNICEF to the other projects in the Region greatly helped. the development and effective operation of the projects for which the several governments were responsible for the major part of their cost. 3.3.2 Venereal Diseases Activities during the year were concerned with giving technical advice to governments on their venereal-disease problems, to assisting with the effective continuation of established control projects and with raising the level of the technical training of health personnel in venereal-disease control. /The first venereal ••• WP/RC9/2 page 32 The first venere~disease control seminar in the Region was held during March 1958 in Tokyo and was attended. by nineteen participants from the following countries: Australia, Cambodia, China. (Taiwan), French Polynesia, Hong Kong, Japan, Korea, Laos, the Philippines, Singapore and. Viet Nam. The seminar secretariat included. two WHO consultants, the WHO Medical Adviser to UNICEF ABO, the WHO medical officers assigned to the venereal-disease control projects in Taiwan and Laos, and. the Regional Adviser on Venereal Diseases and. Treponematoses. The principal objectives were: (1) to review the principles and methods of present-day venereal-disease control and the adaptation of these to the local circumstances, and. (2) to stimulate the exChange of ideas on the major venereal- disease control problems of the countries and territories of the Region and. to consider how these may be approached most effectively. This seminar was a stimulating experience for those 'Who attended. and. was judged successful in achieving its short-term objectives. Post-seminar reports include increased activities and exchange of information. The control project in China (Taiwan) continued to receive international assistance. Sustained refresher training of personnel and intensified supervision by the national and international teams succeeded in further raising the standard. of performance of the 425 health units participating in the project, thus making the complete integration of the work into that of the permanent health services more effective. Further integration was achieved by the several combined surveys carried out covering the venereal diseases, tuberculosis, leprosy and/or general health. The drive against infection in the groups most at risk was furthered with the development of the control programme by the armed. forces with the technical co-operation of the national and international experts. Co-operative activities with the maternal and. child. health service were increased and the promiscuous groups tackled. An evaluation recently completed showed that the project has succeeded. in establishing a large-scale programme fully integrated, into the permanent health services throughout the Island, in which the personnel have been trained, in present-day diagnosis and treatment methods and in which public-health activiti s as case-finding, case-holding and contact tracing have been established. The training of private practitioners and midwives has also been carried, out and, their co-operation actively sought. Increasing publicity in the press on the problems of the promiscuous groups indicated. a reaction to existing conditions and a possible demand for Changes, During the past year the teams examined, for the first time 428 071 persons and the fall in the reactivity rate for pregnant women fram 7.3% in 1954 to 4.9% in 1957 is an indication of the effectiveness of the past activities of the project. This project has continued. to receive UNICEF assistance in imported supplies and equipment and agreement in principle has been reached. for continuation of this on a sliding scale through 1960. The Government has contributed a great deal to the successful operation of this large-scaie project but the present conditions of limited. funds and. staff ceilings have hindered more rapid. progress. /.3.4 Other Communicable ••• ;.4 Other Communicable Diseases 3.4.1 Leprosy WP/RC9/2 page ;; The increasing interest of Member States in the control of leprosy by the latest methods, as reported in the previous annual report, has grown considerably during the year. Leprosy experts from all over the world have visited certain countries in the Region and. leprosy medical officers fram Member States, same of them on WHO fellowships, have visited leprosy control programmes both in and outside the Region. The exchange of technical information between the Regional Office and Member States has grown and co-operation with the Leonard Wood. Memorial has continued. Although all this means a valuable exchange of technical information, there are still questions which remain to be solved.. They include the best way to ensure that the patients take their drugs and the best drugs to give and. the most effective methods of administertng them. It is hoped, that pilot projects now in operation will also help to clarify such matters as case-finding, follow-up of infectious cases, the role of segregation and changes in legislation. During the year a WHO consultant visited China, Korea, and the Solomon Islands, reviewed. the situation in each country and submitted a report with recommendations. The leprosy control project in the Solomon Islands is expanding on the basis of the consultant's recommendations, and supplies and equipnent have been provided by UNICEF. Discussions continued. about implementation of the recommendations for China and Korea. The pilot project in the Philippines assisted. by WHO/UNICEF has continued and expanded with encouraging results. The proJect has been visited by a number of fellows fran other countries. Lepro~ control was the subject of the Technical Discussions held in September in connection with the Regional Committee Meeting. Delegations from the Member States attended together with numerous observers and a panel of three experts. A field trip to a leprosy colony was included, and. the discussion ended with a plenary session, and. a number of conclusions. The latter dealt with segregation, case. finding, treatment, education, the training of personnel and research. Three working papers and the final report of the Technical Discussions were widely distributed. Preparations were made during the year for the WHO Inter-regional Leprosy Conference to be held in India in November 1958. Partipation fram many countries of the Region is envisaged .• ;.4.2 Poliomyelitis Centres During the year under review, the Director of the WHO-designated Poliomyelitis Centre in Tokyo visited China (Taiwan) and. assisted. in the planning and initiation of a survey to assess the state of immunity of the population against poliomyelitS. Four short-term fellowships in methods of laboratory diagnosis of poliomyelitS -were awarded. to candidates from China (Taiwan), Korea, Philippines and Japan. The first fellow went to the Poliomyelitis Centre in Tokyo, and the second and. third fellows went to the centre in Singapore. The Japanese fellow is a senior staff member of the crentre in Tokyo and. his fellowship is for visits to Australia and. Singapore for the purpose of exchanging ideas and experiences. The Chinese and Korean fellows were able to work on serum specimens collected. in their own countries for the surveys. /;.4.3 Trachoma ••• WP/RC9/2 page 34 3.4.3 Trachoma. The trachoma campaign in Taiwan. is one of the largest in the world. By June 1956, all school-children, numbering over two million, had been examined and. treated. For this huge undertaking, 365 teams of health-station physicians and nurses and 83 teams of school-physicians and nurses were trained. In addition, the Whole-hearted co-operation of over 30 000 school-principals and teachers ensured the success of the campaign. The standard. treatment method. used was l'fo antibiotic ointment, twice a day for two months. The routine of treatment in schools was quick, efficient and. hygienic. At the appointed time the children 'Who were to be treated lined up to wash their hands, an older child distributed to each pupil his ow tube of ointment, the children passed before the teacher 'Who took the tube from the child. and applied the ointment in the lower lid. of each eye. The child was then given two small squares of cotton or tissue pa.per, he returned to his seat and. placed. the cotton or paper over his eyes, gently rubbing them to spread the ointment. The tubes of ointment were then collected and. put away. The entire routine required. about ten minutes for fifty children. It was repEated by each teacher four times a day because most of the schools operated in two shifts, and each child had. two treatments a day. The older children treated. each other. Applications were given as soon as the children came to school and just before they left to go home. The WHO short-term consultant in her report said that, "the organization of the campaign is excellent and the work of all concerned is of a high level". The average requirement of ointment was two tubes (3.5 grammes each) for each case of trachoma. Up to the end of 1957, the Government spent an equivalent of US$797 860 on salaries, allowances and. locally available supplies. UNICEF spent US$669 000 for transport, equipment and supplies (mainly antibiotic ointment). WHO provided one fellowship and the services of short-term consultants; up to now, two consultants have visited. Taiwan on a total of four occasions. Since June 1956 the trachoma campaign in schools has been concentrated on: (1) children entering school for the first time; those found with trachoma were prescribed treatment. These cases are re-examined twelve months later and retreated. if found. to be trachomatous; (2) children soon to leave school. There was a certain number of relapses and. reinfections and since trachoma is hardly ever contracted after the age of twelve, children entering the final year of primary school are re-examined and., if necessary, treated.. Trachoma among new school entrants was found. to be much lower in places 'Where their family contacts had. been treated. A new series of trials has been initiated. to treat pre-school children at home. Among tribal people, 'Where the incidence of trachoma is highest, it has been decided to give blanket treatment to entire villages, sulfa tablets being given by mouth. It is believed that with the above approach, by 1962, when 1-1/2 million pre-school children and 140 000 tribal people will have been covered, trachoma will cease to be a public-health problem in Taiwan and inter- national assistance can be withdrawn. /During the past ••• l'rachoma Campaign WHO and UNICEF are helping the Government of China (Taiwan) to control trachoma. Bilharziasis C:ontrol Pilot Project A phase of the general land improvement work being undertaken in the Schis- tosomiasi.s Control Pilot Project which is aimed at reducing the colony of snails in infest- ed streams and ricefields. The WHO-assisted project of the Philippine Government seeks to determine the most effective and economical means of controlling bilharziasis. wp/RC9/2 page 35 During the past year, the following trials were conducted among large selected groups of school-children with trachoma: 1) antibiotic ointment, twice a day for six weeks; 2) antibiotic ointment, intermittently, twice daily, three days each month for six months; 3) oily drops of aureomycin, intermittently, twice daily, three days each month for six months; 4) oily drops of achromycin without hydrocortisone, twice a day for six weeks; 5) oily drops of achramycin without hydrocortisone, twice a day for two months; 6) oily drops of achromycin without hydrocortisone, intermittently, twice daily, three days each month for six months; 7) treatment with sulfonamides only, with continuous medical supervision. These trials will be evaluated by a WHO short-term consultant late this year and. the results, highly important for the continuation of the campaign in Taiwan and. elsewhere, are anxiously awaited by WHO and UNICEF. 4. ACTIVITIES OF THE EPIDOOOLOGICAL INTELLIGENCE STATION The Epidemiological Intelligence Station in Singapore is responsible for the administration of International Sanitary Regulations and, Conventions in a wide area covering the whole of the Western Pacific and South-East Asia Regions and a part of the Eastern Mediterranean and African Regions. The Station serves some sixty countries and territories bordering on the Indian Ocean and the western part of the Pacific Ocean and stretching fram East Africa to the Hawaii Islands. The scope of its activities includes: (1) collection of information on international epidemiology and, quarantine; (2) diffusion of such information by means of radio broadcast from a network of eleven wireless stations, special notifications by telegram or airpost, and, a weekly publication; (3) assistance rendered to governments in connection with settlement of complaints and disputes arising from the application of International Sanitary Regulations and Conventions. During the period under review, there were 872 epidemiological reports and quarantine notifications received. by cable, 3830 by airmail and 643 by surface mail, making a total of 5345 reports and. notifications. Of this total, 4956 were received, from national health administrations and local health authorities. /Quarantinable diseases ••• WP/RC9/2 page 36 Quarantinable diseases 'Were known to have occurred in the following countries within the area served by the Station during the period under review: PLAGUE SMALLPOX TYPHUS Burma Afghanistan Afghani stan India Burma Korea Indonesia Cambodia Pakistan Viet Nam Ceylon Union of South Africa Kenya India Egypt Madagascar Indonesia Iraq Tanganyika Korea Qatar Union of South Africa Federation of Malaya Iran Pakistan CHOLERA Portuguese India YELLOW FEVER Viet Nam Burma Kenya Nil Cambodia Tanganyika India Zanzibar REIAPSING FEVER PaId stan Egypt Thailand Sudan Afghanistan Aden (Colony and Iran Protectorate) Korea Iran Iraq Saudi Arabia Yemen Smallpox infection on board. sixteen ships was notified by health administrations, of which two were ships with pilgrims returning from Jeddah, and among the infected persons were six pilgrims, eleven international travellers and six crew members. There was also a report of a case of typhus among the crew on board a cargo-ship. No notification of infected aircraft was received. Important and urgent epidemiological information, including notificat~on of infected. ships or aircraft, when received, was transmitted to WHO offices and the health administrations concerned. without delay. During the period under reView, 1527 advance notifications were despatched, of Which 257 were by telegram, 1177 by airmail and 93 by messengers (for Singapore only). A weekly bulletin giving the weekly incidence of quarantinable diseases in ports and airports and a summary of notifications from governments under Articles 3 and 6 of the International Sanitary Regulations were issued for broadcast by radio stations from Singapore, Saigon, Manila, Sandakan, Hong Kong, Tokyo, Djakarta, Colombo, Madras, Karachi and. Tananarive. Information on outbreaks of quarantinable diseases in local areas other than ports and airports, When assuming serious epidemic proportions, was included in the bulletin. The broadcast was made by the radio stations according to a fixed. schedule, same daily and. some once or twice during the week. Detailed data on quarantinable disease incidence in countries within the area Which muld not be conveniently included in the weekly radio bulletin, were published in the Weekly Epidemiological Report. Recipients of this pUblication numbered. 498 per issue, of Which 448 were despatched. by airmail. /Information received from ••• WPjRC9j2 page 37 Information received from health administrations regarding the application or withdrawal of sanitary measures against arrivals from infected. local areas was transmitted to the other health administrations directly concerned by means of advance quarantine notifications. Altogether 542 quarantine notifications were despatched, of which 160 were for national health administrations, 116 for local health authorities and 266 for WHO offices. INFLUENZA The influenza. epidemic which was spreading ,in mainland China early in 1957 reached Hong Kong and Taiwan middle of April and spread very rapidly to the Fhilippines, Japan, Thailand., Singapore, the Federation of Malaya in May, when it also reached. Madras and. Bombay in India and. appeared in Australia. In July the epidemic spread to New Zealand and to ather islands of the Pacific when the disease was also present in all parts of the world. While the epidemic gradually subsided during the latter part of 1957, a new rise of the incidence was reported in some areas as, for instance, in Japan in September and October and in Hong Kong early in 1958. As is known, the incidence was very high during the epidemic, especially in densely populated communities, reaching, in some schools or camps, 60 per cent of all pupils or inmates. The disease, however, remained mild causing, with a few exceptions as in the Philippines for exwnple, very few deaths. The sudden appearance of large numbers of cases of a mild. disease, not compulsorily notifiable in most countries, made the collection by the Station of reliable official information on the Asian influenza. epidemic most difficult. However, in response to the Station's request, most of the health administrations supplied. promptly telegraphic reports enabling the Station to keep the health authorities and. the WHO influenza centres regularly informed regarding the progress of the epidemic in the area served by the Station. Assistance was rendered. to governments in making arrangements for the typing of the virus and. for the supply of ampoules of the new influenza. virus fran. Singapore. The Station also dealt with a number of enquiries regarding sanitary measures at ports of departure, obligation under International Sanitary Regulations to report influenza outbreaks and on availabill ty of vaccine. During the pandemic a number of countries imposed drastic measures against arrivals by sea and air. All such measures proved ineffective to prevent the introduction of the disease. CHOLERA Following four years of low incidence (when the annual number of officially reported. cases was under 70 000) the number of cholera cases in India and East Pakistan increased. considerably in 1958 reaching, during the first six mon~ of the year, a total of some 39 000 (against 22 000 the· corresponding first half of 1957). Of these 39 000 cases some 4000 were reported. in Calcutta where the severe epidemic reached its maximum during the latter part of April. IOn 22 May 1958 ••• WP/RC9/2 page 38 On 22 May 1958 cholera appeared in the Bangkok area in Thailand Where the disease was absent since 1949. The epidemic spread rapidly and. reached its peak during the week ended. 14 June, When 2010 cases (with 310 deaths) were reported and the disease was present in 25 of Thailand,'s 71 provinces. Thailand failed to inform the Station promptly on the occurrence of the first cases. Following the Station's representation a first report was received. only on 28 May. This delay in official notification gave rise to numerous enquiries and prevented, the Station from denying false news on the epidemic published by the press. From end. of May, regular reports from Thailand. enabled. the Station to supply promptly official data on the course of the epidemic. The presence of this epidemic in Thailand, has been of considerable interest to all health administrations of countries of the Western Pacific Which (apart from a few sporadic cases in Cambodia) have been free from cholera for many years. Preventive measures taken by some of these countries against arrivals from Thailand and neighbouring countries were clearly in excess of the International Sanitary Regulations. .Enquiries received. by the Station, and. dealt with promptly, included one on the advisability and effectiveness of fumigation of rice cargo as an anti~cholera measure; others related to vaccination certificate requirement fram transit passengers. The reports on the presence of cholera in Thailand. was followed by numerous press reports on the spread, of the disease to Viet Nam, Taiwan and. South Borneo (Indonesia) Which on the Station's enquiry were promptly denied by the health administra.tions concerned. /PAPtr III ••• PART III. PROJECT LIST Projects in Operation from 1 July 1957 to 30 June 1958 This part of the Report contains a list of projects which were in operation during the Whole or part of the period under review. In country projects, the aim given in the list is that of the government in establishing the project, irrespective of the form or extent of WHO's assistance. In the first column "R" means the regular budget; "TA" means Technical Assistance funds; and "UNICEF" the United. Nations Children's Fund. Names of other co-operating agencies are given in parenthesis. Only projects in Which actual field assistance has been provided. by WHO are included in the following pages. WP/RC9/2 page 39 WP/RC9/2 page 40 Project No. Source of Funds Co-operating Agencies Description American Samoa Partici~ation in Regional Meetings and Inter-country Projects Australia. 1 R Australia See WPRO 31.2 and WPRO 38. Fellowships Laboratory. A twelve-month fellowship to study clinical pathology in the United Kingdom. Surgery and medicine. A six-month fellowship to study modern trends and adYances in traumatic surgery in the United. States of America, the United. Kingdom and Austria. Participation in Regional Meetings and Inter-country Projects See WPRO 5; WPRO 23; WPRO 31.2; WPRO 32; WPRO 38; Inter-regional 44. British Solomon Partici~tion in Regional Meetings and Inter-country Projects Islands Protec- torate See WPRO 22; WPRO 31.2; WPRO 34; WPRO 38. Brunei Participation in Regional Meetings and. Inter-country Projects Cambodia 1 TA \ See WPRO 31.1. Malaria Control (Oct. 1950 - ) Aim of the project. To organize antimalaria services; to demonstrate methods of malaria control; to train personnel. Assistance provided by WHO during the year. (a) A malariologist and. a public-health sanitarian; a malaria advisory team composed of a malariologist (team leader), an entomologist, and. two laboratory techniCians; a short-term consultant; (b) medical literature. Probable duration of assistance. Until 1962 (including MESA assistance). Work during the :geriod under review. In about 7510 of the malarious areas (containing 600 000 of the 860 000 people at risk) results have been satisfactory. In about 25% of the malarious areas, malaria transmission has not been completely stopped by residual /spraying due to ••• WP/RC9/2 page 41 spraying due to the semi-nomadic habits of the population, the use of farm-huts often without wails, and the presence of ~.leucosphyrus as a secondary vector. In this area, drug administration has been intensified, people have been encouraged to build. structures with valls and population movement has been anticipated. Co-operation has been secured in a pilot zone, but it may be difficult to obtain the same success on a wide scale. To avoid the problems of normal drug distribution, the use of chloriquinized. or pyrimethaminized salt is being pla.nned .• A malaria advisory team is at work in Cambodia. It 'Will complete its assignment at the beginning of July 1958 • . Cambodia 3 Nursing Education, Phnom-Penh (Dec. 1951 - ) R UNICEF Aim of the project. To set up a school of nursing in Phnom-Penh; (ICA) to develop nursing and. midwifery education. (Asia Foundation) Assistance provided. by WHO dW'ing the year. (a) A senior nurse educator and two nurse educators - one in general nursing and one in midWifery; (b) medical literature. Probable duration of assistance. Until the end. of 1961. Work during the period under review. The new school of' nursing opened in November with 200 first-year students. A three-month pre-clinical block, followed by a study week plan with directed. clinical experience, was introduced in the two-year programme to integrate theory and practice and improve the quality and quantity of nursing care. The number of counterpart personnel was increased and although relatively inexperienced, they are making progress and show leadership potential. Additional experience in public-health nursing for selected graduates of the two-year course was organized in the health centre Which operates as an external service of the hospi tal. Over-recruitment of candidates with limited. basic educa- tion is inadvisable as it will result in excessive wastage. There was also an increase in the number of students recruited for the midwifery school and in the numbers of rural midwives receiving the six-month training course requiring an increase in counterpart personnel. Pre-natal clinics have been established in some of the 'provincial centres and supervision of rural midwives extended. in the provinces. Recommendations for future developments in midwifery (selection, training, legislation, etc.) were prepared. /Cambodia 4 ••• WP/RC9/2 page 42 Cambodia 4 TA UNICEF (ICA) (Asia Founda.- tion) Cambodia 5 TA (ICA) (French Economic Mission) Matel'naJ. and Child Health, Phnom-Penh (Jan. 1952 _ ) Aim of the project. To teach modern methods of maternal and. child care adapted. to the country's resources and cultural background.; to improve the teaching of obstetTics and child care in the Phnom-Penh schools of nursing and midwifery; to improve the teaching of paediatrics, obstetrics and. gynecology at the Royal School of Medicine; to demonstrate methods of combining curative, preventive and. educa- tionaJ. health services; to extend. maternal and child health (including school health) services and make them part of the country's health services. ~A~s~si_s~t~an~c~e~~~~~~~~~~~~4~ar~. (a) A medical officer and. a nurse b medical literature. Probable duration of assistance. Until the end of 1959. Work during the period under rev~. The present phase of the maternal and child. health project in Cambodia is exclusively concerned with school health. In 1957, the programme was extended to cover anotb3r seven schools in Phnom-Penh and a WHO nurse was appointed to work with the medical officer. Medical examinations of the children and in- service training of the dispensary nurses in these schools were started .• Health teaching continued at the Teachers' Training College in Phnom-Penh, and was started at the new Rural Teachers' Training College opened. at KSmpong Kanthuot in November; it was also included in three short refresher courses for provincial teachers. Visits were made to several provinces to study school health problems and. advise local health and education officials on possible ways to meet some of the needs. Royal School of Medicine, Phnom-Penh (July 1953 - ) Aim of the project. To improve the standard of teaching at the Royal School of Medicine to a professional level; to expand. facilities for training hospital assistants. Assistance provided by WHO during the year. (a) Three lecturers - one in ophthalmology, one in radiology and one in physiolo~; (b) fUll stipend. of ten students enrolled in the degree class; (c) supplies and equipment. Probable duration of assistance. Until the end of 1959. Work during the period under review. The Organization provided regular teaching in ophthalmology, physiology and. radiology. In the year 1957/ 1958 there were eighteen new students in the doctorate section, eleven in the second year of study, and twenty-seven Cambodian and. seven Laotian students in the "officier de sante" section. In 1956/1957 the school introduced. a full M.D. course and the enrolment of "officiers de sant~" will probably stop after 1960. /As a result ••• Cambodia 9 TA (ICA) - Cambodia wp/RC9/2 page 43 As a result of a redefinition of the project, assistance will be increasingly concentrated. on the basic sciences. A collective study grant for the Cambodian students was substituted. for the former ar~gement whereby the Organization paid the partial expenses of all students enrolled in the degree class. Rural Health Centre, Takhmau (Jan. 1957 - ) Aim of the project. To plan and implement a comprehensive and well_ balanced public-health programme at the provincial level; to develop model public-health services in the province of Kandal; to use the facilities of the Takhmau centre for field. training of all categories of medical and. health personnel. The project is to be carried. out with the developnent of rural communities and agricultural expansion and in co-operation with the UNESCO-assisted fundamental education project in the rural areas. WHO activities are correlated with those of the United States International Co-operation Administration (ICA), Which is assisting the Government with the construction and. supply phase of the project. Probable duration of assistance. Until the end of 1960. Work during the period under review. With the addition of the WHO public-health nurse to the project in November 1957, a limited. public- health nursing activity was started in the Takhmau area and in conjunction with the UNESCO Fundamental Education project at Toole Bati. The public-health nurse attached to the project is giving regular lectures in first-aid and personal hygiene at the UNESCO Centre. The WHO medical officer is teaChing preventive medicine at the Royal School of Medicine. An infant mortality and maternal health survey of 500 mothers 'Was undertaken in the Takhmau area.. Local staff took an active part in the survey and have also assisted in the health lectures given at Tonle Bat!. Project activities are still limited, as the building is now only nearing completion. lCA is providing equipoont. Participation in Regional Meetings and Inter-country Projects See WPRO 5; WPRO 23; WPRO 31.1; WPRO 32. /China 1 ••• WP/RC9/2 page 44 China. 1 R UNICEF China 3 TA UNICEF Venereal-Disease Control, Taiwan (Aug. 1953 - ) Aim of the project. To train local personnel in case-finding, contact investigation" health education and modern methods of diagnosis and. treatment; to improve laboratory methods; to establish an islan~wide venereal-disease control programme. Probable duration of assistance. Until the middle of 1960. Work during the period under review. The continued in-service training of the personnel and the intensified supervision carried out further raised the general standard. of performance of the 425 health units participating in this island-wide control programme. The integration of the work into that of the permanent health services continued. Routine activities were maintained at the hign level planned and more thar. 500 000 persons were examined. by blood test for the first time. The surveys of selected groups and the combined venereal- disease" tuberculosis" leprosy and. general health surveys carried. out provided valuable experience for the staff besides providing a means for case-finding and for education of the public. The control programme for the armed forces was organized with the technical co-operation of the national control programme. The co-operative effort with the maternal and child health programme for the control of the diseases among the pregnant women and. children was given special attention and the possibilities of dealing with the control of venereal disease among the promiscuous groups of women more effectively were explored .• The reference serologic laboratory continued to evaluate the performance of the twenty-one serologic laboratories of the project and successfully partiCipated. in an evaluation study with the Venereal Disease Research Laboratory" Chamblee, United States of America. Maternal and Child Health, Taiwan (Aug. 1952 - ) Aim of the project. To provide an efficient maternal and child health services throughout the island; to train nursing and medical personnel in all branches of public health relating to mothers and children; to improve health education. Assistance provided by WHO during the year. (a) A short-term consultant in maternal and child health, and. a public-health nurse midwife; (b) one twelve-month fellowship; (c) medical literature. /Probable duration of ••• China 6 TA Probable duration of assistance. Until 1960. WP/RC9/2 page 45 Work during the period under review. In-service training courses for health stations, medical officers, staff level nurses and. private midwives proceeded satisfactorily. To date, 207 health stations, 185 medical officers, 294 staff level nurses and 354 private midwives have received training. Another 170 health stations will be included. in the programme and the WHO public-health nurse midwife will continue to give assistance throughout 1958. Regular supervisory visits are still being made to health stations. Domiciliary experience for student nurses and midwives has been provided under the direction and supervision of the maternal and, child. health staff. The public-health nurse midwife has acted in an advisory capacity to midwifery schools and the maternal and child health sub-committee. A short-term consultant spent three months (June-August 1957) assessing progress and future needs. Nursing Education, Taiwan (May 1952 - ) Aim of the project. To improve the standard, of nursing education and, the quality of nursing services by establishing a school of nursing at the University Hospital in Taipeh. Assistance Probable duration of assistance. Until the end of 1960. Work during the period under review. The Collegiate School of Nursing, which started in 1956, has made satisfactory progress. A nurse educator (mental health) joined the project in November. She is assisting the Government to develop a programme based on the recom- mendations of previous consultants in this field. Assistance continued. in the development of the collegiate school curriculum with particular emphasis on guidance and support of counter- part personnel in teaching and demonstration in the clinical areas. Advisory help was given to joint committees who are successfully analyzing problems and instituting measures to improve nursing service and, nursing education. A consultant in nursing education spent six months in 1957 assessing progress and future needs at basic and post-basic levels. Her report and recommendations are being implemented. The WHO senior nurse educator consults with national nursing leaders and. the United States International Co-operation Administration (ICA) nursing consultant on planning nursing education and service on /the national level ••• wp/RC9/2 page 46 China 7 TA (lCA) China 13 TA UNICEF the national level through membership on the sub-committee on nursing. She is also available to advise individuals and school of nursing faculties on request. One of the main problems is the shortage of well-prepared. teaching and supervisory staff. However, two WHO fellows joined the teaching staff on their return from study in the United States of America and a third fellow will return shortly. Malaria Eradication, Taiwan (May 1952 - Aim of the project. To control malaria and eventually to eradicate it throughout the island, by use of residual insecticides. Assistance provided by WHO during the year. (a) Two short-term consultants - one on arthropod-borne diseases and the other on insect resistance; (b) supplies and equipment. Probable duration of assistance. Until 1962 (MESA). Work during the period under review. Two short-term consultants completed. their assignment and reported.; the consultant on arthropod ... borne diseases proposed a long-term programme for training and. research in "Medical Arthropodology" j the consultant on insect resis- tance found. only slight decrease in susceptibility of anophelines to residual insecticides, insufficient to be of practical importance. Technical assistance has also been provided. through the visits of the Regional Malaria Adviser. An opportunity was g:I. ven to a ranking staff of the Tai 'Wan Provincial Malaria Research Institute to visit malaria surveillance programmes in Ceylon, Thailand and. the Philippines, and to exchange scientific information with the workers in these countries. This visit started in June 1958 and will last two months. Plans have been made for assistance to eradication under MESA in an extensive surveillance programme due to start on 1 July 1958. Trachoma Mass Campaign, Taiwan (Oct. 1954 - ) Aim of the project. To control trachoma in over two million school.- children by a mass campaign, and. to organize services in schools and health stations. Assistance provided. by WHO during the year. A short-term consultant. Probable duration of assistance. Until 1959. Work during the ;period under review. The mass campaign in Taiwan proceeded satisfactorily. All school-children with trachoma and conjunctivitis have been treated.; efforts are now being concentrated. on new school entrants and. on children in their last year of Bchool. /Trials using different ••• : China 14 TA , ; WP/RC9/2 page 47 Trials using different drugs, aureomycin, terramycin and. achromycin in ointment and. in oil and sulfa in tablets, and different treatment schedules are also being carried. out to find the most effective and economical method of treatment. Efforts are also being directed to the treatment of entire families and the pre-school children who have trachoma. In aboriginal areas, whole villages are receiving sulfa tablets. In 1957, WHO sent a short-term consultant to assess the campaign and. results of some of the trials. Later in 1958, another consultant will go to Taiwan to carry out further assessment and to advise on expansion and. continuation of the campaign. It is hoped that by 1961, trachoma will have been reduced to such proportions that cases, when they occur, can be tackled by general practitioners and out-patient departments of hospitals and health centres. Environmental Sanitation, Taiwan (Oct. 1954 - ) Aim of the project. To survey the organization and functions of governmental agencies concerned with environmental sanitation; to assess the chief problems and establish their relative urgency; to carry out a pilot project of modern and economic sanitation procedures; to train personnel. the (a) Two sanitary engineers; ~~--~--~~~~~~~~~~~--~~ supplies and equipment. Probable duration of assistance. Until the end of 1960. Work during the period under review. Assistance provided during the year included. that of strengthening and advising the Taiwan Institute of Environmental Sanitation, as well as assistance to the Taipei Sewerage and Drainage Corps which is planning and designing a water- borne sewerage system for the City of Taipei. The quantity and quali ty of the achievements of the Taiwan Institute of Environmental Sanitation were recognized and reflected in increases in the personnel and budget of this government organization. The Institute,in one of its most important activities, organized eight training courses for sanitarians with a total attendance of 153. Health education activities were carried on through a number of media including food~handlerst courses, seventy of which were held in the report period with a total attendance of 4721 foo~handlers. Rural environmental sanitation demonstration projects were carried. on in seven villages in Taiwan. These projects included school sanitation, water systems, latrines, surface drainage, improvement of animal shelters, rodent and insect control, etc. A survey of collection and disposal practices for night-seil and refuse was carried out throughout the island. A fUll-scale prototype composting plant was built in Ping-Tung following the operation of an experimental pilot plant for about a year. Plans and specifications for a high-rate composting plant for the City of Taipei were also completed .• /That portion of ••• WP/RC9/2 page 48 China 17 R UNICEF China 20 R That portion of the project relating to the planning and design of a water-borne sewerage system for Taipei has been in active operation for about a year. During this period a substantial amount of prepara- tory administrative work was accomplished. and a considerable volume of basic design data collected. Field surveys, geological studies, test borings, ground. water studies and a contour map of the city prepared from aerial photographs were completed. The studies made on the stream pollution survey are now being analyzed. in order to ascertain the degree of treatment required for the Taipei sewage. Tuberculosis Control, Taiwan (April 1951 - ) Aim of the project. To expand the tuberculosis control service and to incorporate in it the BOG work already in operation; to explore new methods of control of ambulatory cases by chemotherapy. Assistance provided. by WHO during the year. (a) A medical officer, a consultant-statistician and an x-ray engineer; (b) three fellowships - one of six months and two of twelve months each; (c) supplies and equipment. Probable duration of assistance. Until the middle of 1960. Work during the period under review. This period saw the broadening of the programme from a limited to a country-wide activity with the commencement of preyalence surveys and. the extension of the service surveys. A special survey and service programme for ambulant treatment of aborigines began in November. Case-finding and. treatment, especially domiciliary chemotherapy, were expanded. A central registry was started. and. a new records system introduced in the tuberculosis centres and some of the new tuberculosis clinics attached to the health centres. Training courses for doctors, nurses and. laboratory technicians continued. A draft syllabus for training of lay tuberculosis workers was approved. The BCG laboratory is carrying out animal studies of three strains of vaccine and a comparative study with the BOG laboratory at Alabang, Philippines, is also in progress. In the mass BCG vaccination campaign" 6 176 882 persons bad been tested and. 3 406 653 vaccinated by the end of June 1958, according to government statistics. Mental Health, Taiwan (Oct. 1955 - ) Aim of the project. To draw up a mental health programme with special emphasis on children guidance and community mental hospitals. Assistance provided by WHO during the year. Two two-year fellowships for study in the United States of America. Probable duration of assistance. Until 1960 /Work during the ... ·cp.ina 28 R <;:bina 29 TA . . -",- ; Cook Islands WP/RC9/2 page 49 Work during the :period under review. The Head of the Department and Professor of Neurology and. Psychiatry of the National Taiwan University Medical College returned from his WHO fellowship during the :period under review. This year saw the realization of the scheme for closer co-operation between the Department and the Provincial Mental Hospital in the exchange of staff and referral of clinical cases and material. A psychiatrist and a psychologist of the Department went on WHO fellowships abroad. for fuxther studies. The 'WHO mental health nursing expert assigned to the nursing education project is working very closely with the Department in an attempt to strengthen mental nursing and the teaching of mental health in nursing. Fellowships Medical education. A six-month fellowship to stu~ new trends in medical education and, teaching in the allied, disciplirv')s of medicine in Hong Kong, Thailand, Burma, the United Kingdom, and. other countries in Europe. Nursing education. A twelve-month fellowship in public-health nursing for study in the United. States of America and a twenty-four-month fellowship in nursing education for study in Hawaii. Public-health administration. A twelve-month fellowship for the diploma course in public health in Australia. Fellowships Dental health. A six-month fellowship to observe dental health practices in New Zealand .• Laboratory. A twelve-month fellowship to study public-health entomology in Australia. Participaticn i~ :'?:e;-l.l)n~.l M~et.;;.nf.L~ p..n,d IntF>:r-~ountry Projects See WPRO 5; WPRO 23; WPRO 32; WPRO 34; WPRO 37; Inter-regional 44; Inter-regional 45. Participation in Regional Meetings and Inter-country Projects See WPRO 31.2; WPRO 38. /Fiji 2 ••• WP/RC9/2 page 50 Fiji 2 Central Medical School, Suva (Feb. 1955 - ) R (China Medical Aim of the project. To train assistant medical practitioners for Board) government service in Fiji and adjacent territories, and to strengthen the staff of the Central Medical School. Fiji 4 R Fiji Assistance rovided. b WHO durin the ear. in biology and. the other in physiology; b (a) Two lecturers - one supplies and equipnent. The China Medical Board. provided a one-year fellowship in anatomy and another for three years in physics. Probable duration of assistanCIi. Until 1960. Work during the period under review. Teaching in biology and. physio- logy was continued.. There was keen participation of students in the biology and physiology courses and. a satisfactory percentage of students passed. the relevant examinations. The students of the medical school are now receiving a year I s instruction in public health including practical experience in the field. A seventeen-day health survey of Gau Island was undertaken in order to teach students in a practical manner about health in relation to the environment. In the final examinations of the school, two papers are required, one in clinical and. one in preventive medicine. Emphasis is now being placed on preparing assistant medical officers (AMOs) for leadership and posts of responsibility in order to facilitate the transition from the school atmosphere to the challenging conditions of work. Fellowships Medical l1brarianship. A six-month fellowship to study medical librarianship in Australia. Participation in Regional Meetings and Inter.country Projects See WPRO 22; WPRO 23; WPRO 31.2; WPRO 38. French Polynesia Participation in Regional Meetings and. Inter-country Projects See WPRO 5; WPRO 31.2; WPRO 38. Gilbert and. Participation in Regional Meetings and Inter-country Projects Ellice Islands Colony See WPRO 22; WPRO 31.2. /GUBJrl ••• .. . Guam Hong Kong 13 R JIong Kong 'Japan 1 R . "'. UNICEF Japan 4 .. R T. ' wp/RC9/2 page 51 Participation in Restonal Meetings and Inter-country Projects See WPRO 31.2; WPRO 38. Fellowships Mental health. A three-month fellowship to stu~ drug addiction and preventive psychiatry in the united States of America and Canada. Participation in Regional Meetings and. Inter-country Projects See WPRO 5; WPRO 23; WPRO 32; WPRO 50; Inter-regional 44. Rehabilitation of CriPRled Children (Nov. 1952 - ) Aim of the project. To consolidate and expand. services for the protection of children against crippling and. deformities, and. for the diagnosis, treatment and rehabilitation of crippled. children; to train local professional and aUxiliary personnel. Assistance are (a) A short-term ~--~--~~~~--~----~~~~~~~ consultant; Probable duration of assistance. Until 1959. Work during the period under review. The medical consultant who visited. Japan in 1952 returned. in October 1957 for one month to evaluate the progress made and recommendations were submitted to the Government for future developnent of the programme. Sixteen additional prefectural hospitals were included in the programme for which UNICEF will provide equipment and. reference books. National Institute of Mental Health, Tokyo (June 1953 - ) Aim of the project. To survey needs and facilities and draw up a mental health programme; to carry out research; to train local professional and auxiliary personnel. Assistance provided by WHO during the year. (a) Medical literature and periodicals, in connexion with the programme of the National Institute of Mental Health for training workers for child guidance clinics; (b) two six-month fellowships. Probable duration of assistance. Until 1960. /Japan 10 ••• WP/RC9/2 page 52 Japan 10 TA Japan l4 R Assistance to Institute of Public Health, Tokyo (March 1955 - ) Aim of the project. To strengthen post-graduate training of health personnel in the departments of the Institute, particularly the Departments of Epidemiology, Medical-Social Services and Environmental Sanitation. Assistance consultant for the study of control li terature • Probable duration of assistance. Until the end of 1959. Work during the period under review. In September/October 1957, a WHO short-term consultant visited Japan to carry out a study of sani tarian training. Information was O!ollected on the courses and. training available for sanitation workers and it \-laS the opinion of the consultant that sanitation had made remarkable strides in Japan. On termination of his assignment a report was submitted to the Government containing specific recommendations with regard. to future work in this field .• ,Nursing Education, Tokyo (Aug. 1955 - ) Aim of the project. To strengthen basic nursing, midwifery and. public- health nursing education; to develop a centre for post-basic training at the Institute of Public Health, Tokyo, and to prepare qualified teachers for the centre. ear. (a) A nurse educator; ~T-~~~~~~~~~~~~~~~~~y~s~and. one of twelve months; Probable duration of assistance. Until the end of 1958. Work during the period. under review. Assistance to the Institute of Public Health has continued. through participation in the teaching programme for the regular and. special courses, consultation and guidance to faculty on evaluation and planning ot curricula and preparation of teaching materials. In co-operation with counterpart personnel, material was prepared on "Method of Planning Classwork and Clinical Experience for Midwifery Schools in Japanll which was used in the midwifery teacher course and as source material for discussion at a conference for educational directors and clinical instructors. Consultant service was given to the curriculum committee which 1s undertaking a study of schools of nursing, midwifery and public health. The WHO nurse consultant attended. four of the regional nursing meetings. A study of assistant-nurse schools was discussed and. planned. /Japan 17 ••• Japan 17 • TA . Japan 18 . R Japan 19 TA . Japan - . Kbrea 10 - ·-R Hospital Administration (July 1956 - ) wp/RC9/2 page 53 Aim of the project. To make a survey of institutional care and to improve hospital management. Assistance provided by WHO during the year. (a) Two fellowships, one for twenty-one months in administrative medicine and the other for six months in hospital administration, for study in the United States of America; (b) supplies. Probable duration of assistance. Until 1959 • Fellowships Haematology• A three-and-a.-half-month fellowship to study management and operation of blood banks in Australia. Medical administration. A six-month fellowship to study systems of medical specialization in the United. Kingdom, Denmark, Austria, Switzerland and. Germany. Fellowships Drug control. A six-month fellowship to study standardization of biologic products and antibiotics in Switzerland, Germany, the United Kingdom, the Netherlands and Denmark • PartiCipation in Regional Meetings and Inter-country Projects See WPRO 5; WPRO 23; WPRO 32; WPRO 37; WPRO 50; Inter-regional 44. Fellowships Drug control. A six.month fellowship to study narcotic drugs control in China, the Philippines and. the United States of America. Haematology. A four-month fellowship to study o~ration and control of blood banks in Australia. Health education. A twelve-month fellowship for the certificate in public-health course with major in health education in the Philippines. Medical entomOlOgy. A twelve-month fellowship for the diploma course in public health with specialization in medical entomology in AustraJ.ia. Rehabilitation. A six-month fellowship to study rehabilitation of handicapped children in the United. States of America. Tuberculosis control. A six-month fellowship to observe tuberculosis control programmes in the Philippines and China. /Korea 11 ••• WP/RC9/2 page 54 Korea 11 TA Korea Laos 2 TA (ICA) Fellowships Environmental sanitation. A twelve-month fellowship to study sanitary engineering in the United. States of America. Health education. A twelve-month fellowship for the certificate in public-health course with major in health education in the Philippines, and a six-month fellowship to study maternal and child. health with special emphasis on health education in the Philippines, Singapore, Hong Kong and China. Other communicable diseases. A six-month fellowship to observe · . leprosy control in the Philippines, Thailand, Singapore, the Federation • of Malaya and Hong Kong, and a six.-month fellowship to study epidemic diseases control in the United States of America and the Philippines. Participation in Regional Meetings and. Inter-country Projects See WPRO 5j WPRO 23j WPRO 32j WPRO 34j WPRO 37. Treponematoses Control, Thakhek, Savannakbet, Saravane and. Pakse (Jan. 1953 - ) Aim of the project. To survey the yaws IJituationj to train local per- sonnel in diagnosis and treatment; to carry out a mass campaign (house .. to .. house case-finding and treatment of all accessible clinical cases and. contacts, and. health education) so as to reduce the incidence of yaws to a level at which the public-health programme can maintain control. the ar. (a) A medical officer and ----~~~~~~--~~--~~~~~~~ supplies and equipnent. Probable duration of assistance. until 1959. Work during the period under review. The field work of the project continued to reach a very high percentage of the population of the area of operation. Re-surveys carried out showed that the prevalence of yaws, though originally not high, was greatly reduced by the mass cam:pa.ign and. has remained low. The need for continued follow-up activities to secure the ultimate eradication of the disease and the need for an effective rural health service have determined th decision to redefine the project to broaden the basis of operations to provide a rural health service in a limited pilot area by means of mobile health teams. ". A serologist was assigned to the project and laboratory equipnent was ordered but was considerably delayed.. The organization of a laboratory service was started. /Laos 8 .•• Laos 8 ~ Laos -. Macao 1 . R Me.la.ya. 1 •.. TA Fellowships WP/RC9/2 page 55 Surgery and medicine. Three twelve-month fellowships for under- graduate medical assistants' studies in Cambodia. Participation in Regional Meetings and. Inter-country Projects See WPRO 5; WPRO 31.1; WPRO 32. Fellowships Malaria. A two-month fellowship to observe malaria eradication programmes in the Philippines, Singapore and. China. Aim of the project. To improve the standard of basic and graduate nursing education and the quality of nursing services; to prepare nurses for administrative and teaching posts; to adapt the nursing education programme to local resources and needs; to develop a well- organized programme for midwives. Assistance provided. by WHO during the year. (a) At Kuala Lumpur - a midwifery tutor; at Penang - a senior nurse educator and. a clinical nursing tutor; at Ipoh (Perak.) - a midwifery tutor; (b) medical li terature. Probable duration of assistance. Until the end. of 1958. Work during the period. under review. Facilities for dOmiciliary midwifery and. ante-natal experience for Division I and II midwifery schools in Perak are now well-established .• Refresher courses for health nurses and midwives from Perak and. other States in the organization and supervision of these services are now in progress. Assistance in the organization of maternity care services and midwifery education continued in the maternity unit in Kuala Lumpur. Advisory help and. guidance was given in the development of domiciliary midwifery experience fields for Division I and. II midwifery students in Selangor. The in~service education programme for nursing service personnel and the development of clinical teaching and. supervision for students in the Penang General Hospital continues~ The WHO clinical tutor completed. her assignment in April. /The fourth course ••• WP/RC9/2 page 56 Malaya 9 R UNICEF Malaya 12 TA The fourth course for public-health nurses was conducted by the WHO senior nurse educator (public health). A counterpart nurse and potential candidate for a government fellowship in teaching in publ.1c- health nursing was assigned. to the school in April. Rural Health Training Centre, Ji tra, Kedah (Nov. 1954 _ ) Aim of the project. To establish a training centre at Jitra for assistant health nurses, rural midwives, dispensers and sanitary over- seers. Staff trained. at Jitra will be assigned to ninety main health centres which the Government is building. These centres and their SUb-centres, in addition to their routine work, will. have responsi- bilities for the welfare of mothers and children, such as domiciliary midwifery, infant care and dental hygiene. A Ire dical officer and Probable duration of assistance. Until the end of 1959. Work during the period, under review. The fourth batch of auxiliary rural health trainees completed. their course in March 1958. A fifth course is now in progress. Teams from the following States have now received training: Johore, Kedah, Kelantan, Malacca, Negri-Sembilan, Pahang, Penang, Pera.k, Selangor, Trengganu. The course now consists of more practical instructions on the typical functions of auxiliary rural health workers and emphaSis is being placed. on the health education of kompong peoples with particular reference to nutrition and. environmental sanitation. The administrative relationships, functions and duties of the various staff involved in the project were redefined in the period, under review, as a result of which there is better understanding of the project at all levels. Aim of the project. To study protein deficiency in childhood and its ' relation to cultural and. social habitsj to collect information on the incidence of protein deficiency, its distribution by race and area, its public-health importance and methods which mignt be used for eliminating it. Assistance provided. by WHO during t~ year. A social anthropologist. Probable duration of assistance. Until 1959. Work during the period under review. The social anthropologist has reviewed and collected information on the incidence of protein deficiency and its relation to cultural and social habits. Plans are being implemented. for a survey of the extent and causes of kWashiorkor in Nyalas. /Malaya 14 ••• c • Malaya 14 "TA . Malaya 15 TA f • Hospital. Administration, Penang (May 1956 - ) WP/RC9/2 page 57 Aim of the project. To review the hospital administration system; to devise a suitable scheme for training lay hospital administrators, taking account of the facilities available, in the Federation or over- seas. Assistance provided. by WHO during the year. (a) A hospital administrator j (b) medical literature. Probable duration of assistance. Until the end. of 1959. Work during the period. under review. As a result of various circumstances beyond. the control of the Organization, the first course for hospital administrators did not start until January 1958. Nine candidates were selected; seven finished. the short introductory course. These trainees are now assigned. by the Government to various hospitals for practical experience and will be recalled for further training when the replace- ment for the WHO expert arrives. During the year under review, the newly-appointed Hospital Secretary of the Federal Mental Hospital was given individual orientation and training. Plans were prepared for a new hospital and. submitted for study, comment and advice. Hospital. Records, Penang (Nov. 1956 - ) Aim of the project. To review and. reorganize the hospital records systems in the Federation and. in Singapore (Singapore 9); to establish and implement a suitable training programme for local personnel in the Federation of Malaya. ;.;A~s~s.;;;.is;;.t_an __ c.,e~;;.ro_vi~de;;;.;..;;d~. _b~WH~O;.....;d:;;;;:ur;;;;.;;i;;;nw...;;;;';;....M..;;e.;;;;ar;;.. (a) A hospital records officer; b medical literature. Probable duration of assistance. Until 1959. Work during the period under review. A medical record. forms committee was organized. in Penang General Hospital to review various medical. record. forms drafted by the WHO hospital records officer. Medical records from 1953 to 1956 in Penang General Hospital were re-filed and numeric guides inserted. in order to bring about a more orderly arrangement. The cards in the master patients I index for the years 1951 to 1956 inclusive (about fifty-five thousand in number) were checked and al.phabetically filed, with the result that many records previously inaccessible have been made available. Proposals were presented. to the Government for establiShment of a medical records office in the proposed 6OO-bed general hospital at Petaling Jaya, including the staff and facilities required. to operate the office. /Lectures on hospital ••• WP/RC9/2 page 58 Malaya. Nauru Lectures on hospital records were given to the students in the hospi tal administration course. In addition, the WHO officer assisted in the review and revision of maternal and child health records and. forms for evaluation of student nurses' progress. The first phase of the project, i.e. improvement of the medical records system at Penang General Hospital to serve as a training field, has not been fully implemented. during the past year, due to delay in obtaining the space and. equipment required. It is, however, expected. that in the coming year it will be possible to complete the first phase and start the training programme for hospital records personnel. Participation in Regional Meetings and Inter-country Projects See WPRO 31.1; Inter-regional 44; Inter-regional 45. Participation in Regional Meetings and Inter-country Projects See WPRO 38. New Caledonia 1 Fellowships R New Caledonia New Hebrides New Zealand 1 R New Zealand Health education. A twelve-month fellowship for the certificate in public-health course with major in health education in the Philippines. Participation in Regional Meetings and Inter-country Projects See WPRO 38. Participation in Regional Meetings and Inter-country Projects See WPRO 22j WPRO 38. Fellowships Health education. A twelve-month fellowship for the diploma course in public health with major in health education in the United. States of America followed, by observation visits to the United. Kingdom, other European countries, Lebanon, India and the Philippines. Public-health administration. A seven-an~a-half month fellowship to study public-health administration in the United States of America, the United Kingdom, other European countries and, Israel. Participation in Regional Meetings and Inter-country Projects See WPRO 23; WPRO 32; Inter-regional 44. /Niue ... Niue !forth Borneo 5 TA UNICEF '. lforth Borneo 1hpua and. New Guinea 4 .R .,. .: WP/RC9/2 page 59 Participation in Regional Meetings and Inter-country Projects See WPRO 38. Malaria Controll Keningau (July 1955 - ) Aim of the project. To study the malaria situation; to train local personnel and to carry out a control programme. Assistance provided by WHO during the year. (a) A ma.la.riologist and. an. entomologist; a malaria advisory team composed. of a malariologist team leader, and two laboratory technicians; (b) a six-month fellowship; (c) medical literature. Probable duration of assistance. Until 1962 (including MESA assistance). Work during the period. under review. A population of 81 000 was protected. during the period under review. Comparison was made between the effects of dieldrin and DDT alone and. dieldrin combined with the administration of drugs. The best results were obtained. in the area 'Where dieldrin and. drugs were combined, although in none was transmis sion stopped .• These rather disappointing results were due mainly to the habits of!. leucosphyrus balabacensis, but administrative deficiencies and. difficulties of transportation played a part. A malaria advisory team recommended. intensification of the use of drugs, improvement of the supervision of spraying operations and drug administration and improvements in parasitological technique. Participation in Regional Meetings and Inter-country Projects See WPRO 31.1; Inter-regional 45. Malaria Control Pilot Project, Sepik District (Oct. - Nov. 1957) Aim of the project. To study some of the entomological aspects of the malaria control pilot project in the Sepik District. Assistance provided. by WHO during the year. A short-term consultant. /Papua and New Guinea 6 ••• WP/RC9/2 :page 60 Papua and New Guinea 6 R Papua and New Guin a Philippines 4 R Fellowships Health education. A twelve-month fellowship for the diploma in content and, methods of health education course in the .United Kingdom followed, by an observation visit to the Philippines. Malaria. A three-month fellowship to observe malaria control in the Philippines, China, the Federation of Malaya and North Borneo. Participation in Regional Meetings and Inter~country Projects See WPRO 31.2; WP,RO 38j Inter-regional 45. Mental Health~ Manila (First phase: Nov. 1949 - Jan. 1953; second, phase: Feb. 1 57 - ) Aim of the project. To organize the Division of Mental Health in the Department of Health, and to plan a mental health programme at the national and regional levels, including the training of personnel. Assistance (a) A mental health speciali st; Probable duration of assistance. Until the end. of 1960. Work during the period under review. The beginnings of a Mental Hygiene Division within the current reorganization of the Department of Health were crystalized, by the assignment of the former Chief of the National Mental Hospital to the post of Director. Actual changes within administrative and clinical levels at the National Mental Hospital facilitated, radical modifications to an encouraging degree. Extensive and intensive in-service training programmes from the chief of service do'WIl to the maintenance section are in progress. The local training resources of the Civil Service Commission, University of the Philippines, Institute of Hygiene and related governmental and non-governmental ' agencies are being used,. The community has responded, collectively and, individually to the extension of the hospital and. domiciliary services of the Outpatient Department principally aimed, at the large patient population of Manila and, the province of Rizal, since these areas make up over 50% of the admissions. The first group of two senior doctors and, two nurses to be awarded WHO fellowships is undergoing four to five months intensive training in administrative and clinical psychiatry in Australia. Budgetary expenses for additional staff, material and, operational plans have been increased to almost six million pesos for the fiscal year. /Phillpplnes 9 •.• Philippines 9 TA . (ICA) Bilharziasis Pilot Project, Leyte (June 1952 - ) WP/RC9/2 page 61 Aim of the project. To determine the most effective and economical means of controlling bilharziasis; to train local professional and auxiliary personnel; to study the hUJDan, domestic-animal and, snail hosts of Schistosoma japonicum and, the parasite itself; to mak~ an epidemiological study of the disease in a highly epidemic area; to plan a control programme. Assistance *,rovided by WHO during the year. (a) An epidemiologist, a zoologist, a public-health engineer and, a short-term consultant; (b) medical literature and equipment. Probable duration of assistance. Until 1959. Work during the period, under review. An extensive evaluation report of the progress to date has been completed. In the initial period, study areas were selected, and surveyed. Following thiS, ecological methods of control were developed, through small-scale field trials. During the tl:;1ird, phase, the team rechecked and amplified its data and is now undertaking large-scale control methods on a community level. A clearer and more detailed, description of the snail habitat is emerging from the ecological studies conducted, in the snail "positive" and, "negative" areas in PalO. By 1959 it is hoped to carry out a critical evaluation which will satisfy the following criteria: (a) they shall prove effective in controlling the disease in man; (b) they shall be economically feasible; and, (c) they shall be acceptable to the community. The control method,s of choice in Leyte have proved to be naturalistic, i.e. to depend on devising ecological changes for despoiling the habitat of the snail and, free living stages of the parasite. During the past year, therefore, increasing emphasis was focussed, on this aspect. A thirteen-month reconnaissance of habitats was completed and the physical factors, characteristics of larger vegetation, microbiota, predation, competition and, parasitism studied. Engineering control methods have caused the greatest disturbance in the colonies resulting in the reduction of snail density. As a by-product of the extensive drainage of the valley (Curahao) in the project area, thirty-nine hectares of land became available for farming and cultivation for the first time. Health education activities continued and a programme centering around the women I s groups and schools was developed. The people are actively participating in the community development programme of the co-ordinating committee Whose activities are based, to a large extent on the project recommendations. /Philippines 12 ••• WP/RC9/2 page 62 Philippines 12 Insti tute of H of the Rlili TA July 1953 - (J ohns Hopkins University) Aim of the project. To strengthen the faculty of the Institute of (Rockefeller Hygiene by a programme of exchange between members of the teaching Foundation) staffs of the Institute and the Johns Hopkins University School of Hygiene and Public Health. Philippines 29 TA UNICEF Assistance provided by WHO during the year. An associate professor in maternal and child health, and three short~term consultants - one in biostatistical methods, one in maternal and, child health and one in mental health. Probable duration of assistance. Until 1959. Work during the period under review. The short-term consUltant in maternal and child health spent one and a half months, the visiting professor in biostatistical methods three months, the associate professor in maternal and, child, health one academic year at the Institute for the purpose of providing instruction and guidance on future developnents in their specialities. The short-term consultant in mental health arrived in June 1958 and will work at the Institute for three months. Reports on their assignments including recommendations on future work were submitted, to the Government. An evaluation report covering the :period 1953 - 1957 was prepared, by the Regional Programme Evaluator. This reveals that sixty-four out of the sixty-nine recommendations made by visiting staff since the project started, have been implemented. Midwifery Training, Philippines (Oct. 1953 - ) Aim of the project. To study the midwifery services and education facilities; to develop a well-organized education programme for midwives; to train village midwives (hilots); to study materni ty- nursing needs and resources; to formulate a midwifery practice act. Assistance midwifery Probable duration of assistance. Until the end of 1958. Work during the period, under review. A separate centre for in-service training for nurses and, midwives from pu.ericultures and rural health uni ts, was established in the Maypajo Puericulture Center and the course for staff level personnel revised. and, strengthened .• Maternity service workshops for puericulture centre staff were held, in conjunction with field, visits of the WHO midwifery consultant and. her counterpart to several provinces. /A statistical evaluation ... . . . : Philippines 43 R (ICA) , . -- WP/RC9/2 page 63 A statistical evaluation of the 1957 hilot follow-up meetings showed. the value of this type of programme when adequate supervision and liaison is maintained.. Mothercraft classes have become a regular part of the maternal and child. health programmes in many centres. A well-organized. referral system between maternity hospitals and public-health agencies has resulted. in better follow-up of post-partum mothers and infants. The WHO midwifery consultant has acted in a consultant capacity to the Midwifery Advisory COmmittee, the Committee on Supervision and. other committees concerned with midwifery education and maternal and. child health services. A mid~fery practice act was prepared for presentation to the Congress by a sub-committee of the Midwifery Advisory Committee. Assistance continued to government and. private schools of midwifery. An encouraging improvement in standards of midwifery education and practice is evident • Environmental Sanitation (June 1955 - ) Aim of the project. To co-ordinate and strengthen environmental sanitation work. Probable duration of assistance. Until 1960. Work during the ;period. under review. This project has been active in strengthening both the central environmental sanitation services of the Philippine Department of Health and also in assisting in the teaching of public-health engineering and environmental sanitation at the Institute of Hygiene of the University of the Philippines. The preparation of a long- and short-range environmental sanitation plan for the Philippines was one of the major achievements of the Government during the period. of this project. This plan, after discussion by the Philippine Public Health Co-ordination Committee, was approved. and recommended for approval by the Secretary of Health. Assistance was given to the City of Manila in planning for a pilot refuse composting plant. The City was also assisted in planning and operating an anti-litter campaign during the period under review. The Institute of Hygiene offered during this year a new course leading to the degree of master in public-health engineering. Four graduate engineers are presently enrolled in this course. /Philippines 51 ••• wp/RC9/2 page 64 Philippines 51 R Philippines 53 R Malaria Eradi- cation Special Account (ICA) Philippines 54 R Environmental Sanitation Training bourse (Feb. 1958 - ) Aim of the project. To provide assistance in the organization of an advanced. training course and in demonstrating environmental sanitation activities in a selected. area. Assistance provided by WHO during the year. (a) A short-term consultant in sanitary engineering and. a sanitarian. Probable duration of assistance. Until 1960. Work during the period. under review. This project was initiated on tbe arrival of a WHO short-term consultant in sanitary engineering in Manila on 10 February 1958. Planning for this project is in an ad:vanced. stage and. with the arrival of a WHO sanitarian in June 1958 tentative studies on the duties of the sanitary inspector in the Philippines and. on the type of training required to undertake these duties were ini tia ted .• It is expected. that the first training centre to be strengthened by WHO assistance will be at a newly-created regional training centre in connexion with an integrated. health services area near Manila. Malaria Eradication (First phase: Aug. -Dec. 1956: second. phase: June 1957 - ) Aim of the project. To eradicate malaria through spraying of all malarious areas and treatment of malaria cases. Assistance provided by WHO during the year. (a) An advisory team on malaria eradication composed of a malariologist (team leader), an entomologist and two laboratory technicians; a short-term consultant; (b) supplies and. equipment. Probable duration of assistance. Until 1962 (MESA) Work during the period. under review. The report of the conclusive consultant to the malaria advisory team gp,ve detailed recommendations for the institution of an extensive surveillance scheme to consolidate eradication over large areas of the Philippines. Plans for its implementation have been worked out by representatives of the Division of Malaria of the Philippine Department of Health, the United states International Co-operation Administration (ICA) and WHO. They will be implemented on 1 July 1958. Fellowships Dental health. A six-month fellowship to study and observe dental health in the United States of America. /Health education ... -. -!hilippines Sarawak 5 :TA . - . . WP/RC9/2 page 65 Health education. A ten-month fellowship to study health education in the United States of America followed. by observation visits to Korea, Japan, China, Viet Nam, Burma., Tha1ltmd and Indonesia. Public-health administration. A six-month fellowship to study public. health administration in the United. States of America, Hawaii, Japan and China and one twelve-month fellowship to study public-health administration in Puerto Rico and the United. States of America. Participation in Regional MeetingS and Inter-country Projects See WPRO 5; WPRO 23; WPRO 31.1; WPRO 32; WPRO 37; Inter-regional 44; Inter-regional 45. Malaria Pilot Project (July 1952 - ) Aim of the project. To study the efficacy, for malaria control in Sarawak, of indoor spraying with residual insecticides in an experimental area; to train professional auxiliary and ancillary personnel for malaria control throughout the country. Two malariologists Probable duration of assistance. Until 1960 TAj 1962 MESA • Work during the period under review. All the highly malarious ar as have been covered and considerable progress made in the less malarious areas. The population protected. in 1957 numbered 150 000. In most areas transmission has been stopped by residual insecticides, supported by mass drug treatment at the time of spraying. Pilot surveillance schemes have been started in two areas. Difficulties encountered have been the problem of malaria in nomads, the use of temporary farm houses and the discovery of the importance of A. barbirostris as a secondary vector. Solutions to these problems are being worked. out. It is prOving difficult to stop transmission completely in the areas adjoining the border with Kalimantan; co-operative effort is anticipated as a result of discussions held at the Borneo Malaria Conferences. Participation in Regional Meetings and Inter-country Projects See WPRO 31.1. /Singapore 2 ••• lP/RC9/2 1age 66 ;ingapore 2 TA University of Malaya (Sept. 1952 - ) (London School Aim of the project. To develop the teaching of preventive and social of Hygiene and medicine in the Faculty of Medicine; to establish a first-class post- Tropical graduate school of public health. Medicine) 3ingapore 4 R UNICEF Assistance rovided. b WHO durin the ear. (a) A lecturer in public health; b one twelve-month fellowship. Probable duration of assistance. Until the end. of 1958. Work during the period. under review. In addition to routine lectures in epidemiology and. medical genetics, the WHO lecturer bas been responsible for the guidance of the field practice of the DPH course students. A WHO fellowship was awarded. to the national counterpart who will go to London in September to take the DPH course. Two fellows from Hong Kong and. one from Japan attended. the DPH course at the University of Malaya. The WHO lecturer also assisted. in the WHO Study Group on Social and Preventive Medicine in Manila, in which the Dean of the Faculty of Medicine and. the Professor of Social Medicine and. Public Health at the Universi ty of Malaya also participated .• Institute of Health (Jan. 1956 - ) Aim of the project. (a) To provide maternal and child. health, school dental and health education services to about 125 000 people living near the Institute; (b) to train at the Institute undergraduate medical and post-graduate public-health students of the University of Malaya (including students from other countries of the Region), and health visitors, healtb inspectors and other auxiliary personnel. Assistance provided by WHO during the year. (a) A senior nurse educator and. a public-health nurse tutor; (b) medical literature. Probable duration of assistance. Until the end. of 1960. Work during the period under review. A curriculum for the public-health nursing course was prepared., field. experience planned and the first public-health nursing course which is a combined. public~hea1th/district nurse course commenced in November. Legislation was drafted for presentation to the Attorney General to establish the "Singapore Joint Board. of Public Health Nursing" as a statutory body ioIhich will be responsible for the overall administra- tion of the course, including approval of the curriculum and conduct of examina ti ons • A pilot district nursing service planned. as a home care service for selected patients referred from the General Hospital was started in April. This pilot project will provide district nursing experience for the public-health nursing students and. is another step towards provision of complete public-health nursing services in Singapore. / Singapore 8 ••• Singapore 8 -" TA Nursin~ Education (June 1952 - ) wp/RC9/2 page 67 Aim of the project. To improve the standards of nursing education and nursing service in Singapore through the development of (a) the clinical teaching units and educational programme in the Singapore General Hospital, (b) clinical fields and educational programmes in psychiatric nursing and, mental health, (c) in-service education, refresher courses and, special courses for local registered nurses and (d) the preparation of local nurses for administrative and teaching positions. are (a) A senior nurse ~--~----.. ~~~~~~~~~~~~~ ~ , and two nurse educators Sj.ngapore 9 TA Probable duration of assistance. Until the end of 1960. Work during the period, under review. The teaching programme in psychiatric nursing at Woodbridge Hospital has made significant progress. A two-year course for graduate nurses and a three:-year course for psychiatric nurses was established. Selection procedures were improved and there was an increase in applicants for psychiatric nursing. "Regulations for training and examination for psychiatric nurses" were drafted and presented througn the Singapore Nursing Board to the General Nursing Council of England, and Wales for reciprocal recognition. An in-service programme for nursing service personnel consisting of one month of classwork followed by directed activities in ward, administration and, teaching is being carried, out in selected, wards of the General Hospital. At Ministry level, a study was done on nursing resources and, needs for the existing services and, for planned, extensions of service. This information will be used, as a basis for planning nursing education programmes to meet future needs. A committee is working on a review and revision of the Singapor Nursing Board legislation. A nursing education committee was appointed and the committee and its sub-committees are actively engaged in various projects, i.e. study and revision of the assistant nurse training programme, preparation of a procedure manual. Hospital Records (Nov. 1956 - ) Aim of the ;eroject. To review and reorganize the hospital records system in the Federation and in Singapore; to establish and implement a suitable training programme for local personnel in the Federation of Malaya. / Assistance provided, ••• WP/RC9/2 :page 68 Singapore Assistance rovided b WHO durin the ear. An expert in medical statistics Who also worked. on project Malaya 15). Probable duration of assistance. Until 1959. Work during the period under review. The medical records comrni ttee created in the Singapore General Hospital approved the various forms proposed by the WHO expert. A new admission-discharge record Which provides a basis for obtaining more extensive information on hospital morbidity and on the use of hospital services was formally accepted. by the senior staff committee of the Hospital. A revised system of patient registration and record filing is now being used. in the Medical Unit II and. the Pediatric Unit of Singapore General Hospital. A new system of requesting and. reporting clinical laboratory examinations was introduced. and a diagnostic coding schedule proposed. by the WHO expert for the Orthopaedic Department was ~t into use. The Government has appointed a hospital records officer for Singapore General Hospital Who will work with the WHO expert until mi~1958 when he will then proceed. to the United. Kingdom for advanced. training in hospital records keeping. On his return m1~1959 he will assume supervision of the medical records department in the General Hospital. It was proposed. that similar positions be created. in Kandang Kerbau Hospital and Tan Hock Seng Hospital for 1959 and. that the two officers selected. for these posts be later sent abroad. for ad~anced. training. The Government and. the Organization have agreed. to sign an addendum to the plan of operations which provides for the evolution of the project from the hospital level to the Ministry of Health, where a statistical division would. be created for co-operation and. supervision of the collection of health statistics, including hospital statistics, throughout Singapore and for compilation and analysis of the statistical data collected. Participation in RegiOnal Meetin~s and. Inter-country Projects See WPRO 5; WPRO 23; WPRO 31.1; Inter-regional 44. Tokelau Islands Participation in Regional Meetings and Inter-country Projects Tonga 1 TA See WPRO 31.2. Environmental Sanitation (March 1958 - ) Aim of the project. To strengthen environmental sanitation services at all government levels; to investigate and study problems of rural and. urban environmental sanitation, and social, economic and cultural factors relating to the improvement of environmental sanitation; to plan, organize, execute and. evaluate a pilot project to demonstrate modern and. economical procedures and methods in environmental sanitation; to train environmental sanitation personnel and. instruct other public- health workers in sanitation. /Assistance provided ••• : Tonga Assistance provided by WHO during the year. (b) supplies and equipment. Probable duration of assistance. March 1960. WP/RC9/2 page 69 (a) A social anthropologist; Work durin the riod. under review. This project was initiated on 12 March 19 on the arrival of the WHO social anthropologist in Tonga. The anthropologist began his studies on cultural factors relating to public-health in the Kingdom, and. it is expected that the pilot project to demonstrate modern and economical procedures and methods in environmental sanitation will be influenced, strongly by his findings. Supplies and equipment including a vehicle are in place in Tonga. Same difficulty was experienced in recruiting a suitable sanitary engineer for this project. It is hoped. that he will be in place shortly after July 1958. Participation in Regional Meetings and, Inter-country Projects See WPRO 31.2; WPRO 38. Vnited States Participation in Regional Meetings and Inter-country Projects Trust Territories • of the Pacific See WPRO 38. ~Islands ~- . Viet Nam 2 Public-Health Administration '. R Viet Nam. 3 " TA , "UNICEF (ICA) . . An eighteen-month fellowship in the teaching of preventive medicine for study in the United. States of America. Maternal and Child Health (Dec. 1954 - ) Aim of the project. (a) To improve and, develop existing facilities with a view to meeting maternal and child health need.s within the general public~ealth and medical care services; (b) to determine standards for the various categories of specialized. staff working in the maternal and. child health field. and to be responsible for recruit. ment, training or refresher training; (c) to assist in the training of staff from neighbouring countries where the maternal and child health problems may be similar to those in Viet Nam.j (d) to study the maternal and. child health problem by means of research and the collec- tion and. analysis of statistical and. demographic data. ar. (a) A medical officer and ----------~--~--~~--~~~~~~~- Probable duration of assistance. Until 1959. /Work during ••• WP/RC9/2 page 70 Viet Nam 7 TA (lCA) Viet Nam 9 R (lCA) Work during the period. under review. The project was redefined. during the period under review. What ~s formerly an isolated. project for the development of the Children's Hospital and some maternal and child. health centres has now taken shape as a detailed. programme for setting up maternal and child, health services throughout Viet Nam. The Children's Hospital and the Tu Du Maternity have been formally designated. as teaching and. demonstration centres. Details of short- and long-term . objectives are contained in an addendum to the new plan of operations. The in-service training of hospital nurses andmidw1ves was continued.. One of the main problems, however, is that of maintaining counterpart nurses in supervisory and. responsible posts to assist in training. Services in the Children's Hospital were expanded.; the maternity services were reorganized. and a prenatal clinic established, which is providing experience for student midwives. Tuberculosis Control (Jan. 1958 - ) Aim of the project. To set up the nucleus of a national tuberculosis control service which will place emphasis on the preventive and public- . health aspects; to complete a tuberculosis dispensary in Saigon and. to integrate it with existing facilities; to continue the WHO/UNICEF. assisted BOG vaccination project and to integrate it with the National Tuberculosis Control Service. Assistance provided. by WHO during the year. A medical officer. Probable duration of assistance. Until 1959. Work during the period. under review. Preliminary plans for the organization of the tuberculosis centre were drawn up and the general outline of a training programme for auxiliary staff was finalized .• Statistical tables and. cards for the centre were prepared.. Follow-up visits were paid. to some of the BCG teams; the BOG programme io now integrated. with the work of the dispensary in the Hong Bang Hospital. Environmental Sanitation (Nov. 1956 - ) Aim of the project. To strengthen national and local environmental sanitation services; to train professional and sub-professional personnel; to carry out pilot schemes of environmental sanitation. Assistanee: provided by WHO during the year. A sanitary engineer. Probable duration of assistance. Until the end of 1959. Work during the period under review. This project has been instrumental in strengthening the newly-created service of environmental sanitation of the Ministry of Health in Viet Nam. /The WHO sanitary ••• . VIet Nam 12 R Viet Nam WP/RC9/2 page 71 The WHO sanitary engineer worked in close collaboration with the chief of this service and, with other departments of the Government concerned with environmental sanitation. A considerable amount of baseline material was collected relating to the present status of environmental sanitation in Viet Nam. This collection of data will greatly aid, evaluation of environmental sanitation activities in the country, as well as assisting the service to plan, organize and implement programmes of environmental sanitation. The project engineer assisted, in the planning, organization and, operation of a school for the training of sanitary agents in Viet Nam. During the period, under review, fifty-nine individuals completed this training course. Graduates of the course were appointed to rural health teams. Assistance was also given in the preparation of a manual for rural health workers published by the Ministry of Health. Although steady progress was made, there has been a constant shortage of personnel and, equipment Which considerably handicapped, the operation of the project. The need for additional personnel and supplies was brought to the attention of the Ministry of Health • Fellowships Nursing care and midwifery. A twelve-month fellowship to study paediatric nursing and two twelve-month fellowships to study obstetrical nursing in Canada. Participation in Regional Meetings and Inter-country Projects See WPRO 5; WPRO 23 j WPRO 31.1; WPRO 32. Wallis Islands Participation in Regional Meetings and Inter-country Projects See WPRO 38. West New Guinea 2 . . R UNICEF .. Malaria Control, Hollandia (Oct. - Nov. 1957) Aim of the project. To conduct studies with a view to increasing th effectiveness of control methods and reducing costs of operation. Assistance provided by WHO and work done. A shQrt-term consultant on malaria, who assisted the government staff with a study to determine problems which had arisen in connexion with the use of dieldrin in the Nimboran area and, ,tbII possible development of resistance. /West New Guinea 7 ••• WP/RC9/2 page 72 West New Guinea 7 R West New Guinea Western Samoa WPRO 5 R Fellowships Public-health administration. A four-month fellowship to observe public- health administration in Ceylon, India, China and the Philippines. Participation in Regional Meetings and. Inter-country Projects See WPRO 31.2; WPRO 32; WPRO ;8; Inter-regional 45. Participation in Regional Meetings and. Inter-country Projects See WPRO 22; WPRO 31. 2; WPRO ;8. Venereal-Disease Control Seminar, Tokyo (17-29 March 1958) Aim of the project. To review the principles and methods of present- day venereal-disease control and. the adaptation of these to local circumstances with a view to improving venereal-disease control in the countries of the Region; to stimulate the exchange of ideas on the major venereal-disease control problems of the countries of the Region and to consider how they may be approached most effectively. Assistance provided by WHO. (a) Two short-term consultants; (b) travel and stipends of nineteen participants from Australia, Cambodia, China (Taiwan), French Polynesia( Hong Kong, Japan, Korea, Laos, Philippines, Singapore and Viet Nam; (C) supplies and equipment. Work done. The major topics considered and discussed were: (a) nature and. extent of the venereal-disease problem in the Western Pacific Region; ~ (b) problems of diagnosis, therapy and management of syphilis, gonorrhoea, non-gonococcal urethritis and the other venereal diseases; (c) penicillin' reactions; (d) prevention and control of venereal disease with particular" reference to special population groups including seamen, prostitutes, armed forces and. pregnant women. The seminar consisted. of the presentation and discussion of the working papers on the various administrative and technical aspects of venereal-disease control as a group. Two working groups considered two subjects of major interest and a permanent drafting committee was responsible for the preparation of the draft report of the seminar. Four field visits were arranged and appropriate films were exhibited. Information was exchanged at the seminar and selected technical literature was made available for pa~ipants. /WPRO 22 ••• -WPRO 22 R UNICEF · - . · , 1 , . · • WPRO 23 TA WP/RC9/2 page 7; Yaws Control, Fiji (Nov. 1954 - ), Western Samoa (June 1955 - ), British Solomon Islands Protectorate (May 1956 - ), Gilbert and Ellice Islands Colony (Jan. 1951 - ) J Condominium of New Hebrides (June 1958) Aim of the project. To reduce the prevalence of yaws by mass examina- tion and treatment with penicillin and, ultimately to eltminate the disease as a public-health problem; to train local personnel in the diagnosis, therapy and epidemiology of yaws. Assistance provided by WHO during the year. (a) A medical officer, a serolOgist and a male nurse administrator; (b) supplies and equipment. Probable duration of assistance. Until the end of 1960. Work durin the riod under review. The WHO team of one medical officer, one serologist and one nurse administrative officer assisted the govern- ments with the operation of the projects in Fiji, Western Samoa, the British Solomon Islands Protectorate and the Gilbert and Ellice Islands Colony. In Fiji, the first re-survey of the mass treatment areas was completed. and. plans developed, for the continuation of follow-up activities in combination with other health work. In Western Samoa, the second re.survey was completed., very successfully utilizing the rural health personnel. Plans have bean made for the re.survey of the total population yearly during an annual "yaws week". The results of the re-surveys in Fiji and, Western Samoa showed that the great reduction in the prevalence of yaws Which foll~wed. the mass treatment campaign has been maintained. In the British Solomon I~lands Protectorate and in the Gilbert and Ellice Islands Colony the initial mass treatment surveys were completed. Plans were made for the necessary follow-up activities. The control project for the Condominium of the New Hebrides was started in June, 1958. Negotiations with the United Kingdom of Tonga. were continued and the Government has agreed in principle to undertaking a yaws control programme in 1959. of Social and Preventive Medicine Manila Aim of the project. To provide an opportunity for medical educators to discuss the unGer graduate teaching of social and preventive medicine in the medical schools of the Region • ........ rovided. b WHO. (a) A short-term consultant for five weeks; b grants to twenty-three lRrticipants from Australia, Cambodia, China Taiwan), Fiji, Hong Kong, Japan, Korea, New Zealand, Philippines, Singapore, and Viet Namj (c) supplies. /Work done ••• WP/RC9/2 page 74' WPRO 31.1 TA WPRO 31.2 TA Work done. Several deans of medical schools and of the clinical professions and professors. of preventive medicine participated. in the discussions, Which centred. around. objectives, curriculum content and. methodology of teaching of social and preventive medicine, organization of the department of social and. preventive medicine, its relationship with other departments, comprehensive health care, practice facilities and research. Environmental Sanitation Seminar (Zone II), Singapore (2-19 Dec. 1957) Aim of the project. To exchange information among Member Governments as to the present status of rural 'Water supplies; to present through the media of lectures, demonstrations, field. trips, working papers and. group discussions recent advances in the field of rural 'Water supply; to explore the possibility of more widespread and. effective assistance by WHO to Member Governments with respect to rural 'Water supply. Assistance provided. by WHO. (a) A short-term consultant; (b) travel and stipends of sixteen participants from Brunei, Cambodia, Ceylon, Indonesia, Laos, Malaya, North Borneo, Philippines, Sarawak, Singapore, Thailand. and. Viet Nam; (c) supplies and. equipment. Work done. This seminar was attended by sixteen official government participants, six official observers and eight WHO staff members. The disciplines represented included. public-health doctors, public-health engineers, chemists, sanitary engineers, sanitary inspectors and sanitarians. A short-term consultant visited a group of countries in advance of the seminar. The seminar consisted of several formal lectures, demonstrations of techniques of water supply installations and. examination procedures, laboratory sessions for participation by seminar members, group discussions on subjects of technical interest within the general subject, field trips and one open forum. A large number of working papers were presented and. discussed. at the meeting. These working papers dealt with the present situation of rural water supplies in the participating countries, together with technical data relating to the solution 'of the problems involved in the use of water supplies. Judging by the replies from individual questionnaires completed by those attending the seminar, it appeared that this seminar was success- ful both in respect of organization and in terms of achievement of the short-term objectives. .. . Environmental Sanitation Seminar (Zone III), Port Moresby (5-23 May 1958) Aim of the project. To exchange information among participating governments and. territories as to the present status of environmental sanitation; to present through the media of lectures, working papers, demonstrations, group discussions and. field. trips recent advances in /the field of ••• -WPRO 32 . R (Rockefeller • .' Foundation) WP/RC9/2 page 75 the field of environmental sanitation of rural areas and villages; to explore the possibility of more widespread. and effective co-operation between countries with respect to cammon problems of environmental sanitation and better utilization of assistance by WHO to Member Governments. Assistance provided by WHO. (a) A short-term consultant; (b) travel and stipend.s for eighteen participants from American Samoa, Australia, British Solomon Islands, Cook Islands, Fiji, French Polynesia, Gilbert and. Ellice Islands, Guam, Papua and New Guinea, Tokelau Islands, Tonga, West New Guinea and. Western Samoa; (c) supplies and. equipment. Work done. Attending this seminar were eighteen governmental partici- pants, seven official observers and. four staff members of WHO. The diSCiplines represented. included public-health officers, assistant medical practitioners, health inspectors, sanitary engineers and one lecturer on the subject of environmental san:ltation. The seminar was planned and operated. as a working seminar with particular emphasis on the training aspects, especially in connexion With rural environmental sanitation. A short-term consultant visited. a number of the participating countries before the seminar. A broad spectrum of subject matter was covered. during the meeting by means of formal lectures, technical discussions, presentation of technical motion pictures, film strips and. individual film slides presented by participants and staff. The seminar also included demonstrations of laboratory techniques and laboratory periods during which participants were given the oppor- tuni ty of practicing these techniques. Four field. trips were provided. to local water plants, sewage plants, housing developments and areas 'Where rural environmental sanitation was being introduced .• A considerable portion of time was devoted to discussions of administrative and non-technical interests by small groups. These discussions revolved around the problems of planning, executing and. administering programmes of environmental sauitation. The study of cultural patterns and the adaptation of environmental sanitation programmes to tit into these patterns was stressed throughout the meeting. Individual questionnaires were completed. by seminar members at the completion of the seminar. The results of these questionnaires indicated that the seminar would. be considered to have been successful. Public-Health Conference and St and Taiwan 13-30 Sept. 1957 Aim of the p;oject. To enable public-health administrators from countries in the Region to exchange experience and. study problems. / Assistance provided. • •• WP/RC9/2 page 76 WPRO 34 R WPRO 37 R Assistance provided by WHO. Travel and stipends of fourteen participants from Australia, Cambodia, China (Taiwan), Hong Kong, Ja;pa.n, Korea, Laos, New Zealand, Philippines, United States of America (ICA), Viet Nam and West New Guinea. The Rockefeller Foundation provided. a short-term consultant. Work done. The group visited nearly thirty institutions consisting of research laboratories, medical schools, institutes of public health, nursing education projects, vital and health statistical services, environmental sanitation projects, hospitals, health centres and. stations, maternal and. child. health services, services for crippled. children, and programmes for control of communicable diseases such as malaria, tuberculosis, leprosy, venereal diseases and. trachoma. During seven conference sessions, the group considered. the subject of compre- hensive health planning, including community development. Aim of the project. To review the leprosy problem, and. the facilities available for dealing with it, in selected. countries of the Region, and to make recommendations. Assistance provided. by WHO. A leprosy consultant for three months. Work done. Recommendations were submitted to the governments for future development of programmes. The Government of the British Solomon Islands Protectorate has since signed. an agreement with WHO and UNICEF fer assistance in a leprosy control programme. Poliomyelitis Centres, SingaEore and. Tokyo (June 1956 - ) Aim of the Eroject. To set up laboratory centres to: collect and study strains of poliomyelitis virus from different parts of the Region; under- take epidemiological studies for the eventual use of the vaccines; train WHO fellows as far as facilities permit. Assistance provided by WHO during the year. (a) Three six-month fellow- ships and. one one-an~a-half-month fellowship; (b) travel costs for the Director of the Tokyo Centre. Probable duration of assistance. Until 1960. Work during the period. under review. The Directer of the Centre in Tokyo visited. Taiwan to assist in a survey of the state of immunity of the population against poliomyelitis and to adyise on the strengthening of laboratory routine and research in virus work. /Fellowships were ••• wp/RC9/2 page 77 Fellowships were awarded to a selected candidate from Taiwan to work at the Centre in Tokyo and, selected candidates from Korea and the Philippines to work at the Centre in Singapore. An experienced, virus worker from the Centre in Tokyo was granted a fellowship to work at the Centre in Singapore for the purpose of exchange of knowledge and experience in new laboratory methods, and, also to visit Australia. Two candidates from Thailand in the adJacent South-East Asia Region were granted, WHO fellowships to study and work at the Centre in Singapore. They also visited, the Institute for Medical Research in Kuala Lumpur, Federation of Malaya. WPRO 38 Training in Health Education (July 1957 - TA • (South Pacific Aim of the project. To provide training in health education to health _ Commission) and, education workers of native origin from the territories of the South Pacific by means (a) of a course to enable them (1) to study the basic principles underlying health education and their application in the territories; (2) to exchange ideas on health education activities and programmes now in progress; and (3) to study plans for further development; (b) of continuous guidance to the trainees in their respective territories. Assistance provided, by WHO during the year. (a) A health education specialist and, two short-term consultants; (b) fellowships to forty participants from American Samoa, British Solomon Island.s Protectorate, Cook Islands, Fiji, French Polynesia, Guam, Nauru, New Caledonia, New Hebrides, Niue, Northern Territory of Australia, Papua and New Guinea, Tonga, United States Trust Territories of the Pacific, Wallis Islands, West New Guinea and, Western Samoa. A fellow from Uganda (East Africa) also attended the course as part of his fellowship programme; (c) supplies. Probable duration of assistance. Until the end, of 1959. Work during the year. The training course, held, in Noumea, New Caledonia, from 1 July to 21 August 1957, was organized. jointly by the South Pacific Commission and, WHO. At the beginning of the course the health education needs and, problems of the trainees were discussed. and, analyzed. Four study groups were set up to d,eal vTi th the follOWing questions and SUbjects: (1) what are the common health needs and, problems of the village life? (2) Who and, what influence the health of the village? (3) how people grOi" up in different communities; (4) how people learn and, change their behaviour; (5) planning and. organiZing health education programmes and, activities; (6) use of health education methods and teChniques. The WHO health education specialist assigned. to the South Pacific Commission made follow-up visits to trainees in the British Solomon Islands, West New Guinea, Papua and New Guinea, Fiji, French PolyneSia, Western Samoa, American Samoa and. New Hebrides, ~. the Regional Adviser visited, trainees in the Trust Territories of the Pacific Islands, Guam and Saipan. /WPRO 50 ••• WP/RC9/2 page 78 WPRO 50 R WPRO 64 R WPRO 65 R Public-Health Administration (DPH fellowships) Aim of the project. To provide fellowships for candidates from various countries of the Region to study for the Diploma in Public Health at the University of Malaya, Singapore. Assistance provided by WHO during the year. Fi ve nine-month fellowships to two candidates from Japan, tvo from Hong Kong and one from West New Guinea. Probable duration of assistance. Until 1959. Work during the period. under review. Three WHO-sponsored fellows, one from Japan and two from Hong Kong, attended the 1957 diploma course in public health. All three candidates passed the course successfully. The external examiner from the London School of Hygiene considered. that all candidates Who were successful could have passed. the examinations in the London School. It is gratifying to note that the standards of these two schools are closely comparable. Two WHO fellows, one from Japan and one from West New Guinea, will attend. the 1958 course. Three WHO fellows from Burma are also expected to join this course. Medical Literature and. Teaching Equipment Aim of the project. To supply small quantities of essential literature, equipment and, supplies to Member Governments for work on demonstrations, training projects and, pilot studies. Assistance provided. by WHO during the year. Medical literature to Japan, Sarawak and. Singapore. Publication of Japanese Paper on Resistance to Insecticides Aim of the project. Translation and publication of Japanese articles on insect resistance to insecticides for distribution to workers in the same field .• Assistance provided. by WHO and. work done during the period. under review. Financial prOvision for translation and publication. Thirty-six papers were translated. and. edited, and copies distributed to governments within and. outside the Region. lInter-regional 44 ••• · . WP/RC9/2 page 79 Inter-regional 44 Seminar on Resistance of Insects to Insecticides, New Delhi HQ (27 Feb. - 7 March 1958) Aim of the project. To provide a means of bringing about an exchange of views, ideas and. techniques among ;persons actively engaged. in research on insect resistance to insecticides in these areas. Assistance provided. by WHO. Participants from the following countries in the Western Pacific Region attended the seminar: Australia - 3; China (Taiwan) - 1; Federation of Malaya - 1; Bong Kong - 1; Japan - 8; New Zealand. - 2; Philippines - 1; Singapore - 1. Inter-regional 45 Malaria Symposi\ml, Bangkok (13-20 Dec. 1957) HQ Aim of the project. An inter-regional malaria symposium. in Bangkok to discuss chemotherapy in malaria eradication, malaria surveillance procedures, susceptibility and. resistance of vector species to insecticides, spraying techniques, problem of residual foci of malaria transmission, country malaria programmes, technical aspects of planning malaria programmes. Assistance provided. bl WHO. Participants from the following countries in the Western Pacific Region attended the symposium.: China (Taiwan) - 1; North Borneo - 1; Federation of Malaya - 1; Papua and New Guinea - 1; Philippines - 1; West New Guinea - 1. Organizational Unit OFFICE OF runIONAL DIRECTOR Public Information Reports and Liai son Unit BUREAU OF HFALTH SERVICES Advisory Services Fellowships Secretarial. Pool for Advisory Services ANNEX 1 LIST OF RIDIONAL OFFICE POSTS Post I - Regional Director I - Administrative Assistant L - Secretary I - Public Information Officer L - Information Assistant L - Secretary I - Reports and Liaison Officer I - Medical Director I - Statistician and Programme Evaluator L - Secretaries (2) L - Clerk/Statistician L - Clerk/Stenographer I - Regional Public-Health Administrators (~) I - Regional Ad~iser on Health Education of the Public I - Senior Regional Malaria Adviser I - Regional Malaria Adviser I - Public-Health Engineer I - Entomologist I - Administrative Assistant I - Regional Tuberculosis Adviser I - Regional Venereal Diseases Adviser I - Regional Maternal and Child. Health Adviser I - Regional Environmental Sanitation Adviser I - Regional Nursing Adviser I - Regional Education and Training Adviser L - Technical Assistant L - Secretary L - Clerk/Typist L - Secretary L - Clerk/Stenographers (8) OFFICE OF ADMINISTRATION I - Senior Administration and Finance Officer AND FINANCE I - Administration and. Finance Officer L - Secretaries (2) I - Internationally recruited L - Locally recruited * Candidate s lected WP/RC9/2 page 81 Nationality China VACANT P.I. U.S.A. P.I. P.I. U.K. P.I. China P.I. P.I. P.I. 1 1) China 1) Canada 1) P.I. Canada VACANT U.K. VACANT* VACANT VACANT* U.K. U.K. U.K. U.S.A. Canada Japan P.I. P.I. P.I. P.I. P.I. U.S.A. VACANT* VACANT WP/RC9/2 pnge .82 Organizational Unit Budget, Finance and. Accounts Personnel General Services AREA REPRESENTATIVES Saigon (Cambodia, Laos Viet Nam) Singapore (Brunei I Federation of Malaya., North Borneo, Sarawak, Singapore) SYdn)Y (South Pacific Area Ta1pet (Japan, Taiwan, Korea Post I - Budget and. Finance Officer I - Finance Officer I - Accountant L - Assistant Accountants (2) L - Cashier L - Accounts Clerks (7) L - Clerk/Stenographer I - Personnel Officer L - Personnel Assistant L - Clerk/Typist I - Administrative Services Officer I - Assistant Administrative Services Officer I - Translator (English-French) I - Assistant Translator (English-French) I - Translator (English-Chinese) L - General Services Assistant L - Travel Clerk L - Supply Clerk L - Registry Assistant L ~ Registry Clerk L - Library Clerk L - Clerk/Typists (4) L - Mail Clerks (2) I - Medical Officer L - Secretary L - Clerk/Typist I - Medical Officer I - Medical Officer L - Clerk/Stenographer I - Medical Officer L - Secretary I - Internationally recruited. L - Locally recruited. '* Candidate under consideration ( NatiOnality U.K. U.K. VACANT P.I. China P.I. P.I. U.K. U.S.A. P.I. / Netherlands VACANT Switzerland Switzerland China P.I. P.I. VACA'Nr P.I. P.I. P.I. 1 3) P.I. 1) VACANT 1) China 1) P.I. U.K. Viet Nam Viet Nam China Canada Australia VACANT* VACANT Organizational Unit Post SINGAroRE EPIDEMIOLOGICAL I - Medical Officer INTELLIGENCE STATION L - Administrative Assistant L - Technical Assistant L - Technical Clerk (4) L - Administrative Clerk (2) L - Accounts Clerks (2) I - Internationally recruited L - Locally recruited. * Also Area Representative, Singapore WP/RC9/2 Page 83 Nationali ty China* India. U.K. U.K. (1) India. (1) U.K. (1) India. (1) U.K. Project China 3 China 6 China 7 " China 13 China 17 " Japan 1 Japan 10 Philippines 12 " " Philippines 51 Papua and. New ) Guinea 4 ) West New ) Guinea 2 ) WPRO 5 . WPRO 23 WPRO 31 WPRO 34 WPRO 38 " Inter-regional 49-3 Cambodia North Borneo ANNEX 2 CONSULTANTS EMPLOYED DURING THE YEAR Field. Maternal and Child. Health Nursing Arthropod-borne Virus Diseases Insect Resistance Trachoma Tuberculosis Statistics X-Ray Rehabilitation of Handicapped Children Training of Sanitarians Maternal and. Child Health Biostatistics Mental Health Sanitary Engineering Malaria Venereal Diseases Study Group on Social and Preventive Medicine Public-Health Engineering Leprosy Educational Psychology Health Education Malaria Inter-regional 49-4 Malaria Number 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 5 3 5 WP/RC9/2 page 85 Nationality Australia U.S.A. U.S.A. U.S.A. U.K. Norway U.K. U.S.A. U.S.A. U.S.A. U.S.A. U.S.A. U.S .A. U.K. U.K • China U.K. P.I. Australia . P.I. ~3) U.K. 1) Switzerland (1) France (3) U.K. (1) U.K. ~l) France 1) Italy (2) Greece wp/RC9/2 page 87 ANNEX 3 . PR)JECT AND RIDIONAL OFFICE INTERNATIONAL STAFF EMPLOYED AS OF 30 JUNE 1958 Country Regional Office Area Field. Total Australia 3 3 Austr"e 2 2 Bolivia 1 1 Canada 3 1 8 12 China 3 1 2 6 Denmark 1 1 France 7 7 Germany 3 3 Greece 1 1 Irel.a.nd .. 1 1 Japan 1 1 Netherl.a.nds 1 1 ,New Zealand, 4 4 Philippines 2 3 5 South Africa ... 1 1 Southern Rhodesia 1 1 Swi t zer l.a.nd 2 2 4 Thail.a.nd ... 1 1 Turkey 1 1 Uni ted Kingdom 8 1 9 J.8 Uni ted States of America 3 7 10 Total - - - 23 3 58* 84 *Consultants not included. WP/RC9/2 page 89 ANNEX 4 GEDGRAPHICAL DISTRIBt1rION OF INTERNATIONAL STAFF TERMINATED OR TRANSFERRED Country Regional Office Field Consu1.tants Total Australia 2 2 Belgium 1 1 Canada 2 2 China 1 1 2 France 1 1 India 1 1 Israel 1 1 New Zealand 1 1 Norway l' 1 I Philippines 1 1 2 4 Uni ted Kingdom 2 4 6 united States of America 3 7 10. Total - - .. 2 13 17 32 ANNEX 5 WP/RC9/2 page 91 LIST OF SUPPLFMENTARY AGREEMENTS SIGNED WITH M1!MBER COUNTRIES DURING THE PERIOD 1 JULy 1957 TO 30 JUNE 1958 Country Title of Project WHO Numbt British Solomon Leprosy Control (agreement) BSIP 4 Islands Protectorate Cambodia Malaria Control (addendum covering MESA Cambodia 1 assistance) Maternal and Child Health (addendum) Cambodia 4** Royal School of Medicine (revised. agreement) Cambodia 5 China Maternal and. Child Health (addendum I to planops China 3** for refresher training of private practising Japan New Caledonia North Borneo Fhilippines midwives, and. addendum III to planops for expansion of maternal and. child welfare . services) Malaria Eradication (agreement covering MESA assistance) Trachoma Control (addendum in letter form; addendum II and. amendment) Tuberculosis Control (addendum) Rehabilitation of handicapped. children (a.ddendum II) Institute of Public Health (addendum) SPC/WHO Health Education Training Course (agreement) Malaria Control (addendum II) Maternal and. Child. Health (addendum II) Malaria Eradication (MESA planops) Bilharziasis Control (addendum) Treponematoses Control (addendum V) BCG vaccination (addendum III) Midwifery Training (addendum II) *umCEF supply programme **Joint with UNICEF China 7 China 13** China 17 Japan 1** Japan 10 WPRO 38 North Borneo 5** North Borneo 7* Philippines 53 Philippines 9 Fhilippines 15* Philippines 17* Fhilippin s 29** WP/RC9/2 page 92 Country Singapore Tonga Viet Nam West New Guinea Int"Et.r-regional (covering WPRO and S~ participation) Inter .. regional (covering WPRO and. S~RO participation) Title of Project MCH Services and Training Progranune (addendum II) Environmental Sanitation Training (agreement) Institute of Health (amendment to planops) Nursing Education (revised ~greement) Environmental Sanitation (agreement and addendum I) Maternal and Child. Health (revised agreement) Malaria Control (addendum II) Maternal and Child Health (addendum I) Seminar on Family Life and Mental Health (agreement) Dental Health Seminar (agreement) *UNICEF supply programme **Joint with UNICEF WHO Number Philippines 40* Philippines 51 Singapore 4** Singapore 8 Tonga 1 Viet Nam. 3** West New Guinea 2* West New Guinea 6* WPRO 60 WPRO 63 FELLOWSHIP AWARDS 1 July 1957 to 30 June 1958 According to Fields of Study and. Countries of Origin 1. HEJ.'.LTH ORGANIZf~TION AND SERVICES PUBLIC-HEALTH ADMINISTRATION Public-health administration Diploma course in pubJic health ••••••.•••••••••••••••• Master of Science in hygiene with concentration in preventive medicine ................................. . PUblic-health administration ••••••••••••••••••••••••••• Hospital and. medical care administration Administrative medicine .•••.•••.•.•......•••..•....•• Hospital administration •••••••••••.•••••••••.•••••••• Medical librarianship Medical librarianship ...•••••••••.••••••..•••••.•.•••.. Medical administration Systems of medical specialization •••••••••••••••••••••• . SANITATION Environmental sarli tation Control of public-health hazards (air pollution) ••••••• . ~ eg <r: ~ ~ ~ ~ ~ ~ ~ ~ Il=< ~ ~ 1 2 2 1 1 1 1 1 ~ I I ~ ~ ~ ~~ E 0 C3 ~ ~ tf.l C3 ~~ j ~ ~ ~ ~ ~ 1 1 -- ] Cl ~ ~ g ~ c9 ~ §j :;:::; H ~ ~ tf.l 1 1 1 1 ~ ~ 0\ I I I I ~~ <m~ Q \,Q \,Q \>1-- f') Public-health administration with emphasis on environmental sanitation .•....•.•.•.••••..•.•..•.•••.. Sanitary engineering .................................... NURSING Nursing care and midwifery Maternal and child, health nursing ....................... N1lI"sing educa ti on .••............•......•..•......•...... Observation and. conferences on nursing administration and. educa ti on ...••......•.•..........•........•....... Obstetri cal ntlI'sing .... . ............................. . Paediatric n-u:rsing .•... . .............•.............•.. Public-health nursing Publi c-heal th n'Ur' sing .........•.•.......•......•.......•. MATERNAL AND CHILD HEALTH Organization of maternal and child health services Diploma course in public health with specialization in maternal and. child. health ••.•••••••••••••••••••••••• OTHER HEALTH SERVICES Mental health Child mental health (diagnostic and, guidance techniques with particular reference to various methods of te sting children) .............. ' ....... · .............. . ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ @ 1 1 1 1 ~ ~ ~ ~ ~ 2 cg ~ ~ 0 ~ AS rn cg ~ ~ ~ p:; .i=§. ~ ~ ~ 1 1 1 1 ~ ~ ~~ fX1 ~ g Il-t ~ g ~8 ~ H rn 1 1 ~ 8 ~ ~ fxi ~ ~ ~ 2 1 'S~ ~~ ",,-2 ~-I\) .. ~.' ~. ., ~,. t .i'l , . Child, psychiatry ........................................ . Clinical psychology ....................................•. Drug addiction and. preventive psychiatry ..••.•......•••. Mental health (Organization and. administration of mental health clinics and practice in these clinics) •••••••••• Mental health (Orientation and training in the adminis- tration of a psychiatric hospital, organization, treat- ment and. rehabilitation of psychiatric cases) •.•••.•••• Health education Diploma course in public health with major in health education (CPII, MPIf) •.•••••.••.•••••••••..••••••••.•••• Diploma in content and methods of health education ••••••• Health educa ti on ........................................ . Maternal and. child. health with special emphasis on health educati on ...................................... . Dental health Dental health Rehabilitation ............................................ General rehabilitation of crippled children •••••••••••••• Rehabilitation of handicapped children ••••••••••••.•••••• Drug control Narcotic drugs control •..••.•.•.•...•••••..•••••.•..•.•.. Standardization of biologiC products and antibiotics ••••• 2. COMMUNICABLE DISE".SE SERVICES COMMUNICABLE DISEA.SES AND LABORATORY Malaria Ma.laria eradication .................. p •••••••••••••••••• Malaria inspectors' course and special training in entomology- ............................................ . *HQ funds ~ ~ gs <X; " I ~ ~ ~ z ~ ~ ~ ~ ~ @ ;:§ ~ 1 1 1 1 2 1 1 2 1 1 1 1* ~ - -~- - ---- .( - ' "- ~ ~ ~ ~ § ~ ~ ~ ~ ~ ~ N ~ t:r.l 0 ~ ~ ~ ~ ~ 1 1 1 1 1 1 . , ~ ~ ~ li! 2 p.. tj ~ &1 ~ Z t:t ~ 4 1 1 ~ g ~ 8 ~ 1 I , I I , , , I ;''''' 1S ~ <al~ o \0 \0 \J1 ........... f\) " II • Venereal Diseases and. Treponematoses Venereal-disease control and. general public health •••••• Venereal-disease control (activities of health centres ~th special reference to venereal-disease control work) Tuberculosis BCG production and. standardization ••••.•••.•.••.••.•..•• Diploma course in public health ~th specialization in tuberculosis control ........................................................... .. Thoraci c sm gery .............................................................................. .. Tuberculosis control ....................................................................... .. Other communicable diseases Epidemic diseases control •••••••• • ••••••••• leprosy control ...................... .. .. .. .. .. .. . .. .. ................ .. Laboratory Clini cal ,pa. tholog;{ .................... ,. .................................................... .. Diploma course in public health ~th specialization in In.edical entomology ...................................................................... . Laboratory techniques (studies on poliomyelitis and. other related. viruses) ................................................................ .. Laboratory techniques ~th emphasis on venereal-disease serology .......................................................................................... .. Public-health entomology .............................................................. .. Virology (poliomyelitis and. other related. viruses) •••.••• 3. MEDICAL EDUCATION, CLINICAL AND BASIC MEDICAL SCIENCES CLINICAL MEDICINE Surgery and medicine Modern trends and. advances in traumatic surgery ...... ·.· Undergraduate medical assistants' studies ••••••••••••••• ~ ~ ~ ~ H ~ ~ ~ 1 3 1 1 1 1 1 1 1 1 a I ~ ~ ~ t3 ~ ~ 0 g r.t:l C3 p::j 0 ~ ~ g ~ ~ j ~ 1 1 1 1 1 1 3 ~ ! ~ ~ ~ ~~ ~ ~ ~8 ~ ~ 1 rx:J ~ ~ ~ ~ ~ !;! ~ 8 ~ 8 ~ 'S~ Otl ........... ([)!:tJ o \.0 \.0 C'. ........... I\) ~ g: if en H * P. 0 ~ CD ....,. ~ ()) ~ () ~ g I-' P' c+ I-'C+ I-' 'l% 0 "",,11 I-' CD Q CD ~ ~ 0 p..\j p. CA p.. ~ t-< \j '< p..tIl () ct- ....,. D en CIl ....,. c+ 0 § () \j ....,- H ....,. 0 ~ p.. 'd S \j I-'Q 0 () ....,- p.. t:r.1 0 t:1 ....,. en \j CD () c+ UI ()) ~ >i I-' 8 0 0 I-' t-t;,CD a §' g 0 H:> CD () P.>P' §; 0' ....,. c+ r--() ....,. 1-3 0 ....,. 0 H 0 g \j 0 p.. P' ~ rr · \j ~ · p. ~ · c+ UI · CD · r" · () · ::s- · ....,- · \j 1-3 .(JQ 0 · ....,. c+ · \j (ll r-- · c+ · g · f\) AUSTRALIA f\) CHINA 0 r-- I-' FIJI \>I HONG KONG I-' JAPAN Vi r-- I-' KOREA. f\) r-- \>I LAOS I-' ~CAO I-' NEW CALEOONIA f\) NEW ZEALAND I-' NORTH BORNEO I f\) IGM~AND ID.'W ::, PHILIPPINES I-' SINGAPORE .j::'" VIEr NAM f\) WEST NEW GUINEA WP/RC9/2 page 99 ANNEX 7 DISTRIBUTION OF VISITS IN ACCORDANCE WITH COUNTRY OF STUDY AND REGIONS Number of Visits from Country of Study AFR AMR EMR EUR SEAR WPR Total Australia 1 3 11 15(15*) Cambodia 1 1 China 1 9 10 Federation of Malaya ,3 3 Hong Kong 1 3" 4 Japan 3 1 2 2 12 20(5*) Korea 1 1 2 Laos 1 1 New Caledonia 1 1 New Zealand 1 2 4** 7(7*) North Borneo .. 1 1 Philippines 2 2 2 4 12 22(4*) Singapore 3 8 11(7*) Viet Nam 1 1 2 Total number of visits - 6 9 6 14 65 100(38*) *The figure given in parenthesis represents the number of visits of more than three months' duration. **Exc1uding two China. Medical Board. fellows. (These include only visits which were begun during the period and. exclude those which, although continuing in the present period., were begun during the previous year. One fellow may visit more than one country in the course of a fellowship and. the tabulation merely indicates the number of fellows a country has received during the period.) PLANNING ~ ~ .. ~-.. --... --.. -.. -.. - ~ .. -; PROPOSALS FRCM OOVERNi"lENT S FOR INDIVIDUAL OR PROJECT FEL:uMSHIPS .~ .. ---. PLANNING INDIVIDUAL FELLOWSHIPS - -->-- -- YEAR APPROVING YEAR OPERATING YEAR • ~ ~ 1>-1. • II--! S g ~ MINOR ~ ~ < '" ....... --... ........... ~. 1--.. ._ .. ) ~ .. -.......... -.. It-·· .. _··_ ... ·•· .. ···_······· .. •··• .. •· .. _ ........... ADJUSTMENTS HEADQUAR'IERs NOTIFY OF REGIONS JF STUDY PLANS • WHO I a Io· .. ~ • ............ _ ........... ..... :xl PROCEEDS TO PLACE 0 FEIJ..{ltlS I GOVERNMENT S E-I SUBMIT z AS roON AS roSSIBLE 0 APPLICATIONS H AND I ~ E-I cr.: INFORM ~ (,) REGION OF ORIGIN H ~ H WHO I ft < (,) E-I PROCEEDS TO ARRANGE H ~ AWARDS AND TRAVEL ~ f;2 H I ~ c ~ ~ r:r:l (f) < (,) ~ H :xl ~ H ~ f:> E-I ~ ~ ...:l ~ ~ ~ ~ ~ (,) ::s: * * * ---- i CP 'S~ 'li~ b~ 1-'1\)