. -~:- THE WORK OF WHO IN THE WESTERN PACIFIC REGION TWEIFTH ANNUAL REPORT OF THE REGIONAL DIRECTOR TO THE REGIONAL COMMITTEE FOR THE WESTERN PACIFIC Covering the Period, 1 July 1961 - 30 June 1962 World Health Organization Regional Office for the Western Pacific Manila, Philippines July, 1962 WP/RC13/2 The following abbreviations are used in this Report: AID ECAFE FAO IAEA ILO MESA SPC TAB UNICEF UNESCO United states Agency for International Development Economic Commission for Asia and the Far East Food and Agriculture Organization of the United Nations International Atomic Energy Agency International Labour Organisation Malaria Eradication Special Account South Pacific Commission Technical Assistance Board United Nations Children's Fund United Nations Educational, Scientific and Cultural Organization United Nations Korean Reconstruction Agency - ii - CONTENTS INTRODUCTION ................................................................... 1 2 3 4 5 PART I. GENERAL THE REGIONAL COMMI'lTEE ................................................................. REGIONAL OFFICE ......................................................................................... 2.1 2.2 2.3 2.4 General ..................................................................................... ......................................................... Organizational structure Regional office staff ...................................................................... Field staff ......................................................................................... AGREEMENTS WITH GOVERNMENTS ........................................................................ CO-ORDINATION OF WOm( WITH OTHER ORGANIZATIONS .••••..••.•••••••• 4.1 4.2 The United Nations and the Specialized Agencies •••••••••. With other inter-governmental organizations •••••••••••••• 4.2.1 4.2.2 South Pacific Commission •••••••••••••••••••••••• other joint werle. ............................................................. .. P'UBLIC Il\IF'O~TION ........................................................................................... .. PARr II. GENERAL STATEMENT OF ACTIVITIES IN THE REGION 1 PUBLIC HEALTH SERVICES 2 3 1.1 1.2 1.3 1.4 Public Health Administration, Health Laboratory Services and Organization of Medical Care •••••••••••••• Iie~ th Education ............... , .......................... . J.1aternal and Child Health ............................... . Nursing ................................................. . HEALTH PROTECTION AND PROMOTION ................................. 2.1 2.2 2.3 2.4 2·5 Dental Health M;ntal Health ............................................ ............................................ Nutrition ............................................... . Social and Occupational Health ••••••••••••••••.•••••••••• Radiation Health, Radiation Medicine and HtllD.aIl Genetics ........................................ . ENVIRON}JIE!NTAL llEALTH •••••••••••••••••••••••.•••••••.••••••••••.. iii vii 3 4 4 4 5 5 5 6 7 7 8 9 13 16 18 20 22 22 22 23 25 26 4 CONTENTS EDUCATION AND TRAINING ••••••••••••••••• It •••••••••••••••••••••••• 4.1 4.2 4.3 Assistance to Educational Institutions •.••••• Fellowships ................................ Educational Meetings and Courses ••••••••••. 5 ~IA ••• " ••••••••••••••••••••••••••••••••••••••••••••••••••••• 6 7 COMMUNICABLE DISEASES ••••••••••••••••••••••••••••••• It ••••••••••• 6.1 6.2 6.3 6.4 Cholera, Diphtheria, Pertussis and Tetanus ............. Tuberculosis ............................................. Venereal Diseases and Treponematoses · ................... . Venereal Diseases ..................... Yaws .................................. Virus Diseases •••••••••••••••••••••••• It .................. . 6.4.1 6.4.2 6.4.3 6.4.4 ......................................... General Poliomyelitis ................................... Smallpox ..........• Trachoma ••••••••••• · ................... . · ................... . Parasitic Diseases - Bilharziasis .................... leprosy .................................................. . HEALTH STATISTICS ............................................... 8 PROGRAMME ANALYSIS AND EVALUATION .•••••••••••..•••••.•.•.••••••• 9 SINGAPORE EPIDEMIOLOGICAL INTELLIGENCE STATION •••••.••.•..•••••. PART III. SPECIAL SUMMARIES OF COMPIETED PROJECTS ~ 27 27 30 31 32 36 36 37 41 41 42 43 43 44 45 45 46 47 48 50 52 Projects completed during the period under review.................... 53 PART IV. PROJECTS IN OPERATION Projects in operation from 1 July 1961 to 30 June 1962 ............... iv 4 CONTENTS ANNEXES 1 LIST OF REGIONAL OFFICE POSTS ••••••••••••••••••••••••••••••••••• 91 2 PROJECT AND REGIONAL OFFICE INTERNATIONAL STAFF El-fI?WY'ED l\S OF 30 JUI\IE 1962 ........................................ 95 3 CONSULTANTS EMPLOYED DURING THE YEAR 4 1 JULy 1961 - 30 JUNE 1962 •••••••••••••••••••••••••••••••••••••• 97 LIST OF SUPPLEMENTARY AGREEMENTS SIGNED WITH MEMBER COUNTRIES DURING THE PERIOD 1 JULY 1961 TO 30 J1JNE 1962 ............................................... 99 5 TOTAL NUMBER OF AvlARDS (REGULAR AND SPECIAL FELLOWSHIPS) FOR THE YEAR 1961 - 1962 ••••••••••••••••••••••••••• 105 6 FELLOWSHIP AWARDS ACCORDING TO FIELDS OF STUDY AND COUNTRIES OF ORIGIN - 1 JULY 1961 TO 30 JUNE 1962 .................................................................. 107 7 DISTRIBUTION OF VISITS IN ACCORDANCE WITH COUNTRY OF STtJDY AND REGIONS .......................................................... 109 - v - INTRODUCTION In accordance with the guidelines laid down in the second and third general programmes of' work covering a specif'ic period, attention has again been centred on the strengthening of' national health services. Ef'f'orts to stimulate and to support national health planning have continued and in spite of' the past year having been a most dif'f'icult one f'or a number of' governments, WHO-assisted projects have in general made considerable progress along the lines f'oreseen, and in some cases, have exceedei expectations. Government understanding and support have grown and there has been better use made of' WHO experts, both qualitatively and quantitatively, although in a f'ew instances governments have not been f'ully prepared to receive the short-term consultants whom they have requested. National personnel have been increasingly involved in international co-operation and co-ordination. Direct assistance to the central services in a number of' countries is bearing f'ruit in some key f'ields and is demonstrating the need f'or attention in others. For example, the progress in central maternal and child health services has led to increased interest in the planning, co-ordination and training problems of' local health services. The need f'or long-term planning of' health programmes and health services is increasingly recognized and there appears to be a growing awareness of' the intricate relationship between the development of' a sound national economy and that of' adequate health services. The preparation of' ten-year public health plans, co-ordinated with related plans in the social and economic f'ields, is among the proposals made by the Executive Board in connection with the participation of' governments in the United Nations Development Decade. The basis of' national public health plans is an overall country survey to determine the priorities f'or action and the most economic and ef'f'icient ways f'or accomplishing them. Experienced public health administrators have been assigned to a number of' countries in the Region to help develop such plans through surveys and the collection of' the essential data on which to establish ~riorities. This has been done in Malaya, where a short-term consultant carried out such a survey and where a public health administrator is now assisting the Government to implement some of' the consultant's recommendations. A similar survey, with joint assistance of' AID and WHO, is being carried out in Korea, and public health administrators are assisting the Governments of' Cambodia and Laos to collect essential data with a view to drafting long-range and comprehensive plans. In all the cases mentioned the health plans are being co-ordinated with related plans in the social and economic f'ields. In the f'ield, slow and patient work over a number of' years is maldng possible the extension of' programmes of' a deeper and more precise nature. A number of' projects entered 1962 with their f'uture activities clearly def'ined f'or some years to come and with good possibilities of' achieving their targets, general political developments permitting. It is now fully understood that integration of specialized programmes into the general public health activities is essential if the health programme is to be maintained and expanded. * * * The continuing growth of' population, the constantly increasing proportion of people above sixty years of age in many countries, and the - vii - relative rise in the number of chronic and disabled patients as a result of modern treatment of acute diseases have resulted in an increasing demand for hospital services. This is to be observed in many parts of the world including a number of countries in the Western Pacific Region. There is a pressing need for reorganization and reorientation of existing hospital services and for technical guidance in the planning and establishment of new services. This is reflected clearly in the growing interest in activities in this sphere. Projects covering hospital administration and architecture, assessment of hospital services, hospital records and other services, as for example laboratory sel~ices, have been in operation during the period under review. A national seminar on hospital administration is being planned by the Philippine Government with WHO assistance. * * * In a number of countries the development of maternal and child health services as an integral component of health services has received new impetus with their expansion to the rural areas. As a nucleus of crystallization for other health services, their role cannot be underestimated. The constructive co-operation of governments and the valuable assistance of UNICEF have contributed remarkably to the further development of the maternal and child health projects in this Region. * * * Considerable attention has been devoted in the past year to the strengthening of nursing services, of nursing administration and to the education and training of professional and auxiliary personnel. Activities in this field have met a full response despite the many difficulties to overcome, as for example, lack of basic education and sometimes suitable training institutions. * * * The objectives of health education have been pursued during the past year in at least three distinct aspects. The importance of health education in the context of specific projects such as malaria eradication, tuberculosis control, control and prevention of cholera El Tor, immunization programmes, etc., continues to be felt on all fronts. With an increasing number of trained personnel, governments have been giving more and better support to health education efforts associated with individual specialized projects. The health education project ,in Malaya embraces, in addition, the objective of organizing a planning and directing unit at the central and state levels and is consequently concerned with the qualification and training of health education workers for service at all levels. The six-week project in Japan had as its objective the assessment of an already established health education service and, as in Malaya, particular emphasis was laid on the problem of the training and qualification of health education worlrers. * * * This has also been a profitable year in the mental health field. Three consultants have been involved in two different aspects of mental health activities. The consultant who visited China (Taiwan) was involved in research problems related to child development and personality changes in a changing culture. Two other consultants, one in Malaya and the other - viii - WATER SUPPLIES - A WHO sanitary engineer is engaged in work to tap ground water sources for villages in Netherlands New Guinea and to train local personnel for sanitation work. l '.-.k~ ... ~.' •. _.~J q. '. '-j';c ~ M " ••••• "'q •... 1 WATER SUPPLIES - Near the WHO-assisted rural water supply project a modern water filtration system for the town of Biak has recently been built. in Viet Nam, were concerned with the problem of providing mental health services, particularly in mental hospitals. Both have recommended a community approach to reach larger segments of the population and one in which the local health unit is involved, as well as the more specialized units at district and higher levels. Mental hospitals are a part of the network, and rehabilitation, rather than prolonged custody, should be the aim. While the personnel requirements for this community approach present a formidable problem to the governments concerned, they are basically another facet of the total health problem from which they cannot be divorced and for which planning cannot be long delayed. * * * From among the many environmental health activities, only a few are reflected in the regional programme of the year under review. Among these the problem of provision of adequate and safe water supplies for our populations has been approached at various stages and from various angles. Training of health inspectors, courses in sanitary engineering, rural environmental sanitation and last, but not least, the development of country- wide environmental health programmes have been in general the main activities in the regional programme. Mbre attention has been focussed on this field as a result of the recent outbreaks of cholera EI Tor and it is hoped that the future will see more intensive efforts to solve the many problems connected with poor sanitation. * * * As the efficiency of national health services depends, to a great extent, on the quality and quantity of trained personnel, emphasis has continued to be placed on activities in the field of medical education and the training of professional and auxiliary medical staff. A marked trend towards the improvement of teaching and the upgrading of medical education standards is observed throughout the Region. Although the acute shortage of qualified staff still remains a problem, a number of countries have taken steps to remedy this situation by expanding their present facilities or establishing new medical schOOls. Of particular note is the growing realization that training done in the country of origin, or in countries with a similar environment and similar problems, is the most realistic way of approaching the present short~ of staff. As a result of the extensive fellowship programme it is now considered in some areas that there are sufficient highly trained specialized technical staff and there is therefore a lesser need for WHO long-term advisers. Short- term consultants in specialized fields may be required but it is felt that the training of suitable local staff should overcome the need for long-term advisers. * * * During 1961, several WHO-assisted malaria projects were redefined to bring them in line with the eradication policy adopted by the World Health Assembly. A number of pre-eradication programmes were started with the purpose of building up the necessary operational facilities before embarking on eradication. One malaria eradication pilot project was started with the purpose of finding out if conventional methods can interrupt malaria transmission under local conditions. Two new malaria eradication programmes were launched with the necessary operational facilities and a detailed plan to eradicate malaria within an established time limit. Attention was also - ix - given to improving epidemiological evaluation in all malaria projects. Of particular interest is the concept that the general public health services should give the necessary support to antimalaria operations. This gradual but essential process starts in the early stages of malaria projects and finally reaches the pOint where, after eradication of malaria, the specialized malaria service ends and the general public health service takes over the entire re~onsibility of preventing the re-introduction of the disease. Considerable progress has been made in the acceptance by governments of the public health approach to the problem of tuberculosis control. The work of the regional tuberculosis advisory team. has resulted in significant advances in the tuberculosis control programmes of the countries visited. The experience gained in the pilot project areas will be used as a basis for the development of national programmes aimed at the elimination of tuberculosis as a public health problem. Programmes against the other communicable diseases - venereal diseases and treponematoses, leprosy, trachoma and bilharziasis - made further progress. The appearance of cholera El Tor, however, in areas which had been free from this disease for decades, points to the urgent need for health administrations to review their machinery for dealing with a large-scale outbreak of epidemic disease. * * * In developing countries, priorities will, for some time to come, continue to be the maintenance and establishment of essential services, including planning in the fields of public health administration, communicable disease control and emphasis on training of all categories of personnel. In the developed countries, the problems of acute communicable disease control are no longer pressing and attention is being directed to programmes of medical rehabilitation, the chronic degenerative diseases, cancer control, cardio- vascular diseases, geriatrics, the protection of the community against ionization radiation hazards. These trends will undoubtedly be reflected in requests for future assistance. * * * A pleasant event to record in the period under review was the achievement of independence by We stern Samoa and the fact that this country is now a. member of WHO. This brings the total number of M;mbers in the Western Pacific Region to sixteen. - x - 1. THE REGIONAL COMMITTEE WP/RC13/2 page 3 The twelfth session of the Regional Committee for the Western Pacific was held in Wellington, New Zealand, from 31 August to 5 September 1961. The meeting was attended by representatives of all Members in the Region, • -. except Laos, and of the Member States responsible for territories in the Region, except Portugal. Representatives of the United Nations, UNICEF, the South Pacific Commission and fifteen non-governmental organizations in official relations with WHO were also present. Dr. P.M. Kaul, Assistant Director- General, attended the meeting as representative of the Director-General. The Committee examined in detail the eleventh annual report of the Regional Director, which, besides covering the work from 1 July 1960 to 30 June 1961, summarized the main health developments in the Region during its first ten years. In its discussion of the report, the Committee reiterated the importance of a flexible approach to programme planning, because of the great differences in the social and economic development of the countries in the Region. Particular attention was given to the development of rural public health services as part of a comprehensive health programme. The programme and budget proposals for the Western Pacific Region in 1963 were discussed by the Sub-Committee on Programme and Budget and approved in plenary session for transmission to the Director-General. The attention of all governments operating or planning malaria eradication programmes was drawn to the importance of critical evaluation at all stages of the programmes, to the need for a well organized and well staffed malaria service and for full and continuing support from the government and the people until eradication is achieved. The Committee reviewed the position of contributions to the Malaria Eradication Special Account and the proposal for the issue of malaria eradication postage stamps, and recommended that all Member States should participate in the scheme. In accordance with the request of the Fourteenth World Health Assembly, the Committee considered the question of programme priorities and reviewed the priorities established at its ninth session in relation to the proposed programme and budget. It decided that no change was required in the present flexible procedure in the Region. The Committee was given a report of the work being done on trachoma in Taiwan by the United States Naval Medical Research Unit No.2. The subject of the technical discussions was "Dental Health". The Committee selected "The Role of Health Services in the Improvement of Community Water Supplies" as the topic for the technical discussions in 1962. . WP/RC13/2 page 4 The Committee confirmed its decision to hold its fourteenth session in Port MOresby, Papua, and accepted the invitation of the Government of Korea to hold its sixteenth session in Seoul in 1965. The thirteenth session will be held in Manila. 2. REGIONAL OFFICE 2.1 General During the year under review the Regional Office continued to improve its accommodation. The provision of better and newer types of office equipment together with the functional construction of the office building itself have increased the administrative efficiency required of the office. In line with the United Nations' decision, the salaries and allowances of internationally recruited staff have been revised effective 1 January 1962. A revised ruling on authorized travel was also enforced which requires all WHO staff, w.i.th the exception of especially graded personnel, to travel by economy class. Efforts have been exerted in line with Headquarters f current world campaign against malaria to invite Member governments to participate in the plan for the issue of postage stamps to commemorate the malaria eradication programme. Among the Members of the Organization who will issue postage stamps are: Cambodia, China (Taiwan), Guam, Korea, Laos, Macao, Malaya, Philippines, Ryukyu Islands, Territory of Papua and New Guinea, Trust Territory of the Pacific Islands, and Viet Nam. Among the countries which are unable to issue the commemorative stamps but have decided to participate in the project by issuing a special cancellation postmark slogan are: British Solomon Islands Protectorate, French Polynesia, New Zealand and Singapore. 2.2 Organizational structure There has been no change in the organizational structure of the Regional Office. An additional WHO representativel was appointed for Cambodia, bringing the number of such representatives to five. This did not involve any change in the organizational structure of the WHO field staff in Cambodia, as the staff member thus designated is also serving as public health adviser of the country concerned. The WHO Representative in Saigon is now therefore only responsible for Viet Nam and Laos. In view of the considerable assistance being given to Laos, it was also decided to appoint a country liaison officer who is responsible to the Regional Director, through the WHO Representative in Saigon. This staff member is also serving as public health adviser to the Government. lFormer designation "Area Representative ". .. t. .,-- 2.3 Regional office staff WP/RC13/2 page 5 There has been no change in the number of posts in the Regional Office. However, the Regional Adviser in Maternal and Child Health was transferred and the Regional Adviser in Nutrition resigned. These two posts have been filled by new staff members. The Regional Adviser in Environmental Sanitation has been transferred to Headquarters and the post is expected to be filled in due course. 2.4 Field staff The recruitment of persons with the necessary technical and language qualifications is becoming increasingly important and it has, therefore, been necessary to find a new approach to this matter. Training programmes to give special additional qualifications to persons with the requisite general baclrground and experience have been organized in the last three years in connection with the malaria programme. Plans are now under consideration whereby the Organization may award training fellowships to persons with the basic qualifications, and other qualities suitable for international health lfOrk, but who require further training to fit them for the responsibilities of a specific post. After a period of in-service training, these trainees would be able to undertru~ responsibilities in specific projects. In this way it may be possible to meet the dearth of qualified personnel by using sources so far untapped. This is a continuing process which may have to be extended to different fields of activity in the course of time. Annexes 1-3 give detailed information on the staffing pattern in the Region. 3. AGREEMENTS WITH GOVERNMENTS Seventy supplementary agreements (or exchange of letter) relating to plans of operation were signed during the period under review. Twenty-six 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 4. A number of problems have arisen in connection with the signature of addendum covering the extension of the services of WHO staff members already in the field, or of a plan of operation covering the assignment of new field teams. The legal basis for WHO assistance is a valid plan of operation or an exchange of letter signed both by the Government and the Organization. During the past year there have been several instances of delay in the signature of such agreements and this matter is being brought to the attention of the Regional Committee in the hope that all outstanding agreements will be finalized expeditiously. If the legal requirements for WHO assistance are not met, then candidates selected for vacant or new posts may have to be re-assigned elsewhere, with resultant delay in the implementation of new projects and a slOwing down of process in continuing ones. WP/RC13/2 page 6 4. CO-ORDINATION OF WORK WITH orRER ORGANIZATIONS The increasing co-operation with other agsncies during the period under review will be mentioned in various parts of this Report; however, the main points are summarized here: 4.1 The United Nations and the Specialized Agencies Co-operation on matters of joint interest was maintained with the United Nations .and the Specialized AgenCies. Representatives from the Regional Office attended the following meetings and, where necessary, presented statements on behalf of the Organization: (a) ECAFE: Second Study Week in Traffic Engineering and Highway Safety, held in Manila, 28 August to 5 September 1961; (b) ECAFE: sixteenth session of the Committee for Co-ordination of Investigation of the Lo~r Mekong Basin, held in Phnom-Penh, Cambodia, 3 to 8 January 1962; (c) ECAFE: eighteenth session, held in Tol\yo, Japan, 6 to 19 March 1962; (d) UNESCO~ South-East Asian Regional Conference on Adult Education, held in Saigon, Viet Nam, 16 to 24 April 1962; (e) United Nations: Human Rights Seminar on the Status of Women in Family Law, held in Tokyo, Japan, 8 to 21 May 1962; (f) UNESCO: Meeting of Experts in Teacher Training for Asian Countries, held in Manila, 14 to 25 May 1962. WHO continued to collaborate with UNICEF in health programmes covering the following fields: communicable diseases, maternal and child health, nursing, rural health, environmental sanitation and, more recently, social services. UNICEF assistance to health projects in the Western Pacific Region has expanded considerably over past years. In 1961 an estimated ~880 000 ~re allocated for supplies and equipment; this rose to over one million dollars in 1962 and programmes under consideration for 1963 reach a total of approximately two and a half million dollars. As in past years, WHO representatives have, whenever possible, accompanied UNICEF representatives during country visits connected with WHO/UNICEF assistance. It has also become the practice of the UNICEF offices in Manila, Saigon and Taipei to discuss with the WHO staff all programme proposals and all draft addenda to agreements. This close co-operation in drafting and planni'ng greatly facilitates WHO technical approval of new assistance. The WHO Representative's office in Singapore has continued to assist the UNICEF Asia Regional Office in connection with the purchase of supplies and their shipment to various UNICEF-assisted projects. The staff of the UNICEF/TAB office in Sydney has again~rovided administrative assistance in connection with the WHO fellowship programme. - ... WP/RC13/2 page 7 The Regional Offices for the Western Pacific and South-East Asia have continued to work closely with the United Nations Committee on Co-ordination of Investigations of the Lower Mekong Basin. Arrangements have been made with ECAFE for WHO to be represented at all meetings of this committee. Part III contains further details of the bilharziasis surveys which were carried out in connection with this project. The WHO Representative in Sydney, who was elected to the General Committee established in connection with the FAO/UNICEF Freedom from Hunger Campaign, has assisted in this campaign so far as his other duties have allowed. The FAO and UNICEF representatives participated in the joint health exhibit held in Sydney in October. There are also close working relationships with FAO in connection with nutrition programmes and as these develop this co-operation will expand. The FAO agricultural engineering expert assigned to the WHO-assisted bilharziasis project in the Philippines completed his assignment and submitted a report on his findings to the Government and WHO. The Seminar on Child Health and the School which was held in Manila, 27 November to 8 December 1961, was organized in co-operation with UNESCO, ,"hich provided the services of a consultant and a secretariat staff member. The WHO Representative and field staff in Cambodia and Viet Nam have continued to give technical assistance in the health field to the UNESCO Fundamental Education Training Centres. WHO has continued its activities in connection with the United Nations joint rural development project in Laos, in which ILO, FAO and UNESCO are also participating. The Director and the staff of the United Nations Information Centre in Sydney have co-operated closely with the WHO Representative and have given their help whenever it was aslred. They have also arranged radio and television broadcasts and press conferences for WHO visitors and have assisted with the public relations aspect of World Health Day, National Health Week, etc. The Regional Office has maintained its close collaboration with the Resident Technical Assistance Representatives whom it has kept informed of all developments with regard to existing and planned programmes financed under the Expanded Programme of Technical Assistance. 4.2 With other inter-governmental organizations 4.2.1 South Pacific Commission The cordial relationships between the South Pacific Commission and the Organization have continued. The Commission seconded two staff members to "~ assist in the Refresher Course on Integrated Rural Health for Assistant Medical Officers in the South Pacific which was held in Apia, Western Samoa, 2 November to 15 December 1961. The Acting Executive Officer for Health acted as Course Director and was responsible for the drafting of the course report. The second joint undertaking between the Commission and the Organization during the period under review, is in connection with the study of maternal and child health programmes in certain territories in the South Pacific area. WHO is providing the services of an advisory team, composed WP/RC13/2 page 8 of a medical officer and a public health nurse, while the Commission will provide office space, administrative and secretarial assistance to the team during its visits to Noumea. The Commission has appointed a second health education officer and has greatly expanded health education projects in the South Pacific area. Assistance in this field has been provided to the WHO-assisted malaria eradication pilot project in the British Solomon Islands Protectorate. 4.2.2 Other jOint work Relations with the South Pacific Health Service (SPHS) have been excellent. Frequent consultations have taken place between the Inspector- General and the WHO Representative in Sydney and many administrative matters connected with the territories in the South Pacific area have been expedited as a result of the assistance received from the SPHS. A number of projects in the Region have continued to benefit from the assistance given by the Asia Foundation, China Medical Board, Colombo Plan, French EconOmic Aid and the Rockefeller Foundation. The China Medical Board has, in particular, supported medical education to a very considerable degree and many discussions have taken place during the periodic visits of its representatives to different countries in the Region. These discussions have been of mutual benefit and assistance, especially in the planning of fellowship programmes. Collaboration with AID continued and every opportunity has been taken to discuss future programmes with this agency1s representatives during the field visits of WHO staff. The present trend is that AID assistance to health activities is being given on a rapidly diminishing scale and governments must, therefore, look realistically to a future where they will have to assume additional financial responsibilities in connection with their health programmes. In Seoul, Korea, relationships have been established with the Scandinavian Mission, which will co-operate with WHO in the utilization of residual UNKRA funds in health projects. This includes the establishment of a radio- therapeutic centre in Seoul. Relationships with the United States Naval Medical Research Unit No. 2 (NAMRU-2) have been strengthened and I should lil~e to mention in particular the technical assistance provided by this unit during the cholera El Tor outbreak last year. Representatives from fifteen non-governmental organizations in official relations with WHO attended the last session of the Regional Committee. Worthy of inclusion in this Report is the fact that the nursing association members of two Member governments were accepted into membership with the International Council of Nurses during the Twelfth Quadrennial Congress held in Australia in 1961. This makes a total of eight associations in the Region to have achieved internationally recognized standards. Although in many countries there are no national committees for meetings of the various agenCies providing assistance in the health field, there is , 1 .. WP/RC13/2 page 9 a considerable amount of inter-agency contact and co-operation. It is, however, believed that health programmes wuld proceed faster,. and the benefit of international and b.ilateral assistance would be even greater, if the governments receiving such assistance were to establish co-ordination committees, which would meet regularly under the chairmanship ofa representative of the health ministry. Such meetings would provide an opportunity for the representatives of all agencies worIting in the field of health to discuss and formulate with government authorities an overall programme. 5. PUBLIC INFORMATION The increasing use of radio in informing the public of the work of the Organization and health affairs in general is indicated by the time given by broadcasting services to the theme of World Health Day 1962, 'Preserve sight, prevent blindness ". One station, the "Far East Broadcasting Corporation II in Manila, broadcasting in six languages to Asia and parts of Africa, devoted twenty-two hours to World Health Day programmes. Other broadcasting services co-operating were: Australian Broadcasting Commission, Sydney Nine local broadcasting stations in Australia Australian Broadcasting Commission, OVerseas Service, Melbourne New Zealand Broadcasting Service Radiodiffusion Nationale Lao, Vientiane Radio Hong Kong Radio Singapore Sarawak Broadcasting Service Radio MUaya, Kuala Lumpur Radiodiffusion Nationale Khmere British Embassy, Phnom-Penh United Nations Information Centre (ECAFE), BangkoIc, for distribution in area concerned Solomon Islands Broadcasting Service Philippine Broadcasting Service (DZFM), Manila Cebu Radio Station ABS, CBN, MBS The press-coverage of the World Health Day theme was equally satisfactory. In Australia and Hong Kong, for example, practically all daily newspapers carried articles based on WHO releases. The press also paid a good deal of interest to the WHO Malaria Eradication Postage stamp project. The role of WHO in international disease control was widely publicized in connection with the cholera El Tor epidemic. The importance of personal and environmental hygiene in preventing the spread of the epidemic was emphasized in press releases issued by the Regional Office. A number of pictorial exhibits were prepared by the Regional Office and displayed during national health weeks, seminars, conferences and fairs in Australia, New Zealand, Japan, Singapore, Malaya and the Philippines. WHO films were constantly requested by television-stations, schools and civic WP/RC13/2 page 10 organizations. Groups of teachers, students, journalists, etc., on an average of 200 :persons per month, visited the regional headquarters in Ivani1a and attended talks and film-shows. ... PART II GENERAL STATEMENT OF ACTIVITIES IN THE REGION .. ~. .. 1. PUBLIC HEALTH SERVICES 1.1 Public Health Administration, Health Laboratory Services and Organization of M;!dical Care WP/RC13/2 page 13 Activities during the period under review and requests received from governments point to sustained interest in the strengthening and expansion of health administrations at all levels. This trend was not only noted in country activities but in inter-country projects as well. For example, a seminar on rural health services is planned for 1952; seminars on health surveys and reporting and on the role of the hospital in the public health programme will be organized in 1963, a seminar on national health planning is proposed for 1964. Significant features of country projects in this field have been the involvement of other agencies on the national as well as the international and bilateral levels, and the integration of health planning in long-range national economic-social programmes. Projects receiving WHO assistance have shown progress during the period although the rate has varied according to the individual country situation. Among the influencing factors were lack of trained national personnel, adverse internal conditions, lack of policies required for further action, inadequate funds, the need to conduct further surveys, and delays in international staff recruitreent. A review of internationally assisted activities in this field reveals the following: In Cambodia, the public health adviser continued to assist the national health administration in assessing current activities and formulating plans of action for health projects, particularly those receiving WHO assistance. A study was made of the organizational and staffing needs of the health services at provincial and lower levels, including the supervision of rural health and maternity centres. Arrangements were made to provide the Institute of Biology ,.,ith a WHO consultant to ensure continuity of its technical role as a diagnostic and referral laboratory centre for the peripheral health and medical units. The rural health and demonstration centre in Taldunau continued operations although full implementation of its aims to provide a model local health service and an area for training health personnel was affected by delays in reaching agreement on a modified plan of operation. Earlier in the year, the post of public health adviser was replaced by that of WHO representative. The holder of the post will, however, continue to carry cut his technical responsibilities aa public health adviser to the Government in addition to his new administrative duties. In Korea, a public health survey is being undertalcen by the Government with vlliO and bilateral co-operation. The objective of this survey is to assess the health programme and to review personnel and material resources vTith a view to drawing up a long-range public health plan. A fact .. finding and co-ordination cOmmittee, appointed by the Minister of Health, prepared a report containing background information for the review of a joint- consultE.nt panel consisting of national, bilateral (AID) and international (WHO) membership. This panel will recommend a long-range national health prograw~e which, it is planned, will cover a period of approximately five WP/RC13/2 page 14 to ten years. The progra.mn:e will be submitted to the national economic planning body for consideration and eventual incorporation in the national economic and social programme. The new public health administration project, which will be implemented in 1963, will no doubt find this report useful in assisting the Ministry of Health to strengthen its organization. Also due for implementation in 1963 is an epidemiology project whose objective is to assist the national health administration in the organization and co-ordination of epidemiological services at all levels and branches under its administration. In Laos, a public health administrator is assisting the national health administration to draft a long-range and comprehensive health plan. In addi tion to his advisory role at Ministry level, the public health adviser also serves as WHO country liaison officer in discussions with the Government and the representatives of the various international, bilateral and voluntary agencies operating in the country. The rural development project, which was inaugurated in 1961, made substantial progress in the first development area in Vientiane Plain. An undertal~ing personally initiated by the late Secretary- General of the United Nations, the project aims at the acceleration of rural development among the four principal ethnic groups comprising the country's population, thus helping them to contribute their share to the country's economic and social development. With this broad-gauged purpose in view, assistance has been given by the United Nations and the $pecialized Agencies (FAO, ILO, UNESCO, WHO) and an overall agreement among these agencies and the Government was planned. The internecine strife in the country has, however, limited project activities and delayed the signature of an overall agreement. Despite this situation a tripartite agreement between the Government, WHO and UNICEF has been signed. In the general plan, a project manager under United Nations auspices serves as overall co-ordinator of the staff assigned by the various agencies to assist the Government in its community development activities. The technical activities of the WHO team, however, are under the direct superviSion of the public health adviser. The team, consisting of a nurse/ midwife and a sanitarian, has been consistently active in the Vientiane Plain area, having assisted in a census and survey which had as their objective the initiation of activities in the general fields of environmental sanitation and maternal and child health. Because of insecurity the project area' was for a lon~ period rather circumscribed (six villages with an estimated population of 2500), although with the cessation of hostile activities it is now planned. to enlarge the area further. Another developing activity in Laos is the Central Health Laboratory to which a WHO consultant is attached. Although expansion of activities beyond the Central Health Laboratory has been prevented by the prevailing situation in the country, this has resulted in the concentration of attention on the strengthening of the central laboratory and the training of laboratory technicians. In Malaya, a public health administrator continued to provide assistance in the expansion of the rural health programme. In this work, special emphasis has been placed on maternal and child health activities and the control of communicable diseases. Consideration has also been given to the integration of mental health practices in local health service activities. In 1963 WHO will provide consultant services aimed at the codification of public health laws and legislation to meet the needs of the expanding health and medical services. The training of public health personnel will be intensified through the establishment of a training centre in Rembau, • A- ------------..... SOCIO- ECONOMIC PROJECTS - Water traffic along the Mekong River. UN and other international agencies are at work in a gigantic project to harness the Mekong River and to control the floods that destroy crop' in the five riparian countries. Surveys have been made by WHO to determine the presence of bilharziasis and the possible spread of malaria and water-borne diseases in these areas . PUBLIC HEALTH SERVICES - Education and training of public health personnel is a basic feature of the work of WHO in the developing countries. A group of rural health workers is photographed after a home visit in a village in laos. WHO staff are engaged in teaching of and demonstration work for laotian pub- lie health workers. WP/RC13/2 page 15 in addition to that at Jitra, and in 1964 WHO proposes to provide consultants in the fields of public health administration, public health nursing and sanitation, to assist in the initial phases. The Government of Netherlands New Guinea has developed an accelerated social and economic development plan as part of its aim to increase the participation of the indigenous population in national activities. The health component of this plan envisages the establishment in the Schouten Islands of a rural demonstration and training area, which will have two purposes: (a) to serve as a pilot health unit, which will be the forerunner of district health and medical establishments in the country, and (b) to serve as an area for the training and orientation of health personnel, both indi~nous and expatriate. It was planned to implement this project in mid-1962, but as a result of lacl;: of funds the project can only be activated in early 1963. In the Philippines, assistance in the public health administration field has been concentrated on three areas: a national seminar on hospital administration, strengthening of the national health laboratory of the Department of Health, and assessment of the rural health services. The first phase of the laboratory project, which was completed in April, resulted in recommendations for increased activity in diagnostiC and referral laboratory services at the central level; supplementary recommendations included closer technical collaboration between the central laboratory and the regional and hospital laboratories, and provision for the technical supervision of the latter two units. Later in the year, a \oJHO consultant will be recruited to advise the Government on its DPT vaccine production, following which a nation- wide DPT immunization campaign is planned. Also completed during the year was the assessment of the national rural health services. The expansion of these services began in 1955 with United States assistance and by 1960 over 1300 units were in operation. The Government sought WHO assistance to assess these services as a basis for strengthening their organization. (See Part III for ~ full details of this project.) \oJHO assistance to Viet Nam has been concentrated on specialized health activities, among which have been projects to strengthen the epidemiological services and the distribution of medical supplies. The epidemiology project, which started in 1960, has accomplished its earlier task of surveying needs and setting up a new central organization; under the new plan it is hoped to establish within the next five years, two regional epidemiological units in the prOvincial areas, and to assist the Government in setting up plans for the notification and control of important causes of deaths. Assistance has also been given to the Government's DPT immunization and venereal disease control programmes which are intended eventually to cover the entire country. Two WHO fellowships (epidemiology and quarantine control) will be implemented under this project in 1962. A WHO laboratory consultant visited Viet Nam in February 1962 to survey laboratory resources in preparation for the organization of a central health laboratory service scheduled to start in 1963; he also submitted appropriate recommendations in connection with the Government's request to UNICEF for material assistance in the production of DPT vaccines at the Pasteur Institute in Saigon. (See Part III.) The medical supplies project made substantial progress during the year. The WHO medical supply officer visited hospitals and submitted recommendations to the Ministry covering the administration of medical supplies and instruments storage, servicing and WP/RC13/2 page 16 distribution. Plans are now being drafted, with the collaboration of AID, with a view to organizing a school for technicians where instruction can be given on the repair and servicing of medical instruments. A committee has been constituted to review and consider drugs for inclusion in the revised Pharmacopoeia and Formulary. Although assistance to rural health services has been principally extended by AID, WHO has also participated in the past through assistance in the training of "agents sanitaires" and midwifery workers. Technical discussions on rural health services were jOintly undertaken in 1961 by the Government, AID and WHO. One of the results of this meeting was the submission of a government request for WHO assistance in the organization of a training course for provincial medical officers in 1964. It is hoped that through further co-operation between the Government, AID and WHO, it may also be possible to establish a pilot project for the training of public health personnel at lower administrative levels. A request from the new State of Western Samoa for the services of a WHO public health administrator to assist in the strengthening and consolidation of its national health administration will be implemented in 1963. EmphasiS will be placed on an existing plan of organization which has been approved in principle by the Government. The importance of adequate and efficient hospital services within the health services of a country is being increasingly recognized. In addition to the organization and reorientation of hospital services, planning of hospitals and hospital architecture has received more attention. In Cambodia, consultant services have been provided to assist the Government to extend and remodel its hospitals within the Five-Year Plan. Advice on planning and construction, as well as on the organization and administration of government hospitals, will provide a basis for future activities in this important field. As a result of a further request from the Government of Japan, the Organization provided a six-month fellowship to study the organization and operation of clinics for chest diseases other than tuberculosis, and medical literature. The hospital administration project in Malaya, which has continued throughout the period under review, has proved to be very useful and has focussed interest on this important field. The preparation and distribution of questionnaires and guides to interested personnel throughout the country will contribute to the further streamlining of the services. The project may well constitute a nucleus of future initiative in this field. A national seminar on hospital administration assisted by the Organization is being planned in the Philippines. This will meet the considerable interest expressed by the staff of government, as well as of private hospitals, in new developments in this field. It is considered that there is a need for a reorientation of hospital services and for strengthening the administrative services in particular. 1.2 Health Education Interest in health education is evident in numerous projects, including those entirely supported by governments. The importance of health education in dental health was brought out at the Technical Discussions during the twelfth session of the Regional Committee held in Wellington. At the Seminar on Child Health and the School held in Manila in November-December 1961, school health education was one of the main topics of discussion. WP/RC13/2 page 17 At the vffiO Meeting for the Exchange of Information on El Tor Vibrio paracholera held in Manila from 16 to 19 April 1962, reports were presented by various governments on the efforts made to disseminate to the public, through all available media, the necessary information on cholera and cholera prevention. Some of the posters used in the campaigns were on display during the meeting. Other governments were in full readiness to embark on a similar campaign with all the means at their disposal. Discussions at the meeting _ placed a good deal of emphasis on the utilization of all available channels of communication to reach the public, particularly those socio-economic groups which are most at risk. The interesting fact was brought out that the groups that had responded best to inoculation campaigns were those which were least at risk. Health education occupies a prominent place in other communicable disease campaigns. A health educator in the Philippines was awarded a vmo fellowship for training in health education connected with malaria eradication. The fellow will be attached, upon return, to the Malaria Eradication Training Centre which, if everything goes according to plan, will be re-established in Manila in 1963. French-speaking health educators have been requested for malaria and rural health projects, but in view of recruitment difficulties, it has been proposed instead that suitable national candidates should be selected for fellowship training in health education abroad. Health education is generally developed from its association with specific projects to the establishment of a central unit or division at the highest health administration level. It is interesting to note that in the 'l'erritory of Papua and New Guinea the establishment of the Central Health Education Council is aimed at ensuring that health education is brought into the activities of all field departments. The continued interest of the South Pacific Commission is reflected in the nucerous health education activities undertaken in the South Pacific territories, particularly follovnng the addition of a new health education officer. During the year under review, the services of two consultants have been provided to the Governments of Japan and Malaya for assistance and advice in strengthening their health education organization and administration at the ministerial level. Their interest in and concern about the effectiveness of nation-wide health education services, with particular reference to the training and qualification of health education workers, signify problem areas of fundamental importance which are probably shared by most of the countries in the Region. The project in Malaya is still continuing and future health education developments in these two countries, with the resources at their disposal, should be a subject of considerable interest to all health authorities. That interest in health education training is not confined only to health education workers is indicated by the theme of an international conference supported by WHO and the Pan American Health Organization, which is to be held in Philadelphia in July 1962: Post-graduate Health Education Preparation of Health Worl:ers. 'mo Headquarters was able to finance the attendance of a limited number of senior health education specialists, including one each from Japan, New Zealand and the Philippines. A total of four fellowships has been provided by the Regional Office for post-graduate study abroad. WP/RC13/2 page 18 1.3 Maternal and Child Health Although the present state of the maternal and child health services within the Region varies considerably, some countries having a well organized service adequately staffed with qualified personnel and fully equipped, while in others there is practically nothing but a plan to initiate such services, there is not a single Member country which does not give a high priority to maternal and child health. Talting as a generally accepted principle that maternal and child health services will have to form a part of and must be fully integrated into the general health services, there are two ways in which such services can be created. In the case of an existing, or a developing, system of general health services, maternal and child health services can be attached to the existing framework, as for example, that which has been suggested in Cambodia. On the other hand,it is also possible to start maternal and child health work as the nucleus of general health services around which the other components can gradually be built up. This system has been followed in Laos, and, to a certain extent, also in Netherlands New Guinea. In the latter system, however, there i'3 obviously the danger that the maternal and child health services, because of the emphasis they receive, may develop too rapidly in comparison with the other health services. No matter which method is followed, the training of the necessary personnel is one of the most important aspects of every project which has as its objective the creation or upgrading of maternal and child health work. The training of all categories of medical and para-medical personnel has therefore continued to receive a very high priority as far as WHO assistance is concerned. Much of this assistance is, of course, given in the nursing projects, but in addition, almost all Member countries have now training institutions where doctors, teachers) social worl,ers, medical students, etc. ) receive training which will qualify them to contribute to the maternal and child health and school health programmes. Training is very important) but equally important is adequate supervision of the trainees once they have finished their course and have started the work for which they have been trained. Lack of proper supervision has presented problems because conditions in the field differ from those at the training institute and at the demonstration project, and the newly appointed health worker often encounters problems and frustrations with which he is unable to deal unless properly supervised and assisted. It seems, therefore, important to emphasize that the combination of supervision with in-service training, such as is done in the health stations in China (Taiwan), seems to be a very useful procedure. The establishment of special training courses for future supervisors will also greatly contribute to more effective supervision. It is noted that in some of the developing countries the mere fact that increasing attention is being given to mothers and children has considerablY raised the social status of these categories of the population. There are, however, many factors outside of the strict medical field which form serious o"'.Jstc,c1es to the establishment of an acceptable standard of maternal and child health. Here, co-operation between the health services and other government departments is required. MUnutrition,. which may affect the I .~ I WP/RC13/2 page 19 pregnant woman, the nursing mother, and the growing child in many ways, can only be tackled in co-operation with the departments of agriculture and animal husbandry, if there are to be sufficient supplies of the most important foods (especially proteins). The help of the department of education is also required so that the population may be educated, in general through the schools, on the correct foods to eat, and persuaded to accept the right ideas about nutrition; health education by health workers alone is not enough. Inadequate communication also forms a serious drawback in the efforts being made to establish adequate medical facilities for the population. Lack of proper environmental health is another obstacle to health progress and here the co-operation of the department of public wor~s is required. During the past year increasing attention has been paid to school health. In the Philippines, WHO is giving assistance to a project in school health education, which has been in operation now for one year, and to which a WHO expert will be assigned in 1963. Recently a summer institute for school health workers was held at the University of the Philippines. In Viet Nam, a plan of operation has been finalized for a school health project which will start in Saigon and be gradually expanded allover the country. In China (Taiwan), plans have been made tor the training of teachers with emphasis on school health; WHO will give technical advice and supplies and equipment will be provided by UNICEF. Tentative enquiries have been made in Korea about the possibility of obtaining assistance from UNICEF and WHO in the training of instructors who will then teach health subjects at the provincial junior colleges of education. The growing interest in school health was recognized with the organization of a seminar on child health and the school, sponsored jOintly by UNESCO and WHO, which was held in Manila from 27 November to 8 December 1961, and was attended by participants from thirteen Member countries. A comparatively new aspect of activities concerned with the care of children is the increasing number of projects related to their social welfare and that of their families. In the past year two such projects were initiated, one in the Philippines and the other in China (Taiwan), and an existing social welfare project in Hong Kong was extended to include social services for children. In these projects; for which the United Nations Bureau of Social Affairs provides expert aSSistance, WHO advises on the health aspects, which include a curriculum for the training of child welfare social workers, and UNICEF provides equipment and supplies. In Korea, which has particular problems in connection with the great number of orphans and orphanages, social services for children have a high priority in the national health programme. Although so far emphasis in the care of children has mainly been on the physical side, or, to put it more directly, on the survival of the child, it seems that the time has come to give some attention to the problems connected with the mental health of children. There is no doubt that physical health comes first, but it has been shown in a number of countries that the mental problems of the growing child are also very important, especially when the child is grOwing up under constantly changing social and economic conditions, as is the case in most Member countries in this region. In China (Taiwan), where these changing inflUences are very evident, a children's mental health centre has been established in Taipei. In addition to treating children who need mental readjustment, it also conducts seminars for teachers of primary schools to mru~e them conversant with the mental problems of the growing child, WP/RC13/2 page 20 and recently classes for mentally retarded children were started. In the coming years, it will be necessary to pay increasing attention to this aspect. A new project has been initiated in the South Pacific in co-operation with the South Pacific Commission. A WHO maternal and child health team, consisting of a medical officer and a nurse/midwife, will assess the existing maternal and child health services in a number of territories in this area, and will make recommendations according to their findings. In April 1962 work was started in Noumea where the nurse/midwife has been gathering relevant background information. In early July the medical officer will join her in Port M:)resby, Papua and New Guinea, where they will start their survey which will last sixteen months. The maternal and child health projects in Viet Nam and Laos have continued their activities and in China (Taiwan), Korea, North Borneo, Philippines, Singapore and Western Samoa, WHO has given assistance • in the form of technical advice and fellowships. The maternal and child health project in Netherlands New Guinea entered a new phase with the departure of I the WHO consultant in January 1962. It is now being continued with the help of UNICEF and technical advice and fellowships from WHO (see also Part III). Co-operation with UNICEF has continued as before. Since UNICEF primarily concentrates on aid to children and mothers, assistance to maternal and child health projects receives a high priority, and there is no doubt that without this assistance, the scope of the maternal and child health programme would be much reduced. Co-operation with other bilateral agencies has also been effective in expanding national programmes. Maternal and child health programmes continue to receive increasing attention from ~mber countries in the Region. Such programmes are recognized as being an essential part of the general health services and although much remains to be done, definite progress can be seen. In addition to what is already being done, it will, however, be necessary in the cOming years to concentrate on the education of the mothers, so that they will be able to use available services to a greater extent than they have done so far. 1.4 Nursing The continuous change in social, economic and other conditions in the countries in the Region and the concurrent need for expansion and improvement of health and welfare services are exerting a profound influence on the quality and quantity of nursing service which the public expects to receive and health administrations are planning to provide. The need for increasing the numbers of nursing personnel, while at the same time improving quality in education and service, is exerting heavy demands, and where local resources are limited outside assistance in various forms may be needed and requested. During the period under review, assistance has continued with the planning, organization and conduct of basic, post-basic and special in-service programmes for professional and auxiliary nursing and midwifery personnel and with the improvement of standards of service. Fellowship awards continue to play an important role in preparing personnel for teaching, supervisory and administrative positions and for clinical specialties. Programmes established within the countries at univerSity or post-basic level are also making a valuable contribution in this field. The need for establishing such courses in other -~- NURSING _ Young Cambodians are shown at the school of nursing in Phnom-Penh which a team of WHO nurse educators helped establish. Training centres for nurses have been set up in many countries with the assistance of WHO and UNICEF. MOTHER AND CHILD HEALTH _ In Netherlands New Guinea, refresher courses for village workers and training 0; traditional birth attendants (bidans) are part of a programme to improve mother and child care and expand rural services. ... WP/RC13/2 page 21 countries is becoming very apparent and is receiving increased attention by governments, nursing bodies and universities. Countries which have received assistance from international staff with educational programmes are the British Solomon Islands Protectorate, Cambodia, China (Taiwan), Laos, Philippines, Singapore and Viet Nam. Fellowships have been awarded to nurses from Cambodia, China (Taiwan), Laos, Philippines, Singapore, Netherlands New Guinea and Korea. Three nursing consultants were provided as members of teams to evaluate and advise on programmes in rural health services (Philippines),mental health (Viet Nam) and maternal and child health services in South Pacific territories. Three consultants were provided for the WHO-sponsored Seminar on Nursing Administration which was held in Tokyo from 16 to 28 October 1961. Thirty-one participants and observers from thirteen countries attended the seminar. The seminar deliberations and subsequent follow-up activities indicate that the seminar was timely and profitable. One very significant development is the increase in activities at national level under the leadership of national nursing bodies. During the period under review, through seminars, workshops, conferences, nursing education committees and study groups, national nursing leaders studied subjects relating to curriculum development at basic, post-basic and auxiliary level, recruitment programmes, nursing and midwifery legislation, accreditation, nursing research and nursing administration. Action initiated and action plans formulated on the basis of the results of these deliberations will have far-reaching effects on the future of nursing in the countries concerned. Assistance with these activities has been provided on request by international staff assigned to the countries, the Regional Advisers on Nursing and Education and Training, and one consultant was provided for a seminar held in Australia. The Nursing Adviser served as a staff member and attended the WHO- sponsored seminars on Maternal and Child Nutrition, and Child Health and the School as a resource person. New programmes in paediatric nursing in the Philippines, nursing education in Laos, and in theatre nursing in Singapore were started during the report period. Eleven field projects are in operation or in the planning stage at present. There are also twelve other field projects or special projects with nurse members in operation or in the planning stage. As in past years considerable assistance has been obtained with fellowships, the provision of teaching materials and supplies and equipment, in co-operation with other international and bilateral agencies particularly UNICEF, AID, Colombo Plan and the China ~dical Board. Every year marks new milestones in the achievement of nursing goals - the preparation and availability of nurses prepared to care for people of all ages in the promotion of health and in all forms of siclmess, both physical and mental. The period under review has seen the pace accelerated and with support and assistance where needed from national and international sources, the years ahead should bring fruitful results. WP/RC13/2 page 22 2.1 Dental Health 2. HEALTH PROTECTION AND PROMOTION In line with the interest in dental health expressed by Members of the Regional Committee at the last Technical Discussions, a plan has been drawn up to train dental officers in the techniques of a dental epidemiological survey so that they may conduct such surveys in their own countries and territories as a preliminary to the drawing up of a national dental health programme. The plan is to be implemented in five phases. Phase one, which is now in operation, takes the form of an enquiry on the state of the dental services in Member countries, in order to determine whether or not assistance would be needed for the conduct of an epidemiological survey. Phase two will talte place in 1963 when a consultant will visit a selected number of countries to collect more data and to explain the scheme of training national dental epidemiologists. FollOwing these visits the training programme will be further planned and it is envisaged that this will take place in 1964, in a suitable area in the Region, for a period of approximately three months. During the period of training, which constitutes phase three of the programme, participants will talce part in an actual survey of the area, in preparation for the survey, phase four, they are expected to carry out in their own countries and territories. The final phase of the programme, which may talce place in 1965, will be the consolidation of these findings by a consultant, and the planning of a national dental health programme for each of the countries and territories concerned. 2.2 Mental Health In spite of their preoccupation with the numerous problems of physical health, more Member governments than hitherto have expressed their concern about some of the basic problems in mental health by requesting consultative services. Three consultants have completed their respective assignments for periods varying from one to six months. One consultant spent a month in China (Taiwan) with an enthusiastic group of young psychiatrists interested in a longitudinal study of the mental health problems of children, particularly in the context of a rapidly changing culture. Two other consultants assigned to Malaya and Viet Nam gave assistance in improving the administrative and technical aspects of mental institutions and in suggesting ways and means of strengthening the mental health services. A fourth consultant is to be recruited in 1962 in connection with still another mental health project in the Philippines. The year under review has seen the implementation of a total of ten fellowships in mental health. One mental health problem most countries have in common is the status of their mental institutions, a subject that often invites the criticism of the press and legislative bodies alike. However, the management and the availability of proper patient care in mental hospitals represent only one aspect of a country's mental health programme, the importance of which has not yet been fully recognized because of the seemingly more pressing problems of physical health and well-being. In terms of fiscal considerations, the problem is somewhat similar to the need for providing safe community water WP/RC13/2 page 23 ~. supplies. Both involve expenditures which appear excessive, and yet no country can afford not to maY~ this provision. A sound mental health programme also pays dividends in the conservation of human resources through the rehabilitation of the mentally ill and efforts directed at mental health promotion. ~ .. Not all approaches involve additional expenditure of money. The consultants' reports contain material relating to a better utilization of available resources. Suggestions have been made towards a wider application of '~ntal health education" among, not only the publiC, but also medical practitioners, public health officers and undergraduate students. Co-ordination between public health and medical education authorities is desired in promoting or strengthening mental health teaching in undergraduate professional schools. Adequate training of a sufficient number of the different categories of psychiatric personnel is of fundamental importance. Such training has been carried on in many of the countries in the Region. Mention might be made of the training of psychiatric nurses in Netherlands New Guinea in which six graduated in 1961 from a two-year course and nine are at present following the course. 2.3 Nutri tion There has been an increasing awareness by governments of the importance of nutrition and the well-being of the community. The effects of nutritional disease are known in most areas but it is the extent of the problem which has to be determined. All forms of disturbances occur from subnutrition resulting from a low intruce of food through states of malnutrition such as the vitamin deficiency state of beriberi, protein malnutrition and gOitre to overnutrition, which is overt in the highly developed cities in the Region. It is not sufficient, however, to appraise the situation; the problems need to be solved. Firstly, interest in nutrition has to be stimulated. This having been done,it is necessary to secure the co-operation of all those disciplines which have a bearing on nutrition. For example)the assistance of the agriculturist, the teacher, the comnnmity development worl:~r, the veterinarian, and representatives of commerce is required at international level, national level in the ministries and throughout the government administration to the field worker, who is responsible for the execution of remedial nutritional work. Through the co-operative efforts of these disciplines, it is possible to increase food production, to improve food distribution throughout the territory and to the family, to improve methods of. food storage, to improve standards of family budgeting, and food processing in industries and in the home. The main avenue of approach is of course through education, either formally, through the schools, colleges, universities, and national training establishments, or informally at all levelS, but particularly in the village where every literate person can give some assistance to those less gifted. With this in view WHO has co-operated closely with FAO, UNICEF, and governments, and plans have been formulated which are directed towards improved nutrition. Such planning is of necessity protracted but it is gratifying to report that certain of these plans have already come to fruition. WP/RC13/2 page 24 A seminar on maternal and child nutrition was successfully held in January. Twenty-six participants from the Region, together with consultants, discussed the nutrition of the infant and the mother, the relationship between nutrition and ill-health and education and training. The seminar commented on the widespread use of artificial feeding with its attendant problems and noted the difference of opinion amongst the medical practitioners regarding methods of feeding and weaning children. It was agreed that the nutrition of the mother was related to the physique and well-being of the child and stressed that further co-operative efforts were required in the field of agriculture and community development to improve the nutrition of the mother through education. Once again it was noted that there was a lack of agreement regarding the clinical criteria of malnutrition. The important role of education could not be overlooked in improving the nutrition of the mother and child. A SymposiunL.on nutrition, sponsored jointly by the Viet Nam Ministry of Health and the Inter-Departmental Committee on Nutrition for National Defense (ICNND) of the United states of America, was held in Saigon from 11 to 17 March 1962. Nutritional problems with particular reference to protein-calorie malnutrition and vitamin deficiency were discussed. The nutrition survey of the Philippines was started in 1958 and has been continuing since then. During the course of the survey, conferences have been held from time to time to discuss the findings of the survey and to consider future planning. The third post-nutrition survey conference was held in the Bicol Region of Luzon Island in April. In China (Taiwan) it has been recognized that goitre is one of the major public health problems and the Government has agreed in principle to a salt iodization scheme which would require some assistance from UNICEF. The Philippines is anxious to stimulate the production of more milk and has received the promise of UNICEF assistance in carrying out this project. The Government of French Polynesia plans to meet its nutritional problems through an expanded nutrition scheme. WHO is providing technical advice and fellowships to assist the training of personnel who will talte an active part in its execution. Provision has been made for technical assistance to the University of ~aya by providing a fellowship for a medical nutritionist. ~~ The Protein Advisory Group (PAG) is now planning an enquiry into the nutritional value of filled milks which are being widely used in the Region. Other research work in hand concerns anaemia. and the assessment of the physique of children in Sarawak. One of the principal problems in the Region continues to be that although malnutrition is widespread remedial programmes are few in number. In some instances governments are already committed to curative services which meet with the approbation of a critical public which demands immediate visible results,yet is unable to appreciate that adequate nutrition is essential for the welfare and prosperity of the nation. The nutritional problems that exist are in many instances associated with the triad of poverty, ignorance and disease. Poverty prevails both in the subsistence farming areas and in many urban canmunities where it leads to ill-health which reduces work output; this in turn aggravates the poverty and so a vicious circle is formed. Ignorance is closely linlred with prejudice. In many instances the problem is that of not knOwing the right foods to consume and as such is dependent on literacy or educational attainment. Many of the highly-developed countries have food fads which lead to nutri tional detriment. It is a disturbing feature of modern food trends that new bad habits are adopted and the good old habits forgotten. The subsistence .A .. WP/RC13/2 page 25 farmer who receives some protection from a cheap but readily available traditional food is now subjected to the high-pressure salesmanship and advertising associated with the promotion of sales of exotic foodstuffs often of low nutritional value. To deal with such problems requires fresh approaches in the field of nutrition education, programmes for which can only be carried out with especially trained personnel. A pattern of training is now emerging in existing field work in the Region which will be used as a guide to more comprehensive programmes in the future. 2.4 Social and Occupational Health In order to train, firstly, staff of government hospitals and later, staff from private hospitals, a four-year university course in physiotherapy has been established at the University of the Philippines. This will be the first course in physiotherapy in the Region providing a university diploma. A suitable curriculum has been developed with the assistance of the College of Medicine of the University of the Philippines; an in-service training course has been directed by a WHO expert, and equipment and supplies, as well as stipends for students, have been made available by UNICEF. It is expected that this course will fill a gap in the existing training facilities for auxiliary medical personnel in the Region and may develop into a training centre of increasing importance. 2.5 Radiation Health, Radiation Medicine and Human Genetics There has been no specific project in the Region connected with radiation protection or the medical use of radiOisotopes. A six-month fellowship was, however, awarded to a fellow from New Zealand to study radiation medicine in the United Kingdom, Canada and the United States of America. A fellow from China (Taiwan) and one from the Philippines participated in the Inter-regional Conference on Radiation Protection, convened in Dusseldorf, Germany, for the study of the imminent public health problems arising from the use of ionizing radiation stemming from X-ray equipment, as well as from nuclear sources. The conference has thrown light on the role and responsibilities of the public health authorities in this field. Australia, Cambodia, China (Taiwan), Japan, Korea, New Zealand, Philippines and Viet Nam sent trainees to the IAEA/WHO Training Course in Radiation Health and Safety, which was held in Chiba City, Japan, 24 October to 21 November 1961. This course covered the basic physical and biological principles involved in radiation health, problems connected with the medical and industrial uses of X-rays, radiOisotopes and other sources of radiation, the public health aspects of atomic energy activities and waste disposal, and the health problems associated wi th atomic energy installations. The riSing need for the establishment of effective radiotherapy departments has led to a request from the Government of Singapore for advisory services to establish such a department. WP/RC13/2 page 26 In Korea, a radiotherapy department will be established within the National Medical Centre at Seoul, the e~uipment for which will be provided from UNKRA residual funds. These have been transferred to the Organization, together with the responsibility for technical advice and for the procurement of the necessary e~uipment in consultation with the Scandinavian Mission. The outline of the project has been laid down in a plan of operation which is still under discussion. A number of countries in the Region are participating in a WHO-sponsored study in the field of human genetics. Selected hospitals in Hong Kong, the Federation of Malaya, the Philippines and Singapore are collecting information for a study of congenital malformations which will be finally evaluated by the Population Genetics Research Unit, Medical Research Council, Oxford. The preliminary 'WOrk for the preparation of this study was completed during the period under review. The study is supposed to take at least one year. 3. ENVIRONMENTAL HEALTH During the period under review, WHO efforts to assist Member countries and territories in environmental health have followed the same pattern as in the past. First priority has been given, wherever possible, to the strengthening, or the prOvision where they do not exist, of environmental health sections in national or provincial health administrations. Training has been given second priority and next in importance are demonstration or pilot projects. The first objective of these priority programmes continues to be the provision of basic sanitary amenities to all households, with emphasis on an ample and convenient supply of good ~uality water and a sanitary toilet or latrine. The recent outbreaks of cholera El Tor have again focussed attention on the need to improve environmental health throughout the Region. At the meeting held from 16 to 19 April in Manila on the Exchange of Information on El Tor Vibrio Paracholera, it was generally agreed that the improvement of community water supplies and the provision of proper excreta disposal were of paramount importance in erecting barriers against the introduction of exotic enteric djseases into Member countries, and also in controlling the spread of either exotic or endemic diseases which are water-borne. vlliO's community water supply programme has aroused interest in Member countries and territories in the Region and a number of re~uests have been received for assistance under this programme. A team of distinguished conSUltants in the administrative, technical and financial aspects of community water supply was provided to China (Taiwan) during the period under review~ This group, after an intensive study, made specific recommendations covering the prOvision of safe and ample supplies of water to all communities on the island. (See also Part III.) Re~uests have also been received from Korea and North Borneo for technical assistance in the same field, and it is anticipated that several other countries may re~uest similar assistance during the cOming year. A considerable amount of interest has also been aroused by the plan to organize a training course in community water supply early in 1963. , ENVIRONMENTAL SANITATION - A WHO sanit'arian in Laos has among his tasks that of teach- ing personal hygiene to village schoolchildren. WHO and other UN agencies are assisting Laos in in a rural development scheme. PHYSICAL REHABILITATION -- WHO has assigned a physiotherapist to assist the Philippine Go- vernment in its bid to improve and expand services for the physically handicapped. In addition to in-service training classes shown above. a four-year collegiate course for physiotherapists and occupational therapists has been established in the state University. WP/RC13/2 page 27 During the year, a water supply project was developed in two rural comr~unities in Houmea and Vaotuu in the I<~ingdom of Tonga. These are the first piped water supplies in the Kingdom and they have had a profound effect upon the policies of the Government with respect to community water supply. Plans have been drawn up for the construction of water systems in twenty-one other villages in Tonga with UNICEF and WHO assistance. It is considered that these installations will be of interest to governments in other Pacific island communities which are interested in water supply development. The Government of Hong Kong has begun the fluoridation of its water supply. The Regional Office has assisted, by training and by field activities, in the widespread dissemination of information on the water-seal pit latrine, which is considered one of the most promising of recent technical developments in the field of rural excreta disposal. A number of countries are now vigorously pursuing campaigns to introduce this sanitary method of excreta disposal into the rural areas. WHO is assisting with a programme for the training of sanitary inspectors in the Philippines in which good progress is being made. Three regional training centres have been set up and staffed by the Government, with the assistance of WHO and UNICEF, and it is anticipated that an additional training centre will be established during the forthcoming year. China (Taiwan) is now planning to continue, with UNICEF assistance and technical advice from WHO, training courses for sanitation staff which were begun some years ago with AID assistance. The Government of Malaya has recently established its own training centre for health inspectors. The territories of North Borneo and Sarawak continue to send trainees to the health inspectors' course at Singapore. Additional courses in sanitary engineering at the undergraduate level have been established in a number of countries. The newly established post-graduate course in public health engineering at the University of New South Wales in Sydney, Australia, has successfuly completed its first year and presently has twelve students, of whom two are from Australia, three from the Philippines, six from China (Taiwan) and one from Malaya. Rural environmental health activities in Laos) Cambodia) Tonga, rretherlands Neif Guinea and the Philippines have continued to receive WHO assistance. Special emphasis has been placed on the introduction of economically designed and hygienically acceptable manually pumped wells, as well as small piped water supplies, where this is economically feasible. 4. EDUCATION AND TRAINING 4.1 Assistance to Educational Institutions It is gratifying to note that the various countries in the Region fully appreciate the relationship between a healthy manpower and political, social and economic development; the need to institute programmes designed to maintain, protect and promote the health of the people to ensure a healthy manpower; WP/RC13/2 page 28 that the services of well-qualified and trained health workers are necessary for the above health programme s to succeed; and that well-organized and integrated education and training programmes to produce the above personnel need to be carried out and should receive high priority. There is an acute shortage of qualified physicians in many countries in the Region and certain countries have taken steps to remedy the situation. In Viet Nam, the Government, with AID assistance, is expanding the facilities of the medical school in Saigon to enable it to admit about two hundred students per year. In addition, a medical school has been established at Hue University. In Malaya, a new medical school will be established at the University of Malaya in Kuala Lu.rqpur. The new Faculty of Medicine of the Uni versi ty of New South Wales in Australia entered its second year of operation. The Royal School of Medicine in Laos and the Papuan Medical College in the Territory of Papua and New Guinea continued their mission of training medical assistants. A marked trend towards the improvement of teaching and the upgrading of medical education standards is observed throughout the Region. The curricula have been revised to include more of the humanities and to provide better integration of basic and clinical sciences. Greater emphasis is being given to the teaching of preventive and social medicine. More efforts are being made to enable medical students to study patients in their natural surroundings, to make the students aware of the community, its health problems and resources, and to acquaint them with the concept of comprehensive medical care. Problems, however, related to large enrolments, the shortage of qualified full-time teaching staff particularly in the basic sciences, and inadequate facilities and finances still exist and need to be solved. There is an increasing tendency for the various countries in the Region to set up their own programmes of training health personnel in line with the philosophy that,as a matter of principle, training must be done in the country of one I s origin, in his own environment and with his own people. More practical and realistic training schemes based on local resources and geared to meet local needs are thus being implemented. Considering that the countries in the Region are in varying stages of technological, political, social and economic development, it is to be expected that the types and levels of training programmes that are operating "\OTill also vary. Some countries such as Australia, New Zealand, the Philippines and Singapore, have elaborate training programmes whereby, in addition to the usual programmes operated by official health agenCies, there are also available university programmes leading to professional degrees in public health. In some other countries,particularly those with limited resources and where the basic educational system is as yet not well developed, training programmes have been geared mainly to the preparation of auxiliary health personnel. WHO assistance in education and training within the Region has consisted mainly of surveying education and training needs, providing lecturers or consultants to plan and to implement local training programmes, in addition to training local staff, providing fellowships for local personnel to supplement local training when necessary, and providing supplies and materials and other teaching aids. I am glad to report that progress has been observed in the WP/RC13/2 page 29 various training projects assisted by the Organization during the period under review. In Cambodia, the Royal School of ~dicine has now become the Faculty of Medicine, of Pharmacy and Paramedical Sciences. The Faculty will graduate its first full-fledged physicians in 1963. In China (Taiwan), WHO assistance consisted of fellowships to provide advanced training to three members of the staff of the Institute of Public Health of the National Taiwan University. The Institute offers short training courses for public health personnel, in addition to being responsible for the teaching of preventive and social medicine to the undergraduate medical students of the College of ~dicine, National Taiwan University. The Institute is planning to lengthen the course for public health personnel to one year. In Fiji, the School of Medicine continued its task of preparing various categories of medical and health personnel for service in the Pacific territories. The preventive and social medicine and public health courses in the school have been strengthened. WHO assistance to the school, in addition to the services of a biology lecturer who completed his assignment at the end of 1961, consisted of fellowships to support students enrolled in the Assistant Medical Officers and the Certificate in Public Health courses. In Korea, WHO, in addition to providing fellowships for training local staff, has assigned a public health administrator to assist the Government in carrying out its training programmes. In Malaya, the WHO tutor in clinical pathology, besides assisting the staff of the Institute for Medical Research in preparing the training course for laboratory assistants, also participates actively in the teaching of the CO~e. It is expected that this project will go a long way to meeting the demands for the services of well-trained and qualified laboratory workers to staff the various hospitals and other laboratories in the country. The Regional Education and Training Adviser also visited Mal~ to assist the Government in formulating plans for the establishment of an institute of health training. In the Philippines, the Institute of HYgiene continued to receive WHO assistance. The Organization provided the services of a short-term consultant in epidemiology, who reViewed, evaluated and n:.ade recommendations on the teaching and research programme in epidemiology in the Institute. WHO assistance to the Institute has been very productive. It has enabled the Institute to upgrade significantly not only the level of training of professional public health personnel but also the teaching of preventive and. social medicine to undergraduate stUdents of medicine , dentistry, nursing, etc., of the University of the Philippines. Furthermore, the research output of the faculty has also increased considerably. The Institute started a new cou.rse leading to a Certificate in Hospital Administration in June 1962. In Singapore, a school of radiography will soon be established to train qualified radiographers of whom there is an acute shortage. WHO will provide the services of a lecturer to assist in the establishment, organization and. WP/RC13/2 page 30 in the conduct of the course. During the year under review, a fellowship was awarded to enable one of the local radiographers to pursue advanced training abroad in preparation for a teaching post in the school. 4.2 Fellowships The fellowship programme constituted the major type of assistance extended by WHO to educational and training activities in the Region. Fellowships were awarded to enable certain key personnel (a) to pursue advanced studies or training abroad when facilities for such training are limited, or not available in their own countries; (b) to observe and study programmes and other related activities in other areas to enable them to become acquainted with recent trends, developments and new approaches in the medical and public health fields; or (c) to participate in educational meetings and courses such as seminars, conferences, study groups, etc. During the year under reView, three hundred and nineteen fellowships of all categories were awarded to participants from the Region (see Annex 5). Of these fellowships, one hundred and eleven were in connection with the usual fellowship programme contained in the regional programme and budget; this number compared favourably with the ninety-four fellowships awarded during 1960-1961. In addition, thirteen special fellowships were awarded, namely, nine fellowships from Headquarters Exchange of Scientific Worlrers (Malaria Eradication) and four special UNICEF fellowships for the Certificate in Public Health Nursing Course in Calcutta. (For the balance of the total fellowships, see Educational Meetings and Courses.) Thirty-five fellows were sent by the other regional offices for placement within the Region as follows: Regional Office for Africa 1. Regional Office for the Americas 5 Regional Office for the Eastern Mediterranean 10 Regional Office for South-East Asia 19 Details related to fields of study, country of origin and the distribution of visits are given in Annexes 6 and 7. As in the past, placement within the Region was encouraged and arranged whenever possible so that fellows could study and observe under conditions similar to those obtaining in their own countries. This has served not only to mruce the fellowship more realistic and practical but also to stimulate the receiving countries to improve their facilities and resources. Practically the same proportion of intra-regional fellowships was observed in 1961-1962 as in the previous years. Problems connected with fellowships were essent~ally the same as formerly and were related to language proficiency, particularly in English, delay in the submission of application forms, and last-minute requests for changes in candidates, programmes or itineraries of fellows, resulting in disruption of arrangements and inconvenience on the part of the receiving governments. TRAINING COURSES -- A WHO-sponsored postgraduate training course in leprosy was held for physicians from Asia and Africa in order to improve their knowledge of leprosy and promote a better understanding of the disease, both among the health workers and the people. FELLOWSHIPS - To help strengthen national health services, WHO awards fellowships for advanced studies in other countries. Over 700 grants have been made in the Region during a ten-year pe- riod. Photo shows a WHO fellow studying bilharziasis control in Japan. WP/RC13/2 page 31 I wish to express my gratitude and profound thanks to the M:;mber governments concerned for their patience, splendid co-operation and assistance not only in arranging placement and programmes, but also for the other services they have extended the fellows. These, I am sure, are mainly responsible for the success of the fellowship programme. 4.3 Educational Meetings and Courses The following inter-country educational meetings and courses were held during 1961-1962: (a) Nursing Administration Seminar, Tokyo, Japan, 16 to 28 october 1961; (b) Refresher Course on Integrated Rural Health for Assistant M:;dical Officers in the South Pacific, Apia, Western Samoa, 2 November to 11 December 1961; (c) Seminar on Child Health and the School, Mmila, Philippines, 27 November to 8 December 1961; (d) Seminar on Maternal and Child Nutrition, Manila, Philippines, 3 to 14 January 1962; (e) Training Course on Vital and Health Statistics for Territories in the South Pacific Area, Suva, Fiji, 8 January to 2 February 1962; (f) Seminar on Smallpox, India and Ceylon, 16 February to 2 March 1962; (g) Meeting for the Exchange of Information on El Tor Vibrio Paracho~era, Manila, Philippines, 16 to 19 April 1962. A total of one hundred and thirty participants, all of whom received WHO assistance, took part in these meetings or courses. Details are given in Part IV of this Report. A total of fifty-three participants from the Region took part in the following short-term (.less than two months' duration) inter-regional meetings or courses: (a) Venereal Diseases Travelling Seminar, Union of Soviet Socialist Republics, 8 September to 7 October 1961; ./ (b) Inter-regional Training Course on Occupational Health, Alexandria, Egypt, 2 October to 25 November 1961; (c) Second Asian Conference on Yaws, Bandung, Indonesia, 30 October to 10 November 1961; (d) IAEA/WHO Training Course in Radiation Health and Safety, Chiba City, Japan, 24 October to 21 November 1961; WP/RC13/ 2 page 32 (e) Training Course on Freeze-dried Smallpox Vaccine Production, Bangkok, Thailand, 6 to 18 November 1961; (f) Inter-regional Post-graduate Leprosy Training Course, Philippines, 20 November to 9 December 1961; (g) Conference on the Training of Health Auxiliary Personnel, Khartoum, Sudan, 14 to 20 December 1961; (h) Inter-regional Training Course on Viral and Rickettsial Laboratory Techniques, Singapore, 12 to 31 March 1962; (i) Conference on Public Health Aspects of Protection against Ionizing Radiation, Dusseldorf, Germany, 25 June to 4 July 1962. Details are given in Part IV of this Report. In addition, there were twelve fellowships awarded to enable participants from the Region to attend long-term (more than two months' duration) inter- regional courses, namely: (a) Training Course on M=dical Rehabilitation, Copenhagen, Denmark, October 1961 to July 1962; (b) Anaesthesiology Training Courses, Copenhagen, Denmark, January to December 1962; ( c) Malaria Eradication: Training Centre, French Language, Belgrade, Yugoslavia, 12 February to 14 April 1962; (d) Training Course on Human Genetics for Teachers in M=dical Schools, Copenhagen, Denmark, which will take place 10 September to 30 November 1962. 5. tA.ALARIA During the year 1961 efforts were made to carry out a critical review of the malaria eradication situation in various countries and territories in the Western Pacific Region. It is an established fact that the feasibility of interrupting transmission is only one of the factors necessary for the success of a malaria eradication programme; other essential factors are the , administrative and operational facilities required for the implementation of the eradication programme. From these standpOints, conditions existing in each malaria project in the Region were examined. ~ The WHO-assisted malaria projects in the Western Pacific Region may be classified into the follOwing categories: (a) Malaria eradication programmes (MEP) (b) Malaria eradication pilot projects (MEPP) -'" (c) Pre-eradication programmes (PEP) (d) Malaria eradication training projects (METP) (e) Malaria eradication field research projects (MEFRP) These categories can be briefly described as follows: WP/RC13/2 page 33 (a) A malaria eradication programme is an operation aimed at the ending of the transmission of malaria and the elimination of the reservoir of infective cases, in a campaign limited in time and carried into such a degree of perfection that, when it comes to an end, there is no resumption of transmission. There are five countries in this region, namely, China (Taiwan), North Borneo, Sarawak, RyuU~ Islands and the Philippines, in which a full eradication programme is being pur.sued. In North Borneo a well-documented plan of operation, covering the whole duration of the programme until achievement of eradication, has been prepared. This plan was implemented on 1 July 1961, on which date the project was officially converted from control to one of eradication. The project is provided with excellent operational facilities including staff and logistic support; periodical assessment bas been carried out and results so far indicate good prospects of achieving eradication as planned. Sarawak also launched its malaria eradication programme in 1961. There is now evidence to support the belie~ that the interruption of transmission has been obtained in many areas. A total of 571 000 population was in the consolidation phase in 1961. A detailed plan of operation for eradication was prepared and provision has been made for adequate administrative and operational facilities. The eradication programme in China (Taiwan) continued during 1961 to be the most promising project in the Region and the accomplishment of eradication is already in sight. Nevertheless, a well-defined small focus of transmission was discovered as late as November 1961. Re-introduction of malaria cases, mainly through mass immigration from abroad, also poses a serious threat to the success of malaria eradication. However, well-planned counter-measures have been implemented to cope with the problem. In preparation for its final phase, the maintenance of eradication, efforts are being made to transfer surveillance duties from the national malaria service to the general health services of the country during the transition from the consolidation to the maintenance phase. During the past year some progress was made in the Philippine malaria eradication campaign; in addition to the administrative difficulties resulting from the change over from a centralized to a decentralized scheme, certain technical problems, including the development of resistance to dieldrin in Anopheles minimus flavirostris and population movement from the malaria-free coastal plains to the hinterlands, have favoured continuation of transmission. A re-appraisal of the programme was made in 1961 by a group of national and international experts from WHO and other participating bilateral agenCies, and their recommendations for the reorganization of the project have been submitted to the Government. WP/RC13/2 page 34 In the Ryukyu Islands, improvements in surveillance activities and epidemiological assessment are required. WHO has arranged to provide a short- term consultant in order to strengthen certain operational aspects of this project. The prospects of achieving eradication soon are good. (b) A malaria eradication pilot project is an operation intended to provide information as to whether certain single or combined antimalaria measures will, if properly applied, bring about the interruption of trans- mission. In two countries in the Region, Malaya and the British Solomon Islands Protectorate, malaria eradication pilot projects are now in operation. In Malaya, the pilot project entered its second year of operation in 1961; progress during the year has been encouraging. In the British Solomon Islands Protectorate, malaria is the largest single cause of hospital attendance and is transmitted by vectors of the Anopheles punctulatus group. The eradication pilot project started late in 1961 and is intended to cover the islands of Guadalcanal and the New Georgia group , with a total population of about 30 000. (c) A pre-eradication programme is a preliminary operation undertaken in a country whose general administration and health services have not yet reached a level which would enable it to undertake a malaria eradication programme and in which, therefore, the necessary basic foundations for this kind of co-ordinated, thorough and time-limited activity have first to be laid. In the Western Pacific Region, such conditions are found in Brunei, Korea, Viet Nam., Cambodia and Netherlands New Guinea. In these countries, therefore: a pre-eradication programme starting in 1962 will have to precede the implementation of full eradication programmes. A malaria eradication programme may start in 1964 in Cambodia if, by the end of 1963, an adequate administrative structure and necessary operational facilities are available. In Brunei a WHO malariologist has been assigned to the project. It is expected that the pre-eradication programme project will be completed by the end of 1963 when a comprehensive plan of operation for a full malaria eradication programme may be obtained. In Korea the results of surveys carried out up to the end of 1961 showed that malaria is widespread with definite foci of transmiss~on, although the incidence is low. The pre-eradication programme is planned to be carried out through 1962 and 1963. In Netherlands New Guinea, antimalaria activities have been continued on a large scale through 1961 including spraying operations, case detection and the use of medicated salt. A total of slightly over 200 000 population out of 450 000 living in malarious areas, was under protection in 1961. The technical feasibility of interrupting transmission has been established in some areas, but administrative and operational facilities must be improved before undertaking an eradication programme. The pre-eradication programme, which covers a malarious population of 260 000, was implemented in 1962. It is considered that in this country a malaria eradication programme may not be implemented before 1965; a decision covering future action will depend on the results of the pre-eradication programme. WP/RC13/2 page 35 In Viet Narn, the malaria programme is further complicated by areas of inaccessibility. Lar@e-scale operations were carried out in 1961. The interruption of transmission appears to be feasible with present techniques in Anopheles minimus but not in A. balabacensis areas. The pre-eradication programme was started in 1962 in order to define the problems and establish the necessary administrative and operational facilities before an eradication programme can be implemented. Should these conditions be fulfilled and security obtained, a fully developed malaria eradication programme could be considered in 1964. (d) Malaria eradication training projects consist of malaria eradication training centres with the properly organized field training area. The malaria eradication training centre at Tala, R1zal, Philippines was • temporarily dis-established in 1961. Efforts to re-establish a new training centre have been made in collaboration with the Philippine Government and AID. It is hoped that the new centre will be opened in 1963. During 1961, twenty~four vlHO fellowships were awarded to fellows from this region to attend regular courses in malaria eradication training centres. Grants of limited duration were also awarded to ten candidates for observation in selected eradication programmes. Assistance in national training programmes has also been provided by the malaria staff in the Regional Office. (e) Malaria eradication field research projects are very special projects designed to find new" ways and means of interrupting transmission vThere conventional methods have failed. In the Western Pacific Region, two research projects were assisted by WHO in 1961. One is with the Department of Parasitology, University of Singapore, where research is being carried out on the development of techniques for quantitative measurement of required immunity reaction to a protozoal infection. The other is with the Division of Malariology, Department ~c of Public Health, Netherlands New Guinea, where an assessment in the field of bioassay methods and their application for determining the activity of DDT residual insecticides, and a research project on the behaviour pattern and longevity of the A. punctulatus group in unsprayed and sprayed areas are being carried out. A third research programme in connection vlith a study of simian malaria, with particular reference to the possibilities of monkeys acting as a reservoir of human malaria, is being planned in the Provincial Malaria Re search Institute J China (Tai i"ran) . Trials with medicated salt were continued in Netherlands New Guinea and Cambodia. The results of the experiment in Netherlands New Guinea indicated the failure of this method to interrupt malaria transmission under the local epidemiological and socio-economic conditions. Malaria programmes in other countries and territories of this region may be mentioned briefly. Laos, Hong Kong, Macao and the Territory of Papua and New Guinea may be grouped together, as malaria problems of varying intensity exist in these territories, and because the antimalaria activities undertru~en by the respective authorities in the past do not follow any of the categories mentioned above. In Laos, a widespread malaria control programme with residual indoor spraying was started in 1957 but had to be suspended in 1961 due to unsettled conditions. In the Territory of Papua and New Guinea) the serious WP/RC13/2 page 36 effects of malaria on public health have co~elled the Government to undertake large-scale control measures. On the other hand, the possibility of malaria eradication from Hong Kong and Macao depends to a great extent on the success of malaria eradication on the neighbouring mainland. International co-o eration and co-ordination have continued as before, mainly through the Antimalaria Co-ordination Board serving the countries of Cambodia, Laos, Viet Nam, M3.laya, Thailand and Burma), the Borneo Malaria Conferences (serving Brunei, North Borneo, Sarawak and Indonesian Borneo), and the Malaria Conference for the South Pacific territories (serving the territories of New Guinea, British Solomon Islands Protectorate, New Hebrides Condominium and Australia). In addition, Asian Malaria Conferences which include countries and territories in the South-East Asia and Western Pacific Regions are usually convened every two years. .The Fourth Asian Malaria Conference is scheduled to tal~e place in Manila in late September 1962. 6. COMMUNICABLE DISEASES 6.1 Cholera, Diphtheria, Pertussis and Tetanus During the past year, the programme for the control, or eradication, of the major communicable diseases - venereal diseases and treponematoses, leprosy, tuberculosis, trachoma and bilhar.ziasis - made further progress, but with the gradual strengthening of the health administrations and services in the various countries, more attention was also directed to other prevalent communicable diseases. The outstanding event of the year in this field was the outbreal~ of cholera El Tor in Sarawalc, Hong Kong, Macao, Philippines and North Borneo. The appearance of this disease, so similar to classical cholera, in areas which had been free from cholera for decades, resulted in the occurrence of a large number of cases and a considerable number of deaths. The governments concerned were stimulated to throw all available resources of manpower and material into their efforts to control the outbreaks, and this was successfuly acco~lished in all areas of the Region except in the Philippines, where the largest number of cases had occurred over the most extensive area and the cases continue to occur. These unprecedented outbreaks pointed to the urgent need for a better understanding of the epidemiology, prevention and control of the disease. Accordingly, with the encouragement of certain governments, WHO arranged for an ad hoc meetine; for the exchange of information on cholera El Tor, which was held in Mlnila in April 1962. Participants from fourteen countries of the Western Pacific Region attended, together with participants from the South-East Asia and Eastern Mediterranean Regions and a large number of observers. Four WHO expert advisers provided technical guidance and various aspects of the El Tor problem were considered and discussed in plenary sessions, including diagnosis, epidemiology, prevention and control, treatment, research, and inter-country co-ordination. The consensus of opinion was that the meeting was most valuable, not only for participants from those countries which had experienced outbrealcs, but also for those from countries which were so far free from the disease. • , MALARIA - Viet Nam receives help from WHO and AID in the fight against malaria. In many instances elephant travel provides the only means by which spraying teams can reach remote villages. MALARIA - Helicopters, among other means of transport, have been used to ferry medicated salt to nomadic tribes in the forest areas covered by the WHO-assisted antimalaria medicated salt pro- iect in Cambodia. wr:/RC13/2 page 37 A striking feature of the outbreaks was the international attention they attracted and the ready assistance which was made available by other countries, bilateral and international agencies, as well as by private organizations, including airlines and pharmaceutical manufacturers. WHO and the bilateral agencies assisted with technical advice and by organizing studies on various aspects of the problems in certain areas. The outbrerucs also served to stimulate health administrations to review their preparedness and machinery for dealing with a large-scale outbre&{ of epidemic disease, and focussed particular attention on the need for improved environmental health and health education. The gains recorded in these respects in some areas were quite noteworthy. There has been an encouraging increase of interest in maldng effective use of the potent prophylactic agents available for the control of diphtheria, whooping cough and tetanus, With the major emphasis placed on diphtheria. In Singapore, the Government embarl~d on an intensified over-all immunization programme covering diphtheria, whooping cough and tetanus,. as well as smallpox and BCG immunization. The Diphtheria Immunization Ordinance, 1961, was passed making diphtheria immunization compulsory for the appropriate age groups. The immunizations are to be carried out by the maternal and child health service, the school health service and the four mobile teams recruited and trained for this purpose. The project was planned with the technical assistance of WO and UNICEF provides equipment and supplies, but not vaccines. In Korea, the Philippines and Viet Nam, where immunizations against diphtheria, whooping cough and tetanus have been carried out to a variable extent in the past, the Governments decided to intensify their immunization programmes to achieve the effective control of these diseases. liRO assisted with the preparation of the plans for these intensified programmes, including those for the respective DPT vaccine production laboratories which UNICEF has agreed to support with supplies and equipment. Pending the production of adequate quantities of vaccine of good potency, Korea and the Philippines have continued immunization with the limited quantities now being produced in their own laboratories, and Viet Nam started a vaccination campaign at the beginning of 1962 with vaccines and equipment provided by AID. It is of special interest to note that the immunization programme in Viet Nam is one 0f the responsibilities undertaken by the newly established Epidemiological Unit of the Ministry of Health, which has trucen steps to establish effective reporting and whose plans include the establishment of a public health laboratory service and a medical statistical service to co-operate with the epidemiolOgist. In China (Taiwan) J the extensive country-wide DP immunization c~ign was carried into its eighth year, with an encouraging fall in the prevalence of diphtheria and the number of deaths, particularly when compared with the averages for the past five years; however, a number of cases still continue to occur. With the change in policy covering bilateral aid, the project faces increased administrative difficulties. 6.2 Tuberculosis In view of its wide distribution, its often high prevalence and its serious socio-economic implications, tuberculosis is still rated as an WP/RC13/2 page 38 important J if not the most important J public health problem in most of the countries in this part of the world) and high priority is given to national and international efforts to control the disease. The objective of WHO's policy in this field is to reduce effectively and economically the tuberculosiS problem by the most rational application of the available Imowledge and resources within a comprehensive public health programme adapted to local conditions. The measures used for controlling tuberculosis consist of different methods to break the chain of transmission of the infection at different points. Primary measures are required to prevent transmission of the infecting agent and the se must be supplemented by methods to reduce the risk of developing tuberculosis following unavoidable infections. With the introduction of effective anti-tuberculous drugs in the last decade, the means now exists for a direct attack on the tubercle bacilli in the human reservoir of infection. It is also possible through vaccination and through chemoprophylaxis, both to increase the specific immunity of the non-infected population against the development of tuberculosis, and to reduce the risk of developing the disease among those already infected. These control measures must be applied on a community basis owing to the widespread nature of hidden infectious and potentially infectious sources. In view of the dynamic epidemiological changes of the disease, their application must be executed as a long-term continuous programme. In order to secure the maximal impact on the control of tuberculosis with existing and potential resources of the community, all these measures should be integrated into one programme falling 'VTithin the operational framework of the general public health service. The implementation of these principles under varying local conditions should always be g~ided by objective evaluation of the applicability of recognized control measures. The objective of such a programme in countries with a high prevalence of tuberculosis is to eliminate the disease as a public health problem as rapidly as local resources allow. In countries with a low prevalence of tuberculosis and a better developed public health service, the objective should be an attempt to eradicate the disease. During the first few years of the existence of WHO, there had been no means for a direct attack on the ubiquitous tubercle bacilli. The assistance to countries in tuberculosis control was therefore limited to efforts directed towards the increase of resistance of the susceptible by BeG vaccination. In recent years, however, the means also exists for attaclcing the bacillus directly and thereby intercepting the transmission of infection. The emphasis in tuberculosis control is now to develop a comprehensive public health programme in which reliance is not placed on the independent application of any single control measure, such as vaccination or treatment, but on the most effective integrated use of all control measures that can be deployed on a community basis. In the Western Pacific Region, many countries have already the nucleus of a tuberculosis control programme. Some still take a clinical approach. However, the importance of solving the problem through the public health approach is gradually gaining acceptance by many governments. This can be reflected by an increase in the number of government requests received by WP/RC13/2 page 39 the Regional Office in the past few years. During the year under review} the Regional Tuberculosis Adviser visited Brunei, Cambodia, China (Taiwan), the Federation of Malaya, Korea, Philippines, Netherlands New Guinea, Ryukyu Islands, Singapore and Viet Nam. The regional tuberculosis advisory team which is composed of a statistician, a bacteriologist, an X-ray technologist ana. a public health nurse, was organized in July 1961. The team has worked in the Philippines for two-and-a-half months; in China (Taiwan), for one month; in Viet Nam for a period of seven months, and is now working in the Federation of Malaya. The service components of the team can be explained as follows: (a) wpidemiological service For the purpose of guiding the planning, execution and evaluation of ~ national tuberculosis control programmes, the team assists governments in collecting epidemiological data, qualitative as well as quantitative, on the load of infective sources and the pool of the infected people in the community. To gain reliable data at a reasonable cost, it is important that this information be made available from the control programme and that the personnel operating the programme are trained in the use of uniform and consistent techniques. The assistance to the Government of the Republic of Viet Nam in carrying out a tuberculosis prevalence survey in Saigon/Cholon in 1961-1962 is an example of this type of service rendered by the team. (b) Preventive service The purpose of the preventive service is to prevent the development of tuberculous disease following virulent infection. It may be done either by vaccination of the uninfected or by chemoprophylaxis of the infected. The BCG vaccination service, if adopted, has to be planned and executed on a long-term basis. Emphasis has to be given to the high potency of the vaccine, at the time of vaCCination, the complete coverage of the susceptible population, and to the constant and systematic assessment of these two elements of the service. Last year members of the team assisted in the training of BCG assessment workers and the preparation of a protocol for BCG assessment work in the Philippines. In countries where tuberculous infection is low, chemoprophylaxis can profitably be given to recently infected persons. A progra.znIl)e of this kind is being carried out extensively in Western Samoa. The regional tuberculosis advisory team plans to visit the islands in 1964 in order to evaluate the project. (c) Case-finding service The purpose of the case-finding service is to detect as high a proportion as possible of the total community load of infectious and potentially infectious cases of tuberculosis within the shortest duration of time. Based on the information collected during the survey, mass screening on the prevalence of the disease is then made selectively on priority groups to reduce the cost to a m1n~mum. Different case-finding methods, ranging from direct microscopy of sputum for tubercle bacilli alone to repeated X-ray examinations combined with refined bacteriological investigations, have to .be developed in accordance with local conditions. The assistance of the team in Saigon during the year under review serves as another example of this type of service. WP/RC13/ 2 page 40 (d) Treatment service The primary purpose of the treatment service should be the protection of the uninfected or the reduction of the incidence of tuberculous infection in the community. In view of the fact that the number of hospital beds available for the tuberculous in most of the countries in this region is very limited as compared to the total case load, strict discrimination has to be exercised in selecting cases for institutional treatment. The majority of those detected 1- must be treated at home. In order to ensure prolonged regular self-administration of drugs at home, the co-operation and assistance of community agencies have to be sought. The team may assist governments in evaluating objectively the degree of co-operation thus obtained and in guiding the direction of its development. (e) Assessment service The purpose of this service is to measure objectively the ~uality of the national tuberculosis control programme and thereby to assess the efficacy of each control measure, such as post-vaccination allergy, the reliability of diagnostic techni~ues, regularity of self-administration of drugs, maintenance of e~uipment, etc. The visits of the team to the Philippines and China (Taiwan) are examples of this type of service. It cannot be stressed too much that, in addition to all the services mentioned above, the basic requirement for the success of a national tuberculosis control programme is a uniform and continuous programme for training all categories of personnel. While carrying out practical warl,- in each country, the team members pay special attention to the training of their respective national counterparts. As time goes on, it may be proved that the maintenance of such a regional tuberculosis advisory team is an economical and effective means of providing assistance to governments in the field of tuberculosis control. As in previous years, the BCG vaccination campaigns in China (Taiwan) and the Philippines have been carried on steadily and effectively with WHO/ UNICEF assistance. The national BCG vaccination projects in Hong Kong, Japan, Korea, Malaya, Netherlands New Guinea, Singapore and Viet Nam are also proceeding smoothly. FollOwing laboratory and field studie s for more than five years, WHO officially accepted at the end of 1961 the use of freeze- dried BCG vaccine under special conditions. Through this change of policy, more people in remote areas, especially in outlying island territories, may benefit from the protection afforded by BCG vaccination. Tuberculosis worlrers in Australia, British Solomon Islands Protectorate, China (Taiwan), Federation of Ma.laya, Hong Kong, Japan, Netherlands New Guinea, New Zealand, the Philippines, Singapore, Tonga, Viet Nam and Western Samoa, have expressed their willingness to talre part in a WHO co-operative study on the isolation and classification of mycobacteria from human sources in tropical and sub-tropical areas, with the Department of Tuberculosis, National Institute of Health, Tokyo, and the Public Health Laboratory, Perth, serving as WHO-assisted reference laboratories. The comparative trial on a lyophilized liquid medium for culturing tubercle bacilli developed in .#, WP/RC13/2 page 41 Czechoslovakia is also being conducted in Singapore and Taipei. The co-ordinated efforts of Member countries may also help to solve such pending problems in the field of tuberculosis control, particularly in tropical countries, such as the efficacy of BCG vaccination in a population with a high prevalence of non- specific tuberculin allergy, a safer technique of vaccinating the neWborn with BCG, search for less expensive methods of supervising domiciliary chemotherapy, etc. 6.3 Venereal Diseases and Treponematoses 6.3.1 Venereal Diseases Last year mention was made of the reported increase of the venereal diseases in some countries, particularly of syphilis among the teenage groups. In 1961, in order to evaluate the situation, WHO undertook a survey among Member States and in the Western Pacific Region, four countries reported an increase in syphilis and eleven an increase in gonorrhoea. These reports show that in many countries syphilis and gonorrhoea are again becoming a cause of concern to health administrations. Two countries in the Region, Cambodia and Viet Nam, decided to taclue their venereal disease problem and are now planning control programmes with the assistance of WHO. In China (Taiwan), the Government continued the venereal disease control programme along established lines with material assistance from UNICEF and technical advice from WHO. The Joint Commission on Rural Reconstruction has alao assisted with some local costs. This island-wide programme continued to render valuable service to a vast number of patients but has still to face many difficulties, including a shortage of suitable medical officers willing to undertake venereal disease control work and of trained epidemiological field investigators. During the fiscal year 1962 the Reference Serologic Laboratory of the Shihlin Serum and Vaccine Laboratory participated in the Syphilis Serology Evaluation Study conducted by the Venereal Disease Research Laboratory, United States Public Health Service, with very satisfactory results. Technical information and literature were provided on request to a number of countries and contact was maintained with their technical personnel. Two fellowships were granted to enable personnel from China (Taiwan) to receive training in public health and venereal disease control in Japan and Hong Kong. The lack of interest shown in venereal disease work by technical personnel, with a consequent shortage of suitably trained medical officers and epidemiological field investigators, and the absence of a strong basic health service in some countries were the major difficulties faced in the development of effective control programmes, apart from the almost general shortage of funds. Two countries participated in international studies organized by WHO. The Rapid Treatment Centre, Manila City Health Department, Philippines, co-operated with the Copenhagen Gonococcus Centre in a study of the increased resistance to penicillin of strains of gonococci, and the Serologic Laboratory of the Tol~o University, Japan, participated in a study of the fluorescent treponemal antibody test. IfP/RC13/2 page 42 It is fortunate that with added experience, the occurrence of serious reactions following the administration of penicillin is now comparatively rare and is no longer considered a deterrent to the use of this drug in the treatment of the venereal diseases, except in cases known to be sensitive to the antibiotic. Thus this very effective and cheap therapeutic agent is still available for the fight against the venereal diseases. 6.3.2 Yaws Further progress was made towards the goal of the eradication of yavTS from the endemic areas in the Region through the continuation and expansion of activities in Cambodia and Malaya, the start of a yaws eradication project in the Kingdom of Tonga, and the continuation of surveillance activities in the other areas in which yaws had reached the stage of near eradication. The Territory of Timor has yet to undertwte a specific yaws eradication programme but it is believed to be an area of low endemicity. In Cambodia the project, which has the assistance of a WHO medical officer, as well as material assistance from UNICEF, is combined with mass smallpox vaccination of the population. Examination of 153 506 people at the initial treatment survey revealed 2.2 per cent. of active yaws, including 0.398 per cent. of infectious yaws. During a resurvey of 28 143 people in the former high prevalence areas it was found that the percentage of active yaws was 1.82 per cent., including 0.081 per cent. of infectious yaw.s. Cambodia can, on the whole, be regarded as an area of low endemicity. The resurveys have shown that the campaign has achieved good results in the former high prevalence areas, since during the resurveys there is a tendency towards deliberate over- diagnOSis. The combined teams at the same time performed 12 230 primary smallpox vaccinations and 142 421 revaccinations. In the Condominium of the New Hebrides, the Government successfully concluded the second resurvey, which covered all areas except for the main island of Efate, where no case of yaws was found in a survey of 50 per cent. of the population, and Tanna, where some of the population are opposed to the yaws campaign and no survey was therefore undertal~n. The results of the second resurvey of 40 436 people showed that yaws had reached the stage of near eradication in most areas. The nedical officer in-charge expressed the opinion that in most parts of the New Hebrides it seemed unlikely that yaws would recur, since the people had developed great faith in penicillin and would probably go for treatment if there is a nurse or dresser within a reasonable distance. The remaining danger spots are the more remote areas of Santo and Tanna where 4.7 per cent. of the 3469 outpatients seen at the Mission Hospital during the year were found to suffer from infectious yaws. ThiS, however, indicated that even on Tanna some of the people with yavls will report for treatment. A ''yaws week" was carried out in April 1961 when all the dressers were asked to look for cases in their villages. A few cases were reported and treated although none was a confirmed case. It is proposed to malee the "yaws week" a regular feature of the health department's programme. In the Philippines where mass campaigns have reduced former high prevalence areas to low prevalence areas, and where the prevalence in certain unsurveyed areas is believed to be lOW, a WHO treponematoses advisory team) in conjunction with the national team, completed preparations and initiated WP/RC13/2 page 43 fact-finding sample surveys in accordance with a survey design prepared by WHO Headquarters. Before the start of the work, a WHO statistical consultant visited the Philippines to brief the staff on the statistical aspects of the work,and representatives of the Disease Intelligence Centre and of the Institute of Hygiene, University of the Philippines, participated in the briefing sessions. The WHO health statistician attached to the health statistics project will assist the national statistician of the yaws team in the surveys. An attempt will be made to determine the true extent of the remaining latent reservoir of yaws by co-operating with the WHO Serological Reference Laboratory, Copenhagen, in comparing sample results of standardized reagin testing (i.e. VDRL) with those of techniques using treponemal antigens. The regular "yaws week" was again carried out in Hestern Samoa but the resurvey was concentrated on the population under 15 years of age. In one district, Satupa'itea, the yaws recheck was successfully combined with the tuberculosis survey under the leadership of the WHO tuberculosis expert. Only eight cases of infectious yaws, all und~r seven years of age, were found in the 28 820 persons examined. These children had all missed the previous treatment surveys and it is possible that they were excluded from treatment as they were infants during the last outbreak of poliomyelitis. Seven of the eight cases came from one district. Western Samoa continues to be at .the stage of near eradication and UNICEF has agreed to provide penicillin for continuation of the surveillance work. In October/November 1961 the Second Asian Conference on yaws was held in Indonesia, followed by a conference to evaluate the achievements of the yaws campaign in the South-East Asia and Western Pacific Regions. The conference considered the technical and administrative aspects of yaws eradication, and stressed several important points including: the need for recognition of the long-term public health effort required to ensure that yaws will not again become a public health problem; the need for exchange of information and inter-country co-ordination of activities, particularly in the border areas; the need for careful studies to determine the factors which may be responsible for the recurring sporadic cases of infectious yaws; the importance of the co-ordination of anti-yaws activities with those of other communicable disease control programmes, with the ultimate goal of integration into the expanding rural health services; and the need for WHO to continue stUdies to work out a practical clinico-serological methodology for fact-finding surveys on a sample basis in large rural popUlations. 6.4 Virus Diseases 6.4.1 General The number of viruses discovered with present-day techniques has ,~ increased rapidly and their importance as causes of disease has been fully recognized. In many countries and territories of the Region the virus diseases have remained largely an unchartered field because of lack of adequate virus laboratory serVices, which at one time were only available in some countries of the Region, including Australia, China (Taiwan), Hong Kong, Japan, Singapore and Ne,,, Zealand. During the past year, however, there has been an increased recognition of the need for such services and two countries, Malaya and the Philippines, took steps to establish virus laboratories with international and bilateral assistance. vTP/RC13/2 page 44 WHO provided fellowships for laboratory workers from three countries to enable them to obtain training in virology abroad and in addition an inter- regional training course on viral and rickettsial laboratory techniques was held in Singapore in March 1962. Participants from eight countries of the Region attended,along with four from the South-East Asia Region and six observers from Singapore. The course provided valuable training and contacts fOr workers in the field. During the period of this Report the Department of Virology and Rickett- siology of the National Institute of Health, Tokyo, Japan, was designated the WHO Arthropod-borne Virus Regional Reference Laboratory for the Western Pacific and the John Curtin School of Medical Research, Australian National University, Canberra, was similarly designated for the Australasia region. The functions of this type of reference laboratory are: to identify and study .' arthropod-borne virus strains isolated in its area of coverage; to prepare reference sera and antigens from viruses isolated in its region and to provide small amounts to collaborating laboratories; to maintain prototype and reference strains which should be made available to other reference laboratories; to collect and disseminate epidemiological and technical information on arthropod- borne Viruses, in co-operation with WHO Headquarters; to receive WHO fellows for training; to keep WHO Headquarters fully informed of newly isolated strains and of epidemiological developments, and to report annually on the work performed. The WHO Regional Poliomyelitis Centre, Tokyo, Japan, was designated WHO Enterovirus Reference Laboratory with a consequent broadening of its functions and it has been proposed that the Singapore centre should be similarly designated. The Respiratory Virus Laboratory of the National Institute of Health in Tokyo, which was already an Influenza Centre, was designated a WHO Reference Laboratory for Respiratory Virus Diseases other than Influenza. 6.4.2 PoliOmyelitis The accumulating evidence that the Salk vaccine was effective in preventing paralytic poliomyelitis, if a potent vaccine were effectively used, and the increasingly wider acceptance of the effectivenss, safety and ease of administration of the oral poliomyelitis vaccine have stimulated several countries in the Region to underta1;:e or plan vaccination campaigns against poliomyelitis. According to reports received: Japan decided to use oral poliomyelitis vaccine (Sabin) to deal with an outbreak which starte.d in Kyushu in 1961. In the space of a few weel~s 12 140 790 children were successfully vaccinated in a nation-wide campaign covering the three-month to six-year age group and the six- to ten-year age group in the epidemic area. This was followed by a rapid.fall in the incidence of the disease. A second vaccination campaign was carried out in the first quarter of 1962 and 14 790 000, or 84 per cent. of the children between three months and thirteen years of age, were vaccinated. It is hoped that no further poliomyelitis epidemics will occur but a few cases are expected from those not vaccinated and from some of the vaccinated. In Singapore, the Government also undertook an oral vaccination campaign directed to infants and pre-school children. The WHO Poliomyelitis Reference Centres in Tokyo and Singapore assisted with the vaccination campaigns in their respective countries. .J. WP/RC13/2 page 45 In Korea, the Government also decided to undertake a vaccination campaign, using oral vaccine, and WHO provided the services of a short-term consultant from the WHO Poliomyelitis Reference Centre, Tol~. China (Taiwan) is also planning a vaccination. campaign against poliomyelitis with assistance from WHO and possible support of UNICEF. 6.4.3 Smallpox During the past year all countries in the Western Pacific Region have remained free from smallpox. However, with the present-day means of rapid transport, there still persists the possible danger of the introduction of infection from the existing endemic areas of the world, and health administrations have continued their efforts to guard against the importation of the infection with good reason. In Cambodia, the combined yaws-smallpox campaign contributed its quota of 12 300 primary vaccinations and 142 421 re-vaccinations to those performed by the general health services. Since the health officers and quarantine officers of the countries of the Region where smallpox is no longer endemic do not have the opportunity to observe the disease, vlHO organized a seminar on smallpox which tool~ place in two parts, the first in India and the second in Ceylon. In Madras, the clinical and laboratory aspects of the disease were demonstrated and discussed, and in the port of Madras, Mandapam Camp (India), and in Colombo, the quarantine measures being carried out were demonstrated and discussed. Health officers and quarantine officers from ten countries of the Region attended the seminar. Several countries continue to use glycerinated liquid smallpox vaccine by force of circumstances, but the instability of the product and the need for the provision of adequate cold storage to prevent the loss of potency are major disadvantages, particularly in remote areas. Freeze-dried vaccine offers greater stability, even without refrigeration, and its adoption for use, particularly in the remote areas, is desirable. Recognizing the need for adequate training of technical personnel engaged in vaccine production, WHO organized an inter-regional training course on freeze-dried smallpox vaccine production which took place in Bangkok in November 1961, Medical officers in charge of vaccine production from nine countries in the Western Pacific Region attended the course. 6.4.4 Trachoma The trachoma research and evaluation project in China (Taiwan) was .~ continued with the technical assistance of WHO and the material assistance of UNICEF. The field operations of the epidemiological survey, started in September 1960, were terminated in July 1961 and an analysis of the data collected in this well planned and well executed survey, which covered a stratified two-stage sample involving 1/250 of the population, showed that trachoma was widespread with marked local difference in the prevalence and relative gravity of the disease, that the relative gravity of the disease varied with the local prevalence, that the highest rate of active trachoma WP/RC13/2 page 46 was consistently in the 15 - 20 years age group, and that trachoma in Taiwan was not a "family disease" as many households had only one trachomatous member. The second follow-up examination of the clinical trials was carried out during December 1961. .The first follow-up examination, which took place one year after the commencement of treatment, had shown that trachoma in Taiwan was susceptible to antibiotic treatment, that tetracyline in ointment was as effective as, if not better than, chlortetracycline, and that the intermittent treatment schedule, while more economical, was also more effective than the continuous schedule. The second follow-up examination conducted one year later. showed that the cure rates in Taiwan were a little lower than those obtained in other parts of the world, notably North Africa. However, the trials were limited to first-grade primary schoolchildren, while the better results from other countries .were obtained from older children and adults, and cure rates are known to improve with age up to 20 years. The reinfections and/or relapses were also higher in Taiwan. In February 1962, a trachoma expert from WHO Headquarters visited Taiwan to review the results of the epidemiological survey and clinical trials, and to formulate a new plan of operation for the trachoma control programme which was continued at the same time as the trachoma studies. The new plan, based on the results of the epidemiological survey and clinical trials, was completed and accepted by all concerned. It provides for a six-year programme aimed at the reduction of trachoma to the level at which it ceases to be a public health problem and the prevention of the disabling complications and sequelae of trachoma in the total population. Case-finding is expected to start in late 1962 and will be carried out by the local health personnel, while the supervision of the treatment, applied at home by a member of the household, will be the responsibility of community workers recruited and trained for this purpose. In addition, all the primary schools will be covered, examinations being done by the local physicians and health workers, and the treatment applied by the school-teachers. In the high prevalence areas mass treatment will be applied without case-finding. The trachoma centre has started testing field procedures, recording, reporting, etc., in four circumscribed areas and clinical trials will be conducted in an attempt to develop a still more effective and economical means of mass treatment. The evaluation of the project will be based on the results of a sample survey conducted during the sixth year. 6.5 Parasitic Diseases - Bilharziasis In the Philippines the bilharziasis control project successfully continued its programme of research and training, demonstration of control measures by snail control, improved sanitation, case-finding and treatment, health education, integration of control work into that of the rural health services, and expansion of the work to endemic areas outside the pilot area. The research and training activities took place in Palo, Leyte. The major research work was concentrated on: (a) field studies to determine the efficacy of plain TWSb and TWSb/6 in the treatment of Schistosoma japonicum infections; (b) determination of dissolved oxygen and micro-biota studies in snail positive and snail negative areas; (c) molluscicide experiments in the laboratory, using sodium pentachlorophenate, Bayer 73, and other chemicals, including metaldehyde, sevin, stabilized chevreul salts (S.C.S) and I.C.I.- 24223 hydrochloride; and (d) trials of the application of molluscicides as .J • .. '- j ,_L WP/RC13/2 page 47 a terminal measure in several snail colonies that were previously subjected to ecological control measures. The work on molluscicides was undertaken as part of the WHO re search programme. The staff of the pilot project provided technical assistance to the rural health units and other agencies in the municipalities of Mayorga, La Paz and Buravren, where bilharziasis control has been integrated into the general health programme. Further progress was made in this integration programme with the popularization of the water-sealed type of latrine, particularly in La Paz and Mayorga. Health education, case-finding and treatment vrere pursued with increased vigour, but snail control in the target areas lagged somewhat, Owing to delay in receiving the support required of other agencies whose co-operation is essential if the planned work is to be carried out effectively. The training of the first two regional bilharziasis advisory teams was completed and they started field work in Samar and Mindoro in the third quarter of 1961- Parasitological and malacological surveys were carried out inthree towns in Samar and three towns in Mindoro, topographical surveys made of selected snail colonies and plans prepared for snail control. The engineering groups of the teams have started to carry out these plans with the help and co-operation of other government agencies ruld local and barrio officials. The project continued to receive the assistance of UNICEF which provided equipment and supplies for the regional bilharziasis advisory teams. vlHO provides technical advice on the development and evaluation of the project, and plans vrere prepared for a special evaluation in 1962 by a HHO bilharziasis advisory team, whose members will include a consultant in public health administration. WHO provided a fellowship to enable a national zoologist to study in Japan. The bilharziasis survey of the FAC-assisted Vientiane Plain Agricultural Station Combined Project, which WHO undertook at the request of the United Nations ~kong River Basin project, was successfully completed. No case of infection and no intermediate snail host for Schistosoma japonicum were found. A survey of the corresponding project in Thailand yielded similar results. 6.6 Leprosy The objectives have continued to be to recommend and mal~e more widely known the public health approach to leprosy control, as recommended by the WHO Expert COmmittee, to assist governments to plan control work along these lines, and to train personnel. Recognizing that a major problem in developing effective leprosy control activities in most leprosy endemic areas is the acute shortage of trained technical staff, WHO organized the first inter-regional post-graduate leprosy training course in the Philippines in November/December 1961. Thirty-four doctors from countries of the African, Eastern Mediterranean, South-East Asia and Western Pacific Regions attended, including thirteen WHO fellows from ten countries in the Western Pacific. Twelve additional partiCipants also attended who were not financed by the Organization, and applications from other candidates had to be refused since the number of participants was already too large. The course dealt with all technical aspects of the disease - clinical bacteriology, histology, therapy, epidemiology, prophylaxis and control - by means of theoretical lectures, clinical seminars, laboratory work, field visits and discussions. The enthusiastic response of the participants to the course WP/RC13/2 page 48 and the number of applications for attendance gave evidence of the need for such training. Increased interest in strengthening their leprosy control work was shown by several countries, including Cambodia, China (Taiwan) J Korea, Malaya, Singapore and certain of the Pacific Island territories. A progressive change in thinking in favour of the public health approach to leprosy control and the adoption of legislation in line with scientific advances bas been noted. WHO was unable, because of limitation of funds, to meet the demand for expert technical services from all the countries needing such services but plans have been made to provide these in the future. In Korea, a leprosy control project was started with WHO assistance and a study made of the leprosy problem and the leprosy work being carried out. Training in leprosy was introduced in the medical schools and plans were prepared for future activities. In the Philippines, the Government successfully continued the programme of work for the control of leprosy, including case-finding through the four stationary skin clinics, ten travelling skin clinics and eight sanitaria (leprosaria), treatment of cases on a domiciliary basis and in the sanitaria, follow-up'of cases, and research activities. Further progress was made in the local training of different categories of personnel and four medical officers received fellowships for training abroad, one from WHO, two from the Colombo Plan and one from the Protestant Mission for leprosy and the Philippine Government. The integration of the work into that of the established health services was also pursued 'tnth further gains. Wi th a view to malting case-finding, follow-up and supervision of domiciliary treatment more effective, twenty-four nursing attendants were trained and attached to the offices of the provincial health officers in the endemic areas. In the provinces which do not have stationary or travelling clinics, the cases discovered are referred to the municipal health officers who undertake their management under the supervision of the provincial health officers. The project continued to receive the material assistance of UNICEF; this included the transport necessary to enable the nursing attendants to carry out their field work effectively. WHO continued to assist tecl111ically with the evaluation and development of the programme. 7. HEALTH STATISTICS There has been an increased awareness of the importance of vital and health statistics in countries and territories in the Western Pacific Region. This awareness is evidenced by the growing number of requests from governments for advisory services and by the interest formally expressed by many governments in participating in regional seminars on vital and health statistics. A health statistics project was started in the Philippines during the past year with the objective of imprOving the health statistical services of the Government at national, regional, prOvincial and local levels. An international expert has been assigned to the project since its inception, •• .> - .... .~. WP/RC13/2 page 49 and a national staf'f member, who has been worldng with the expert, will be awarded a twelve-month fellowship in September 1962 for advanced training in health statistics in the United States of America. The vital and health statistics project in Viet Nam, which commenced in December 1960, has been proceeding satisfactorily and morbidity statistics throughout the country are being compiled for use in the determination of the health needs of the people and in the planning and evaluation of the medical and health services. The international expert assigned to the project is planning to conduct a training course for local statistical personnel in the latter half of 1962. The 1-THO expert for the hospital records project in the Federation of Malaya has started a third training course for medical records officers. A fellowship of twelve-month duration will be awarded in July 1962 to one of the twenty medical records officers thus far trained, to enable him to undertake advanced study in medical records in the United Kingdom. The project, which has as its direct objective the improvement of the hospital records system of the medical service in the Federation, will soon develop into a hospital records and health statistics project, \fhich will extend from hospital records to health service records and to all branches of health statistics, viz. hospital statistics, health service statistics, morbidity statistics, causes of death and epidemiological statistics. This is obviously a progressive development and a desirable evolution. It is believed that the expansion of the project will improve the health statistical services of the Government and provide the necessary statistical data for the planning and implementation of effective long-term health programmes. It has not been possible to recruit a suitable expert for the hospital records project in Singapore because of the shortage of medical records experts. Arrangements were, however, made for the expert assigned to the Federation of Malaya to visit Singapore for one month in the second half of 1961 and again in 1962 to assist \nth the improvement of the medical records system in government hospitals. This project, too, is evolving into a hospital records and health statistics project designed to cover all branches of health statistics. It is expected that the implementation of the expanded project will strengthen the statistical machinery of the Ministry of Health and produce adequate health statistics useful for health planning and programme evaluation. A hospital records project will be implemented in the Philippines in the latter half of 1962 in order to train local personnel in medical record-l;:eeping and to improve the hospital records system in government hospitals. The implementation of this project will make it possible to secure, on a permanent baSis, statistical data on hospital morbidity and hospital utilization which can be used as a basis for planning a national medical service. A medical recoms officer is scheduled to undertal~ twelve months of training in the United States of America on a WHO fellowship and, af'ter completion of study, he will work as national counterpart to the WHO expert. A training course on vital and health statistics was held in Suva, Fiji, from 8 January to 2 February 1962 with the objective of training basic statistical personnel for the health administrations of the South Pacific territories. The course was organized in such a way as to provide practical WP/RC13/2 page 50 training in the methods and procedures for the collection, compilation and analysis of vital and health statistics. The statistical methods and procedures adopted were designed to meet the educational, socio-economic and organizational framework of the South Pacific territories. A total of twenty-two participants from eleven territories attended the course with interest and e~thusiasm. This was the fourth vital and health statistics training course held in the Region. In addition to the short-term fellowships provided to participants in the above trainj.ng course, two fellowships were awarded to government officers from Japan and the Terri tory of Papua and New Guinea to enable them to undertake advanced studies abroad in vital and health statistics and in epidemiology and ntatistics, respectively. A statistician was assigned to the WHO tuberculosis advisory team to assist in the statistical planning of tuberculosis surveys in a number of countries and in the compilation and analysis of the data collected. An epidemiologist/statistician has been worlting with the trachoma special study project in China (Taiwan) and has taken charge of the collection, tabulation and ~~alysis of epidemiological data relating to trachoma on the island. /.. consulte"l.t in epidemiology and statistics was sent to Korea in May 1962 for a period of t~ee months to review the national epidemiological and health stat::'stical services and to make recommendations for their strengthening and further development. Although statistical development is a long and slow process, it is hoped that through assist.ance to governments in the form of country and inter-country r~cjects, fellowships and advisory services, the vital and health statistics of countries and territories in this region will eventually fulfill national needs and attain international standards. 8. PROG""£!\!.f~ ANALYSIS AND EVALUATION Special attention was given, during the past year, to programme analysis and evaluation vThich ht'l.s now become a routine in all WHO-assisted projects in the Western Pacific P.3gion. Country projects are periodically assessed by the project staff in collaboration vrith their national counterparts, and inter-co~ntry projects, such as seminars, conferences and training courses, are evaluated by the regional staff after the meeting. The results of period.:l.cal evaluation of country projects are included in the quarterly project reports) v.·hile the terminal evaluf!ttions of inter-country projects are incorporated in the final reports on the meetings. When any member of the field staff leaves a project a detailed evaluation is presented in his assignment reportj vThen tl'.e operatiollP,1 officer from the Regional Office visits the project, his field v::'sit report includes the results of an on-the-spot evaluation. On teTTinaticn of a project, a final report is prepared which contains a complete evaluation covering the whole period of the project from start to finish. Copiec of assignment reports, field visit reports and final reports are sent to the goverIl.!r.,2nts concerned for consideration and comments. .. WP/RC13/2 page 51 It should also be mentioned that every fellowship awarded is assessed, after the return of the fellow, in respect of his contribution to the country and in terms of the benefits derived by the government from the fellowship. In addition to the above-mentioned routine evaluations, it is now planned to ~ee a follow-up evaluation of all country projects one to two years after their completion.. UNICEF-assisted projects, which have received WHO technical approval or advice, but do not have WHO expert personnel, will also be included. During the period under review, eight project staff members attached to seven country projects submitted assignment reports with a broad review of project activities and a critical assessment of the results so far achieved. Six country projects terminated during the past year and summaries of the werle done will be found in Part III. During the same period, ninety-five field visit reports were prepared by the regional technical staff, and the trachoma control project in China (Taiwan) was specifically visited and evaluated by an expert from WHO Headquarters. Since the last meeting of the Regional COmmittee, seven inter-country meetings have talcen place and the organization and achievements of these meetings have been evaluated. A further assessment will be carried out in 1963 on the basis of the contributions made by the participants to their countries as a result of their attendance at these meetings. Where recommendations were made at an inter-country meeting, follow-up evaluation will be mainly based on the extent to .which the recommendations have been implemented by the participating countries. It is hoped that the governments concerned will fully co-operate in these evaluations. As mentioned earlier in this Report, an inter-country tuberculosis advisory team is now operating in a number of countries. One of its functions is the evaluation of the tuberculosis control programmes in the countries visited. An inter-regional treponematoses advisory team assigned to the Philippines is undertalcing a survey of yaws prevalence in order to facilitate the evaluation of the national yaws control programme. An inter-country maternal and child .health advisory services team is assessing the nature and extent of the principal maternal and child health problems in territories in the South Pacific area. Ten short-term consultants in specialized health fields were sent to countries and territories to evaluate particular aspects of health problems; their reports include a critical assessment of the specific situation surveyed and useful recommendations were forwarded to the governments concerned. As in previous years, whenever baseline data were available, statistical methodology was used in project evaluation to measure the quantity and quality of the accomplishment. All newly appointed project staff were briefed on methods of project evaluation and were particuarly encouraged to collect baseline data to permit statistical evaluation of project achievements. The experience gained from the evaluation activities in the past years forms the basis for the planning and operation of future projects and programmes. It is believed that the Imowledge gained in one country is also useful to other areas and it is hoped that this will be profitably shared by all countries and territories in the Region. WP/RC13/ 2 page 52 9. SINGAPORE EPIDEMIOLOGICAL INTELLIGENCE STATION In accordance with the decision of the Director-General to centralize at Headquarters the administration of the International .Sanitary Regulations and Conventions, the Singapore EPidemiological Intelligence Station ceased to function as from 1 January 1962. . . .. . PART III SPECIAL SUMMARIES OF COMPLETED PROJECTS SPECIAL SUMMARIES OF COMPIETED PROJECTS A complete list of projects current during the year will be found in Part IV. The following projects are described in fuller detail as they were completed during the year. Project number WPRO 84 (China ( Taiwan) ) Japan 24 Malaya 28 Netherlands New Guinea 6 Philippines 64 Viet Nam 18 Community water Supply Health Education Survey of Mental Services Maternal and Child Health Public Health Administration Health Laboratory Services r, .. . .. . ... . , -;-. 1. COMMUNITY WATER SUPPLY PROJECT, CHINA (TAIWAN) WP/RC13/2 page 55 For about eight weeks in the months of October, November and December 1961, WHO provided a team of three consultants on community water supply to the Government of China (Taiwan). The terms of reference of the team were to review the status of the community water supply and to submit recommendations for its long-term development with particular attention to financial, administrative and legal problems. The consultants studied the functions and organization of the governmental agencies concerned with water supply, reviewed water supply statistics, the legal, administrative and financial factors relating to community water supply, studied the Government's plan for its improvement and development, and discussed with appropriate government officers all of these topics. At the conclusion of this work the team made recommendations on the specific action to be talren by the Government, listed the most suitable organizational structure for carrying out a water supply programme in Taiwan, and indicated methods of developing sources of funds for this purpose. Prior to the arrival of the consultants, considerable data were accumulated for their review, and an official liaison a8€nt, the Director of the Public \-lorks Bureau of the PrOvincial Department of Reconstruction, was appointed. An official steering cOmmittee, which included the Minister of Interior, the Director of the Public Health Administration, the Chairman of the Water Resources Planning COmmission, the Secretary-General of the Council for United states Aid, the Commissioners of the Provincial Departments of Reconstruction, Health Administration and Finance, the Chief Secretary to the Taiwan Provincial Government, a representative of the AID mission in China, the Professor of Sanitary Engineering, National Taiwan University, the Chairman of the Taiwan Waterworlcs ASSOCiation, and the WHO Representative) was set up. In the course of their visit, the consultants observed that the problem of community water supply was acute. Although water quality was in 8€neral fair, water quantity was inadequate. Pressures in city systems were low. The water utilities generally had an insufficient income to maintain and extend their services adequately and the demands of an increasing population in the communities with piped water supplies were not being met. Of the ten major water services, seven were not keeping pace with new' additions to the population. The general observation was made that with few exceptions, the char8€s for water were too low to meet required interest and amortization charges, and to provide adequate maintenance and operation. The consultants remarked that the island of Taiwan was moving step by step from a traditional agriculture economy toward a modern agro-industrial economy under the determined and vigorous pressure of a national economic plan and national leadership. This movement was producing an ever increasing concentration of population in and around major population centres. Under these conditions, four important parallel and contemporaneous developments were called for: (a) universal electric power; (b) communications, in particular transportation; (c) water; and (d) general urbanization, that is, provision of streets, housing, drainage, schools, shops, offices, factories and other services, public and private; which go naturally with the concentration of WP/RC13/2 page 56 human beings. It was noted that the national programme had taken care of electric power and was proceeding with communications, that over 83 per cent. of the total population of Taiwan were served With electricity but that less than 30 per cent. had running water. However, water supply and general urbanization had not been tween in hand by the National Government but had been left to the Provincial Government or to local governments and private initiative, with the result that the percentage of people in the country with a piped water supply had stood still for almost a decade, and in seven of the ten largest cities had actually gone back in the past five years. The consultants recommended that the National Government adopt a positive and defined community water supply programme and policy, and establish two major new laws. The first law should declare national policy, assign the chief programme responsibility to the PrOvincial Government, and define the relation of local self-government to the community water supply systems. The second major new law should be a revised public water supply act to specify the duties, procedures, powers and rights of individuals, of corporations and of the Government as to water resources and administration. The consultants also recommended the creation within the Provincial Government of a single administrative agency which should be responsible for the provision of an adequate water supply, the conservation and the prevention of pollution of water resources, and the promotion of effective management of the community water supply programme. The functions and duties of the proposed Provincial Department of Community water Supply were outlined, as were the facilities which the cities, towns and counties should provide in regard to community water supply and their relationship to the new department. The findings and recommendations of the consultants were discussed in detail with national officials before the consultants left Taiwan. The consultants I report is now under study by the Government. 2. HEALTH EDUCATION, JAPAN A short-term consultant was sent by WHO to Japan on a six-week assignment to advise the Government on the re-organization of its health education programme. Three aspects of his performance might be commented upon at this stage by means of a preliminary evaluation. First, the contacts he made in Japan at different levels of the health administration afforded him an opportunity, not only to gather information, but also to give health authorities and health worIters, particularly those directly concerned with the health education programme, a proper orientation of what health education actually is. While the educational value of such individual and group contacts mayor may not be long-sustaining, they could be viewed as the beginning of an orientation process .to be sustained by future visits of the Regional Adviser on Health Education, and by the efforts of the senior workers and faculty members who will receive proper training abroad, and who will be in a position to exert their leadership in a newly developed field. WP/RC13/ 2 page 57 Second, the recommendations made by the consultant, particularly those related to the initiation of professional leadership by qualified specialists at the Ministerial and other levels, and to the training of such specialists, involve such fundamental issues that action along these lines is a matter of priority if progress in the national health education programme is seriously envisaged. A sense of urgency on the part of the Government in studying the recommendations can be gleaned from a letter the senior government official in charge of health education wrote to t.he consultant urging the early despatch of .his assignment report. It appears likely, therefore J that action will be taken along the lines recommended. Third, the link the consultant has established with health worl~ers in Japan is being utilized by some of the latter for further consultative services. Already he has been consulted by mail on the health education aspects of a local tuberculosis control programme. More may be expected. An even closer tie will be established in future when staff holding key posts in the Government or those designated to hold such posts are sent abroad for post-graduate studies, particularly to the United States of America. In all these aspects, the project has served a useful pUrPose and the recommendations made will be followed up by the Regional Adviser on Health Education when that post is filled in the latter part of 1962. 3. SURVEY OF MENTAL SERVICES, MALAYA Two previous surveys were undertaken by WHO consultants for the Government of Malaya, one in 1954 on the mental health services and another in 1956 on psychiatric nursing. Some of the recommendations were implemented but the basic problems of organization and administration and of shortage of qualified personnel remained. At the request of the Government, another WHO consultant spent three months, from February to May 1962, on a thorough survey of all the mental institutions in the Federation. The two mental hospitals were overcrowded to the extent that many of the patients were not provided with the elementary necessities of hospitalization. Advice on a rearrangement of beds to provide more space and on the reclassification of patients to permit better grouping and therapeutic situation has already been implemented. It is hoped that other recommendations relating to conditions in and around the hospitals are practicable enough to be accepted and also acted upon. The consultant also recommended the establishment of a regionalized system of mental health services) starting with the rural health units at the local level and redefining the functions of mental hospitals, in order to reach all segments of the population and to reduce the load placed on these hospitals. The personnel requirements for such a system would be of a magnitude that would take a number of years to fulfill. But a good start can be made in the undergraduate teaching of mental health and psychiatry, and in the implementation of a system of mental health education for public health personnel, medical practitioners and the mentally ill} as well as communities at large. WP/RC13/2 page 58 To undertal~ and promote these and other activities suitable to the growing needs of a rapidly developing country, it is essential that a senior medical officer at the ministerial level be designated to take overall charge of a nation-wide mental health programme, one which will be looked upon as a model undertalcLng by all developing countries in the world. 4. MATERNAL AND CHILD HEALTH PROJECT, NETHERLANDS NEW GUINEA This project was started in 1956 when plans were made for a maternal and child health programme with the assistance of WHO and UNICEF. The original ~ I j objectives were to train infant welfare nurses who would work in the villages l. .. from which they had been recruited under the supervision of senior staff and to provide supplementary feeding in infant welfare centres and in schools for malnourished children, pregnant and nursing women. In the initial stages, supplies and equipment were provided by UNICEF while WHO assistance was limited to technical advice. In 1959, however, it was decided to develop the programme further and 't'ffi0 agreed to make provision in 1961 for an adviser in maternal and child health, and fellowships in 1959, 1960 and 1961. UNICEF agreed to provide transportation, supplies and teaching equipment. The terms of reference of the VlHO medical officer were to evaluate the maternal and child health activities and to assist the Department of Health to draw up plans for future work with special reference to the following objectives: to establish closer co-ordination and integration of the preventive, curative and health promotional services for mothers and children~ to strengthen paediatric services and training activities. The medical officer started his assignment in February 1961. He spent the first months travelling throughout the country, collecting information on the maternal and child health work that had already been done and assessing the present maternal and child health activities. An interim report containing a number of suggestions and recommendations was submitted to the Director of Public Health. The second half of his assignment was used to implement some of the suggestions made and to assist in the development of new training courses. In the course of the year the WHO medical officer stayed in Netherlands New Guinea, the follOwing changes took place: (a) A post-graduate course to train senior village workers as supervisors was initiated in the middle of 1961. (b) The number of training centres for infant welfare nurses was increased from four to six. (c) A form was designed to give the infant welfare nurses information about the children in their area who had been discharged from hospital, thus enabling them to follow up such children after their return to the village. WP/RC13/2 page 59 (d) New recording charts were designed for the mothers and children visiting the maternal and child health centres. (e) During visits to almost all the districts, discussions were held with doctors, nurses and other health workers to make them more ''maternal and child health minded". (f) steps were talren to initiate a mass treatment campaign covering all children with ascariasis. UNICEF undertook to provide the piperazine tablets required. ( g) The importance of the training of ''bidans'', or traditional birth attendants, was stressed and new courses were initiated for the purpose. (h) The distribution of sldmmed milk and vitamin A-D capsules was improved and the number of beneficiaries increased in both the maternal and child health centres and the schools. One year is not a sufficiently long period for a project in a vast and inaccessible country to shOW important changes. Some results have, however, been obtained and it 1s expected that these will increase in the coming years, as the work is being continued by the head of the maternal and child health division, who was the national counterpart of the WHO consultant. The main developments are as follows: (a) The supervision of the maternal and child health village workers has improved, both in quality and in quantity, as a result of the training of senior Papuan nurses, midwives and village worIt.ers. (b) There is better co-ordination between the work done in the field and the hospitals as a result of the referral system which has been developed. (c) The maternal and child health services are gradually being integrated into the general health services. This move vall receive new impetus with the implementation of the WHO-assisted project for rural health development, which is expected to start in 1963, and in which it is planned to demonstrate how all medical services, including maternal and child health, should be co-ordinated into one general medical service. 5. PUBLIC HEALTH ADMINISTRATION, PHILIPPINES This project which was implemented in November 1961 and completed in May 1962 had the following objectives: to assess the national rural health programme and review its role and performance in relation to organization, staff, policy and operation; to appraise the training programme for the different categories of rural health personnel with a view to determining requirements that would best meet their responsibilit,ies in the fieldj to review and report on the progress of the integratictP~':o;f activities of the WP/RC13/2 page 60 specialized health services into those of the rural health units, and observe how the latter are co-ordinating their programmes with official and voluntary agencies in the medical, health and related fields. The WHO team. consisted of a public health administration consultant, a public health nurse consultant and a sanitary expert, the latter post being filled alternately during the field visits by the Regional Sanitary Engineer and a project sanitarian. The WHO staff cOllaborated closely with their national counterparts and the government/WHO team. worked as one unit and submitted a joint report. The project's activities were divided into three phases, namely, preparatory, field visits and the preparation of a final report. The preparatory phase covered orientation of the international staff to local health conditions; gathering of background information, including technical and administrative material to be needed in the survey; and devising their work programme. In the field visits, it was decided to observe a cross- section of the operating rural health units, taldng into consideration such influencing factors as accessibility> population size, staff composition and special health activities added to the regular staff duties. The last phase was spent in Manila where the findings were consolidated and the conclusions and recommendations formulated. The joint team visited 40 rural health units in 25 provinces, out of a total of more than 1300 rural health units in 56 provinces. All eight regional training centres were also visited. The team. used forms devised earlier, consisting of an inf'ormation sheet which the rural health unit staff was requested to fill, and an interview guide which each team. member used in conferences with their opposites in the rural health units. The information collected by each member was pooled together in post-visit meetings of the team. and served as a basis for appraising the rural health units covered. The govern:rrent/WHO team's report inclu.ded the following conclusions and recommendations: (a) Training The regional training centres might consider reviewing their training programme, including the methods used, with a view to meeting health personnel needs and requirements in the field. With this end in view, the staff of a provincial health office might be involved at a certain stage of training and a further opportunity provided the health personnel to observe actual field conditions in selected rural health units. (b) Staffing pattern In addition to the legal requisite of emplOying population size to determine the staff requirements for the rural health units, other criteria might also be conSidered, particularly those related to local health problems and needs. (c) Redefinition of functions of rural health units WP/RC13/2 page 61 It was suggested that a review be made of the present functions of the rural health units with a view to enabling the staff to respond more readily to local health needs and requirements. (d) Environmental health The Government's attention was drawn to the importance of this activity in all local health programmes. (e) Health supervision over vulnerable age-groups A hiatus in health supervision was observed in the vulnerable age-groups ~ of infants andr~choolchildren as evidenced by the high morbid! ty and mortality among them. It was, therefore, recommended that health supervision over these age-groups should be increased. (f) ''Difficult areas II It was not easy to find staff for some rural health units located in "difficult areas ". The Government was, therefore, urged to offer certain inducements such as housing privileges, increased pay, longer leaves, attendance at national seminars and meetings, etc. (g) Integration of specialized health services into the rural health units Before specialized health services were integrated into the rural health units, the following should be ascertained: that the rural health units staff fully understood what was required of them and why it was required, that the ~ extra work involved would not disorganize the planned programme of the rural health units and that, when indicated, additional staff would be supplied. 6. HEALTH LABORATORY SERVICES J VIm NAM The objective of this project was to assist in conducting a survey and in submitting recommendations on the facilities, resources and means for strengthening health laboratory services in Viet Nam. The WHO consultant's services covered a period of three months starting in late February 1962. His activities consisted of visits to laboratory institutions and conferences with their staff. In the course of these viSits, observations were made on the facilities and resources available, their needs, and the activities they were undertaking~ The consultant also assisted the UNICEF Supply Officer to prepare a supply list required by the pasteur Institutes which are producing DPT vaccines in connection with the Government's immunization programme. Among the institutions visited were the Pasteur Institutes of Saigon, Dalat and Nha Trang; the Central Pharmacy Laboratory and the Nutrition Laboratory, Saigon; hospital laboratories at the University WP/RC13/2 page 62 Hospital, Cho Ray; the Infectious Diseases Hospital, Cho !Cuan; the Children's Hospital, Nhi Dong; the Saigon Hospital; the Hospital of Binh Duong; the Tuberculosis Hospital, Hong Bang; the Medical School Hospital, Hue; the hospital in Tourane; the hospital in l{y Tho; and the National School of Medical Biology, Saigon. The consultant's report contained the following observations and recommendations: (a) For the further development of laboratory services in the country, three approaches were sug@ested, viz., (i) Designation and development of a central health laboratory which will serve as a national diagnostic and reference laboratory centre. The consultant considered the Pasteur Institute, Saigon, as the most suitable for the purpose, although other sites were also suggested. Whatever the site, it was anticipated that an entirely new laboratory would need to be constructed after about ten years. (ii) Stimulating the professional interest of staff in laboratory work through employment inducements, offering fellowships abroad, and providing for research opportunities. ( iii) Developing and stimulating re search programme s. The following were recommended: the aetiology of infectious diseases most influencing infant mortality, endemic plague and venereal diseases surveys. Work on the last two diseases are presently under the sponsorship of the Ministry of Health. (b) International assistance to laboratory activities. The consultant recommended that a five .. year programme of assistance should be developed and that WHO should provide an expert, fellowships, and a small amount for supplies and equipment. The GoverIlJll:nt has requested WHO for an expert in health laboratory services. (c) Establishment of a governing council for health laboratories. It was envisaged that such a group should recommend on policies on health laboratory activities in the country. Membership of this council would be vested in representatives of the Pasteur Institutes, of the Ministry of Health and the senior executive staff of the Central Health Laboratory • (d) A su~sted health laboratory programme covering a period of approximately five years contains the following features: (i) establishment of a central health laboratory in Saigon, taking account of the institutions suggested for this purpose; (11) establishment of regional laboratories in Hue, Dalat and Nba Trang some two years after the Central Health Laboratory has been inaugurated; • ~ .. WP/RC13/2 page 63/64 (iii) creation of an office of laboratories under the Director- General of Hospitals and Public Health. The possibility of the Director of Laboratories also serving as ex-officio Director of the Central Health Laboratory was suggested; (iv) concentrating all hospital microbiological examinations at the Central Health Laboratory with the exception of the examination of direct smears; (v) providing further inducements for the recruitment of scientifically qualified personnel for the health laboratory service; (Vi) undertaking of research in fields of special interest to public health; (Vii) negotiating external assistance from the following agencies: WHO, through advisory services; UNICEF for supplies and equipment; Colombo Plan and bilateral agencies for fellowships and also supplie s and equipment. PART IV PROJECTS IN OPERATION PROJECTS IN OPERATION This part of the Report contains a list of the projects - country, inter-country and inter-regional - that were in operation during the whole or part of the period from 1 July 1961 to 30 June 1962. Oontinuing projects for which the only assistance given during the period was technical advice from the Regional Office are not shown. In country projects, the purpose for which the government under- took the project is stated. Details of the assistance provided by WHO and work done are given for completed inter-country or inter-regional projects. Such details are not given for continuing projects. Under the heading ''Fellowships 'f are shown those fellowships awarded during the same period that do not form part of assistance to a larger project. A table showing all the fellowships awarded, by subject of study, is given in Annex 6. The starting and finishing dates are shown in parenthesis after the project title; in some cases the finishing dates are still tentative. Names of other co-operating agencies, whether or not they have contributed funds, are given after the source of funds. The abbreviations used include the following: R- regular budget; MESA - Malaria Eradication Special Account; TA - Expanded Programme of Technical Assistance. other abbreviations are explained on page ii. a· WP/RC13/2 page 67 WPRO 14 Group Fellowships on the Clinical Diagnosis of Smallpox and Seminar on Smallpox (16 Feb .... 2 March 1962) R A seminar to familiarize health personnel with the clinical and laboratory aspects of smallpox, the quarantine measures being used to prevent the export of the disease from endemic areas and those to prevent the entry of the disease into non-endemic areas. The seminar satisfied a need arising from the existing danger of the introduction of smallpox through the present-day rapid means of communication with smaJ.lpox endemic areas and the probable unfamiliarity of health personnel of non-endemic areas with the clinical and other aspects of the disease. The WHO Regional Office for South-East Asia undertool~ to make arrangements for the seminar in two parts, the first of which took place in M9dras and the second in letmdapam and Colombo. In Madras the programme included a demonstration of cases of smallpox, together with the consideration and discussion of the clinical diagnosis and management of cases, and a demonstration and discussion of the laboratory diagnosis of smallpox. In the port of Madras, in Mandapam Camp (India) and in Colombo, the quarantine measures being carried out were demonstrated and discussed. There were ten participants from the Western Pacific Region, one each from Australia) Federation of Malaya, Hong Kong, Japan, North Borneo, New Zealand, Philippines, Republic of Korea, Republic of Viet Nam and Singapore. Three participants from the South-East Asia Region and several observers from India also attended. The Western Pacific Region provided travel and allowances for ten participants and two temporary advisers and supplies and equipment. WPRO 22 Yaws contrOl, Tonga (April 1962 - 196) R UNICEF To reduce the prevalence of yaws by mass examination and treatment with penicillin and ultimately to eliminate the disease as a public health problem; to train local personnel in the diagnosis, therapy and epidemiology of yaws. WPRO 28 Seminar on Child Health and the School, Mmila (27 Nov. - 8 Dec. 1961) R (UNESCO) A seminar to identify the most important problems of schoolchildren and '~_ young people in the Region, make reconnnendations for improving and extending health programmes for them, and consider what schools may do, in co-operation with parents and health and other agencies, to meet the health needs of schoolchildren. There were twenty-four participants - from Australia, China (Taiwan), Federation of Malaya, French Polynesia, Hong Kong, Japan, Netherlands New Guinea, New Zealand, Papua and New Guinea, Philippines, Republic of Korea, Republic of Viet Nam, and Singapore - and two observers from UNICEF. WP/RC13/2 page 68 WHO provided three short-term consultants, four seminar sta:f'f members, cost of attendance of the participants, and supplies and equipment. UNESCO provided the services of a consultant and a secretariat sta:f'f member. WPRO 37 Poliomyelitis Centres, Singapore and Tokyo (June 195~1964) R A short-term consultant was assigned to Korea for two weeks in April 1962 to advise and assist the Government with its new project of inoculation against poliomyelitis. Board To co-ordinate antimalaria wrIt in the countries represented on the Antimalaria Co-ordination Board (Burma, Cambodia, Federation of Malaya, Laos, Republic of Viet Nam, and Thailand). WPRO 44 Nursing Administration Seminar, Tokyo (16-28 Oct. 1961) TA A seminar to bring together nurses engaged in nursing education and nursing service administration to exchan@e views on nursing administration in countries of the Region - its function in health programmes, how it can be improved at all levels, and how nurses can be better prepared for administrative posts - and to malte recommendations for action and study. Discussions centred on ways of establishing effective relationship between nursing and other health services and between nursing education and nursing services, of providing nursing of high standard under prevailing conditions, and improving skill in nursing administration. There were twenty-five partiCipants - from Australia, Cambodia, China (Taiwan), Federation of Malaya, Guam, Hong Kong, Japan, North Borneo, New Zealand, Philippines, Republic of Korea, Republic of Viet Nam, and Singapore - and representatives from the United States Operations Missions in Korea and Viet Nam and the International Council of Nurses. WHO provided two short-term. consultants and six seminar staff members, costs of attendance of the participants, and supplies and equipment. WPRO aduate Medical To increase the number of assistant medical and dental officers in the health services of the South Pacific island territories by providing fellow- ships for undergraduate studies at the Central Medical School, Fiji. Two twelve-month fellowships were awarded to assistant dental officers from Western Samoa. • T,VP/RC13/2 page 69 WPRO 68 Trial of Medicated Salt (Pinotti1s Method), Pail in , Battambang Province, Cambodia (July 1959 - 1963) MESA To carry out a trial distribution of chloroquinized salt, so as to study the technical and administrative aspects of distribution in a particular social and ethnic environment and, by assessment of epidemiological trends, to ascertain whether malaria endemicity has been reduced and transmission stopped. (Chloroquinized salt has been substituted for the pyrimethaminized salt which was used in this project until May 1961.) WPRO Advi sor Team To assist countries of the Region in assessing their tuberculosis programmes. The team has already visited China (Taiwan), Federation of Malaya, Philippines and Republic of Viet Nam. WPRO 76 Refresher Course on Integrated Rural Health for Assistant Medical Officers in the South Pacific, Apia, Western Samoa (2 Nov. - 11 Dec. 1961) R (SPC) A five-week refresher course on integrated rural health (including environmental sanitation, maternal and child health, medical care, public health, tuberculosis and health education for eighteen assistant medical officers from American Samoa, British Solomon Islands Protectorate, Cook Islands, Fiji, Gilbert and Ellice Islands, New Hebrides (British Service), Niue, Papua and New Guinea, Tonga and Western Samoa. WHO provided three short-term consultants, costs of attendance of the trainees, and supplies and equipment. Two staff members were seconded by the South Pacific COmmission. WPRO 77 Training Course on Vital and Health Statistics for Territories in the South Pacific Area, Suva (8 Jan. - 2 Feb. 1962) R A training course to train basic statistical personnel to meet the actual needs of health administrations of South Pacific territories and to provide practical training in vital and health statistics. The training course comprised not only lectures, demonstrations, discussions and laboratory exercises on the methods and procedures for the collection, compilation and analysis of vital and health statistics, but also field visits to government agencies' responsible for civil registration, vital and health statistics in Fiji. MOre time was alloted to exercises than to lectures and the reports turned in by the partiCipants were corrected by the teaching staff. There were twenty trainees from American Samoa, British Solomon Islands Protectorat.e, Cook Islands, Fiji, Gilbert and Ellice Islands, WP/RC13/2 page 70 Netherlands New Guinea, Papua and New Guinea, Tokelau Islands, Tonga, the United states Trust Territory of the Pacific Islands and Western Samoa. WHO provided two short-term consultants, travel and stipends for the trainees, supplies, equipment and technical literature. (In addition to those listed above, two participants from Fiji attended at government expense.) WPRO 80 Participation in United Nations Mekong River Basin Project: Bilharziasis Surve of the Vientiane Plain ricultural Station First phase: June-Aug. 19 0; second phase: 1 June - 7 July 1961) R (ECAFE) Two surveys have been made in selected areas of the Mekong River Basin in Laos and Cambodia. The first survey, designed to obtain information on the prevalence of the disease in man and the vertebrate hosts and to identify the vector, consisted of search for the host vector, stool examination for ova, and intradermal skin test for schistosoma. As a result of the survey, the consultants reported that there appeared to be no significant, if any, incidence of schistosomiasis in the areas investigated. The second survey was made at the request of the Committee for Co-ordination of Investigations of the Lower Mekong Basin. The objectives were two: (a) to search for active and latent cases of human schistosomiasis in the survey area, and (b) to carry out an ecological survey and to search for possible intermediate and other hosts of Schistosoma japonicum in the area which has been selected for the establishment of the Vientiane Plain Agricultural Station. All the investigations carried out in the project area failed to establish the presence of schistosoma infection in any of the possible human, animal and snail hosts examined or to demonstrate the presence of any Oncomelania quadrasi or Wattebledia snails. There remains to be considered the question of the possibility of the future importation of Schistosoma japonicum. Hence, the progress of the research work being carried out now in South Thailand should be eagerly watched by all those concerned and the position reviewed in the light of new findings, as it is possible that at present an unknown snail vector of schistosomiasis in South Thailand might be one of the species found by the survey team. WPRO 82 Seminar on Maternal and Child Nutrition, Manila (3-14 January 1962) R A seminar to describe and define the practical problems being met with in public health practice in the field of maternal and child nutrition; to study present lcnowledge about food and nutrition relevant to these problems; to consider effective means of educating mothers and other members of the family about adequate diets; and to arrive at a conclusion about the use of .. WP/RC13/2 page 71 artificial feeding of infants in the light of present knowledge. It was attended by twenty-six participants - from American Samoa, Cambodia, China (Taiwan), Federation of Malaya, Hong .Kong, French Polynesia, Japan, Netherlands New Guinea, North Borneo, Philippines, Republic of Korea, Republic of Viet Nam, Ryukyu Islands and. Singapore - and eight observers from UNICEF, FAO, AID, the Philippine Government and WHO field staff. WHO provided two short-term consultants, the cost of attendance of twenty participants, and supplie s and eCluipment. UNICEF provided the cost of attendance of six participants. Services in the South Pacific To study existing prOvisions for maternal and child health care in certain territories in the South Pacific area with a view to investigating the principal health problems, the extent of preventible mortality and morbidity among mothers and children, and suggesting public health programmes designed to improve the situation in the light of the social and economic possibilities of each territory. WPRO 84 Water SUPPly Progra.mme s (Oct. 1961 - Special Account for Community Water Supply To assist countries of the Region with the organization of water supply programmes. The project provides for three consultant teams, to be constituted according to needs. See page 55 for a summary of the assistance provided to China (Taiwan). WPRO 113 Meeting for the Exchange of Information on El Tor Vibrio Paracholera, Manila (16-19 April 1962) R A scientific meeting to bring together senior medical officers of countries and territories exposed to a resurgence of El Tor vibrio paracholera (cholera El Tor) for a thorough exchange of information on the epidemiology, prevention and control of the disease. There were twenty-one participants from the Eastern Mediterranean, South-East Asia and Western Pacific Regions - China (Taiwan), Federation of Malaya, .Hong Kong, Indonesia, Japan, Macao, Netherlands New Guinea, North Borneo, Pakistan, Philippines, Republic of Korea, Republic of Viet Nam, Ryukyu Islands, Sarawak, Singapore and Thailand - and more than twenty observers from AID, the United States Armed Forces and. from among research and. health workers in the Philippines, Japan, Ryukyu Islands and the Pru{istan-SEATO Cholera Research Laboratory. The meeting, which was conducted in plenary sessions only, agreed with a recommendation of the Scientific Group on Cholera Research that on epidemiological and clinical grounds El Tor vibrio paracholera and classical cholera are indistinguishable and that the former should also be declared WP/RC13/2 page 72 quarantinable. This was the substance of a subsequent reco:mmendation submitted by the International Committee on Quarantine and acted upon by the Fifteenth World Health Assembly. WHO provided four temporary advisers, cost of attendance of sixteen participants (three provided by the Eastern Mediterranean and South-East Asia Regional Offices), and supplies. Australia 200 Fellowships R: Laboratory (three months), leprosy control (six months), occupational health (six months). British Solomon Islands Protectorate 2 Malaria Eradication Pilot Project (Sept. 1961 - 1971) MESA TA (SPC) To find a method of interrupting malaria transmission in the Protectorate and collect the data needed for planning malaria eradication; and to train staff in preparation for an eradication programme. British Solomon Islands Protectorate Education Nov. 1959 - 19 R UNICEF To carry out a basic programme of general nursing for nurses and medical assistants, and a programme of midwifery and maternal and child health combined with the nursing programme for women nurses. ramme To provide the national director of the programme with any technical assistance and administrative advice necessary to the proper implementation of the programme until such time as a plan of operation for a malaria pre-eradication programme is prepared. Cambodia 1 Malaria Pre-eradication Programme ( Oct. 1950 - 1970)MF.SA TA (AID) To organize antimalaria services; to pave the way for malaria eradication; to train personnel. Cambodia 3 Nursing Education, Phnom-Penh (Dec. 1951 - 1965) R UNICEF (Colombo Plan, AID) To set up a school of nursing in Phnom-Penh; to organize nursing and midwifery training. • Cambodia 4 Maternal and Child Health (Second phase: V~y 1962 - 1965) TA UNICEF WP/RC13/2 page 73 To develop a national maternal and child health programme and give some further assistance in school health. Mission, AID) To raise the standard of teaching at the ROyal School of Medicine to professional level and to increase facilities for training hospital assistants. Cambodia 8 Treponematoses Control (Sept. 1959 - 1963) R UNICEF To train professional and auxiliary medical personnel in yaws control methods; to reduce the incidence of yaws by mass treatment with penicillin and eventually to eliminate the disease; to organize in the project area a rural health service which will also continue the yaws control 'WOrk; and to carry out a smallpox eradication campaign in the area. AID) To plan and implement a comprehensive provincial health programme; to build up model public health services in Kandal province; and to give field training to all categories of medical and health personnel at the Takhmau centre. Cambodia 10 Public Health Administration (March 1960 - 1963) R To survey health conditions and prepare long-range national health plans, and to reorganize as necessary the central and local health administration. Administration and Architecture TA A WHO consultant to advise the Government on the planning, construction, organization and administration of government hospitals. China 1 Venereal Disease Control, Taiwan R UNICEF Three fellowships (each for six months) were awarded under this project, for which staff and other assistance were provided between 1953 and 1959, and 1960 and 1961. WP/RC13/2 page 74 China 6 Nursing Education, Taiwan (May 1952 - 1964) TA ( China ~dical Board) To improve the standard of nursing education and the quality of nursing services by establishing a school of nursing at the University Hospital in Taipei. China 7 Malaria Eradication Progracwe, Taiwan (May 1952 - 1964) MESA (AID) To complete the eradication of malaria from Taiwan by use of residual insecticides) antimalarial drugs and an effective surveillance system. China 14 Environmental Sanitation, Taiwan (Oct. 1954 - 1962) TA (AID) To survey the organization and functions of governmental agencies concerned with environmental sanitation; to assess the chief problems and determine their relative urgency; to carry out a pilot project of modern and economic sanitation procedures; and to train personnel. China 17 Tuberculosis Control, Taiwan R UNICEF Two fellowships (one for twelve months and the other for six months) were awarded under this project, for which staff and other assistance were provided between 1956 and 1960. China 20 Mental Health, Taiwan (Oct. 1955 - 1965) R To carry out a mental health programme with particular attention to child guidance and community mental hospitals. China 27 Institute of Public Health (Aug. 1958 - 1964) R (China Medical Board, AID) To strengthen the training at the Institute of Public Health, particularly that in epidemiology and public health practice. China 34 Trachoma Research ruld Evaluation, Taiwan ( Jan. 1960 - 1967) R UNICEF To improve Imowledge of the epidemiology of trachoma and related viral and bacterial infections of the conjunctiva in Taiwan; to define and standardize the criteria for their diagnosis and cure; to develop methods of treatment which are effective and practicable on a large scale; and to provide data on which to base control measures and later evaluation. r WP/RC13/2 page 75 China 200 Fellowships R: Food control (six months), ~ntal heal tl'1 ( twelve months), occupational health ( twelve months), public health administration (two for five and a half months, one for twelve months). Cook Islands 200 Fellowships R: Tuberculosis control (six months). Fiji 2 Central Medical School, Suva (Feb. 1955 - 1964) R (China Medical Board) To train assistant medical officers for government service in Fiji and adjacent territories, and to strengthen the staff of the Central Medical School. Fi i 200 Fellowshi s R: Maternal and child health (twelve months), mental health one for three months, two for six months). Hong Kong 200 Fellowships R: Dental nurSing (two for twenty-eight months), mental health ( one for three months, one for ten months). Japan 4 National Institute of Mental Health (June 1953 - 1963) R To survey needs and facilities and draw up a mental health programme; to carry out research, and to train local professional and auxiliary personnel. Japan 21 Control of Virus Diseases R Two fellowships (each of six months) were awarded under this project, for which a short-term consultant was provided in 1960. Japan 22 Care of the Deaf and Mute R Two fellowships (six months each) were awarded under this project, for which a short-term consultant was provided in 1960. Japan 24 Health Education Advisory Services (Oct.-Nov. 1961) R See page 56. Japan 200 Fellowships R: Drug control (two for six months), enviroIllOOntal sanitation (two months), health statistics (four and a half months), hospital and medical care administration (two for five months), nursing (six months), public health administration (one for twelve months, one for six months, one for five months). WP/RC13/2 page 76 Korea 4 Leprosy Control (Nov. 1961 - ~966) R To improve the leprosy control programme by co-ordinating the present control work, providing health education, and training medical and other personnel concerned with leprosy control. Korea 13 Malaria Pre-eradication Programme (June 1959 - 1964) MESA To survey the malaria situation, organize a national malaria service and train staff, so as to enable an eradication programme to be planned and implemented. for Public Health Trainin To set up two demonstration centres, one for urban health and the other for rural health; to implement pilot projects for disease control and health promotion, in which trainees of the National Institute for Public Health Training may gain practical experience; to organize short-term pre-service, in-service and refresher training for goverr~nt health workers. Surve To eValuate the available health services and to develop a long-range integrated national health programme, which w~ll tclre account of the .country's health needs and the resources that can be applied, including those from external sources which may be made available to the Government. Korea 19 Tuberculosis Control (March 1962 - 1967) TA To develop an effective and comprehensive tuberculosis control programme; to reduce and eliminate the infection as a public health problem. Korea 200 Fellowships R: EPidemiology (twelve months), nursing (second year award). public health administration (twelve months). Laos 2 Central Health Laboratory (Jan. 1953 - Aug. 1959; Nov. 1960 - 1965) TA To establish a public health laboratory service and train laboratory personnel. r Laos 6 Maternal and Child Health (Sept. 1959 - 1964) R UNICEF WP/RC13/2 page 77 To ascertain the prinCipal maternal and child health needs in Laos and set up training programzooSj to improve maternal and child health services as an integral part of the general health programme. Laos To survey health conditions and prepare long-range national health p1ansj to develop a programme of work appropriate to local. conditions, and to organize the operation of the national heal.th administration at the central and peripheral levels. Laos 10 Rural Development in Public Health (March 1961 - 1970) TA UNICEF (United Nations, FAO, ILO, UNESCO, Colombo Plan) To provide practical training courses in nursing and midwifery and in- service training; to promote and develop environmental sanitation; and to carry out health education, particularly as regards home sanitation, maternal, infant and child care and nutrition. Work carried out under this project is a part of the programme, assisted by the United Nations, for the economic and social development of the rural population. It is planned to set up four centres in rural areas, with staff from the participating agencies. Laos 12 Nursin~ Education (1962-1970 TA To develop a training programme which will prepare nursing/midwifery personnel for the hospital. and health services in the country; to extend and improve the present hospital and health services, to promote health, prevent disease and to provide adequate care to the sick. YelaYf 14 Ho~ital Administration May 1956 - 1964) TA To review the hospital administration system and to provide training for lay hospital administrators in the Federation or overseas. MalaY( 15 Hospital Records Nov. 1956 - 1964) TA To review and reorganize the hospital records systems in the Federation and to train local personnel. WP/RC13/2 page 78 Project To find a method of interrupting the transmission of malaria; to collect the data needed in order to plan for malaria eradication; and to train personnel. Clinical Patholo To raise the standard of training at the Institute for Medical Research and to reorganize its course in clinical pathology. Mala 24 Public Health Administration Feb. 1900 - 19 3 R To extend and improve health services, particularly in the rural areas. Malay( 28 surve~ of Mental Services Feb.-May 19 2) TA See page 57. MalaYj 30 Health Education Advisory Services Jan. 1962 - 1964) R To survey the health education activities at the national and state level in order to evaluate the effectiveness of present methods of health education and recommend immediate improvements when applicable. Malaya 200 Fellowships R: (twelve months). Dental nursing (two for twelve months), laboratory Malaya 201 Fellowships TA: Rehabilitation Netherlands New Guinea 2 Malaria April 1955 - 19 TA UNICEF Two fellowships (three and one-fourth months each) were awarded under this project, for which staff, fellowships, and technical advice have been given in past years. Netherlands New Guinea 6 Maternal and Child Health (Feb. 1961 - Jan. 1962) R UNICEF See page 58 .. r Rural Environmental Sa.ni tation TA UNICEF WP/RC13/2 page 79 To carry out a pilot project of rural environmental sanita.tion, including a study of relevant technological, social, economic and cultural factors (particularly those affecting village water supply and human excreta disposal), and to train government employees through village demonstration work. Netherlands New Guinea 200 Fellowshi s R: leprosy control (three months), nursing twelve months, public health administration (one for four months, one for four and a half months). New Zealand 200 Fellowships R: health ( six months). Clinical medicine (two months), occupational North Borneo 5 - Malaria Eradication Programme (July 1955 - 1968) MESA TA UNICEF To eradicate malaria from the whole country. This is a conversion of the malaria pilot project started (under the same project number) in 1955. Pa ua and New Guinea 200 Fellowshi s R: maternal and child health three months). TA UNICEF Health education ( twelve months), To work out measures for controlling bilharziasis, and to test them by application in a community; to train personnel to give technical guidance and to carry out the control measures; to plan a national bilharziasis control ~- programme for the endemic areas. 'ene Universit of the Phili ines Manila Johns Hopkins University, Rockefeller Foundation) To strengthen the faculty of the Institute of Hygiene by exchanging members of the teaching staffs between the Institute and the Johns Hopkins University School of Hygiene and Public Health. Course To organize an advanced training programme for sanitary inspectors and to demonstrate environmental sanitation work in a selected area. To revise aIid implement the plan for malaria eradication. Phili~ines 59 Paediatric Nursing March 1962 - 1966) TA UNICEF To extend and inq"lrove the present health services with particular reference to the promotion of health, prevention of disease and provision WP/RC13/2 page 80 of adequate care for children (paediatric nursing); to establish closer co-ordination and integration of the promotional, preventive and curative services at all levels. PhilifPines 62 Health Statistics July 1961 - 1964) R To review and reorganize the health statistical services of the Department of Health and at provincial and local levels and to train personnel; to develop and improve vital statistics. Phili Public Health Administration Adviso Services - May 19 2 R See page 59. PhilifPines 71 Physiotherapy July 1961 - 1966) TA UNICEF To organize, at the State University, collegiate courses for training of physiotherapists, and to develop professional standards to ensure a high quality of service; to provide in-service training in physiotherapy for sub-professional workers. Phili TA To strengthen the organization, administration and management of the Alabang Serum and Vaccine Laboratory. A consultant was provided by WHO in 1962. PhiliP!ineS 200 Fellowships R: Health education (two for five and a half months, nursing (two for twelve months)" public health administration (three and a half months), tuberculosis control (five months). RyulsY( Islands 1 Malaria Eradication Programme April 1962 - 1963) MESA To make a comprehensive review of the antimalaria activities in Yaeyama Gunto and to draw up plans for the achievement of eradication in that area; to train national malaria staff. Two fi ve-weelc fellowships have been awarded. Sarawak 5 MaJ.aria Eradication Programme (Jan. 1956 - ) TA MESA To eradicate malaria from the whole country. This is a conversion of the malaria pilot project started (under the same project number) in 1952• ,- Singafore 4 Institute of Health Jan. 1956 - 1965) R UNICEF WP/RC13/2 page 81 To provide maternal and child health services, school dental services and health education for the population (about 125 000) living near the Institute; and 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, health inspectors and other auxiliary personnel. Singafore 8 Nursin~Education June 1962 - 19 4) TA To improve the standards of nursing education and nursing service in Singapore by developing (a) the clinical teaching units and the 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 training of local nurses for administrative and teaching posts. singa10re 14 Island-wide Domiciliary Midwifery Service Jan. 1959 - 1965) R To extend the supervision of midwifery practice to the whole island; to give refresher courses for qualified midwives; to integrate institutional midwifery at Kandang Kerbau Maternity Hospital with the domiciliary services in urban and rural areas; to give midwifery trainees more domiciliary experience, particularly in rural areas. Singafore 15 School of Radiography Dec. 1961 - 1965) R To set up a school of radiography in order to be able to meet the demands for well trained and qualified radiographers. A twelve-month fellowship was awarded in December 1961. Singapore 200 Fellowships R: Maternal and child health (six months), public health administration (one for six months, one for twelve months). Singapore 201 Fellowships TA: half months). Port sanitation and quarantine (four and a Tonga 1 Environmental Sanitation (March 1958 - 1963) TA UNICEF To strengthen environmental sanitation services; particularly to study the problems of rural and urban environmental sanitation and the social, economic and cultural factors affecting them; to plan, execute and evaluate a pilot environmental sanitation project and to train personnel. Tonga 200 Fellowships R: Clinical medicine (twelve months). WP/RC13/2 page 82 Trust Territo of the Pacific Islands 200 Fellowshi s R: Public health administration three months • Viet Nam 3 Maternal. and Child Health (Dec. 1954 - 1966) TA UNICEF (AID) To set up a maternal and child health service as part of the general public health and medical care services by improving and extending existing facilities; to train personnel for the service; to train staff from neighbouring countries with maternal and child health problems similar to those of Viet Nam; to undertake research on these problems. Viet Nam 7 Tuberculosis Control (Jan. 1958 - 1966) TA UNICEF (AID, French EconOmic Aid) To set up the nucleus of a national tuberculosis control service, with emphasis on preventive and public health work; to complete a tuberculosis dispensary in Saigon and to integrate it in the existing facilities; to continue the UNICEF/WHO-assisted BCG vaccination project and integrate it in the national tuberculosis control service. Viet Nam 11 Vital and Health Statistics (Dec. 1960 - end of 1964) R To develop and improve health and vital statistics. Viet Nam 14 Preventive Medicine (Jan. 1960 - 1965) R To set up a communicable-disease control service, study the local pattern of communicable diseases, organize a system of notification and routing of reports, and draw up a long-range plan for the control of the major communicable diseases in the country. second phase: June-Dec. 1962) R To develop a uniform hospital system with particular reference to the implementation of the reconmendations submitted by the WHO consultant in 1961. The immediate objective will be the re-organization of government hospitals in Saigon and the long-term objective, the development of a five-year national hospital plan. Viet Ham 16 Malaria Pre-eradication Programme (M9.rch 1959 - ) MESA (AID) To train national staff and to make preparations for the implementation of a malaria eradication programme. ...... Viet Pharmaceuticals WP/RC13/2 page 83 To improve the distribution of medical supplies and pharmaceuticals to hospitals, health centres, and similar establishments, and the arrangements for the maintenance of medical equipment; to organize a central purchase system for medical supplies and prepare standard lists of medical supplies, equipment, and pharmaceuticals • Viet Nam 18 Health Laboratory Services (Feb.-June 1962) R See page 61. ... Viet Nam 19 ~ntal Health (Jan.-Dec. 1962) R To carry out a survey of the Central M:ntal Hospital; to review the overall mental health services and to prepare appropriate recommendations. Western Samoa 3 Tuberculosis Control (June 1960 - 1963) R To expand and improve the chest clinic in Apia Hospital and to malre it the headquarters of the national tuberculosis control programme and the main service unit for Western Samoa; to carry out a case-finding programme (by a mobile team based on the national headquarters) and.a programme of prevention, including vaccination. Western Samoa 200 Fellowships R: Clinical medicine (one for twelve months, two for six months), public health administration (six months). Inter-regional 55.1 Inter-regional Post-graduate Leprosy Training Course, Philippines (20 Nov. - 9 Dec. 1961) TA A post-graduate training course attended by thirty-four doctors, many of whom were in charge of leprosy control campaigns, from Burma, China (Taiwan), Federation of M3J.aya, Hong Kong, India, Japan, Mauritius, Netherlands New Guinea, Nigeria, Pakistan, Philippines, Republic of Korea, Ryulqu Islands, Sarawruc, Singapore and Thailand. Thirty-five lectures were given, covering all technical aspects - clinical bacteriology, histology, therapy, epidemiology, prophylaxis and control. Special attention was paid to the practical approach to leprosy problems, by means of clinical seminars and clinical demonstrations, practical laboratory work, visits to leprosy institutions and practical demonstrations of leprosy control work in the field. WHO provided a short-term consultant and travel costs and stipends for thirteen faculty members and for twenty .. two participants. WP/RC13/2 page 84 Training Course on Freeze-dried Smallpox Vaccine R A training course whose main purpose was to provide a demonstration of the recently improved techniques in freeze-dried smallpox vaccine production. The course also included lecturers and practical work, during which all the participants prepared vaccine, of which they took samples back to their .. countries. It was attended by seventeen participants from Australia, Cambodia, China (Taiwan), Federation of Malaya, Iraq, Japan, Jordan, New Zealand, Pakistan, Philippines, Republic of Korea, Republic of Viet Nam, Thailand and Turkey. Sixteen of the participants were actively engaged in smallpox vaccine production or were in charge of institutes where smallpox vaccine was being prepared; several had previous experience in the production of freeze-dried vaCCines, and some in the preparation of freeze-dried smallpox vaccine. Laboratory facilities for the course were provided by the Government of Thailand. WHO provided a short-term consultant (who had conducted the course in Yaba in 1960) and fellowships for fifteen participants. Conference on Yaws Bandun R UNICEF A yaws co-ordination meeting was held from 30 october to 3 November 1961, followed by a conference from 4 to 10 November 1961 to evaluate the achievements of the yaws campaigns in the South-East Asia and Western Pacific Regions and the methods used in those campaigns, and to discuss the problems which are arising in organizing the later stages of the campaigns and in integrating them into the rural health services. WHO provided costs of attendance of the twenty participants from Burma, Cambodia, Ceylon, Federation of Malaya, India, IndoneSia, PhilippineS, Thailand and Western Samoa. Inter-regional 89 Malaria Eradication: Training Centre, French Language, Bel~ade (19 1 - MESA To establish and operate a French-language malaria eradication training centre to train malariologists, entomologists, sanitary engineers, sanitarians and other categories of staff in malaria eradication techniques. Two participants from Laos attended the course. Inter-regional 92 Inter-regional Training Course on Occupational Health, Alexandria ( 2 Oct~ .. 25 I~:>v~ lS6l) R (1LO) A course, sponsored jointly by 1LO and WHO, to give training in occupational health to workers from various countrie s, and thus stimulate WP/RC13/2 page 85 ~ the development of occupational health in those countries. The course, which covered all aspects of occupational health, included lectures, laboratory demonstrations, discussion sessions, and particular attention was paid to practical aspects and to field visits. There were thirty-one trainees - from Ceylon, China (Taiwan), Cyprus, Federation of Malaya, India, Indonesia, Iran, Iraq, Japan, Kuwait, Lebanon, Pakistan, Philippines, Sudan, Thailand, Turkey and United Arab Republic. , WHO provided three short-term consultants, fellowships for twenty-one trainees, supplies and equipment; ILO provided fellowships for the other ten trainees and the services of two staff members. Inter-regional 93 Conference on the Training of Health Auxiliary Personnel, Khartoum (14-20 Dec. 1961) R A conference at which participants exchanged experiences in the training and utilization of auxiliaries at the country level and reviewed the principles enunciated by the Expert Committees. It was attended by forty-one participants - from Afgr~nistan, Burma, Central African Republic, Chad, Brazzaville, Ethiopia, Fiji, France, Ghana, Guatemala, Guinea, Indonesia, Iran, Iraq, Japan, Laos, Lebanon, Madagascar, lvbrocco, Nepal, Nigeria, Pakistan, Ruanda-Urundi, Saudi Arabia, Senegal, Singapore, Somalia, Sudan, Tanganyika, Tunisia, Turlrey, United Soviet Socialist Republics - and representatives from UNICEF, AID and the Public Health Mission to Ethiopia of the Federal Republic of Germany. WHO technical staff from Headquarters and each of the Regional Offices also participated. Inter-regional 96 IAEA/WHO Training Course in Radiation Health and Safety, Chiba City, Japan (24 Oct. - 21 Nov. 1961) R (IAEA) A training course, sponsored jOintly by the International Atomic Energy A~ncy and WHO, for persons having responsibilities in the field of radiation health and safety. It covered the basic physical and biological principles involved in radiation health, problems connected with the medical and industrial uses of X-rays, radiOisotopes and other sources of radiation, the public health aspects of atomic energy activities and waste disposal, and the health problems associated with atomic energy installations. The course was followed by a study tour in the Kansai area of Japan from 22 to 26 November 1961. Twenty-one persons attended - from Australia, Burma, Cambodia, Ceylon, China (Taiwan), India, Indonesia, Japan, New Zealand, Pakistan, Philippines, Republic of Korea, Republic of Viet Na.m, and Thailand. WHO and the International Atomic Energy Agency jOintly provided the director of the course, two teaching assistants, the costs of attendance of fifteen trainees, and supplies; the United States Public Health Service provided a lecturer and the Government of Japan provided lecturers, facilities for the course and costs of attendance of six Japanese trainees. WP/RC13/2 page 86 on Public Health Aspects of Protection Dusseldorf Ge~ A conference to bring together public health administrators who carry high responsibility, or persons directly responsible for radiation protection in the public health services at the national level, to enable them to discuss the,role of public health services in respect of radiation protection, to .' rev~ew the present situation of radiation protection services in different countries, to discuss desirable trends in the organization and administration of these services within the public health services, and to consider requirements as regards qualification and training of public health personnel in charge of radiation protection services.. China (Taiwan) and the Philippines sent participants to the cOnference. Inter-regional 199 Inter-regional Training Course on Viral and Riclrettsial Laboratory Techni9,lles t Singapore . (12-31 March 1962) R A course to promote the application of virology in public health, to demonstrate the importance and potentiality of the virus and rickettsial diagnostic laboratory as an integral part of the public health service of a country and to review the more modern and practical laboratory techniques for virus and rickettsial diagnosis. It was attended by twelve participants - from Ceylon, China (Taiwan), Federation of Malaya, Hong Kong, India, IndoneSia, Japan, Philippines, Republic of Korea, Republic of Viet Nam, Singapore and Thailand - and by six observers from Singapore. WHO provided five short-term consultants and fellowships for the trainees. Inter-regional 114 Venereal Diseases Travelling Seminar, Union of Soviet Socialist Republics (8 Sept. - 7 Oct. 1961) TA Eighteen participants - from Brazil, Cambodia, Ceylon, Denmark, India, Indonesia, Iran, Iraq, Italy, Japan, Lebanon, Liberia, Philippines, United Arab Republic, United Kingdom, Venezuela and Yugoslavia - studied the methods in use in the Union of Soviet Socialist Republics for venereal disease control in rural, urban and maritime populations, the trends in research and the education and training of personnel. WHO provided three short-te~ consultants, interpreters, and cQsts of attendance of the participants. Inter-regional 117 Training Course on Medical Rehabilitation Copenhagen, Denmark (Oct. 1961 - July 1962) R TA (United Nations, ILO) A course, organized in collaboration with the Danish National Health Service and the Medical Faculty of the University of Copenhagen, to give physicians specialized training in rehabilitation. The syllabus included WP/RC13/2 page 87/88 theoretical and practical instruction in anatomy, physiology of the locomotor nervous system, blood circulation, traumatology and psychology in relation to disability. Fellowships were awarded to trainees from Japan, Philippines and the Republic of Korea. Inter-regional 120 (1950 - 1964) Anaesthesiology Training Courses, Copenhagen TA To stimulate the development and improve the standards of national anaesthesiology services by providing training for medical personnel. Fellowships were awarded to trainees frc~ China (Taiwan), Hong Kong, Japan, Republic of Korea and RytU~ Islands. ANNEXES / r Organizational Unit OFFICE OF THE REGIONAL DIRECTOR Public Information BUREAU OF HEALTH SERVICES Advisory Services Fellowships LIST OF REGIONAL OFFICE POSTS Post .' I .. Regional Director , I ... Liaison and Reports Officer L ~ Administrative Assistant L .. Clerk/Typist . I .. Public Information Officer L ~ Public Information Assistant L .. Secretary ,I .. Director of Health Services ~vI ~ Assistant Directors of Health Services (2) L - Secretaries (3) L .. Clerk/Typist v I - Regional Adviser on Public Health Administration I .. Regional Statistician and Programme Evaluator • I .. Regional Adviser on Maternal and Child Health ,,,I .. Regional Adviser on Nursing I .. Regional Adviser on Communicable Diseases I - Regional Adviser on Environmental Sanitation v I - Regional Sanitary Engineer ,I - Regional Adviser on Nutrition vI .. Regional Adviser on Tuberculosis I Regional Adviser on Health Education ,_ I .. Senior Regional Adviser on Malaria ,I .. Regional Adviser on Malaria v: I .. Regional Entomologist I .. Regional Sanitary Engineer I .. Administrative Officer : I .. Regional Adviser on Education and Training L .. Technical Assistant I - Internationally recruited L ~ Locally recruited WP/RC13/2 page 91 ANNEX 1 Nationality China U.K. Philippines Philippines Denmark Philippines Philippines Philippines (1) China (1) Germany Philippines Philippines Philippines China Netherlands Canada U.K. VACANT U.S.A. U.K. China VACANT Italy China China Philippines U.K. Philippines Philippines WP/RC13/2 Annex 1 page 92 Organizational Unit Fellowships (continued) Secretarial Pool for Advisory Services OFFICE OF ADMINISTRATION AND FINANCE Budget, Finance and Accounts Personnel General Services Post L .. Secretary L ... Clerk/Stenographer L .. Secretary L .. Clerk/Statistician L - Clerk/Stenographers (9) . I - Chief, Administration and Finance I ~ Administration and Finance Officer ,.! I .. Administrative Officer L ... Secretary L ... Clerk/Stenographer I - Budget and Finance Officer I ... Finance Officer L ... Assistant Accountant L ... Budget Analyst L ... Cashier L ... Accounts Clerks (5) L .. Budget Clerks (3) L ~ Clerk/Stenographer I - Personnel Officer L ... Personnel Assistant L ... Cler1VStenographer L .. Clerlt/Typist I - Administrative Services Officer I ... Translator (English-French) I .. Translator (English .. French) . L .. Translator (English .. Chinese) L .. Administrative Assistant L ... General Services Assistant L .. Librarian L .. Supply Clerk L ... Travel Clerk L .. Registry Assistant L ... Registry Clerk L ... Clerk/Typists (3) L .. Mail Clerks (2) L .. Building Maintenance CUstodian L .. Junior Registry Clerk I .. Internationally recruited L ... Locally recruited Nationality Philippines Philippines Philippines Philippines ( 8) Philippine s (1) China Japan VACANT Belgium Philippines Philippines U.S.A. U.K. Philippines Philippines China Philippines Philippines Philippines France U.S.A. Philippine s Philippines Netherlands Switzerland Belgium China France Philippines Philippines Philippines Philippines Philippines Philippines Philippines Philippines Philippines Philippines • -4<' Organizational Unit WHO REPRESENTATIVES Phnom-Penh (Cambodia) Saigon (LaOs, Viet Nam) Singapore (Brunei, Federation of Malaya, North Borneo, Sarawak, Singapore) ~ (South Pacific Area) Taipei (China (Taiwan), Japan, Hong Kong, Korea, Portuguese Territory, United states Territories) OFFICE OF Coum'RY LIAISON CFFICER Vientiane (Laos) Post v I ... M:!dical Officer L - Secretary y I - Medical Officer L ~ Secretaries (2) ",I ... M=dical Officer L ~ Administrative Assistant L ... Administrative Clerk L - Senior Messenger L - M= ssenger " I ... M=dical Officer L ... Secretary - I ... Medical Officer L ... ClerlVStenographer L ~ Driver/Messenger L ... Secretary I ... Internationally recruited L ~ Locally recruited WP/RC13/2 Annex 1 page 93/94 Nationality Netherlands VACANT U.K. Viet Nam U.K. U.K. India U.K. U.K. U.K. Australia Australia China China Viet Nam I I I PROJECT AND REGIONAL OFFICE INTERNATIONAL STAFF EMPLOYED AS OF 30 JUNE 1962 \ Country Regional Office Area Field Argentina ............. - - 1 Australia ............. - 1 1 Belgiuo. · .............. 2 - 1 Bolivia · .............. - - 1 Canada · ............... 1 - 9 China · ................ 6 1 7 Denmark · .............. 1 - 1 Egypt · ................ - - 1 l'"'rance · ............... 1 - 8 Germany · .............. 1 - 2 Haiti · ................ - - 1 Ireland · .............. - - 1 Israel · ........ .- ...... - - I 1 I Italy · ................ 1 - 3 Japan · ................ 1 - 3 Korea · ................ - - 1 lebanon · .............. - - 1 M=xico · ............... - - 2 Netherlands 2 1 1 2 · .......... ; I New Zealand · .......... - - I 4 Philippines · .......... 4 - I 5 I I WP/RC13/2 page 95 ANNEX 2 Total 1 2 3 1 10 14 2 1 9 3 1 1 1 4 4 1 1 2 5 4 9 WP/RC13/ 2 Amlex 2 page 96 Country Portugal · ............. Rhodesia · ............. South Africa .......... Switzerland ........... Thailand · ............. Turkey ................ United Kingdom ........ United States of America ............ TOTALS ......... Regional Office - - - 1 - - 5 2 28 Area Field - 1 - 1 - 1 - - - 4 - 1 2 13 - 7 5 84 Total 1 1 1 1 4 1 20 9 117 J. I "j I i ..... - Project Cambodia 15 China 20 Japan 24 Korea 18 (WPRO 79) Korea 19 Malaya 28 Philippines 12 Philippines 64 CONSULTANTS EMPLOYED DURING THE YEAR 1 JULy 1961 - 30 JUNE 1962 Title Hospital Administration and Architecture Mental Health, Taiwan Health Education Advisory Services Public Health Survey Tuberculosis Control ( Bacteriology) ( Statistics) Survey of Mental Services Institute of Hygiene, University of the Philippines (Epidemiology ) (Public Health Administration) Public Health Administration Advisory Services (Nursing) (Public Health Administration) Philippines 76 Laboratory Manamement and Administration ~~ Islands 1 Malaria Eradication Programme Viet Nam 15 Hospital Administration Viet Nam 18 Health Laboratory Services Viet Nam 19 WPRO 28 Mental Health (Mental Health) (Nursing) Seminar on Child Health and the School, Manila WP/RC13/2 page 97 ANNEX 3 .~ Number Nationality 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 France U.S.A. U.S.A. China U.K. Denmark Australia U.S.A. U.S.A. U.S.A. U.K. U.S.A. China France Sweden Germany Netherlands U.S.A. WP/RC13/2 Annex ~ page 9 ~ Project Title Number Nationality WPRO 37 Poliomyelitis Centres, Singapore and Tokyo 1 Japan ~ WPRO 44 Nursing Administration Seminar, Tokyo 2 (1) U.K. (1) U.S.A. WPRO 76 Refresher Course on Integrated Rural Health for Assistant Medical Officers in the South Pacific, Apia, Western ,~, Samoa 1 Australia WPRO 77 Training Course on Vital and Health Statistics for Territories in the South Pacific Area, Suva, Fiji 2 (1) Australia (1) New Zealand WPRO 80 Participation in United Nations Mekong River Basin Project: Bilharziasis Survey of the Vientiane Plain Agricultural Station (Bilharziasis Control) 1 Philippines WPRO 82 Seminar on Maternal and. Child Health Nutrition, Manila 2 U.K. WPRO 84 Water Supply Programmes (China and Korea) 3 (2) U.S.A. v~ (1) U.K. WP/RC13/2 page 99 ANNEX 4 LIST OF SUPPLEMENTARY AGREEMENTS SIGNED WITH MEMBER cotmTRIES DURING THE PERIOD 1 JULY 1961 TO 30 JUNE 1962 Country British Solomon Islands Protectorate Cambodia Brunei China Project Title Malaria Eradication Pilot Project (plan of operation) Nursing Education (exchange of letter) Malaria Pre-eradication Programme (exchange of letter) Treponematoses Control (exchange of letter) Assistance to Public Health Laboratory (Institute of Biology) (exchange of letter) Malaria Pre-eradication Programme (exchange of letter) Venereal Disease Control (eighth addendum) Maternal and Child Health (seventh addendum and eighth addendum) Trachoma Control (third addendum) Environmental Sanitation (exchange of letter) Institute of Public Health (exchange of letter) Trachoma Research and Evaluation (exchange of letter) *Joint with UNICEF **UNICEF supply programme WHO Number BSIP 2* BSIP 3* Cambodia 1 Cambodia 8* Cambodia 14 Brunei 3 China 1* China 3* China 13* China 14 China 27 China 34* WP/RC13/ 2 Annex 4 page 100 Country Project Title Fiji Fiji School of Medicine (exchange of letter) Japan National Institute of Mental Health (exchange of letter) Hospital Administration (exchange of letter) Care of the Deaf and lfrute (exchange of letter) Rehabilitation of the Physically Handicapped (exchange of letter) Health Education Advisory Services (exchange of letter) Korea Leprosy Control (plan of operation) Malaria Pre-eradication Programme (third addendum) National Institute for Public Health Training (exchange of letter) Public Health Survey (exchange of letter) Tuberculosis Control (plan of operation) Laos Public Health Administration Rural Development in Public Health (plan of operation) Nursing Education (plan of operation) MaJ.aya Rural Health Training Centre (fourth addendum) *Joint with UNICEF **UNICEF supply programme WHO Number Fiji 2 Japan 4 ..... Japan 17 Japan 22 Japan 23 Japan 24 Korea 4 Korea 13 Korea 15 - Korea 18(WPRO 79) Korea 19 Laos 9 Laos 10* Laos 12* " .... Malaya 9** Country MUaya ( continued) Netherlands New Guinea North Borneo Philippines Project Title Hospital Records (exchange of letter) Tuberculosis Control (plan of operation) Health Education Advisory Services (plan of operation) Malaria Eradication Pilot Project (sixth addendum) Rural Environmental Sanitation (exchange of letter) Rural Health Developnent (plan of operation) Nursing Education (plan of operation) Malaria Eradication Programme (plan of operation alld first addendum) BCG vaccination (-sixth addendum) Maternal and Child Health Services and Training Programme (amendment to fourth addendum and seventh addendum) Leprosy Control (third addendum) Virology Centre (exchange of letter and first addendum) Malaria Eradication Programme (exchange of letter) Tuberculosis Control (exchange of letter and plan of operation) National Seminar on Hospital Administration (exchange of letter) *Joint with UNICEF **UNlCEF supply programme WP/RC13/2 Annex 4 page 101 WHO Number Malaya 15 Malaya 25* Malaya 30 NNG2** NNG 9* NNG 11* NNG 13* North Borneo 5* Philippines 17** Philippines 40** Philippines 49** Philippines 50* Philippines 53 Philippines 69 Philippines 70 WP/RC13/2 Annex 4 page 102 Country Philippines ( continued) Sarawak Singapore Tonga Viet Nam Project Title Physiotherapy and Occupational Therapy (plan of operation) School Health Education (plan of operation and first addendum) Social Services for Children (first addendum) Laboratory Management and Administration (eXChange of letter - 2) Emergency Assistance to El Tor Paracholera Project (plan of operation) Malaria Eradication Programme (plan of operation and exchange of letter) Island-wide Domiciliary Midwifery (exchange of letter) School of Radiography (plan of operation) Environmental Sanitation (exchange of letter) Yaws Control (plan of operation) Maternal and Child Health (exchange of letter) Tuberculosis Control (exchange of letter) Vital and Health Statistics (exchange of letter) Hospital Administration (exchange of letter) Malaria Pre-eradication Programme (exchange of letter) *Joint with UNICEF *,lE-UNICEF supply programme WHO Number Philippines 71 Philippines 73* Philippines 74** Philippines 76 Philippines 81* Sarawak 5 Singapore 14 Singapore 15 Tonga 1 Tonga 2* Viet Nam 3* Viet Nam 7 Viet Nam 11 Viet Nam 15 Viet Nam 16 ',-. ~. - o!. -+ Country Viet Nam (continued) Ryu~~ Islands Inter-country Project Title Health Laboratory Services (eXChange of letter) Mental Health (exchange of letter) Malaria Eradication Programme (eXChange of letter) Regional Tuberculosis Advisory Team (plan of operation) Regional Tuberculosis Advisory Team (plan of operation) Refresher Course on Integrated Rural Health for Assistant Medical Officers in the South Pacific (eXChange of letter) Participation in United Nations Mekong River Basin Project: Bilharziasis Survey of the Vientiane Plain Agricultural Station (exchange of letter) Maternal and Child Health Advisory Services in the South Pacific (exchange of letter) Maternal .and Child Health Advisory Services in the South Pacific (exchange of letter) Maternal and Child Health Advisory Services in the South Pacific (exchange of letter) Maternal and Child Health Advisory Services in the South Pacific (eXChange of letter) Maternal and Child Health Advisory Services in the South Pacific (exchange of letter) Planning of Community Water Supplies (exchange of letter) *Joint with UNICEF **UNICEF supply programme WP/RC13/2 Annex 4 page 103/ld+ WHO Number Viet Nam 18 Viet Nam 19 Ryulcyus 1 WPRO 75*(Singapore) WPRO 75*(Viet Nam) WPRO 76 WPRO 80 WPRO 83 ( Australia) WPRO 83 (Cook Islands and Western Samoa) WPRO 83 (New Caledonia) WPRO 83 :(Nev BebI'14es) WPRO 83 (Tonga) WPRO 84 (China) 1. TOTAL NUMBER OF AWARDS (REGULAR AND SPECIAL FELLOWSHIPS) FOR THE YEAR 1961 - 1962 Fellowships awarded under the Western Pacific Region programme and budget WP/RC13/ 2 page 105/106 ANNEX 5 Total fellowships ........................................ III ( i) (ii) Non-project fellowships •••••••••••••••• 57 Project fellowships •••••••••••••••••••• 54 2. Participation in educational meetings and courses (a) Inter-country programmes Number of participants Number of seminars, conferences, etc. ......................................... 7 (Please see WPRO 14, 28, 44, 76, 77, 82, 113) (b) Inter-regional programmes (less than two months) 130 Number of participants •••••••••••••••••••••••••••••••• 53 Number of seminars, conferences, etc. ........................................ 9 (Please see IR 55.1, 73.2, 85, 92, 93, 96, 103, 109, 114) (c) Inter-regional programmes (two months or more) Number of participants ............................... . Number of training courses •••••••••••••••••• 4 (Please see IR 89, 117, and 120) 3. other special fellowships Total fellowships ............................... , ....... . (i) HQ Exchange of Scientific Workers (Malaria Eradication) •••••••••••••••••• 9 (ii) Special UNICEF fellowships for CPHN course, Calcutta .•.•.•••.••••••••• 4 GRAND TarAL ...... 12 13 319 ===== J j}". FIELD OF STUDY I. HEALTH ORGANIZATION AND SERVICES PUBLIC HEALTH ADMINISTRATION Public health administration ••••••••• Medi~;]l records ••••••••••••••••••• Hospital and medical care administration ..................... SANITATION Environmental sanitation •••••••••••• Food and drug control •••••••••••••• NURSING Nursing and midwifery ••• o •••• o. 0" • Public health nursing ••• 000000. 0 0 ••• Medical social work • ~ .......... e .... ., ... MATERNl,L AND CHILD HEALTH Ma wmal and child health •••••••• 00 • OTHER HEALTH SERVICES J\1ental health 0 •••••• 000 •••••••• 0 •• Health education •••••••••••••••••• occupational health • o •••••• 0 ••••••• Nutrition ........................................... He a Ith sta tistic s .................................... Dental health ••••••• 0 •••••••••••••• Rehabilitation ..................... Drug control ...................................... • Six extensions or second '"'Year awards .. Fellowships awarded under WPRO 59. ;S ...:r ~ E-< ~ <: 1 I ~. t\ FELLOWSHIP AWARDS 1 July 1961 to 30 June 1962 According to Fields of Study and Countries of Origin CJ) CJ) Q z z «: " Q~ z~ ;S :s Q >< z ~§ Q CJ) E-< <t: ~ 0 .... <...:r «: ~ ffi ~ Z 't: w" a:l Z §g w CJ) ~~ ::E .... o Q .... CiS 0:: 0 <';: :r: o 1~11. I=t g 0 <t: ~w U <t: ~ zz u U 11. 0 u.. - ...:r 1 3 4 2 2 1 1 1 1 2 1 1· 1 1 1 1 1 I 1 I I 3(1-> 3 2 4 1 1 1 2 2 1· 2 I I 2 'It CJ) Q Q Z Z Q~ :s <t: CJ) ~ ~ w ...:r z~ 0:: <t: 0 «:p .... p ~ 0- >< 0-N :3" 0- <t: t;l 1:5 ~ o-~ ~ w <t: W :r: >< z .... o-z 0- 0:: CJ) 1 1 1 2 20 1 1 1 3 1 I \~ >< (.,? O::Q gz 5;!«: o::...:r w~ ::E E-<U ~ <: E-< .... " ~~ Z E-< 0 0:: , ..... ~ E-< E-<ci:: > 1 I «: 0 ::E <: CJ) Z 0:: w E-< CJ) w ~ 1 i 3(1~ I ! ;;J. i :><: 0\ ~~ oq-..... ro !:O f-'~ ~~ [\) FIELD OF STUDY II. COMMUNICA BLE DISEA SES SERVICES COMMUNICA BLE DISEA SES 11alnria .•••.••.••••. ,. ........... . Venereal diseases and treponematoses Tuberculosis •••.••••••••••••••••• Control of viral diseases ••••••••.•• Quarantine procedures •••.•.•.••••••• Leprosy .................................. . Epidemiology •.•••••••••••••••••• La 'borDtory ......................................... .. III. MEDICI. L EDUCA TION, CLINIC1.L AND BASIC tv1EDICAL SCIENCES CLINICA L MEDICINE surgery an:! medicine ............. -e ......... Ra i.-:!iology ............................................ . Control of rheumatism and cerebral palsy •••••••••••••••• _. Ca rdiology •••••••••••••••••••••• ~ ...l ~ [-I !3 <c 1 1 s ~ <c u ~ .... ::r:: u 1 3 2 ~ Z <c ...l ~ ~ o u 1 Z<c g>- [-1< ...l ~~ W,.:; 0u.. ~O 2 1 .... 1:1 u.. '-' Z o :::.::: '-' Z g Z <C 0. <c .-. 2 <C w 0:: ~ 5 1 1 U'l Cl<c Zw <cZ ~S en I ~ '-' o [-I ~ j !Z ~ 2 1 ~ <c ...l r.5 N :E: ~ 1 o <c en Z ~ w <c 5 ~ :<Q '-' 0. P .... 0.:S: = <::: ~ ::r:: o.;z; 0. 2 1 ~ Z <c ...l ~ ::J ~ 3 W 0:: ~ ~ 2:i ·en 1 1 1 ~(/) 0 0 [-IZ .... <C g§...l w~ '-' U'l!::; <C I~ ~ Z ::J U o 0:: <c f-r [-I 0. 1 ~ <c Z [-I W :> 2 1 I <c g . .2; ;;3 ~ w [-I U'l w :E: 3 7 14 1 I 1 TOTAL .................... 3 I 3 6 17 I 1 ==t-==+== k I I =--d: .....L=4=:_ :4:=4=:=4-- I :1:.:::= 4 18 I 10 I 2 2 I 2 I 10 I 3 7 3 7 GRAND TOTAL ........ 111 Not included in the Table are fellowships awarded for participation in educational meetings or training courses granted under (a) inter-country programmes, (b) inter-regional programmes. and (c) other special fellowships, i.e., HQ Exchange of Scientific Workers (malaria eradication) and special UNICEF nursing fellowships for study in Calcutta. These are mentioned elsewhere in this Report (see pages 31-32 and Annex 5). .!". '" ' .. t ~ . .a .. 'g?;~ 'm~ l><~ I-' I-' gO'\~ f\) ! WP/RC13/2 page 1(1)/110 ANNEX 7 DISTRIBUTION OF VISITS IN ACCORDANCE WITH COUNTRY OF STUDY AND REGIONS Country of study AFRO AMRO EMRO SEARO WPRO TOTAL Australia ........ - - 5( 5) 1(1) 8(6) 14(12) China · ........... 1 2 - 4 22 29 Fiji ............ " - - - - 3 3 Hong Kong ..... " .. - - - 4 11 15 Japan · " .. " " " " . " . " - 2 1 2 21(2) 26(2) Korea · " " .. " " " " " . " - 1 - - 2 3 Malaya . " " . " " " . " " . - - - 1 13(2) 14(2) New Zealand " " .. " " - 1 2(2) 6(6) 1 10(8) Netherlands New Guinea .. " " " " " " " " - 1 - - - 1 Philippines " " " " " " - 4 2(2) 1 18(5) 25(7) Sarawak. " . " " " " " " " " 1 - - - - 1 Singapore " " " " " " " " - - - 2 10(2) 12(2) Territory of Papua and New Guinea .. - - - - 3 3 Viet Nam " " " " " " " " " - 1 - - - 1 Western Samoa " " " " - - - - 1 1 Total number of visits " " " " " " " " " 2 12 10(9) I 21(7) 113(17) 158(33) =========-============================================== The figures in brackets() represent the number of visits of not less than three month's duration. This tabulation includes only visits which were begun during the period and excludes those which, although continuing in the present period, were begun during the previous period. 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. The figures refer only to individual fellowship visits and do not therefore include group visits to sites of educational meetings and group training, courses or activities.
World Health Organization (WHO) · Technical Documents
Twelfth annual report of the Regional Director to the Regional Committee for the Western Pacific covering the period, 1 July 1961 - 30 June 1962
View original document
The full text is hosted by the publishing organisation. lawenc.com indexes the metadata and links to the official source.
Full text
Key facts
Organisation
World Health Organization (WHO)
Document type
Technical Documents
Source
World Health Organization