World Health Organization (WHO) · Technical Documents

Brief reports received from governments on the progress of their health activities

December 31, 1973 World Health Organization

Full text

WORLD HEALTH ORGANIZATION

ORGANISATION MONDIALE DE LA SANT~

REGIONAL OFFICE FOR

THE WESTERN PACIFIC

BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL

26 October 1973 ORIGINAL: BRIEF REPORTS RECEIVED FROM GOVERNMENTS ON THE PROGRESS OF THEIR HEALTH ACTIVITIES Attached are brief reports submitted by governments to the Regional Committee on the progress of health activities in the following countries and territories: Australia French Polynesia Hong Kong *Japan Khmer Republic Macau *Malaysia New Zealand *Republic of Korea **Republic of Viet-Nam *Portuguese Timor The following were received but copies are not available for distribution. They are available in the Library. Laos Rapport Annuel des Statistiques Sanitaires 1972 Rapport Annuel du Service National d'Hygiene et de Medecine Preventive Rapport Annuel du Service National de la Protection Maternelle et Infantile Rapport Annuel du Service National de Laboratoire de la Sante Publique ENGLISH

*Available

in English only.

**Available in French only.

ORIGINAL:

ENGLISH

AUSTRALIA BRIEF REPORT ON HEALTH ACTIVITIES, 1972-19731

NATIONAL HEALTH SCHEME

Administration of the present system of voluntary health insurance has been transferred from the Australian Department of Health to the Department of Social Security. Under the present system the public may obtain financial protection against the cost of using hospital and medical services. Persons who insure themselves are eligible, after obtaining treatment, for Australian Government hospital and medical benefits which supplement amounts payable by a health insurance organization known as fund benefit. A patient is required, however, to meet a small portion of the cost of medical services that he receives. The financial year 1972-1973 was the third year of operation of the Health Benefits Plan whereby medical benefits are closely related to the fees most commonly charged by medical practitioners. Following a review during 1971-72 the level of the most common fee was increased with effect from 1 July 1972, but as Government and fund benefits were also increased, the patient's contribution towards the cost of a medical service remained the same. For example, where a general practitioner charges the common fee the patient is required to pay 80 cents for a surgery consultation and $1.20 for a home visit. Following its election to office in December 1972 the Australian Government established a Health Insurance Planning Committee to prepare detailed recommendations on the timing and method of implementing the Government's universal health insurance program. The Report was tabled in Parliament in April 1973 and is currently being considered by the Government. 'rhe proposed new program will cover medical services provided on a fee-for-service basis, free standard ward hospital treatment, some provision for community health centres, ancillary health services and domiciliary services. The health insurance scheme will be funded by a Health Insurance Fund financed by a 1.35 per cent. levy on taxable incomes and a levy on workers' compensation and motor vehicle third party insurers. The levy will provide from exemption for low-income families and contribution ceilings for high-income earners.

Submitted by the Australian Embassy, Manila. 30 July 1973: text amended by the Repre8entative of Australia during the meeting of the Regional Committee.

- 2 -

The Australian Government has announced its intention to promote the regionalisation and modernisation of hospitals, linked with the development of c09mlnity-based health services and preventive health programs. In consequence the Government established the Interim Committee on Hospitals and Health Services Commission which will be established as soon as the legislation is passed by Parliament. The Interim Committee is responsible for submitting recommendations on allocations of both capital and operating funds to develop and maintain health care delivery systems for the benefit of all Australians. The Interim Committee has recently proposed a major comw~nity health program to develop facilities and services in a co-ordinated manner for the provision and planning of prevention, treatment, rehabilitation and related welfare aspects of community health. The report has recommended the provision of financial assistance by the Australian Government to the State Governments for the development of community health facilities and services in particular localities. COMMUNITY HEALTH CENTRES

The Australian Government is moving to establish community health centres in the Australian Capital Territory and Northern Territory for which it has direct responsibility. The Government proposed that the Territories should be pace-setters for the rest of Australia and in July 1973 the first health centre was opened in the A.C.T. The centre is staffed by two doctors, a dentist, a pharmacist, a district nurse, two social workers. a psychologist and other health personnel. Community health centres are seen as important means for slowing the rate of increase in the cost of health services by shifting emphasis away from hospital in-patient care to community care, reducing the fragmentation and duplication of services and offering a means of better co-ordinating health services with the related welfare services.

QUARANTINE

Greater use of air travel has increased the risk of importing human, animal and plant diseases. Nevertheless, as a result of the work of the Q.uarantine Service, Australia has remained free of such diseases as plague, smallpox and yellow fever. However. during 1972, 41 cases of cholera were reported, all arising from one incident, throught to be due to contaminated food served during a plane flight to Australia. These cases were the first notifications of cholera since a single imported case in 1969. No secondary cases were reported and, in consequence, the World Health Organization did not declare Australia as an area infected by cholera.

•

- 3 -

As a result of the outbreak, legislation was tightened concerning the issuing of International Certificates of Vaccination against cholera to travellers fpom overseas countries. The episode served as a sharp reminder of the problems posed by the speed of modern travel, and of the need for increasing vigilance by quarantine authorities throughout the world. "

Investigations are being undertaken concerning the establishment of a high security animal quarantine station on an off-shore island, not less than 100 miles from the Australian mainland. The station would enable imports of improved breeds of cattle, sheep, pigs and goats to be made without risk of introduction of exotic animal disease. 4. COMMUNICABLE DISEASES

The Australian Department of Health acts as an agency for the collection and dissemination of statistics on notifiable diseases in Australia. These statistics are circulated widely throughout Australia and overseas. Infectious hepatitis remains one of the most prevalent infectious diseases in Australia and one of the most difficult due to the problems of isolating and culturing the organism. The disease continues at a high level although there was an apparent decline in incidence with 6118 cases in 1972 oompared with 7509 oases in 1971. Notifioations of venereal diseases are chiefly for gonorrhea, of which 11 037 cases were reported in 1972. New cases of syphilis during 1972 numbered 1217. Tuberculosis notifications continued to fall with 14.9 new cases reported per 100 000 population in 1969 and 11.4 in 1972. Early diagnosis is achieved in the majority of cases by routine ohest X-ray examinations • 5. ANTI-SMOKING CAMPAIGN

In the light of a detailed review of the health hazards of smoking, the Australian Government launched a campaign in September 1972 to warn the public of the hazards of smoking. The campaign was introduced after Australian and State Government health eduoation experts had agreed upon its design. In 1972-73 the Australian Government made available approximately $484 '000 for the campaign. The oampaign has made extensive use of

- 4-

advertising on television and radio and in the press. Publications have also been distributed to adults and schoolchildren. In addition. special educational material has been prepared for use in schools. Legislation tor compulsory health warnings on all cigarette packets has been enacted in all States, following the early lead given by the Australian Capital Territory and the Northern Territory from 1 January 1973. It is compulsory for Cigarette advertising on television to conclude with the warning that smoking is a health hazard. The gradual elimination of all forms of promotion of smoking, coupled with increased education programs, is seen as the approach most likely to succeed in reducing the health hazards of smoking.

DENTAL SERVICES

A Dental Services Branch has been established within the Australian Department of Health. Its major function is the implementation, development and co-ordination of the new Australian school dental services scheme. The establishment of the Branch reflects the Government's concern at the standard of dental health in the community, particularly amongst children, and its desire to raise this standard and increase public awareness of the importance of dental care. Under the scheme, the Australian Government will provide substantial grants to the States to develop a school dental service in accordance with agreed prinCiples so as to ensure a unified service throughout Australia. When fully developed, the service will offer free dental care to all children under fifteen years of age. The aervice will be staffed basically by dental therapists working under the general direction and control of dentists. So as to facilitate the rapid development of the serVice, agreement has been reached with the New Zealand Government whereby some Australian students will be trained as dental therapists in New Zealand training colleges pending the further development of Australian training schools. 7. OCCUPATIONAL HEALTH

An Occupational Health Branch has also been established within the Australian Department of Health. The Branch will initially rationalize and co-ordinate the existing, but rather limited, services already being provided for Australian Government employees and organize the development of a comprehensive occupational health service to cover all Australian Government employees. The main objectives of the proposed occupa-

- 5 -

tiona1 health service are to protect employees against health hazards arising from their work, to assign employees to jobs for which they are best suited, to adapt jobs to the health needs of employees and to provide means necessary for the highest possible degree of physical, mental and social well-being.

VITAL STATISTICS

Estimated mean population ••••••••••••••• Live births Total deaths ••• 0.0 •••••• 0 ••••••• • ••••••••

Crude birth rate per thousand ••••••••••• .o.o.o . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

Crude death rate per thousand ••••••••••• Infant deaths under one year •••••••••••• Infant mortality rate per thousand 11 ve births ................................................. .

12 755 900 276 362 21.67 110 650 8.67 4777 17.29

12 959 100 264 969 20.45

109 760 8.47 4430

)

ORIGINAL:

FRENCH

FRENCH POLYNESIA BRIEF REPORT ON HEALTH ACTIVITIES IN 19721

POPUIATION

1962 1967 1971 2.

84 551 inhabitants 98 378 inhabitants 119 168 inhabitants ACTIVITIES OF HOSPITALS AND INFIRMARIES (Number of beds: 913) Out-patients 136 431 157 021 174 653 In-patients 10 927 13 771 13 502 Number of patient days 177 490 207 777 209 864

Year 1970 1971 1972

HEALTH EXPENDITURE the budget of 1971 422 297 000 22 047 257 444 344 257

There are two different sources of financing: French Polynesia and the French National Budget: a)

Budget of French Polynesia: Regular Budget Medical Research Institute Total - - - - -

1970 316 500 000 22 100 000

1972 448 725 25 246 O( O(

338

600 000

473 971 O(

Submitted by the Director of Public Health, 12 July 1973.

'\ - 2 French National Budget Economic and Social Investment and Development Fund (FID'ES) •..•••••••••••••••••• Contribution to the operation of the Endemics Service (remuneration of doctors, pha,rmacists, nurses) ••••••• Filariasis Control Service •• Total •••••• 12.7Q

1.271

21 250 000

33 809 000

30 293 022

165 090 000 20 497 781 206 837 871

184 545 450 21 108 727 239 463 177

255 818 180 23 389 817309 501 019

Total health expenditure Budget of French Polynesia French National Budget Total _e • • • • • •

338 600 000 206 837 871 545 437 871

444 344 257 239 463 177 683 807 434

473 971 000 . 309 501 019 783 472 019

i.e., An average annual per capita expenditure amoutni to (in US dollars) ••••••••••• 4.

$62

$78

$90

MANPOWER

Health Services Number as of 31.12.70 Public Research Health Institute Endemics Service 27 + 6 5 contractual service 3 4 1 290 298 629 Number as of 31.12.71 Public Researoh Health Institute Endemics Servioe 5 + 1 34 + 5 oontractua1 service 3 9 1 Number as of 31.12.72 Public Research Health Institute Endemics Service 5 + 1 35 + 7 contractual service 3 8 1 321 374 749 805

Category Doctors Pharmacists Dentists (contraotua1) Social worker Midwives (State diploma) Health assistants, Nurses Office clerks, General service workers, drivers TOTAL -

16 32 53 682

16 32 54 765

17 33

309 350 711

---

• - 3 -

Doctors under an authority other than the Health Services: 2 School Health Social Welfare Fund 20

3 c)

Doctors in the private sector as of 31 December 1972:

ORGANIZATION

The new Mamao hospital (central hospital), with its modern airconditioned buildings, was opened on 24 April 1970. With its 410 beds, it is a most successful achievement. After the modernization of the Taravac hospital, which has also been completed, plans have been made to reorganize the old Vaiami hospital with a view to setting up modern pneumo-phtisiology and neuro-psychiatry services. Work in connexion with the new central supply pharmacy and the home for the aged in Taravao is making good progress and it is expected that these services will become operational at the end of this year.

6. Leprosy

CONl'ROL OF MAJOR PUBLIC HEALTH PROBLEMS

The use of sulfone drugs since 1950 has resulted in a significant decrease in the number of leprosy cases. The prevalence of the disease is now at 2.25 per 1000 with 271 cases under treatment for a population of 120 000. The number of new cases is fairly stable, between 5 and 10 per year. These are usually detected through routine medical check-ups (in 1972, 6 out of 7 cases were detected when examining contacts of leprosy patients or during school visits). The high percentage of cases where the disease take a non-allergic form or produces a variable reaction (i.e., 50%) and the large proportion of patients who are not inactivated after being treated for 5 years (36 out of 89 lepromatous cases, i.e., 40%) show the difficulties which must be faced in French Polynesia when it comes to the eradication of this disease. These difficulties are essentially due to: dissemination of patients in remote islands, hence, little opportuni ty to examine contacts inadequate level of sanitation and health education

.. • - 4 -

It should, however, be noted that attendance for treatment at the clinics has improved and that patients are more cooperative, which makes it possible to envisage the elimination of leprosy in the coming decades. Venereal diseases These diseases seem to be on the decrease: 84 cases were reported to the Endemics Service against 134 in 1971. One hundred eighteen cases of gonococcal infection were recorded for the entire Territory and the total number of cases of syphilis is estimated to be twenty. Penicillin is still potent against gonococci and no antibiogram have shown any evidence of resistance. Syphilis: Declared cases are of the primary and secondary forms as well as a few old visceral cases or neurosyphilis. It may, therefore, be assumed that venereal diseases are at a level sufficiently low in comparison with the large number of young or unmarried people so as not to be considered as a serious health problem. Tuberculosis A total number of 212 new cases and 13 relapses were recorded in 1972 in the central register of the Tuberculosis Control Centre. The incidence is therefore 1.9 per 1000 for the 119 000 population concerned; 1.4 per 1000 if we take only into account the new cases which have been confirmed by the laboratory; and 0.77 per 1000 counting only those with positive smears or the excretor index. This seemingly stationary situation is due to the development of case-finding activities. The excretor index as a whole has decreased by 25%. In comparison with the previous year, the general index for the Windward Islands (80% of the population) is diminishing I 1970 = 151 new cases; 1971 = 141 new cases; 1972 = 135 new cases. Special case-finding efforts have been made in the Tuamotu Marquesas during the past year, which accounts for the 46 cases found in this group (Tuamotu and Marquesas) with a 12 000 population, giving a rate of 3.8 per 1000: "conJunctural" index. Cases are usually found starting with the 15 year olds with a peak in incidence at the two extremes of the adult age group. As far as Tuberculosis Control Centre is concerned, systematic case-finding (approximately 15 000 X-rays) has accounted for 44% of the recorded cases and made it possible to find 28.1% of all forms with positive smears. There were 4048 visits at the urban dispensary of the Tuberculosis Control Centre. Staff of its Social Service made a total of 2067 home visits or various other visits and kept 959 new contacts under surveillance.

I ,>

- 5 -

As for preventive activities. considering both the work of the Tuberculosis Control Centre and those activities which are integrated within the General Health Services, a total of 3745 BCG vaccinations have been given to newborns and infants and 1187 vaccinations and 3279 repeat vaccinations have been given to school-age children and similar groups (Freeze-dried BCG. Pasteur Institute, Paris). A special campaign has been carried out at 1:',11 levels concerning bacteriological case-finding and the control of persons showing cough symptoms: interviews, teohnical notes, signs and posters, etc. Filariasis Filariasis (lymphatic filariasis) control activities cover the entire Territory. They have been the responsibility of the Medical Research Institute since 1949. The following amounts have been allocated for filariasis control activities: in 1970 in 1971 in 1972

20 497 781 21 108 727 23 389 817

Prophylaxis is based on Notezin which is given to the entire population. Evaluation of this programme is made by taking 20 mm3 blood samples from each individual and checking them for microfilaria. Before control activities were started, 25 to 40% of the population were carriers of microfilaria. Depending on the area, the carrier index is now between 7 and less than 1% and clinical signs have all but vanished. "Louis Malarde" Medical Research Institute In addition to filariasis control activities, the "Louis Malarde" Medical Research Institute is carrying out various research projects dealing in particular with: Oceanography Entomology Immunology medical aspects and especially ichtyosarcotoxism vectors of dengue fever and filariasis, blackflies and biting midges dengue fever, rubella. parasitiC diseases (filariasis strongyloidosis).

- 6 -

Budget of the Medical Research Institute: 1970 1971 1972 22 100 000 22 047 257 25 246 000

7. CONCLUSION Activities of the health services in 1972 remained - as was the case the preceding years - within the framework not only of curative medicine but also of preventive medicine and the control of major public health problems. Health education is gradually being introduced and should become a major feature within a few years.

... /

. ORIGINAL: ENGLISH

HONG KONG BRIEF REPORT ON HEALTH ACTIVITIES, 19721

GENERAL HEALT'rl

The general health of the population remained good during the year. The major oommunioable diseases are under control and there has not been any major epidemic in recent years. There was no outbreak of cholera but preoautionary measures against the disease were continued. Over the past twenty years the pattern of disease has ohanged. There are less deaths from communicable diseases and more deaths from non-communicable diseases and from accidents. The leading causes of death are cancer, heart and hypertensive diseases, pneumonia, cerebrovascular diseases and tuberculosis.

VITAL STATISTICS

The estimated mid-year population in 1972 was 4 077 400. The number of known live births was 80 344 giving a crude birth rate of 19.7 per thousand population. This is the first time since 1960 in which the previous continuous downward trend in birth rate appears to have reversed. Further observations of the birth rate in future would be of interest. The number of known deaths was 22 135 giving a crude death rate of 5.4 per thousand population. The infant mortality rate fell further to 17.5, and neo-natal mortality rate to 11.6. The maternal mortality rate continued to remain very low at 0.20 per thousand total births.

COMMUNICABIE DISEASES

Communicable diseases notified during the year were 10 873, and tuberculosis comprised 77~ of the notifioations. Compared with the previous years there has been a notable reduction in the number of communicable diseases notified, decreasing from 23 742 in 1967 to 10 873 in the year under review.

lSubmitted by the Director of Medical and Health Services, Hong Kong, 5 July 1973.

. - 2 Cholera On three occasions routine examination of nightsoil samples revealed the presence of cholera vibrio in certain nightsoil routes on Hong Kong Island. Subsequent investigations for cholera organisms from these routes proved negative. No case of cholera was reported during the period when positive nightsoil samples were obtained. The public was informed of the findings and advised to observe strictly the rules of personal and food hygiene. Diphtheria The annual inoculation campaign continued to give encouraging results, and from the number of cases recorded in recent years, the stage of eradicating the disease from the community appears almost to have been r~ached. In 1972 only five cases were recorded. This shows an even lower figure than the 25 cases recorded in 1971. Poliomyeli tis Only four cases were reported. The vaccine is offered free at Government maternal and child health centres and a general immunization campaign is mounted annually. About 78% of infants received one dose of type I polio-vaccine soon after birth, and 74% of infants received two doses of trivalent vaccine at maternal and child health centres. Epidemiological surveillance of the disease was maintained throughout the year, including virological investigation of laboratory specimens for polio-virus and the carrying out of a poliomyelitis faecal survey among normal children to find out the distribution of polio-virus in the community. Measles The disease incidence and its mortality have remained satisfactorily low in the last five years. Since 1967 measles vaccine has been included in the public health vaccination programme and the vaccine is now regularly available at the maternal and child health centres. Annual campaign is conducted each year in order to encourage parents to bring their children who have not previously been vaccinated, to the inoculation centres to receive immunization. Influenza The disease occurred sporadically during the year. Epidemiological surveillance was continued. Influenza A virus was isolated from a number of throat swabbings and throat washings sent for virological investigations. The influenza virus strains isolated were antigenically closely related to the variant A/Hong Kong/107/7l showing a certain degree of antigenic deviations from its prototype A/Hong Kong/68 (H3N2).

... - 3 Tuberculosis The mortality rate from this disease has fallen to 32 per 100 000 of the population and the notification rate fell further to 206 per 100 000 population. Ninety-six per cent of the babies born received BeG vaccination within 72 hours of birth and BeG vaccination is also directed at school entrants and school leavers. Several lines of investigation with BeG are under way. These included an investigation of the different techniques of giving BeG to new born infants, a study on the advantages and disadvantages of direct BeG and a survey of children born after 1 July 1966 notified as suffering or dying from tuberculosis. As a result of a large scale trial with the Medical Research Council to assess the effectiveness of standard ohemotherapy in Hong Kong, the six months of three drugs daily (PAS, Isoniazed and Streptomyoin) with whioh treatment was usually initiated, was reduoed to three months. The study to evaluate the most effective drugs for the treatment of resistant cases is almost oomplete and as a result, it is now possible to treat many drug resistant cases on a completely outpatient basis. A study of the possiblli ty of reducing the lengthy period of treatment for tuberculosis, averaging some 18 months, is now well under way. The results of these many investigations are of international interest and it is hoped that they will revolutionize the approaoh to the treatment of tuberculosis. Venereal diseases The recorded incidence of early infectious syphilis continued to remain low in 1972. A reduction in the incidence of latent and late syphilis was noticed. There was a slight increase in the number of gonorrhoea cases but the number of cases of chancroid and lymphogranuloma remained comparatively unchanged. Leprosy Due to the decreasing incidence of the disease, the number of new cases admitted to the Hay Ling Chau Leprosarium for treatment has shown Plans are being made to phase a notable reduction in recent years. out and eventually close the leprosarium. Future leprosy cases requiring hospital treatment will be accommodated in the special infectious disease unit of the Princess Margaret Hospital scheduled forcompletlon in 1974. Other infectious diseases Other infectious diseases showed little variation during 1972, and require no separate comment.

- 4 4. MA'IERNAL AND CHIID HEALTH SERVICES AND FAMILY PLANNING

Almost all babies are born either in hospital maternity wards or in maternity homes and confinements at home attended by private midwives now represent less than one per cent. of the total deliveries. The maternal and child health service offers free maternal and child care at 35 centres, 20 of which are full-time. A new full-time centre in South Kwai Chung was opened in autumn 1972. Attendances at the health centres continued to be satisfactory. Family planning clinics in the maternal and child health centres are at present conducted by the Family Planning Association which is subvented by Government in its activities. In future the Medical and Health Department will assume a more direct role in family planning by directly providing the service through the Department's own maternal and child health clinics.

HOSPITALS AND OUT-PATIENTS SERVICE

There are now 16 733 hospital beds available in Hong Kong, representing 4.1 beds per thousand of the population. Of these beds, 7037 are in Government hospitals and clinics, 7621 in Government-assisted hospitals while the remaining 2075 are provided by private agencies. Apart from general hospitals, Government also maintains other hospitals for specialized purposes, e.g., the mental hospital at Castle Peak, the two infectious disease hospitals, the Tsan Yuk Maternity Hospital and the newly opened Siu Lam Hospital for the severe grade of the mentally subnormal. The number of inpatients treated in Government institutions is in the region of 170 000 a year. In some hospitals the pressure for admission is high a~d temporary beds are used whenever the need arises. There are 49 Government general outpatient clinics and specialist facilities are available in the larger polyclinics or specialist clinics. In the more densely populated areas evening outpatient sessions are held at ten clinics and on Sundays and public holidays outpatient sessions are also held among six ·of these clinics. The more remote areas of the New Territories continued to be served by two mobile dispensaries and the 'floating clinics' while the 'flying doctor' service to more isolated and inaccessible villages was maintained.

MEDICAL DEVELOPMENT

The medical development programme continued to make satisfactory progress. During the year a total of seven projects were completed. They are the Siu Lam Hospital for the mentally subnormal; the Medical and Health

r· ..

- 5 Department Institute of Immunology; stage one of the South Kwai Chung Polyclinic; the new clinical building and the new pathology building and the virus laboratory at Queen Mary Hospital; the Medical and Health Department Laundry; and the new Victoria Public Mortuary. Work also began on an urban clinic and maternity home at Tsz Wan Shan, and on major alterations and the new outpatient department at St. John Hospital, Cheung Chau. Construction work for the General Wing of the Princess Margaret Hoepital continued satisfactorily. The end of 1972 completed the medical development programme for the ten-year period 1963-1972. The target of providing 4.25 hospital beds per 1000 of the population as set out in the ten-year plan has been achieved. Plans for future development beyond the previous ten-year period would be separately examined in 1973.

FINANCE

The actual expenditure of the Medical and Health Department for the financial year 1972-73 was $235 24, 875. To this should be added

SUbventions totalling $110 loB 034 to many non-Government medical institutions and organizations. The capital expenditure on hospital and other buildings totalled $51 923 641. These amounts represented 9.24~ of the Hong Kong's total expenditure during the year. This does not include expenditure on environmental sanitation by the Urban Services Department and the District Administration of the New Territories.

,ENGLISH ONLY

JAPAN REPORT ON THE PROGRESS OF HEALTH ACTIVITIES FOR THE FISCAL YEAR 19721 (April 1972 - March 1973)

ORGANIZATION OF NATICNAL AND LOCAL HEALTH ADMINISTRATION

With the reversion of the Ryukyu Islands (Okinawa Prefecture as the 47th prefecture in Japan) from the administration of the United States of America to our country which took place on May IS, 1972, the Ministry of Health and Welfare has been made responsible for their health and welfare program in the same way as in the other 46 prefectures. On 1 June 1972, in order to cope with the increasing importance of health and medical care for the aged population, the Division of the Health for the Aged was newly created in the Social Affairs Bureau in the Ministry of Health and Welfare, and on the same date the former office for International Affairs in the same Ministry was made as the International Affairs Division to be ready to cope with the increased program of international cooperation on health and related programs, by integrating some programs used to be carried out in other Divisions. The prefectural and municipal health centers, of which there are 839 (including 7 centers in Okinawa Prefecture), continued to carry out their routine functions as local community health service agencies. 2. HEALTH BUDGET

The total national health budget including a subsidy to the local governments for the fiscal year 1972 was ¥l81 563 million; in the fiscal year 1971 it was ¥l65 696 million.

•

VITAL STATISTICS

The estimated population as of 1 October 1972 was 105 742 000 (for 1971, 104 345 000). The following table gives some of the vital 1

Submitted by the Embassy of Japan in Manila on 17 August 1973.

- 2 -

statistics data for the calp.ndar year 1972 and a comparison with 1971. (Figures for 1972 are appr~ximate.) 1971 Births: Number Rate (per 1000 population) Deaths: Number Rate (per 1000 population) Infant deaths: Number Rate (per 1000 total live births) 2 000 973 19.2 684 521 6.6 24 805 12.4 1972 2 038 678 19.3 683 760 6.5

23 777 11.7

The average life expectancy at birth for the Japanese people, prepared on the basis of the 1971 data, indicates 70.17 years for males and 75.58 years for females; the comparable figures for the previous year were 69.33 years for males and 74.71 years for females.

MATERNAL AND CHILD HEALTH

During the calendar year 1972, 1 645 770 visits were made to the clinics by mothers. and 5 711 357 by children (including 1 331 235 children of 3-year old). Public health nurses paid 287 148 home visit on mothers and 8Y~ 481 on children. At the end of March 1973, there were 608 maternal and child health centers in the rural areas (595 centers in 1972). During the calendar year 1972, 69 781 low weight babies were reported.

5. TUBERCULOSIS CONTROL In the calendar year 1971. the number of deaths from tuberculosis decreased further same as the previous year; there being only 12 549 a rate of 11.9 per 100 000 population (for 1971, the rate was 13.0). During 1972, 44 257 000 persons (45 293 000 persons for 1971) received health examination for case-finding purposes. The case-finding rate was 0.06% (0.07% for 1971); 4 489 000 were vaccinated with BeG. The total number of registered tuberculosis patients as of the end of 1972 was 540 557 (618 711 for 1971); 20.8% of them were hospitalized. 68.6%

, - 3 -

were under domiciliary treatment, 9.8% did not receive any medical treatment and the remaining 0.8% could not be traced. During the same period, 147 941 cases were newly registered (for 1971, the number was 158 164). For 1970, the total expenditure on tuberculosis treatment was estimated to be 135 billion yen.

CANCER AND CARDIOVASCULAR DISEASE CONTROL

The recent trend in Japan is that deaths from malignant neoplasms and other degenerative diseases have been increasing remarkably, comprising an important proportion of the total deaths; particularly, the so-called adult diseases such as vascular lesions affecting the central nervous system, malignant neoplasms and heart diseases which have been placed as the first, second and third causes of deaths. As for cancer, we have been carrying out special measures for early detection and treatment of stomach cancer through mass-examination cars and cancer treatment facilities, since this comprises the large portion of canoer cases: about 2500 patients were detected to be suffering from stomaoh cancer during 1972 out of 2.5 million people aged 40 years and over. As for cerebrovascular diseases, we have been also carrying out health screening through the network of health centers and home-visit guidance by the public health nurses; about 727 000 homes are visited annually. '.

7. COMMUNICABLE DISEASES CONl'ROL

As in previous years, the following successful immunization programs were carried out during the calendar year 1972. The number of immunizations given was as follows: 3 235 000 for smallpox; 1 949 000 for diphtheria; 542 000 for diphtheria-whooping cough combined, 3 611 000 for diphtheria-whooping cough-tetanus combined; and 2 823 00 for poliomyelitis (attenuated vaccine). The incidence of poliomyelitis was dramatically reduced after the successful oral administration of Sabin-type poliomyelitis vaccine. In 1972, only 7 cases were reported (in 1960, 5606 cases). The number of Japanese encephalitis cases has decreased compared with 1971, and only 37 cases were reported. The number of persons who received voluntary immunization for Japanese encephalitis during 1972 is estimated to be about 13 million. The number of cases of dysentery has decreased yearly; 7104 cases were reported in 1972.

- 4 -

One imported case of smallpox in a Japanese male, occurred among the arrivals from Bangladesh. After staying there from 9 February to 16 March 1973, he returned to Tokyo on 18 March and was hospitalized on 23 March. There was no secondary outbreak as the necessary control measures were undertaken.

FOREIGN QUARANTINE SERVICES

During the calendar year 1972, 39 439 vessels (1 316 007 per~o~) and 33 602 aircrafts (2 850 779 persons) received health inspeotion at the time of their arrival from abroad; 194 985 persons were vaccinated against quarantinable diseases before going abroad (this number excluded those vaccinated at places other than the quarantine sta~ions); 923 ships were granted deratting certificates and 7664 ships received de ratting exemption certificates.

ENVIRONMENl'AL HEALTH

As of the end of March 1972, a popUlation of 87 651 665 (about 82.7% of the total population) was covered by some kind of public water supply system. At the end of March 1973, there were 314 cities operating sewage treatment plants and a population of 19 870 000 benefitted from these services. At the end of March 1973, there were 1144 nightsoil treatment plants and 114 community sewage plants. At the end of March 1973, it was estimated that a population of 94 820 000 was covered by tre wastes disposal programme, either by incineration or composting methods, and landfilling. The Environment Agency established in July 1971 ~as most responsibility for the administration of the environmental pollution programme at national level. General reco~~ition and awareness of environmental problems have rpcently become intensified and various anti-pollution counter-measures h'lve been implemented in a number of areas. Partly due to this general ;.: ,.'nd, improvements have "lJeen made in some areas, but there are many other sectors in which pollution prevails unabated. Atmospheric pollution, poU1Xt1..cm ~ue to sulphur oxides, suspended particulate'>, Cin,j carbon l1~de have recently shown a downward trend.. Hcwev"~. n: :.rc·~[ oxides and phydrocarborus, believed to be the .un oe.wJe of photochemical smog, oontinue to pollute the environment. Regarding water pollution, although aGme signs of improvement have been made in large rivers in suburban areal!, it is rampant in rivers near

- 5 -

urban centers and urban areas in which there is industrial concentration. In the Ise Bay and Setonaikai (the Seto Inlanc. Sea) areas where geo~ra ph:cal confinement ard tidal stagnation tendencies are strong, pollution is particularly ':!onspicuous. Noise c;oea ted by aircraft, n3\~ super express railway lines, and other high-speed transportation systens are also creating serious problems. In addition to the destruction of the Datural environment in such areas as rivers, lakes, swamps, oceans, 'orests, etc., there are cases in which certain wild life, such as the Tancho crame or Toki (crested ibiS), has al~ost become extinct due to det,erioration of their environment. Thus, deterioration of the natural environment has been progressing on a nationwide scale. In spite of the measures taken to terminate the omission of PCB into the environment by discontinuing its production, a vast accu~ulation of PCB has 'llready been released, and this is having an adverse influen::oe on the environment. Once released into the en'Jironment, these poll;;.ting substances cannot be easily recovered. As to the forms of accumUlative pollution, there were cases of problems caused by gradual precipitation and accumulation of pollutants on the bottom of oceans, bays, lakes, etc., as exemplified in the colloidal sediment (hedoro) and eutrophication problems. Deterioration of water quality, generation of odo~, and damage to fishery due to the red-tide caused by these types of pollution have presented serious economic problems throughout the country.

10.

FOOD SANITATION

During the calendar year 1972, 5910 food inspectors were stationed in 839 health centers. 3 213 460 food handling establishments were inspected. For the same year, the total number of food poisoning cases reported was 1406, involving 37 232 patients and resulting in 37 deaths. Chemical synthetiC to be used as food additives are fully controlled under an authorization system by the Government. At the end of 1972, :37 chemical synthetic focd additives were authorized. 11. NUTRITION AND HEALT'-l: PROMOTION

During the calendar year 1972, 1 502 539 cases of individual nutrition guidance and 101 224 group sessions, including demonstrations by kitchen cars, were given by the nutrition staff of the health centers. As of the end of March 1973, there were 262 authorized dietician training schools and 194 679 licensed dieticians. In order to promote the health of people particularly that of the elderly, a "Health Index" was prepared to be used as a guide for the general public on how to improve their health and daily living.

.. - 6 -

12.

DENTAL HEALTH

One hundred and twenty-nine health centers were equipped with dental faclli ties and dentists, and ('ontinued to pl'!y an importal'1t role in the preventive dental health programme. During the year 1972, 192 546 dental health guidance consultations were given to pregnant women and 1 738 349 to children. 13. MENTAL HEALTH

Continuous efforts were made to improve the mental health program, lncluding the care of the mental cases. The number of mental hospitals, mental beds, etc., at the end '::Jf December 1972 as compared with the s~me data in 1968, 1969, 1970 and 1971 is shown below: 1968 Number of me:1ta1 hospitals Number of psyhiatric units in general hospitals number of men1:a1 beds 853 446 1969 859 902 486

472

473

500

217 015

232 156

242 014

250 450

256 379

There are many governmental agencies carrying out the program for the promotion of mental health guidance for the public as well as for me:1tally retarded childre:1 and adults. Services for counselli:1g and h0m~ visit guidance of mental patients being given at 832 hea1tt cent"r~:, t:rder the auspi,~es a:1d technical V;ll''3.nce of 33 local mental heal th'nnters. <~re

14.

MEDICAL SERVICES

At the end of the calendar year 1911, there were F026 hospitals (7974 for 1970) with a total bed capacity of 1 082 647 (1 062 553 for 1970), showing an increase of 52 hospitals and 20 094 beds against those available in 1970. At the end of the calendar year 1971, there were 69 857 general clinics (68 997 for 1970) and 30 317 dental clinics (29 911 for 1970), showing an increase of 860 general clinics and 406 dental clinics.

, - 7 -

At the end of the calendar year 1971, there were 123 178 physicians (11. 7 per 10 000 population). 39 218 dentists (3.7 per 10 000 populatien), 83 246 pharmacists (7.91 per 10 000 population) and 319 219 nurses (30.4 per 10 000 population). This mean0 an increase of 4188 physicians, 1359 dentists, 65 pharmacists and 35 747 nurses. A network of accident and emergency medical care has been established throughout the country; at the end of October 1971 the number of such :'acllities, either public or private, reached 4684 .

15.

PHARMACEUTICAL CON'!'ROL

During the calendar yecr 1972, 2118 pharmaceutical inspectors visited 250 001 pharmaceutical facilities (out of a total of 278 469 such facilities), such as drug and medical supply manufacturers, pharmacies and blood banks. The control of stimulants and narcotics and measures to deal with narcotic addicts were continued. As for the blood supply service, the Government, recognizing the seriousness of increased risk of serum hepatitis among the population due to "professional blood donors" who used to represent the larger portion of blood supply resource, made a decision 9 years ago to develop a nationwide voluntary blood donation campaign; the ratio of voluntary donation to the total donations increased to 99.4% during the year 1972, in 1970 it was 97.9% (in 1964, only 7.7%).

. --

The ~onitoring system for adverse drug reactions established in March 1967 continued its activities in order to ensure the safety of drugs. During the fiscal year 1972, 271 cases of adverse reactions were reported through the doctors of those hospitals designated as part of the drug monitoring service (approximately 250 cases for 1972). Based on the information collected throlliSh -:he moni taring service and other :10urces, appropriate regulations on the use of anticonvulsants, estrogens and progestogens ard ataractics agents were drawn up in 1972. Since April 1972, Japan has been participating in the WHO Research Project :'01" International Drug Monitoring, has been supplying the adverse '''''[1 ~ ti on case reports to WHO regularly.

ORIGINAL:

FRENCH

KHMER REPUBLIC BRIEF REPORT ON THE HEALTH SITUATION I

In spite of the fact that the health infrastructure has been largely destroyed as a result of the war, which is now entering its third year, the activities of the Ministry of Public Health have not slowed down. On the contrary, it has had to face enormous difficulties aggravated by the influx of displaced persons fleeing from areas where fighting is in progress and seeking refuge in the urban centres. The Ministry of Public Health is focussing attention on the field of preventive medicine: A. CONTROL OF COMMUNICABLE DISEASES

1. A cholera vaccination campaign is being carried out in the entire country. Number of persons vaccinated to date: 470 785. 2. BCG vaccination campaign in schools, factories, nurseries and displaced persons' camps - this campaign. has been very strongly

reactivated as the Tuberculosis Control Unit had to reduce its activities considerably following the events of 18 March 1970.

3. Malaria control operations in the provinces of Battambang, Kompong Thorn, Pallin and other provinces where security conditions are favourable. a) Techniques used: - spraying operations - distribution of malaria drugs to inhabitants in the malarious areas as a preventive and curative measure b) Epidemiological and entomological surveys

4. Poliomyelitis control campaign in the city of Phnom-Penh for children in the age group four months to six years. 5. Venereal disease control - reactivation of control activities by expanding the Service, provIding it with equipment, supplies, drugs and staff and launching an intensive programme and mass propaganda among the population. 1

Submitted by the Minister of Public health, 13 July 1973.

- 2 -

6. Leprosy control - distribution of drugs to leprosy patients in their homes, at the out-patient department of the Pen Chum dispensary and the Troeung leprosarium coupled with the distribution of food to the patients. The Ministry of Health is arresting lepers found circulating in the city and sending them to the Troeung leprosarium once a week. 7. Plague control in Svay Rieng - a fatal case has been reported in Svay Rieng. Measures taken: - ectoparasites - trapping of rats - chemoprophylaxis and chemotherapy B. ENVIRONMENTAL SANITATION

The sanitation campaign for the city of Phnom-Penh includes: 1. 2. Waste collection Individual garbage bins for each house Increase in the number of garbage collection vehicles (Phnom-Penh municipal services) sewers which are in bad condition and cleaning out of filled or otherwise obstructed sewers. Installation of new pumps to eliminate storm water and to avoid flooding. Control of public buildings, housing and displaced persons' camps. Drinking water supply for the sanitary engineering unit in displaced persons' camps. Installation of a new water filtration system based on coconut fibers and balls of burned paddy and filtration of individual water supply in earthen containers. These facilities were provided in Kambaul (Kandal) to meet the needs of approximately 800 inhabitants.'

4. Sewerage - repair and restoration of the sewerage system and

- 3 -

Testing for residual chlorine in the water supply systems for the city of Phnom-Penh and the periphery. A Master Plan concerning water supply and sanitation for the city of Phnom-Penh has been prepared and is to be implemented in the near future.

HEALTH EDUCATION

The health education campaign includes the following activities: distribution of leaflets, statements over the radio, television programmes on various public health subjects.

OTHER SERVICES

Nutrition, maternal and child health, family planning. E. HEALTH REGULATIONS CONCERNING PUBLIC HYGIENE AND GENERAL SANITATION

In the field of curative medicine, the Ministry of Public Health has managed with its limited facilities to provide for the construction of infirmaries and hospital clinics in the provinces. It has set up in the capital city a workshop for the maintenance and the repair of medical, radiological, refrigerating, electrical and mobile equipment. In the field of medical and social work, the Ministry of Health Is play.ing an active part in the development of the National Rehabilitation Centre, with the assistance of UNDP, the Rotary Club, the Khmer Red Cross, etc. The creation of this centre is justified by the fact that since the war, which started in April 1970, a large number of our casualties among the military, whose number is constantly increasing, have had to have amputations. The problem of functional rehabilitation must be dealt with and the activities of the Centre will be extended to cover medical cases: paraplegics, cerebral lesions, the blind, deformities due to leprosy and poliomyelitis sequelae, retarded children. The construction on this centre is nearly completed and it should become operational within a few months. For the current year the total allocation for public health amounts to

1,034,604,700d90 (707,183,759dOO for the past year).

ORIGINAL:

ENGLISH

MACAU BRIEF REPORT ON THE PROGRESS OF HEALTH ACTIVITIES - 19721

AREA AND POPULATION

The ~otal area of the Portuguese Overseas Province of Macau is 15 515 km and its population is 248 636 inhabitants, according to the census made in 1970. 2. GENERAL MORTALITY

The total number of deaths and the rates in the last five years were as follows: 1968 Deaths Rates per 1000 inhabitants 1508 5.18

1969 1474 4.98

1970 1516 5.13

1971 1543 6 022

1972 1539 6018

The 10 major causes of death in the last three years were as follows: Causes by groups Heart diseases Cancer - all types Tuberculosis - all forms Cerebrovascular diseases Senility All accidents Bronchitis. emphysema and asthma Pneumonia Hepatic cirrhosis Symptoms and other ill-defined causes of morbidity ....................... Q

1970 ••

1971 290 235 156 148 163 68 71 34 45 35

1972 256 243 204 154 136 93 68 39 24 23

• • • • • • • • • • • • • 0.0.01110 • • • • •

••• 0.0 ••• 0 . . . . . 0 •• 0 ••• 0. ••••• 0 •••• 0.0.0.0

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 ..

........................................

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 .. .............. 0 ..

.0 ••••••• 0

• • 000 • • 0 · . · • • • • • • • • • 00

••••••••• 0.0· •••• 0 ••••• 0

273 247 150 141 156 90 (a) (a) 39 (a)

.0 • • • • • • • • • 0.0 •••••• 0

•••• 0

(a)

Did not figure in the 10 major causes of death. TOTAL (80.69% in 1971; 80.57% in 1972)

1245

1240

Submitted by the Director of Health and Welfare Services. Macau. 5 July 1973.

TUBERCULOSIS

Tuberculosis, mainly of th'" l'lngs, continued to be the transmissible disease of greatest incidEnce in Macau, despite the work done by the Prophylactic and ;'herapeutL: Centre.

1968 Tuberculosis: All forms

1969

1970

1971

1972

... Pulmonary ... Cases Deaths ... o •• 0 ••••••••••••• 0 •••••

...

Cases •• oe • Deaths

1330

235 1207 227

1157 161 1142 155

1263 137 1257 133

1304 156 1298 151

1678 204 1673 201

The rates of mortality of tuberculosis in relation to the general mortality were The rates of the total newborn vaccinated by BCG

1').6

10.9

9.9 41.1

10.1

13.2

....... 0 •••••• 0 ••••••

33.1

45.2

51.2

54.1

TRANSMISSIBLE DISEASES

Malaria continues to be eradicated; c) Diphtheria continued to decline; d) The number of deaths from tuberculosis was similar to that in 1967 and 1968; however, the deaths constitute only 12.15% of all cases reported in 1972, a rate lower than those observed in 1967 and 1968 (15.42% and 17.66%).

We emphasize the following:

h) No cholera cases were reported in 1972;

The following table shows the incidence and mortality of the main transmissible diseases in the last five years: C = Cases ""

D = Deaths

1968 "

1969 D

1970 D C

1971 D C D C

1972 D

'" CO'.lgh

Cholera Whooping

:1).

18 20

,)iphther~

14 6

I\moebic d :{sentery

13 1

16 2

- :3 -

1968 DISEASES C Bacillary dysentery Unspecified dysentery Paratyphoid fever ·Typhoid fever Malaria Acute poliomyelitis Measles Syphilis Tetanus Tuberculosis pulmonary Tuberculosis other D

1969 C 2 19 2 32 1 7 159 5 7 1142 15 D

1970 C 1 D

1971 C 1 1 D

1972 C 2 11 2 74 a) 2 D

7 15 3 23

2 1

9 1 34

1 1

24 1

7 158 4 17 1207 33

32 42 1

10 227

1 6 155 6

16 1257

89 3 17 1298

1 83

6 151 5

3 6 1673

4 201

2 -

133

5. MATERNAL AND INFANTILE ASSISTANCE In 1972, at Macau hospitals and maternities, 2750 children were born alive, 997 (36.25%) at government maternities. However, the estimated number of births in Macau was 4898. There was no maternal mortality. Infant mortality (aged under one year) was 81 (16.5~), being the major cause of death: prematurity (14), acute upper respiratory infections (13), pneumonia (6), hemolytic disease of newborn (10). The only organized ante-natal assistance service and infant health service is provided by Government. Ante-Natal .I\ssistance Clinic No. of pregnant women registered for the first time in 1972 ............. QO......... No. of attendances in the clinics ••••••••••••••• Q ••

236 1434

Infant Health Service Clinic No. of children registered for the first time in 1972 · .•...•.••.. 0 ..•••...... 0........ No. of attendances in the clinics ••••••••••••••• 467 3309

- 4 -

SALUBRITY AND SANITATION

A sewerage system in Macau has been recently reconstructed, serving about ~ of the population. Plans are going on for the construction of other sewerage systems in suburban areas where, due to existing circumstances, there are still hundreds of huts without any hygienic conditions, occupied by farmers and domestic animal breeders. Urban housing states are being built to provide people with economic houses and reconstruction of housing states in suburban areas is being widened in order to replace the existing huts, so as to achieve a solution to better salubrity in the outlying zones. Macau population is provided with a drinking water supply, subject to the usual control. It is used by about 85% of the inhabitants, although 15% may still use water from springs and numerous wells in the city.

HEALTH AND SANITARY MANPOWER

The staff of the Macau Health Services consists of: 1 Director (who is also the director of General Hospital) 1 Health Officer for the city of Macau 1 Health Officer for the islands of Taipa and Coloane (also practicing general clinic) 9 General clinic doctors 8 Specialist doctors 1 School health doctor 1 Malariologist 2 Pharmacists 44 Male and female nurses, the latter also practicing midwifery 43 Auxiliary nurses 17 Nuns, some of them working as nurses and others in the laundry and kitchen 1 X-ray technician 3 Laboratory assistants 7 Pharmacy assistants 1 Social assistant 2 Social workers 20 Administrative officers 12 Administrative auxiliaries 11 Sanitary agents 18 Skilled workers 8 Motorists 230 Servants and other minor personnel

- 5 -

The following physicians and paramedical professionals were in the Macau Health Services on December 31, 197?, practicing either in private clinics or private hospitals. re~istered

104 55 83 1 13

Doctors Dentists Chinese traditional medicine practitioners (herbalists) Odontologist Midwives 4 Massagists

IMPROVEMENTS IN MEDICAL AND SANITARY INSTALLATIONS

In 1972, the Macau Health Services continued to improve its facilities by: a) building a mental health hospital; b) building of a rural medical clinic in Coloane, to replace the former one. As far as equipment of the services is concerned, all items bought for the clinics of estomatology and radiology room are in use. The sanitary-demographic statistics section has been installed in a room at the Health Department and provided with furniture.

HEALTH SERVICES EXPENDITURE

In 1972, the Government provided the following amounts: From the ordinary budget: From the Development Plan budget Patacas $ 5 677 200.57 (US$l 113 177000) 8.15% of the total budget Patacas $1 316 842.10 (US$258 205.00) 6.13% of the total budget.

ElISE!) '.:.'EXT

ENGLISH ONLY

BRIEF

REPORT

ON THE PROGRESS OF HEALTH ACTIVITIES IN MALflYSIil **."****.]fo-*,*********~~******** *·:HHf··X-*

TWENTY-FOURTH OF

SESSION

THE W .H.O. RIDIONAL COMMITTEE OF THE WESTERN PACIFIC

28TH AUGUST -

5TH sEPmmER, 1973

AT WELLINGTON, NEW ZEALAND

000000000000000000000000000000000

DIVISION OF PLANNING lllID DEVELOP),Q:NT t~nrISTRY

OF HEilLI'H, MAhWSIJ>.

Kualn. Lumpur.

31ST JULY, 1973.

BRIEF Rl!!roRT ON 'I'HIj PROORli:':!F.I nl MALAYSIA

(."\1;"

l{!ilJ.Vl'H AO'l'IVl'l'Xl/l"

------------------_ ... _-------------------

Malaysia iG a federation of 13 States, eleven States arc in PENINS'ULAR MALAYSIA and SARA'~AK and SA13.\H are in the island of Borneo. SIZE : It covers an area of 127.581 square miles. PeninsL;.lar Malaysia haG an area of about 50 806 sq. miles an'l ':loth Sara\~ak and Sabah have an arf'_of approximately 10,175 sq. miles. LOCATION : ----.-h'l.ti tucle

Malaysia lies in a crescent close to the between11 and 7 0 0 North and Lon-:itudes 100 and 119 East. Peninsular ~!alaysia and the States of Sarawe.k and Sabah are sepa.ratecl by 400 miles of the South China Sea. Peninsular Malaysia has a land frontier wi thThailand in the ;1orth, ~Jhile in the south the Republic of Singapore is linked with it by a CaUG8way. To tho west, across the Straits of Malacca lies the Indonesian island of Sumatra. Saral-Iak and Sabah has a larHl frontier with Kalimantan Indonesia a11<l to its north'-6ast lie the Philippine Islands. 00 ........-,.

. equator

CLHIAT8 --_

: interplay of China ~ea. daily averaze oVGrywhere comparatively

~'l.laysia is subjected to maritime influences ru1U to the Hind systems which orir,imxte in the Indian Ocean and the South The avera"e annual rainfall varies from 60 to 160 inchGs. Tho 0 0 temperature variosfrcm 10 tc 90 p. Tho relative h:.unidity is ",enerally high, though the nic:ht temperature in most places is low.

roPULATIGN -..-.-..------Malaysia has a total population of 10,536,713 (1970 Census, figures). Of this fiCSuro 8,900,972 are ir. Peninsular Ealaysic.. 628,269 in Sa'Jn.l-t and 1,007,502 in Sara1'/ak. This shews an increase of 2,622,214 peoplG in Peninsular Ma12;'sja since the 1957 Census population and increases of 173,848 people in S&')ah o.nl cf 262,973 people in Sarawak since the 1960 Census population. The popul:ltion densities in trw various st.'ltcs of MalaYSia =e as folloHS :Area in ,.sg:!f1.:i1:.~ f..0.E.~.l_at io.!!,

Density por __~q.mil~.!L

Perlis Kedal1 PenD.ng

Perak Selangor Negri Sembilan !11al(;'~coa

Johore Pallang Trengganu KelQJltan PENINSULA..'1. MALI,Y5IA Saban Sarawak JoJAS'r MALAYSIA' }l.,1LAYSIA

307 3.639 399 8 110 3 166 2 565 637 7 330 13 886 5 002

124 158 .962-813 777 104 1 589 513 1 657 333 485 308

407 250 291 648 503 088 413 174 .. _68.9.2.21 ~. 2.OP. 212.

7~)_

404 265 948 196 523 1139 639 176 36 83 120

dP..8Ci6

.••1.72. 22 .2.1_ 21

4.?__Q2Q l§...J72 127 581

28 725

628 269 .1 007 ....5.Q~

1...tS.3;L17J.. 1() 5~_H3

§3

The population in Ponillsul"r ~lalaysia consists of thre~ main races, Mala,ys, Chinese end Indians. T~e l'h13;Ys ruprosont about 6).2'1. of the population, the Chinese 35-~~ and the Indians including Pakistanis 10.6~. The remaining 2% consist of l~~sians, Europea~s and Others. In Sabah the of the popUlation. K~dazans

arc the largcst racial groups - about ene-third

In Sarawak tho Than (Sea Da;yak) is considered the largest group, folloW'::d by Chinesc and then Mala;ys. ~LTH ADMINISTRATIOr~

At the turn of the century, almost all the medical anJ health services were provided -c>y Govornm,mt, 'filis aocidcmtal rr.onopoly wns, however, dilut"d by the setting up of estate nnd mines hcspi tals by the rubber and mining industries. In recent years, a fe'1 privn.tc hospitals wore established by missionary bodies and other organizaticns. In

1948, the Federation

,,1'

!,fal~ya

il.greemant decentralis0tl control to

an extent whore, excepting for some federal institutions such as mental hospitals and leprosa:o:-io.s, 'the executive contrel ever the service bec1llDe fundamentally a State matter. In 1957, with the declaration of Independence, Health hecame a Federal mntter, uxcept for certain preventive meaeures in tho Municipalitids and other Lec::>.l Authority Areas. (In the formn.tion of Maloysin. in 196), Health in Sarawak bec~~e a Foderal matter while in tho State of S::!.bah it remained a State mattor '.Ultil 1970. The Central Government assume(l responsibility for hoal th in this :3tate in 1971.

GENERAL }IEALTIL$ITUATIOl! :

EXcept for an outbron.k of Cholora El Tb~,the country has been relativC'ly freG from oth'"r commLmic;J.blc ltis;;ase. 'llie general hUi'.lth of the population contin~Gs to improvG with the vnricus mortality rates progr~ssively declining. VI'l'AL STATISTICS

The Rate of Natural Increas~ is gri'.<lually declinins- and so are the Crude Mortality and other Mortality Rates.

~-...

Tl113I..g

~----,..-

..........

_ •. ~_____,, _____ ~, __ ll:lI.l"t:,~I'L_, _.. , ___,., _____. _______

POPULI,TION, R:d',J OF tU,TURi,L UrCm;f.S;;;, Cl~UlJE BIRTH RI.TE, CRUDE D&\T}1 RATE AID em.mE MORTALITY RATES IN PENINSUL.ilR

~I "

'I (mid-year) I Rat_e_+ _RAt_e_+__N_e_o-_-+, ~ -195-;---+-Natlll _':~ant_i I_noreas. i, _ _ _

Year

I I

Estimated Population

i ,

Rat. of : N.turlll

i I

Cru:!e

Birth

i 1

Cr1!1e

CrUde

1dortlllitv

Death

Hate

Toddl'::.t-.!~~erruu. ~ 11 ' 3.2

6 V8 758·

33.;--1" 31.4 28.8

46.2

,'12.4

30 30 26

1900 1965

6 909 009 8

O~ 030

40.9 36. '/ 32.2

1970

10 536 743*

<5.2!

9.5 7,9

69 50 41

6 6 4.2

2 4 2:03 1.48

6.9

. 1971 9 4el 510t 25.8' 32.6 L' I ______ 6.6 ~______ 22.5 ~~______ 38.5 4.00 ~______ ~____________________________ L-__ ~__L-___ 1.24

'" Census

+ Excludes Population

!)f

Ssr:YNak and Sal:>ah.

-3DEVELOflfENT PLANS : Malaysia is in the Fourth Five year D~velopm0nt Plan period (1971-1975). The Capital Investment in the Health sector of tho PI~ has been revised up\ wards to 1>1$246.0 million. It involvos the implemontation of no loss than 1,500 projects covuring Poninsubr Kn.laysia , Sabah and Sc.rawak. Although we are only in the third year of the plan pcriool, positive action has beon taken to implemont 1,182 projects cf the total planned projects. Of these, 517 projects have been completed and commissioned, 225 projects arc under construction, 95 have gone out on tondor and 285 are in various stages of planning. RURAL HEALTH SERVICE

To correct the imbalance in the distribution of the medical and health servioes in the country, the Rural Health Scheme lias introduced to provide preventive and curative service including dental-care and mat~rnal and ohild health oare in the rural areas where some 60% of the population live. This involved the building of an effective not-work of main health oentres, health sub-centres and midwives' olinics. The following table shows the physical progress m~ie in the implementation of the Rural Health Scheme.

TA..ELE II

1st IIalsya

2r¥I l.ialoya

1st llalsysia

Plan ( 1955-1'}60)

Plan ( 1961-1965> 31 114 617

Plan ( 1966-1970)

_.---- ----.. --. -..-----r-------~IIlain Health Centre Health Sut>-Centre

: Total; i ~--+1_(..:19_7_1>-+-! (_19_7_2)_t--______ ! 'I I

2r¥I Malaysia

Plan

i !

a 8

J 58 ~

3 14 45

4 6 119

51 200 1107

I l Mi~ifeCli.·_~_·_c

_____~ ____ 26 ____ ___L

Almost 4 million or two-thirds of the rural populdion are now provided ~r.ith basic preventive and curative services. The remote areas w~_lich are not yet covored by this scheme, mobile dispensaries and subsidiary maternal ana chiln he~lth olinics provide service on a weey~y or fortnightly basis.

T!·J3..I:!....!P

ATTENDANCES

}~T

.----~-.-.,

ILl:ALTH CEHTRCS, HOM:!: VISITS .'IND I!OM'0 D,,)LIVERI~S

.. ----.- ..-_ ~

......

------__ .J

i Total

I 1961 1965 1970 1971

Attendances at Health Centres 5 114 419 6

lieme Visits

Home Deliveries

! I

91<1 819 1 484 767 1 729 296 1 987 293 2094346

50 119 64 555 76 455 77 755 83840

I 1

96<) 864

6 869 631 7 ,01 627 8362977

1972

I !

-4PUBLIC (a) ~TH

PROIGRAMMES :

~arantinable Diseases

The outbreak of Cholera ~l Tor biotype Ogawa continued during 1972. Peninsular Maln,ysia had 287 cases with 4 deaths, Sarawak had 118 cases ~lith 1 'death and Sa"bi\h had 121 cases .. i th 4 deaths. By the end of tlie year the whole country ~.;as declared free from Cholora.

(b)

Tuberculosis :

~e National TuberculoEis Control Programme was officially launched in 1961 and has been fully cperational since 1965. The aim cf the programmo is to reduce and eventualiy eliminate the ne~dless human suffering caused by tuberculosis by using all the effectiv3 weapons available that ru~e of proven I3fficacy and practic"l applicability, basud on advances in bio-medical, technological and operational research.

In order to develop tho programme so as to produce the maxim~m epidemiological impact on the problem definite and procise priorities h['.ve beon established and at pro sent th8 tuberculosis progrnmme has defined tho following three basic objectiv8s : (i) (ii) (iii) Protection of at lcctst threo-quo.rters of tbe suscoptible population with BCG vaccination. Identificcttion of two-thirds cf the infocticus cases prevalent in the community. Render at least 95% of.those infectious cases identified permanently non-infectious with adequate trecctment.

To achieve these objectives the programme has to reach the. entire population and the measur·JS have to be of a permanent I4"1.ture. The National Tuborculosis Programme has therefore been evolvad on this basis ahd consists of the three inter...relllted com;;>onants. 1. 2. The Training Programme. The BeG Vaccination Programme. The Case-finding and Tre:ltment I'rogrD1llllle. th~t

In addition ,the National Tuberculosis Conferences of 1969 agreed to achieve successful implementation the following are also necessary -

4. 5. 6.

Int0gration of th\J programrno with the basic health survioes. Tuberculosis Man:.gerial Teams. Community Participation. :

(c)

Ma13,ria -----

Following tho suceessful Maloria Eradication Pilot Projoct in 1960/ 1964 and a countrY-I.ide Pre-Sradic:ltion survoy in 1965/1966, the Nationnl Malc.J.I'ia Eradication Programme was launchod in 1967. It was origin.:>.lly pl=od for a 10-year p<Jriocl but vrns e;x:tl.mdod to 14 Yam's. It will be carried out in phases and stagGS from the Nortll te the South. Up to tho end of 1972, the programme has oc-vored thu States of Perlis, Kedah, Pcnang, Kelantan, Perak, Trengc;anu, Pahang ancl Selangor. Gensrally, there has been a sharp drop in Malaria incidence in all those States.

- 5The programme is being progrc)Ssi voly expanded from yer...r to yec.r Md the whole of Peninsub.r 11alnysia is ,)XP,-,ct;)Q to b8 covered by 1974. Tho aim is to o.chicve toted and oomp10te er~clioQ.tion by 1982 with the oontinuecl support of li.H.O. (d) Lepro sy CPE~

The National Leprosy Control Progr~me was launched in 1969 to reduco the incidence of leprosy and thereby eliminate the disease as a public health problem in 20 ye=s tim". A sum of Jl,7 million "ms approved fer the implementaticn of the Plan. Undar this Programrne, the trGatmG!lt (.f leprosy has been decentralised and facilities are provicleJ. at all the Hos;lit".ls and Health Centres to treat the patients. Only highly infectious pati0nts requiring speCial c:.\re ar" admitted into the leprosarium. The integration of leprosy service with the general mGdical and health services has not only brought down the treatment cost pJr capita but has also helped to bre~k public prejudice against the disease, and raisud tho morale of the paticmts. In-patients treatment cost M$1,200/- per patient pur year as compaNd to about $20.00 per yetJ' per patient who is reeciving Out-paticmt trelatmJl1t. The numh"r of pati,mts now recoiving Out-pationt treatment at various hospitals and He:J.l til Cuntros is arou.nd 4,500 in 1972.

,Immunisation a~ainst Small~ox, Tctanus and Pertusis is routinely pcrformou by every h"alth centr" ::mel clinic. A tota.l of 190,530 primary v::LCcinations were porformcd in 1972. Somc 170,304 children completed thoir courses of inoculC1.ticn against Diphthcrio.,· Tet'anus Md Portusis. No case of Smallpox has beon ruperteu since 1960. The incidenoe of Diphtheria has declined from 23.58 per 100,000 po;:>ul:J.tion in 1961 to 4.22 in 1971. (f) ~<?..~al Sanit_<l:tiC!!!. :

Environmcnt~l SanitC1.ticn is one of the b~sic services offerod by the rural health sto.ff. A pilot prcject 'iGS start,~l in 1967 in every State in Peninsubr MalaySia covering ::.p:;;roximately 30,000 people Md has proved successful, In 1972 it has ':leon 13xpan,:lld to covor 300,000 pvpulo.ticn =:1 will be.further llxpanded to cover 450,000 pcrscns in 1973.

(g)

School Health -----.., ... -

........ ~

startod in 1967, the; 8cho.)1 h<oc.Hh s.Jrvioe cevoroJ rur:J.l primary scheols. The Joint School Ik.J.lth Comr:1i tt"o c:;nduoted state-lov"l seminars covering about 1,500 key soheol QZlcl hualtI1 {'ersonnol in 1971.

(h)

Health Education -----~.

: ~)(~rmon.tos

Health IDlucntion

all basic services and. h:)n.lth activities

and is carriod out by all ho:\lth stC1.ff oithor by the purson-to-person approach in tho clinic or Juring hom;; visits cr 'lY th" community 1).pprc3.ch, utilizing inlividual and group reSOQrcos in tho community to get community participation in improving their own health and sanit0.I'y conditions =ound thom~

Family planning is administored by thu National F'lJIlily Planning Board with the objective of reducing propub,tion iSI'mlth tv 0. mMo.goable proportion so that tho result of the country's plannod eoonomic developmont will yield greater benufits and increase the ~Gr capita incomo cf the people.

- 6 -

Since 1971 the Ministry of H0alth has be",n ccllaborating 'lith the National FMlily PLulning Board in intoerating family planning s8rvicGs with th~ oxisting rural hea.lth sorvices. Starting with pilot-demonstration projects in eight distriots covoring 798,000 pecple in 1971, the inteero.tion proer=e will be expanded from 1973 \,ith UNFPA and ~lorld Bank assistal':lCe, so that integraticn will cover .approximately 86.a}b of tho rural population by the end of 1976. HEALTH PLANNI$ :

A Health Planning ~~d Research DiVisions was established in 1969. The main aims of the Division is not o~ly to fcrmulate development plans for the health sector but also to supurvise sctual projoct implementation. _~ppropriate and timely eV(1.luativework wilfbc'undertcicen"frOm- timetotime so as to lend maximum efficiency ,:md effectiveness tc all development work of the health sector. The Division will assist the country in identifying health ~roblems and ne0ds, as'well as in establishing policies and final objectives within the health secter which will contribute to the nati ~'nal plD.l'l fer social and. ecC'nomic development, con::mnant and complementary tc the objectives est",r,lished in the other sectors.

PATIENT-CARE SEaVICE: Every existing hospi ttll in the country is bdnis renov"te·,f o.nd expanded =d Mcillary departments have be.'m enlarged to COPiJ with tho ever-increasing demMd for meflical care. This demand is incr()Osing net only becausG of thG growing population but also due to m,:re an1 more people taking to modGrn medical treatment. The uemand rate for admissions has incre~sed from 4+.3 per 1000 population in 1960 to 56.1 in 1972 and this can be expecto'l to inCrOo.s0 stoadily. Howover, the demand rate for cut-patient trea1ment in hospitals has inoreased at a much slowor pace from 637 per 1000 popUlation in 1960 to 641 in 1912. This slower rate of incrJase is due to the numerous C',ltpatient de,lartments in health centres 11.11d c~ispensaries whic:l are scroenin;,; ca.et1B bef'c:>!"" they NIMh the hospital. statistics shm, that ·2ur hospitals Gre bcinei mere efficiently utilised as the avera..,:;e numb"r of patients treatod per occupiecl b<Jd ros increased from 30 to 45 per a~um. However, tho average duration of stnlf per pationt has declined from 12.4 dnlfs to 8.1 dnlfs. The overall bed cap~.city

of Government hospitals has incrc1:l.sed from

20,337 in 1957 to 27,930 1)y the end of 1972. The n~ber of sp cialist units are on the increase as more and more metlical specialists become avcdlahlc. Besides the basic specialities, units in radiothernpy, nauro-psychiotry, plastic sur,s;"ery, caruio-thoracic, and genito-urinnry units have also beon e:tablished. TABLE IV ... .. .--.....-.----~ ~

,--

IIQfirI~I~S1illI _<L'{}l'T~1j'am

.-AT QUT..."EATIllm'...Jl~Ma1J'.S

Hcspital Admissions HOBP. Out-Patient treatmtlnt ~

.1957 271 490

1.921. 450 873

1970 489 532

.1..21.1 502 371

1972 551 888 6 990 157

281 965 5 451 471

5 706 062 5 997 925

- 7Besides Govornmunt hosl''' t2.lc, thore aro iniustrial and pri vo.te hospitals and matornity homes ,lith ,.., tet,o.l hel-ccrr.,)10mcmt of 6,227 "hieh hiJJlclletl about 119,460 in-po.tionts Q,..'l_' 1.23 millicn cnt-po.tionts. ;lc d'lto. ~G uvaila1)le of the voluma of l'u:~iQnts hunllol by eJnoral prnctitichors ~JUt with more than 852 praetidng molic:1l pr:1cti tivn,:,rs in ;Jri vate s-:etcr thoir contribution is signific'l:lt. j)1'1JT!'.L SERVICES :

In the provision of Dent;'),l Services, em;lhasis is placod on tho ;:rcvention of dental disoases Dl1l0l",g school chilclr,)n. A comprohensive fvrm cf dentnl treatment is provide~, ani this inclulos ex~i~o.ticns, scaling, polishing of to~th, topical ap;11icntion of flucrides, fillings of teoth, oxtr,-,ctions, prcvisivn of dentures, ortho,lontics anel majer or:ll surg(;lry. Tho aim is to rentler dental fitness to ev.)ry chile, in sch<'c1. Prierities cf tre"\tmcmt are also provided to ante-natnl and nursi11g mcthors and pr0-sehool chilrlrLln. The ddento.l policy h:18 heem enl['.rg0d to include trcntment cf adult memb()rs of the public. Like the medical ;md h8~,lth survices, thv dentn.l service is boing expanrled .)rimarily into thv rurd ar<Jo.s. Of til.) 465 ddntal clinics about 60% are to be found in tho rur.,l o.rv"s. Theru o,ru 48 mo.in clinics, 140 scheol d0nt'l1 clinics, 11 lent",l clinics attached to Goner",l llcspi tals, 41 dcmtlll clinics in Nain Health C0ntrGS and 190 H(;o,lth Sub-CentriCs an1 17 m01:Jile clinics, and 18 p,",rt-time cliides. .TA!3 ......-'.... -_. ~.~- --.--.~------

12 6q Ne,. of Clinics

19 6 2, 322 1032040

12lQ 450 170'~417

.12H 4/)/+ 1949323

_rn~

146 655140

Toto.!

a.ttendQ..,.~cGs

444 2215324

There is ncw (l, Dental Fo,cltlty at th0 Univ0rsity cf Nabya for the tr::1ining 0f iontal surgeons 0.."11 at IJros"nt thoro arc; 62 :l,,:lt::l stud.)nts undorgoing training. As rul int(;rim moasure, fe,ruic:::n Jental sur~c;ons hav.J b00!1 recruited on contr::1.ct t8 ovorCGmo thi..: ~:;r8s0nt shortG.,;e of Jontal surg2cns" In u.ddi ticn, Idgis12tioTI h_'!s ':Lk:n \}llC!.ctCd. tc r2quirIJ :lunt;J,l surgeons un first rogistr~tion to serve D. tH0-YiJ:tr csmpulsory ':.;orvice in the Covornmont._ Thu FluoriJ.o.tion of Pll'llic ,J::-,tGr Stl;J,·,lics, a ;u':Jlic h0::1lth me:)'sure to roduce the incicloncc of dontL1.1 carriers, h::-.,s be: . . ;n 2.Pl~,r·,)ve.J by the Gov~r.,lment ~nd will bE),.implomentod in 197,~.

- 8 II - SARAWAX

The estimated population of the state of Sarawak in 1972 is 1,037,364 based on the population census of 1970 at the rate of 3.1% of annual increase • I. "DEVELOPMI:NT

! () ,

In the 2nd Mala.ysian Plan, emphasis is placed on the expansion of the Medical and Health services into the rural areas which are not covered by existing facilities. The introduction of new pattern of rural health units in the State is a maj~r step forward in closing the ;aps in the existing service system. " For the period 1971 - 1975. the total allocation is J{17,570,01O. In 1972, the total alloc~tion was J{3,463,315 of which ~,469.505 was expended which represent 71%. " (i) &rawak General 8os;i tal"

This hospital is now fully commissior.ed and has a total bed strength of 582 beds. The old hospital buildings have been converted into the Medical and Health Office and a hostel for Hospital Assistant~.

(ii) Dispensaries In 1972 four new Rural Health Sub-centres were fully commissioned. Similarly two floating clinics providing basic curative facilities plus Dental Service. was commissioned in July of 1972.

(iii) School Dental Service Twelve school clinics with 12 chairs were establishGd in 1972. (i v) Mass Health Callpaign Funds under this sub-head are utilized for the purchase of material for the construction" of sanitary latrines and water supplies to provide safe water and sanitary facilities to the rural people as a meane of improving their health and standard of living. In 1972 an additional 30,253 people benefited from this scheme. (v) Miscellaneous At the Sarawak Mental Hospital improvements to the attendants Barrack, the installation of a new laundry machine, the purchase of a Land-rover for Home Visiting and the construction of a new 8-bedded female security ward. At the Charles Brooke Memorial Hospital for leprosy a blook of six docr barracks waS completed. At the Simanggang Divisicnal Hospital, a 10 bedded maternity wards and the new operation theatre wore completed. At the Sarikei District HOspital, improvements to out-patient Department as well additions of a 10 bed maternity ward, 8 b~d second class ward and 6 bad paediatric wcrd were completed. At the Miri Divisional Hospital a 3-tray refrigeration chamber was " installed in the mortuary. At the Marud~

District HOspital a new Mortuary was oonstructed.

- 9 -

II.

Public Health

~e~i2~

(i ) ~'Y'j..'!:,J1.o_ntr2.l_tr2..:Le_st.. The aim of the Sarawak Malaria Control Prcject is to maintain the gains that has been already achieved. In 1972 there were 2,431 cases detected as compared to 1,643 of 1972. This slight increase was due in part to an improved ~ystem of case detection. The main area of continued transmission were still the border areas of First and Second Divisions the security areas in 3rd Division nnd Punan (nomads) of Fourth Division.

(ii) 1!ibor.Eu!.osis Contr_o.!, B,y the end of 1912, 657,834 vaccinations has been given since the project started. In 1972 alone 67,~8 vaccinations were given an~ 1,231 new oases were registered. Of the 2,533 cases under treatment 115~ failed to collect drugs against 21~ of the previous year, thus reflecting general improvements in Follow-up procedures. A Central Case Register of T.B. Cascs which has introduced in 1970 and is functioning well. This register provides useful epidemiological data for future plnnning and direction of the progr3mffie. It is also pcssible to evaluate the efficiency cf the treatment programme for the whole state. Of the new cases registered in 1972, 807 wore sputum positive. New cases by X-rn,y shows 287 for advanc,ed, 652 mcder3tely advanced alid 153 with mimimal lesions.

At the end of 1972 there were 51 Rural Health SUpervisors in the stat-e. These workers are assignwd to rural area.s and each worker has to look after five to eight villages comprising of two to three thousand people. This progr~e is becoming increa.singly popular as more water supplies are being established. Since 1961 when constructicn of water supplies was included in the Scheme, 427 systems wero completed and. tr._ey serve a popUlation of 94,348. The WHO and UNICEF continue to provide assistance to the programme.

Total 106

1961 1

1968 13 1 3 3 10

1969 37 8 4 1

1970 25 2

i 1971

Pipe/Gravity Feed Pump/~torage/pipe

11 14

Rain/Dam/Storage R~in catachment Sanitary well Population served La.trines

I 1

9 193 94348 1 j 7436

1 727

I 1972 30 I 57 5 2

I i I

- 1806~

18 16258

5 I 61 32 71 16940,22101 30253 , _I, 1192 ! 2707 ,

, 1 I i 5 I

I I

! ___ 1

- 10 -

(iv)

Sahool Dent..<:!.. Services This "ervice is designed to build up a group of dentally fit children in primary scheels by establishing in the schools deDtal clinics, staffed by dental nurses. In 1972 twelve new School Dontal Clinics were added bringing tho total to 60 School Dcnt~l Clinics. In the same year the total 11ttendances was 115,897 as comparcd .~i th 110,195 for 1971 and 82,145 for 1970. '

(v)

Maternal Child He111 th Services ...... .. "'" ..............,:uld ... .. ~ ,

--.--~~--,-~--

This is 11 rosponsibility cf municipalities ~d districts oouncils which numbcr 22 in the state. The midwives =e trainud by Medical Department to ensurc thnt they reached an ·adequate standard bufore they are registGred as midl'lives. Subst=tial aiel ,i.s given by UNICEF' in the form of equipment, skim milk-and vitamin capsules. The Medical Departm(mt .subsidisoothe s'.lrvioe by the proviclion cf drugs anti consumables. Up to end. of 1972, 120 clinics stClff()(t by 192 midwives were in 0peration.

-I

1_~~~8 r! --~~2.-t- 1970 Clinic attendanoes Home Visits Dalivcries Immunizations

1971

1972

410382, 415 082 1428 728 491 467 545 179 , ' N.A. \100 734' 93 423 82 717 95 096 9 917 14 501 N.A. \ 8 747 9 960 N.A. N.A.

B.C.G. Triple Antigen(doses) Poliomyelitis Smallpox Diphtheria

N.A. N.A.

19 55 54 24

,--IV.

307 347 462 009 14

15 48 52 16 !

120 458 817 436 2 785

17 77 71 22 2

224 18 714 390 87 706 865 87 561 1 472 126 058 949 : 7 124

Traini~

This continue to roccive top priority. Apa.rt from doctors, dentists, pharmaCists, most c~tegorius of staff are train0d locally. Th()re are training schcols for Nurses, Assistant Uursos, Hospital Assist=ts =d Rural Health Supervisors in Kuohing. There is alsc a training scheol for midwives in Sibu. At the or.~ cf 1972, thero aro 357 staff of all categories under trc.ining, 51 in ,rost Malaysia and overseas centres and 306 in Sarawak. In 1971 thoro were only 206 staff in training. In-services training courses are conducted for dispensers, laboratorJ assist3nts, anaosthetic t0chnicians and x-rD.lf technicians.

- 11 ..

III

(a.)

Maternal and Child .. -.- _ ...... .. - --Health -- .. ,

-.,'......;:.;:.:...;.,::-'

Services :

Maternal and Child Health Services prcvided thrcugh health centres, villa:,;e grcup sub-centro::; and mcbile clinics continue to expand thrcughout the State. There are at Ilr0sent 15 health cel1tras, 136 village group sub-centres and 18 clinic-cum-dispensaries. Immunixation a~ainst tuberculcsis, pcliomyelitis, ciiphtheri.a, tetanus, whooping cough and smallpox are carried out. Of the 27,502 births registered in Sabah in 1912, 7,016 took place in Hospitals and another 3,640 were supervised by rural health nurses.

~i~~~_c~..E..a~: The anti-malaria campaign, Hhich covers the whole State, has reduced the number of malaria cases from an estimated 250,000 ill 1958 t~ 11,067 in 1972. In certain problem areas transmission continues, though on a lesser scale. (b) !~es_c.u.lo_E}i~ font:~:2LI'L0eE.eE.:.~ The Tuberculosis Contrcl ProgrClJll.":le started in 1960 with mass X-rrw and B.C.G. campaign. By tha end of 1969 the control activities were a.lready covering 10';:; of the estimated State population. At present c~se dctection is done both by mass X-ray campaign and sputum examination. Direct B.C.G. inoculation is given to children aged 19 years and belm••

(c)

In 1972, 612 tuberculosis cases (including a. few whioh wore nonpulmon!:1.ry) WOl'O diagnoSJd. In 1960 thore were 2,652. There were 39,919 persons inoculD.ted with B.C.G. in 1972 comparod with 7,500 in 1960.

(d)

g,~3£tyItinab..!~Di£l_~Ep":

Except with the outbreak of EI tor cholera in November, 1972 with 121 confirmod cases reported, the st~te is free of other quarantinable diseases. MEDICAL CARE

II.

CurativG services are provid.ed from 14 hospitals with 2,013 beils and 35 static dispensaries with 384 rest beds. Three of the hospitals provide specialist services, Numbor of patients admitted into hospitals and dispensaries vlere 60,869 in 1972 as compared with 20,296 in 1960. Dm!TAl... SER..Y.ICE,~

III.

There was somo 8 dental officers in olinics in the State were recorded at the Clinics. IV. '

expansion of the dental services in 1972. There are the service. There arc altogether 20 school dentn.l with 28 school dental nurses. 36,574 attcnde.lloes General Dental Clinics and 62,507 at School Dental

TRAllTING . . Trainiil,o; of the folloHing categories of staff are undertaken locally in th" State (a) Staff Nurses; (b) Assistant' l1ursos j (c) Rural Health Nurses; (d) Laboratory Tochnicians; (e) Junior tuberculosis ~d antimalari~l workers; and (f) Rural Health Assistants.

Other categcriGs dlf staff 0'6' Public Health Insp0ctors, R~io "•• ·:·~.·s School Dental Nurses and Dcnt~l Technicians aru tra~n8d ~n

ORIGINAL:

ENGLISH

NEW ZEALAND 1 BRIEF REPORT ON PROGRESS IN HEALTH ACTIVITIES, 1972-1973

INTRooocrroN

Increasing attention has been given to ways and means of strengthening and improving primary medical services. The development of group medical practices and health centres in particular are being encouraged by Government.

In 1970, the Hospitals Act was amended to enable Hospital Boards with the prior approval of the Minister to establish health centres to integrate the various facets of community health. preventive and curative care, as well as rehabilitation under a central control. The capital costs of health centres are to be financed by grants to hospital boards, from a special provision in the Health Department appropriation. Government has approved the provision of a subsidy of ~ of salary up to a maximum of $35 per week for approved practice nurses. social workers and practice managers employed in health centres. subject to conditions as to minimum numbers of each of these categories of worker. On 1 April 1972, the transfer of psychiatric hospitals, with the exception of Lake Alice Hospital. to Hospital Board control became effective.

GERIATRIC SERVICES

All major Hospital Boards have been requested to set up geriatric assessment and rehabilitation wards under the direction of a specialist regional geriatrician. This programme is aimed at adequately and promptly assessing all aged patients admitted to hospitals. and to institute an effective programme of rehabilitation with a view to returning them to suitable accommodation in the community.

DISEASE CONTROL

No further cases of poliomyelitis have occurred since 1970. 1971 and 1972 were marked also for the first time by the absence of the reported cases of diphtheria. lSubmitted by the Director-General of Health, 23 July 1973·

- 2 -

Pulmonary tuberculosis continued its downward trend to an all-time low in 1971, but a marked up-swing occurred in 1972. The full reason for and the significance of this swing is not yet clear, but so far is not continuing in 1973 with, to date, notifications being lower than even in 1971. The rubella immunisation campaign was extended to all primary school children in 1971, and it is aimed to maintain this herd immunity by immunisation of pre-school children by their general practitioners. As an indicator of the success of this programme, congenital rubella was made notifiable in 1972 and two cases have been notified since that date. Infectious hepatitis continues to be the most prevalent notifiable disease while in 1971 serum hepatitis was made notifiable as a separate entity. Notifications have predominantly come from drug abuse and tattooing.

A pilot hypertension survey has been conducted in association with the M.M.R. Unit and a wider survey is being planned. 4.

DRUG CONTROL

Several measures have been taken in the control of drugs and narcotics as a means of controlling drug abuse and dependency. They include the establishment of assessment and treatment centres, and restrictions on the dispensing of narcotics by private practitioners. A major review is being undertaken of the legislation relating to drug misuse.

•

NURSING

Government has approved that as soon as practicable overall responsibility for future nursing education be transferred from the Department of Health to the Department of Education. Two pilot programmes have been started within the technical education system. These Cover three academic years (3000 hours), and ~ of the stUdents' time is spent in gaining clinical nursing experience in health agencies of all kinds, with the aim of ensuring that graduates can provide comprehensiTe nursing services.

•

- 3 -

ENVIRONMENTAL HEALTH

The Clean Air Act 1972, which became effective on 1 April 1973, is expected to improve the control of air pollution in New Zealand.

NOISE

A Committee of the Board of Health was formed to draft a report on the problems of noise in New Zealand, and to recommend the necessary action to improve the reduction and control of noise. The report will be published in 1973. 11-

SUBSIDIES

Since 1970 an improved scheme for subsidising local authorities' water supplies and sewerage works has been administered by the Department of Health. A subsidy of $1 for $2 is offered on the actual cost of approved works. The value of subsidies paid in 1972/73 financial year was about $3 million.

DENTAL HEALTH

In February 1972, the Ministers of Health for Australia and New Zealand concluded an agreement whereby up to 100 Australian student dental nurses would be trained at the Schools for Dental Nurses at Wellington, Auckland and Christchurch. 75 students have already, or are to commence, training in 1974 and a further 25 in 1974. 10. SOLID WASTE DISPOSAL

Following publication of a Report on a National Survey of Public Refuse Tips in New Zealand, a departmental committee on Pollution of the Environment will be publishing guidelines for refuse disposal during 1973. A subsidy scheme for local authority refuse disposal is under consideration.

- 4 -

11.

FOOD STANDARDS CONTROL

Because of the importance of food quality to public health, a Food Standards Committee under the Food and Drugs Act was formed to advise the Department and the Minister on food standards to ensure that the quality of food is under continual review. 12. BENEFITS

Health: The Royal Commission of Inquiry into Social Security which reported early in 1972 made a number of recommendations concerning health benefits, and several of these have been implemented. Those of major importance are medical benefits, and include increases in both the standard and higher General Medical Services Benefit; an extension of the higher rate to children up to their tenth birthday; and increased rates for urgent attendances and extended time. An immunisation benefit for children and adolescents has also been introduced, which is accepted in full settlement by medical practitioners. 13. OCCUPATIONAL MONITORING

The National Radiation Laboratory has provided a monitoring film service for persons occupationally exposed to radiation in New Zealand since 1951, and the service has been extended over the years to include some ASian and Pacific users. During 1972, of the 897 establishments regularly using the service, 59 were located overseas. 14. ENVIRONMEm'AL RADIOACTIVITY

Three low-power nuclear devices were tested in the atmosphere at the French South Pacific test site between 26 June and 28 July 1972. The results of monitoring by the National Radiation Laboratory have been published in "Fallout from Nuclear Weapons Tests Conducted by France in the South Pacific from June to July 1972", published by the Laboratory in October 1972 (NRL - F/49).

ENGLISH ONLY

Brief Repor.t on Health 10

Korea for

Presentation at the Twenty fourth session of the Regional Committee

Republic of Korea

General Introduction

The population of the Republic of Korea was about 32.4 million

(32.416,000) in 1972.

It had been increasing rather rapidly since the

Korean War (1950 - 1953), at about three per cent per annum, but the national policy of population control adopted in 1962 helped to bring it down. Simultaneously, as a result of the five year develop_______ ,. __ ,,_ --.,. . r--~

meJ;l.t plans started since 1962, a precipitous social as well as economic change was set into motion which tended to reduce the hitherto high level of fertility. The birth rate of 42.9% per 1000 population

in 1960 dropped by more than ten points in 1 '166 and came down to

29.3 per 1000 persons in 1970.

The national growth rate therefore

has declined from 2.7% during 1960 - 1966 to 1.9% during the 1966 -

1970 period. Population density is also high in·Korea.

It increased from

254 persons per square kilometer in 1960 to 320 per sq. km in 1970. Since three fourth of the country is mountainous, the population density is estimated at 1362 persons (800 persons per sq. km of rural land) per sq. km of arable land. among the highest in the world. Vital statistics in Korea have been and still arc far from complete. Persistent attempts have been made to supplement the required - 1 Such population densities are

information through deIIlographic surveys and special studies. Aceordingly. it has been estimated that crude IIlortality was l3.0 p.,er 1000 population in 1960 but dropped to 9.0 in 1966 and 8.5 per lOOO in 1970.

The reduction was most marked among infants and Life expectancy at birth, consequently, has

the I to 4 years old.

been rising and was estimated at 64.8 years for males and 68.7 years for females, for children born in 1970. Causes of deaths have even been more difficult to establish with certainty for obvious reasons. Even so, the rank order of

the ten leading causes of death has been changing consistantly, except for pneUIIlonias and tuberculosis that continue to occupy lather high places in the order. There has been a persistent and somewhat steep rise in urbanization in urban areas (cities of 5~.

000 or more are defined

as urban) was 250/0 in 1955 but rose to 340/0 in 1966 and 43. 3% in 1970, with a cOIIlIIlensurate depletion of population settle on cultivations. The rise in Urbanization has only kept pace with the rise

in industrialization.

The HealthProbleIIls Control and eventual eradication of cOIIlIIlunicable diseases,

- 2 -

with tuberculosis occupying the first position, has been the main public health concern in Korea. typhoid is still endemic. Of the enteric group of diseases,

The relatively poor quality of drinking Japanese encephalitis occurs

water is partly responsible for this.

in epidemic form every few years. About half the population is infested with one or the other forms of intestinal parasitosis. Increasing urbanization is now only adding to the importance of communicable disease control. Population control has assumed great importance lately. On it depends the success not only of the health program.m.es but economic development as -a whole. Korea's family planning pro-

gramme is directed at this problem with the following planned objectives:

Year

Projections without F. p. Programme. Total pop. Birth rate (million)

ProjecnonsWith F.P, Progranune Birth rate Total ~:e. (million)

1970 1973 1976

32.4 30.9 29.9

32.5 34.9 37.4

28.0 24.6 21.2

32.2 34.1 35.8

While malnutrition is not likely to pose a general problem, ".

it is feared that with growing overcrowding, malnutrition and

- 3 -

deficiency dilleasea may increase ...rnou6 t.l;." ym....,"lg<lr ;;.gc groups. Mater:nal and; child health care and family planning services, there . fore, are also assuming greater importance day by day. Korea now faces health problems both of developing and deve· loped coUDtries. Rapid industrialization and overcrowding have

generated urgent problems of air and water pollution and genera.l environmental health. And, with gains being made in the control of diseases and a longer life span (an increase of 11 years over the last decade), rise in the degenerative and cardiovascular diseases and cancer is inevitable. also on the increase. Industrial and road accidents are

Governmental Health Policies Under the country's Third Five Year Development Plan, starting 197Z. priority continues to be given to economic development with significant achievements in the industrial eedn,.. As the primary objective of achieving a high degree of iJ:Idustrialization is being materialized. the Government is gradually giving att~ntion ar~as,

to social welfare of the population, especially in the rural

by pramoting a more balanced development of other sectorr

In this connection, the priority health objective were formulated as follows: -4 -

(1) to expand and strengthen the health services network in

order to IIleet the health needs and to balance the. provision of h-ealth services between urban and rural area; (Z) to strengthen disease control IIleasures for such diseases .. s tuberculosis, parasitic diseases, acute communicable dis-

ease, and leprosy, and drug quality control in order to maintain a health labour force and to protect a hea.lthy population from danger; (3) to expand family planning and MGH programmes in order to reduce the rapid population increase and to reach a higher level of health in children and mothers. (4) to miniIIlize the environmental pollution and factory hazards in urban and industrial areas, and to expand the provision of

safe water supply in rural areas; (5) to improve waste disposal so as tQ reduce transmission factors of communicable diseases; (6) to expand the health insurance system as a means of developing a social security system. To attain the above goals, the governIIlent has instituted health progranunes to (i) expand and strengthen the rural health services especially in the doctor-less fishery and farming areas,

- 5 -

(ii) control of com.m'lllicable diseases including protection against

and treatment of chronic diseases, (iii) organise family planning services to control population growth hand in hand with iInproved maternal health through extended MCH services. (iv) promote qualityand safety of foodstuffs and drug and (v) iInprove the basic environmental sanitation including sanitary water supply systems.

Progress Achieved 1. Strengthening of Health Services There were Z66 hospitals in the Republic of Korea with a total of 19.759 beds. Of these, 46 hospitals with Z.~74 beds were "

in the rural areas and the rest in urban. with a big discrepancy . between rural/urban distribution. i. e •• 13 beds for 100,000 rural population and 133 beds for 100.000 population in cities. the hospitals are in private hands. Most of

To iInprove the rural situation.

the Government has es.tablished 19Z health centres and 134Z health subcentres throughout the country, in close coordiDation with 47 . government, city and provincial hospitals with a total of 3941 beds.

In addition, a phul has been formulated to establish small 30 beds

treatment; centres. one for each of the 140 counties (or Guns), because though each health centre is providing both preventive and curative services yet curative services are not adequate.

- 6 -

Health Manpower Development The fairly well established training system of health per-

sonne1 has now been considerably extended in the past twenty years. The rapid expansion has resulted in some imbalance in the types of l¥rsonne1 trained, compared with the needs, leading perhaps to some brain drain to other countries. There are, at present, over 16,000 doctors in the Republic of Korea, giving a doctor-population ratio of approximately 1 : 2,000. The ratio will be reduced to 1 : 1,200 by 1986. The ratio

of dentists to the population is I : 13,000. portant categories are: y

Some of the other im-

Pharmacist Herb doctor Mid wife laboratory technician X-ray technician

1,920 11,000 4,800 10,000 33,000

1 1 :

By 1972, there were 19,700 licensed nurses, with no information as to how many were inactive. Starting from 1967, a six-

month programme of training of health aides was begun, with

UNICEF assistance, to provide peripheral health workers.

- 7 -

The period oftrainiDg was extended to nine months in 1968 to prepare them as multipurpose health workers. 500 traineeE have

been admitted annually to such a training course since 1970. other categories of staff such as pharmacists, sanitary engineers, sanitarians. laboratory technicians, radiographers and a wide range of single purpose workers are being trained in larger numbers.

It must be mentioned that the sizeable number of herbalists

are licensed to practice outside of the public health services.

Fantily Health Service A new Bureau of FamUy Health was created in 1972 with

MCH, famUy planning and nutrition sections.

FamUy planning is

getting Inuch national and international support and is set to lower the annual rate of population increase fro:n the current rate of 1. 9¥o to 1.5% in 1976. and iIllplemeuting Integration of MCH with faInUy planning

nutrition activities jointly with other ministrie3

are the recent development worth Inentioning.

DiRease Prevention and Control AS

a reSQ).t of close surveillance and regular prevention cases of diseases such as small pox have not been

prub~ammes,

- 8 -

met with for IDany years. After a decade of tuberculosis programm.e implementation, the 1970 prevalence survey has shown l8CY. reduction in the disease during the period 1965 - 1970. a1;ld 4.20/. in 1970.) (Radio10gially, 5.1'Vo in 1965

It is also obvious that IDany other diseases are on the decline although reliable statistics are hard to come by. Unpublished

data concerning the incidence of malaria and typhoid fever (collected by Dr. 1. S. Kim among the Korean physicians) show the following trend. Incidence Eer cent for Malaria TYEhoid

Years 1910 - 14 1925 - 29 1945 - 49 1965 - 69

H.5 5:7 6:5 0.1

3.1 2.1 2.8 1.1

For parasitic diseases, the Government enacted the Parasite Prevention Law in 1966 and instituted stringent control efforts through sanitation, health education and drug treatmem. All these measures have apparelJl:ly lowered the incidence by 300/0. Japanese encephalitis and epidemic haemorrhagic fever

- 9 -

which were pnce very prevalent are also less prevalent

lWW.

A control programme against encephalitis by xneans of immunization is now under study. Safe rural water supply is expected to

reduce the enteric gr oup of diseases to an appreciable extent.

Proxnotion of EnvironxneDf:al Health Control of environmeDf:al hazards and im.provexnent of water

supply have been =ade the =ajor objectives. 'Adequate and safe water supply for rural areas has been given the highest priority.

In 197Z, it was planned to construct 8,800 sim.ple piped-water systems and 110,400 public wells to cover the entire rural population (15,450,000) by 1976. This no doubt.was a bold and ambifro~'n

tious plan, raising the percentage of rural safe water supply

7.8% in 1971 to 1000/. in 1976. 1n 1912 alone, 1,400 sim.ple pipedwater system.s were installed. Although waste disposal has received less attention, const~uction

wise, yet long term plannjng has been undertaken and

methane gas installations are being encouraged in rural areas, through material as.sistance froxn UNICEF. Pollution of air and water. especially in cities. has received a great deal of attention. Air and water pollution monitoring systems have been introduced and a central cOnUol rooxn has

- 10 -

been established in City of Seoul.

Forty six monitoring stations

would cover 9.1 million population in industrial and metropolitan areas. The enactment in 1971 of legislation for prevention of

public nuisance gives the government necessary means to enforce control measures in this respect.

Health Statistics Reporting of morbidity and mortality is being improved.

The international code for diseases has been translated in Korean and would be in use in all the provinces by 1973. Training of

health statisticians has been started with WHO/UNICEF assistance. This is expected to overcome the difficulty about insufficient information, not to mention greater reliability of the data.

Future Perspective Although much needed help in the improvement oi health of .the nation is expected from general economic development and rising GNP, no efforts are being spared in keeping population growth low and health hazards under check through health progrd.mmes. Tllis partly reflected in the rising allotment for health,

from year to year as shown below. In addition, considerable

- 11 -

assistance in cash and kind has been received from

international

bodies like UNICEF /WHO /UNFPA and the national voluntary associatio~.

Budget of MOHSA ",

In million won Year Health Budget Proportion of Health Budget to Total National Budget

1962 1964 1966 1968 1970 1972

784 962 1431 2386 4321 5870

0.88 1.28 1. 01

0.90 1.00 0.91

Achievements in dealing with health problems have been notable so far. With more attention given to health planning.

better health manpower development and deploytnent and persistent and systematic progranune implementation, we are bound to reach nearer and nearer· to our declared goals.

- 12 -

hoh-w. .f...L.~ RAPPORT SUCCINCT SUR LES ACTIVl'rtS DE LA RiPUBLIQUE DU VIET-HAM

EN 1972-1973.

-------------------------.---------------------------Les acti vi tea a ani tairea de la Republique du Viet-. 1972 , . . durant l', annee , , et lea aix premiers .,:1 I de l'annee 1973 ont ete marquee. par : 1.- Les realiaations selon 1. plan sanitaire de 4 ana aveo dea aetivitea , qui eat a aa ,2. annee d'applieation , , apecialea pour reaoudre lea proble... a&nitairea poaes par l'ottenaive ooDmUDiate (1972). 2.- L'adaptation ,de certaiM., progr...... aanitaires aax oonditions de la period. de paix qui auit 1. oeaaez-leteu et 1•• preparatita , -.n vue de l'elaboration du prochain plan _tional de aante.

x X I.

Realiaationa aelon le plan de 4 , , !pa , qui eat annee d'applleation et activite. apecialea.a/- SoiDa _dioaUlt.

a aa 2e

D'lJq)Ortantea .sures ont ete appliqueea en Ne d'ameliorer les servic.s de oonsultation. exteronea, de. .ervicea d'urgence et de pediatriedea bopitaux. L'accent , , " , a ete m. sur le releTe_nt de la qualite des soina par la reorganisation de l'administration hespitaliere, le redre •• emant de 1a disoipline du personnel et le rentorce_nt de la .upervision teobniqueo

au nombre de lits, il e.t reste .ensibleMnt sana ohan&e..nt notable. aependant deux grands hOpitaUlt nationaux dotant respeotive..nt de et 1.000 lita De tOllOtiounant qu'.'· partie durant la oonstruction, vont etre ouverts dana 1e courant de l'annee 1974 •

~uant

sao

••• / 2.

- 2 -

b/- Programmes de sante p~blig~e. Les programmes de lutte contre 18S maladies transmissibles n'ont oesse de 8e developper surtout dans 1. oourant de 1912 ou le. evenementa dUB a l'ottensive commanist. ont a~te 1. nombr. de retugiea de ta90n tree senaible. 1. I " ,

Graoe aux campagnes de vacoination menees en temps que les .. sures dlbygiene publique ettect~.es dans les , , " , oamps des retqie •• DOna n'avons noteauoune epidea1e au sein 4e oes oentres qui , l1"oupent des gens qui vi vent dans des conditions asses precaires. , , La peste et le cholera sont en regression , , , , , dans le pa~s. Mais le debut de l'ann._ 1973 , a _te marque par ~e reorudesoenoe de. oa. de tievre , hemorragique ohez 1_. enfants qui se sont apparus dans ditterentes province. du pa78. Par une lI1.e au point du traitement des malade. dans les hopitaux , , et de larges oampagne. d'education san1taire et d'nygiene .. , J publ1que incitant la population a detruire le. 5~t.S larvaires , d •• aou.tiques, nous avons pu Juguler oette poussee , tout en notant une , diJl1.nution sensible du taux de morbid1te et de mortalite.

meme

La vaocination ohez les entants d'age .colaire oontre le . . .ladies oontagieuses (diphterie, coqueluche, , ) , variole. tetano8 a pu prendre , .on ampleur graoe au develop" pe_nt du programme de sante , seolaire mis sur pied ,..ur une ", tres large echelle dana les ecoles prlmaires de. regions urbaine. et rurales. avec la collaboration du Ministere de l'~ducation nationale et des a.sooiations de. parents d'.leves.

oontre la tuberculos. oontinue progresser normale..nt at la vaocination au BOG de. nouveaux~s_ et de. Jeune. entanta, oonstituent la partie 1& plus , , , iapor~te de la prevention contre 1& tuberculo.e, a et. , acceptee de plus en plus par la population •

La prograllllD8 de

l~tte

••• / 3.

, - 3 11 .n e.t d. "ae que le programme de lutte contre 1& lepre qui. _lgre lea ditt10ulte. pro....nant d. llignoranoe du :publio .ur la _lad1., a pu pr.ndr• •on .xt.ns10n grao. au 4e"ouement .t au dJD&ai... de .on dingeant et de ••• oollaborat.ur •• :

2. En oe qui oono.me 1& J)l"ot.ot1oD. 4e 11.nTiron"" nement. d•• progre. ont .te r.ali ••• dan. llapproTiaionnement .n eau, dan. ll .... d. oolleot. et d. , lioration d•• oonditione , traite , ..nt d•• d.obets .t or4ur.s _nag.r•• , au ni"eau des oite. et 4. c.rtain.. son•• rural•••n partioul1.r dans lea , etait , "'---baaeaux ou 111 •• ur pie4 le progr-.- dit d.WUlllDaux .an1tair •• •• '\.

Le. preparatit. en we d. l'.tude .ntr.pri.e par 1. Oomit. Int.rmini.teri.l ~1& lutt. oontr. la pollution

4. l'&1r ont pu oo...ncer sur la , ba •• 4•• r.oo...n4ationa , 4u oonsultant 4. l'OMa en la _ti.r. qui a apporte un oonoour. extr..._nt pr.oieux. A ,

til. a".o 1. programme d. planlrioat1on t.-111al. tnt.gr., continue a retenir l'attent10n tout. partioulier. d. notre , a1ni.t.r. d. la Sante.

La prOF. . . . d. prot.otion _t.m.lle et intan, »

En vue d I apporter 4.. .oin. oontiDUs la _re at " " , , a l'.ntant, l'e.prlt de sante d. la t.-1l1. a ete inoorpore dana 1& pol1tique _n.e par le progr.... de PItI.

un. oliniqua pilote pour le. soina des entauta 4e 1 6 ana " " , a .t. r.ali •• ~pour ~. nou".au .1.t... 4e. .oins , experl_nter , , ooapl.t. err.ctuea par dirterent •• oategori.. 4. per.onnel , ..dioo-.an1tair•• D'autr. part 1•• oliniqu•• d. planirioation taDdl1al. augaent.nt en nosr. et pr.nnent leur ext.nsion aa ni".au d•• di.triot.. Ella. pourront .erTi., de .upport a 1& pol1t1qu. de oontrol. d.aographiqu. qui , , ••ra pro.alguee clans par 1. Coll1t. national tntera1nia, un a".nir tr •• prooh. ,/ , t.ri.l , , 4. Population ore. r.o....nt par 1. gou".rnement et prea14. par 1. Premi.r II1ni.tr •• A , ,

De"_ a

• •• / 4.

.. 4 -

Lutte contre llabus des drogues.

La lutte contre tout , llabuB des drogues prend , .on aapleur et eat marquee par des mesures de repression du traftic illioite, de lleducation sanitaire de la population, surtout chez les Jeunes et llinstallation par le Him.tere de la Sante dlun Centre national de Traitement et de Rehabilitation des Toxioomanes,aveo la oollaboration de. autre. Himsteres. I-

0/- Developpeaent des re8sources en personnel de sante. Lllnatitut National de Sante Publique continue deployer se. ettort. pour aener bien ses fonctions surtout dan. le domaine de la tormation du personnel. Ainsi , A' , a oote de. coura de tormation de. , Techniciens de Sante publique et dlassistents , de Sante , publlque, des cours de perteotionnement destines aux medeclns, aux sages-temmes, , " , aux intirmieres, aux techniciens ajoutes a des , , semioaires organises solt pour reviser les programmes d'etude, Bait • pour ,orienter certaines en , , categories , de personnel nouveau ", .ante publlque, ont ete enregistres durant l'annee ecoulee.

De meme des etudes ont ete menees pour ameliorer le. . .thode. d1enaeignement avec l'aide d. l'OMS atin " d'alever la qualita de la tormation de tout •• les categories 4e par_ollllel.

" ,

II.

Adaptation de certaina programmes sanltaires aux con, , ditions de la periode de paix et preparatits en vue , r $e l'elaboration du pro chain plan de sante.

1. Le programme de lutte contre Ie paludisme qui ,. ." , avait reduit 8es aet1vites durant la , periode de , guerre, a pu reprendre 80n essor depuis Ie debut de llann.e 1973. Avec llimplementation des retugies dans des regIons ayant , , , repria la a.curite, ce programme jouit d'une priorite de prem1 er ordre.

• •• / 5.

- 52. Aveo , la paix revenue, une campagne qui , oonsiste a envoyer , dee equipe. mob11ee conduites , par dee medecina dans 1.. regions ,rurales avec , un rytbae , regulier atin , de donner t de. soins medicaux,de medecine , , , preventive et d educatlon , , san1taire a la population a ete ad~sur pied et a recolte de. r'.ultata tree enoouraseantll. Cette oampasoe a pour , ettet de Jeter les bales neo ••• aires pour lnitier le per80nnel de .ante a la medecine co..unautaire qui va .e concreti, .er dan. 1. tutur par de. r.ali.ation. plus pratiques et durabl... Ain.I dan. le oadre de oette action, des medecin8, de. pharmaciens, de. dent1stes et tout le per80nnel auxillaire de. hOp1taux , ont ete IIObili.e. pour, a tour de role, taire partie dell equipell IIOb1les en que.tion. I " , , A , , , " A

ration du proohain plan eanita1re, un oomte central consul" cree " " , . tatit a ete , , au .ein du Mini.tere d. la Sante, depuill 1. debut de l'annee aveo l·a •• i.tance d•• oon.ultants de l'OMS. ~e oomt', co.po.' d 1 experts viet~en. et internationaux, , d'entreprendre des .tude. " a envisage neoe" •• aires a pouvoir , , identitier le. e1e.ants des buts et objeotit. du plan s&nitaire national.

, , 3. Dan. 1e domaine de. prep8l"atits en vue de l' e1abo,

1/- L'actuel plan eanitaire de 4 ana continue etre , de ta90n regul1ere " applique aveO de. re-.n!ement. d. oertain8 progr..... .elon le. b ••oins nouveaux. 2/- La, .ituation d. paix aotuelle, bi.n qu'.lle soit .ncore tout a tait relative, vu l.s violation. des accords du c •••• s-l. teu oo-.1s •• par lea communi.te., a permi. , publique " o.rtain. prosr __e. d. lIant. a .e developper dans de. conditions plus tavorable ••

ENGLISH ONLY

BRIEl RBPORT ON TIlE PROGRESS OF HEALTH ACTIVITIES IN PORTUGUESE TIWOR

YEAR -

1972

•

REP02UCA PORTUGUE5A PIOfIMCIA If TIMOI

REPARTI<;:10 PROVINCIAL DOS SERVI<;:OS DE SAODE " AS~IS~NC1A

1- PnEAWBLB

Pon ....... Provinco of Tiaor eoapria.. o.atorn balt of t. ,.land of Timor, T.rrit.r" of O'-C.... and Aabeno, tb. i.1.nd of At.'re and tbo ialot of J.eo, t.t.1tnl tbo .re. of 18.89~ a •• Kiloaot.ra (7.686 aq. ailo.). Dfli ia tho .apital of tho Provinc•• Total popalatlon of Tiaor according to 1a&t c.aana 1. of 615.000 lnhahitnuto witb • bin. rat. of 2a.~0 and • aona11ty rate of 12,~0. Tbe r.ti~ of aedlc.1 and nuraing ataff in .ctive •• rvic. to the totol nuobor of populati.n 'os 1 Doctor nnd 8 Hor••• for 30.000 peoplea. Tho ho.pitali.atl ... indoxi. of 1 bod for 406 inhabitant., wlich reprea.nt. an i~ provr~w.ai !a relation to pa.t y.ar. 1- SAMlTA!lI COnnAGE All oy.r the Province exi.taa 1 aanitar" cen'or in Dili _itb an • .erg.ncy conter. 11 bo.pitala ( 2 re,ional and 9 rural) 12 S.....nlt.r" c.utora - Polegael •• de SaUd. 47 JIIU'al sui h17 Poat. 1. Ma'oruit7 cont.ra ( 2 realona1, 12 rural) I aural cono.ltation and treataent poot, loubd in oconOllic811y illiporttlllt areaa. ( a,riculture and cattl. rearing). Tb.re are aDd.r oonatructloD 5 aore rural conoul tatlon and treat..at PA"t". AnDOud t. Provincial Dopartaant of ilaa1tb .nd WaUfare Sarvica. al.o tlrp. f . .8U",1III. 1-1a"ai••1 sob•• l 01 Nar.inl 2-Pbar.ao ••tl.al sarYlc •• with ita T.ebnlD.1 Laboratory. a-a.I ••• C.E.f. (aobil. brigado of .tady and coabat of ond ..ic di.o •••• in Tiller). Tb. p••1i8 .aaltb .orvice i. carri.d out by -nalegacle. do sa&do (.ub-•• nitar" cODtara) and by rural aanitary po.t .nd by B.l.B.e.B.T •• 3- SANITARY ACTIVITIES 1~70 1972 1171 ASSIstDCI ACTS. PaU••to _dar _bula17 treat.ent 329.030 3r.O.271 380.141 1I•• pUaU.a. p.tienta 9.MS i:l.030 10.112 H_"r .t t ... d . .ab 1.168.710 1.178.917 1.HHJ.;:52 743.842 w.."r .f i.Jaot.n. 802.U3 850.ll4 NWtber ot _parettoD (grand and minor) 6.138 6.91~ 6.&2& C1iaioal laboratory az..lnatioaa 49.570 45.1:11 46.161 Yaociadio ... 204.404 261.J51 209.112 4.6:14 ~10lrapbl0 ....in.tloa. 3.02G 3.097

III .. ·

REPUBLICA PORTUGUES .. PlDYlMtll Df TlM~.

REPARTlC;ilO ;PROVINCIAL DOS SERVIC;:CS DE SAO DE 10 A5~ISfNCIA

•

... ftUI!AL I!I;ALTn Th • •1• • t ih. H•• lth Senic•• ia to extend U. n.twork up to most relliote plac •• 01 rur.l .re •• aDd tbu., take the .edico-aanltary a •• l.t~nce to tlJC 1ar,.at part 01 populatloa. Baa.d on tbi. point of Yi.w, b •• lth .ervicoa .t"rie. to con.truct rural cOD.ul..taHon aad treat. .nt po.t. wbieu at pr'eflCllt IU'• .,hUed twice •••ek by th. anne. po.ted in l'Ul'al .aaital'y poot. Priority b •• been ,1.,.a to the place. ecouoaically !aport.ut. rt- PUBLIC U§4LTIl

&.1. School n.altb, schoel be.lth •• nic. In DIU ha. U. own .t.,f, coa.hUng of I!I j)nctor .Dd a Dune In the ... t 01 the bland the aobool h •• lth b .nnexed t'l t .• c Dele".ci . . d. ~.6d. (.ob-••nU • ..,. b.a1tb cente ... ) and to tbe rural local Ll1 p •• t. In the lield .f It"".,.nti.,•••dlc ine, scbool b •• l tal 10 DiU oarrled nnt ;;tllal1poz, TIUVU(D.P.T.). BeG, antitetanic and T.A.D • .,.cciDation•• L!alarioaetrlc .un.y• •m: .tQol· exnminatioD. al'ft c.rrl.d out ev~ry .::cnr. Weakly ch_o-prepylaxl. againat ml'llftri. by Py .....tb_in i. done rlurin:: tile leett.,. period, with ,oee! re.ul ta, .0 tbat e.,ery y •• r in illh populnt 1 nn tbe .ple.a rat. t. "sittng down. b.2. , . .uni.atioDe aad vaccination. '"

I.port.nco ha. h.en "iv.n to tLio importaat •• ctor of pullie 3ecltb in pro.,.nti, tbe 1af.cto-cont."ioue dh.a•••• special .U.nUoD ia directed to .,aceia.tba a"ai. . t ... Up.x at .. gular p.rlo •• , tho. no c •••• bee beou report.d fer ..... ral y •• re. Ii_"n of .,.ccio.tion ••oln.t .aallpolt dene in 1972 1a 203.000. otber .,0.ein8tion. don• • rerri.,ax, D.C.G., oral entipolyo- .,ooln. aad T.A.B. bee.... of abaoraal iaere... in tho typhoid c.... in DiU.

• ,

&.3. Flet .,dna•••".1'.1 endemic d18e •••• l

&.3.1. Lepro.r PI"O.p.c,loa• • re •• de .U o.,er the pr..,inc. to filld ae .. c ••••• ~Iumber of re,i.tered c •••• i. 1.022. Wo.t of the ca ••• are of indeterained type. Treet_at h don. by Sulphon injectiona ..,.ry fortniKht .nd follow UT' oi the c •••• 1. don. by B.I.~.C.E.i •• "01.1'1. Tb18 1a on. of 'lb. endoaic cU •••••• t.hot top. tbe 110t 01 all dieeoses. Tb.r. were ,.,ort.d 14.8M ca... of ao!arb during tb. year. cb.mo-[,l"ophyl.zi • • peel.1ly i8 achool ead in .... are •• 01 bleb .ndemicity ao well as radical tre ..... t of all c •••• t. doa. tbroQ8bout th. PrOYlnce. sanitary eng.n•• riD, work.. ia carri.d out In ••• pnri. 01 PI"O.,lno., ,p.cbBy in Dill to .liataat. by Itllina or drat . . area. f • .,ourable to anopheles bre.diD". Epideaiololioel . . . . 11 •• entomologloal .tadl.. are a1.0 cnrried out. V.et.r eoatl"Ol a. a .... ure of .olari. control h being done in .ddition to .lJoYe a ••tioDed acU.,iU .. , in Dili by oae or InJ"Yicitlin,.. nnd outdoor lO&lia, .1 In •• cticide by TIFA. ~.;;.2.

&.3.3. Pil.r10.i •

.,••• tina tnataeat

by uetraaan G .... /K#. of body wheight el~~rj·.[}',~.x

/1/ ...

, • IlEPOBUCA PORTUGUE5.A ..O".CIl DI TIMOI IlEPARTlC;:J.O PROVINCIAL DOS SERVIC;:CS DE SAOOE I: AS~IS@NCII\

aontb. h doae .. ith aood reeulta a • • pilot proj.ct in aa lillited Dleltoend.aie .rea. prep.ratioaa are b.ing mad. to .xt.ad tbi. technique in other .ad. .ie are •• of filariaee •• Speci •• fouad in Tiaor .re w. S.nkroftl and Bl'1l&ia "alayi. V.ctor., .re A.Barbiro.tris and c.'at.,.n. resr,.ctiT.ly for Dr.llahyi ~l:Id IY. Bankroftl. Tuberculo.l. Tbl. t. aa otb.r 8nd ..lc di ••••••• Duriaa tb. y.ar tb.re were report.d 1.M3 c .....

&.a.4.

p ...lao. b •• already. mobil • • icror.dio,raphy unit. rrosp@ctiona tbn• • • • aicroradioal'1lpby ..Ul start iD 1973.

&.J.I. Otb.r . . . . .le ni ••••••• ....... elba" .... U.l.iati.... (aoat cOIDoDly foaad are Ancyl'l"toal1d. . Mcarl. L.lariooid•• , Tricocfiphalua dhpar and Enhroblua Ver:ltc 1llare.), ... De ....t . .ieo... being· tb. ao.t c_on Tok.l.u or c •• c.ulo:- t '""nt.d .1tb . . r,r , .. re.atl • •1th Grl •• of.JTla.

6- CtlSr OF THE !!EALtu SDV1CU.

The ,lobal co.t InclwU.....lari •• of .U h.alth p.noael h 27.B94.4~7t1f'. IVe bop. t. b. able to improve our tinaacl.l .erTle •• for the yeflre Rhe:"l.

Dill, 17tb. July, 1973 Chief

et t,IJ......1ttl Department

.' I..

ILl l •

/ I

Liladar AmarcbllDd.

Key facts

Organisation World Health Organization (WHO)

Document type Technical Documents

Adoption date December 31, 1973

Source World Health Organization