WORLD HEALTH ORGANIZATION ORGANISATION MONDIAU DE LA SANTi REGIONAL OfFICE FOR THE WEmRN 'AClPlC IUREAU R'GIONAL DU 'ACIFlQUE OCCIDENTAL REGIONAL C(M(IT'mE Twenty-fifth session Kuala Lumpur 2~9 Septem~er 1974 'lWENTY-FOURTH ANNUAL REPORT OF THE REGIONAL DIRECTOR (1 July 197' - 30 June 1974) Corrigendum Page 8, paragraph " first line Change the number of neal th zones from 16 to 2. WPR/RC2513 Corr.2 30 Ootober 1974 ORIGINAL: ENGUSH
• • WORLD HEALTH ORGANIZATION ORGANISATION "ONDIALE DE LA SANTa REDIONAL COMMITTEE REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL OU I'ACIFIQUE OCCIDENTAL Twenty-fifth session Kuala Illmpur 2-10 September 1974 TWEN'lY-FOURTH ANNUAL REPORT OF THE REDIONAL DIRECTOR (1 July 1973 - 30 June 1974) Corrigendum Page 43, section 3.4, Smallpox eradication WPR/RC25/3 Corr.l 23 August 1974 ORIGINAL: ENGLISH first sentence : delete "cases" and replace by "case" fourth sentence: delete "Deoember" and replace by "January"
. WPR/RC25/3 , . WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC TWENTY-FOURTH ANNUAL REPORT (1 July 1973 - 30 June 197.> OF THE REGIONAL DIRECTOR TO THE REGIONAL COMMITTEE FOR THE WESTERN· PACIFIC TWENTY - FIFTH SESSION THE WORK OF WHO IN THE WESTERN PACIFIC REGION TWENTY-FOURTH ANWJAL REPORT OF THE REGIONAL DIRECTOR TO THE REGIONAL COMMITTEE FOR THE WESTERN PACIFIC Covering the period, 1 July 1973 - 30 June 1974 World Health Organization Regional Office for the Western Pacific Manila, Philippines ,July 1974 WPR/1w2513 The following abbreviations are used in this report: ASDB ECAFE FAO IAEA IBRD ILO SEAMHO SPC UNDP UNESCO UNFPA UNICEF USAID WFP Asian Development Bank Economic Commission for Asia and the Far East Food and Agriculture Organization of the United Nations International Atomic Energy Agency International Bank for Reconstruction and Development International Labour Organisation Southeast Asian Medical and Health Organization South Pacific Commission United Nations Development Programme United Nations Educational, Scientific and Cultural Organization United Nations Fund for Population Activities United Nations Children's Fund United States Agency for International Development World Food Programme -11- - -"',- CONTENTS INTRODUCTION •••••••••••••••••••••••••••••••••••••••••••••••••• Ix 1 2 3 PART I. GENERAL STATEMENT OF AC'l'IVITIES IN THE REGION STRENGTHENING OF HEALTH SERVICES ••••••••••••••••••••••••• 3 1.1 1.2 1.3 1.4 Planning and management of health services •••••••••• Organization and delivery of health care •••••••••••• Health laboratory services •••••••••••••••••••••••••• Family health ••••••••••••••••••••••••••••••••••••••• 1.4.1 Maternal and child health and family 3 7 11 13 health ••••••••••••••••••••••••••••••••••••• 13 1.4.2 Nutrition •••••••••••••••••••••••••••••••••••• 15 1.4.3 Health education ••••••••••••••••••••••••••••• 16 HEALTH MANPOWER DEVELOPMENT •••••••••••••••••••••••••••••• 17 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Health manpower planning •••••••••••••• 0 ••••••••••••• Training of auxiliary health personnel •••••••••••••• Educational methodology and technology •••••••••••••• Direct assistance to countries •••••••••••••••••••••• Fellowships programme ••••••••••••••••••••••••••••••• Intercountry programmes ••••••••••••••••••••••••••••• Group educational activities •••••••••••••••••••••••• United Nations Fund for Population Activities 18 18 18 19 20 21 33 (UNFPA) ••••••••••••••••••••••••••••••••••••••••••• 34 COMMUNICABLE DISEASE PREVENTION AND CONTROL •••••••••••••• 3.1 Epidei!i:J.<?logic~l s.urveillance of.,!orrrnunicable diseases •••••••••••••••••••••••••••••••••••••• ~~~.' 33 3.2 Malaria ••••••••••••••••••••••••••••••••••••••••••••• 34 ,.2.1 General review............................... 34 3.2.2 Progress of work in the malaria projects ••••• 35 Parasitic diseases other than malaria ••••••••••••••• Intestinal parasitic diseases •••••••••••••••• Schistosomiasis •••••••••••••••••••••••••••••• -11i- 42 4 5 3.7 CONTENTS Smallpox eradicat10n •••••••••••••••••••••••••••••••• Bacterial diseases •••••••••••••••••••• 0 ••••••••••••• 3.5.1 3.5.2 3.5.3 3.5.4 Cholera •••••••••••••••••••••••••••••••• • i. 0 ••• Plague ••••••••••••••••••••••••••••••••••••••• Enterio infeotions ••••••••••••••••••••••••••• Diphtheria-pertussis-tetanus ••••••••••••••••• Mycobacterial diseases •••••••••••••••••••••••••••••• 43 44 44 45 45 45 46 3.6.1 Tuberculosis ••••••••••••••••••••••••••• -:..... 46 3.6.2 Leprosy...................................... 49 Virus diseases •••••••••••••••••••••••••••••••••••••• 3.7.1 3·7.2 3.7.3 3.7.4 3.7.5 3.7.6 3.7.7 Poliomyelitis •••••••••••••••••••••••••••••••• Japanese enoephalitis •••••••••••••••••••••••• Dengue haemorrhagia fever •••••••••••••••••••• Haemorrhagic fever (Korean type) ••••••••••••• Traohoma ••••••••••••••••••••••••••••••••••••• Infectious hepatitis ••••••••••••••••••••••••• Influenza •••••••••••••••••••••••••••••••••••• 50 50 50 51 51 51 51 51 3.8 Venereal diseases and treponematoses •••••••••••••••• 52 3.9 Veterinary public health ............................ 52 3.10 Vector biology and control.......................... 52 3.10.1 Vector control in general •••••••••••••• ,...... 52 3.10.2 ~'!-!Q2t1 sur'Vet.l!.tld. oon'trol- ~ ~-~ .... ~: .... .-~_;;" 52 3.10.3 Vector control training •••••••••••••••••••••• 53 3.10.4 Safe use of pesticides ••••••••••••••••••••••• 53 NON-COMMUNICABLE DISEASE PREVENTION AND CONTROL •••••••••• 53 4.1 4.2 4.3 4.4 4.5 4.6 Canoer •••••••••••••••••••••••••••••••••••••••••••••• Cardiovascular diseases ••••••••••••••••••••••••••••• MetabolI0 diseases •••••••••••••••••••••••••••••••••• Dental heal tl1 •••••••••••••••••••••••.•••••••••••••••• Mental health ••••••••••••••••••••••••••••••••••••••• Prevention and oontrol of alcohorism and drug dependence and abuse ••••••••••••••••••••••• It ••.•••• PROPHYLACTIC AND THERAPEtry:'~C S~TANCES' ;. •••••••••••••••• -iv- 53 54 54 55 56 57 6 7 8 CONTENrS PROMOTION OF ENVIRONMENTAL HEALTH .••••••••••••••••••••••• 6.1 6.2 6.3 6.4 6.5 6.6 Provision of basic sanitary measures •••••••••••••••• Pre-investment planning for basic sanitary services •• ., .•••..•••..•.••.•.••.•.••• 0 •••••••••••• Control of environmental pollution hazards •••••••••• Health of working populations ••••••••••••••••••••••• Biomedical and environmental health aspects of ionizing radiation •••••••••••••••••••••••••••••••• Establishment and strengthening of environmental health services and institutions •••••••••••••••••• Food standards programme •••••••••••••••••••••••••••• DEVELOPMENT OF HEALTH STATISTICAL SERVICES •••••••••••••• COOPERATION WITH OTHER ORGANIZATIONS ••••••••••••••••••••• 8.1 Cooperation with the United Nations and related 57 58 61 61 62 64 64 66 agencies ••••••••••••••••••••••• 0.................. 66 8.2 Intergovernmental organizations ••••••••••••••••••••• 72 ( ) '72 8.2.1 Asian Development Bank ASDB •••••••••••••••• 8.3 With other organizations •••••••••••••••••••••••••••• 72 8.3.1 8.3.2 South Pacific Commission (SPC) ••••••••••••••• Southeast Asian Medical and Health Organization (SEAMHO) •••••••••••••••••••••• Other joint work ••••••••••••••••••••••••••••• 72 73 73 9 CONSTITUTIONAL, LEGAL, FINANCIAL AND ADMINISTRATIVE DE'VELOPfw1ENTS ••••••••••••••••••••••••••••••••••••••••••••• 74 9.1 The Regional Committee .0 •••••••••• 0 •••• 0 ••••• 0 •• 0... 74 9.2 Regional Office •••••••••••••••••• 0 ..•. 0............. 76 9·2.1 9.2.2 9·2.3 9. 2 .4 Organizational structure ••••••••••••••••••••• Salaries and allowances ..••......••••••••.••. Regional Office building .•...•.•.•••.•..•.••• Regional obligations and expenditures ...•.••• -v- 76 77 77 77 CONTENTS 10 PUBLIC INFORMATION •••..••••..•..••. ,. .••...••••.....•• ,... 81 11 WHO PUBLICATIONS ,.,. •.•.... ,.,. ..... ,.,. •• ,.,. •••.•.• ,........... 83 PART II. SUMMARIES OF SELECTED PROJECTS PLANNING FOR SEWERAGE DEVELOPMENT AND WATER POLLUTION CONTROL IN SINGAPORE •.••..•••.•••••••••••.•..•.•••••••••••••• 87 NUTRITION ADVISORY SERVICES. SINGAPORE ••••••••••••••••••••.•. 91 NATIONAL INSTITUTE OF PUBLIC HEALTH. REPUBLIC OF VI~-NAM ••• ,.................................................................... 94 FIRST REGIONAL COURSE ON BACTERIAL INFECTIONS OF THE GASTROINTESTINAL TRACT. MANILA AND SAIGON (18-26 FEBRUARY AND 11-19 MARCH 1974) .•...........•..••••••.• 106 FIRST MEETING OF THE TECHNICAL ADVISORY COMMITTEE ON DENGUE HAEMORRHAGIC FEVER. MANILA (5-7 MARCH 1974) .••..•...•. 108 PART III. PROJECT LIST PROJECTS IN OPERATION FROM 1 JULY 1973 TO 31 MAY 1974 •..•.•.. 112 ANNEXES 1 MAP OF THE WHO REGION FOR THE WESTERN PACIFIC •••.••••••• 149 2 STRUCTURE OF THE WHO REGIONAL OFFICE FOR THE WESTERN PACIFIC AS AT 30 JUNE 1974 .•.....•••••.•••.•.... 151 3 TRANSLATED WHO PUBLICATIONS ISSUED BY OTHER PUBLISHERS IN THE WESTERN PACIFIC REGION .••.•.•.•.••.••. 153 -vi- .. CONTENTS TABLES AND GRAPHS NUMBER OF FELLOWS BY COUNTRy................................. 23 BREAKDOWN OF SOURCES OF FUNDS FOR FELLOWSHIPS AWARDED FROM 1 JUNE 1973 TO 31 MAY 1974 AND TYPE:3 OF STUDIES ARRANGED ••.••.•••.••..••••..•.•••••••••••.•• 25 PROFESSION OF FELLOWS ••.•.••.••••••••..•••..••••••••••••••••• 27 FIELDS OF STUDY OF FELLOWS •...•....•.•••••••••••••••••••••.•• 29 PLACES OF STUDY AND BREAKDOWN BY REGION OF ORIGIN OF FELLOWS CONSIDERED FOR LONG- AND SHORT-TERM STUDY IN WPR ....•••••...••.••••••••••••.•••••••••••••••.••••. 31 PROMOTION OF ENVIRONMENTAL HEALTH - LONG-TERM IN'I'ERCOtJNTRY' PROORAMME: ••••••••••••••••••••••••••••••••••••••• 59 TABLE OF OBLIGATIONS INCURRED BY THE WORLD HEALTH ORGANIZATION WESTERN PACIFIC REGION, 1950-1973 ••••••••••••••• 79 GRAPH OF OBLIGATIONS INCURRED BY THE WORLD HEALTH ORGANIZATION WESTERN PACIFIC REGION, 1950-1973 .•••••••••••••• 80 -vl1/v111- Spraym,'n preparing for his work. in bnckground i" r1 "yam house" whicn in some Flreas is usudlly left unsprayed due to local t"boos. DDT spraying in Papua New Guirea's 14 districts ha; given protcdion against mcldria to almost 1.5 million individuals. A WHO malaria team is assisting the Govern- ment in its malaria control prog- ramme. Mr Auaustus 8Jlo, Senior Medical Assistant ,d the North Ffale Tr'ainlng Centre. Paunangisu, New Hebrides, conducts examination of primary schoolchildren. This is part of c-lctivitics at the centre, established with WHO assistance, to provide public health training for nurses ilnd dressers in New Hebrides. INTRODUcrION In introducing this annual report. I thought it would be helpful to list the accomplishments. the problems and what needs to be done in the major fields of activities in the Region. Strengthening of Health Services Accomplishments The operational researoh study carried out in Rizal Province in the Philippines has demonstrated that this type of approach can improve the delivery of health oare services. The application of the methods employed and the encouraging results obtained should also be of interest to other countries. Training in national health planning was arranged in Peninsular Malaysia as well as in Port Moresby for medical officers in the South Pacific area. This type of training complements the regional oourses arranged for central health planners in that health workers at the middle and local levels are oriented on the process and are. therefore, better able to participate in organized efforts to plan on a natio.nwide basis. Project formulation and management practices received impetus from two major efforts: (a) the methodology of project formulation was reviewed in the light of country exercises by WHO and national staff who recommended its further development and trial in larger national health development projects; (b) the management procedures of WHO-assisted projeots in certain countries were examined and measures for their improvement were developed jointly with the national and WHO staff assigned to these projects. A feasib:l.l1 ty study for an intercountry project on hospital design, administration, and the maintenance of eqUipment and supplies was completed' by a team of WHO consultants. The study reported the interest of 17 governments in the Region in making use of a pool of advisers in the hospital field and in participating in the training of various categories of hospital workers in the three regional training oentres to be established as soon as funding from UNDP has been approved. PrOblems and what needs to be done The development of health services suffers from many constraints. Some administrations are satisfied with what they have; others lack manpower and funds; in still others, health receives a very low priority. National health planning also suffers from constraints which may be conceptual, methodological, or due to the lack of policy/administrative support. -ix- Objective assessments should be made to determine whether the organization and resources of the health services are adequate to carry out the goals assigned to them. The findings will provide factual information upon which to formulate a health policy. More use should be made of the new approaches, such as oountry health programming, project formulation and project/programme management, being developed by WHO. Even if national resources are limited, effectiveness and efficiency, as well as more coverage, can be achieved by trying and testing alternative approaches through operational research teohniques. Intercountry consultations should be promoted for defining and finding solutions to common problema on a regional or sub-regional basis. Efforts should be exerted to inform the publio of the needs and conditions of the services in order to stimulate their interest and mobilize the1r support. Health Laboratory Servioes Aocomplishments In most oountries in the Region. a oentral health laboratory has been set up. These oentres are in various stages of development but onoe strengthened they will serve as the basis for the development of intermediate and peripheral level laboratories. To support this develop- ment. fellowships have been awarded to senior staff and programmes established within Oountrie. for the training of laboratory teohnicians. With the collaboration of the Centre for Disease Control. Atlanta, United States of America. a proficienoy testing programme in the field of venereal disease serology has been established. Almost all the participating laboratories now meet the standards set. The production and control of bio10gioal projeots. in particular, of vaccines. have improved oonsiderably. Most of the freeze-dried smallpox vaooine produced in the Region oonforms to the .international standard. Problema and what nseds to be done More attention and support need to be given to the development of health laboratory servioes in view of the important role played by them in medical care, epidemiologioal work and surv.illanoe. This development should follow olosely that of the h.alth •• rvioes, but this has not been the oase in a number of oountri.s. It is not unusual to find c.ntral health laboratories whioh are not only I.riously und.r- manned but allO laok .quipment and. .... ntial suppli.s. Th. d.arth of qualified senior Itaff, and. ev.n qualified laboratory t.ohnioians, is partioularly regrettable wh.n it is oonsid.r.d that the reliability and aocuraoy of laboratory .xaminations and the produotion of vaooines and other biologicals d.pend upon the availability of qualified personnel. If satisfaotory services are to be maintained, it is imperative that the health authoriti.s. partioularly in the developing oountries, should do th.ir utmOlt to retain trained personnel in -x- government service and to provide them with the facilities required so they can function adequately. Family Health Accomplishments A growing acceptance of the family health approach in promoting the health of mothers and children is reflected in the planning and formulation of health programmes in the fields of maternal and child health. family planning. nutrition and health education. The first step in this approach was the integration of these services into the framework of the basic health services. In 1974 there were multi- disciplinary family health projects in 10 countries or territories, all of which were receiving technical assistance from WHO with funds provided by the United Nations Fund for Population Activities (UNFPA). Three more such programmes are being negotiated. While in prinCiple health education should be part of all health programmes, integration has been particularly effective 1n family health programmes. The result has been increased general interest and community participation. In a number of countries. nutritional surveillance has been improved, food and nutrition policies formulated and more staff trained. Nutrition activities are also being gradually integrated into family health programmes. Problems and what needs to be done In view of the rapid development and expansion of family health programmes, more attention needs to be given to programme evaluation and a built-in mechanism and standards for this activity should be incorporated in all such programmes. In order to ensure the smooth continuation of ongoing aotivities, timely planning for project exten- sions and the expeditious submission of project requests to UNFPA are important. In those countries where national expertise is now available. still more efforts should be made to integrate nutrition into the family health services. Where national nutrition policies and national committees exist, emphasis should be given to promoting further the coordination of activities with other sectors than health. Although the training of health personnel is being given priority, there continues to be a shortage of health educators and of faculty in health education in universities and schools of public health. In some instances, no appropriate national counterparts have been provided. -xi- Health Manpower Development Accomplishments During the period under review. the Regional Teacher Training Centre in Sydney started functioning. Five workshops have been col'lducted .. the ini tial three in 1973 directed towards deans of medical schools and other senior faculty and two in 1974 being focused on single topics. namely "curriculum development" am "evaluation". There is now total acceptance by participating countries of the role of the Teaoher Training Centre in Sydney and it is most enoouraging that a number of oountries are taking steps toward the establishment of national centres. A master of science in oocupational health is now being offered by the Department of Social and Preventive Medicine, University of Singapore, and a master of science of public health by the University of Malaya in Kuala Lumpur. WHO provided assistanoe in the fora of short-term consultants. At the National Institute of Public Health in Saigon, the first olass of 31 pUblio health teohnioians graduated late in 1973 at the end of a three-year oourse. Good progress is being made in the oonstruotion of the physioal faoilities of the Institute despite rising costs and difficulties encountered in proouring building materials. The new building is expeoted to be ready for oooupanoy by the end of 1974. In Papua New Guinea, the first course for the diploma in health service administration, developed with the assistance of a WHO staff member, ended in Deoember 1973. The students who attended the course are now employed within the national administration. A further 18 nurses qualified in the three-year programme in Laos bringing to 29 the total number of state diploma nurses now prepared with WHO/UNDP assistance in that oountry. A prograae to prepare midwifery teachers has been introduced in Malaysia. A signifioant event was the oonvening of the Technioal Advisory Committee on Nursing in December 1973. The Committee looked at the ourrent preparation and utilization of nursing/midwifery personnel throughout the Region and prepared guidelines and proposals on possible approaches toward the solution of problems of training and utilization of suoh personnel. A major theme which emerged frOll the meeting was the need to practioe a multidisoiplinary approach at all levels and in all aspects of the planning, implementation and organization of health care delivery systems. Following the first regional seminar on health manpower planning held in September 1973. countries in the Region have shown an increasing interest in manpower studies. A study has already been completed in the -xl1- Republic of Vlet-Nam and ones are planned for Fiji and Malaysia later in 1974. A number of countries have agreed to participate in a worldwide study, ooordinated by WHO Headquarters, on the multinational migration of nurses and physicians. The ultimate objective is to devise intervention strategies to correct the adverse effeots arising from such migration. Problems and what needs to be done The recruitment of suitably qualified staff remains a major pro- blem. In some countries, the lack of national counterparts has meant that, despite the assistance given by WHO for a number of years, there is as yet no tangible sign that activities would continue in the same way should the WHO staff be withdrawn. Furthennore, in some areas the curricula used for training of health personnel bear little relevance either to needs or the actual situation in which they will work after training. The "brain drain", both internal and external, continues to be an important problem in several countries. Each year WHO awards approximately 400 fellowships to countries in the Region. Although the main purpose of the fellowship programme is to build up a pool of skilled health personnel, the question sometimes arises as to whether the fields of study requested or the utilization of staff on completion of their fellowships are truly in accordance with national health priorities and needs. More studies in health manpower planning and utilization are required in most countries in the Region. This activity should also involve in-depth studies into the relevance of course curricula to the tasks later expected of health workers. The acceptability, suitability and relevance to field conditions of new categories of health workers, such as medical assistants, have still to be tested. Feasibility studies related to the subsequent development of national teacher training centres will be required in several countries in the near future. WHO assistance will be needed in the first few years after the establishment of such centres. The continuing education and retraining of health workers at all levels are major areas for future action. Greater efforts need to be made to ensure the proper utilization of the WHO fellowship programme. Communicable Diseases Accomplishments A number of significant contributions in elucidating the epidemiology of certain diseases and in the implementation of control measures against some of the major diseases were made during the period under reView, -xUi- In Laos, the snail Lithoglyphopsis aperta was confirmed to be the pre- dominant intermediate host of endemic schistosomiasis. Various other ecologic characteristics which have a bearing on future snail control programmes were also studied. The presence of Leptospira infections in Fiji and Tonga was confirmed. The nature and extent of the filariasis problem were studied in a number of countries in the South Pacific with attention being given in particular to the insect vector and its control. Active immunization programmes with varying degrees of coverage against smallpox, cholera, typhoid fever, poliomyelitis, diphtheria, tetanus, pertussis and plague are in operation in a number of countries. Despite the occurrence of an imported case of smallpox in Japan, the disease did not spread. As a result of the concern of a number of countries in the Western Pacific and South-East Asia Regions, a WHO technical advisory committee on dengue haemorrhagic fever (DHF) was formed. The committee held its first meeting in Manila in March 1974 and produced guidelines covering clinical and laboratory diagnosis, the prevention and control of epidemics, and epidemiological surveillance. These are now in the process of clearance and will be distributed to the countries concerned at the earliest possible date. The BeG vaccination programmes continued to improve and there was an increase in coverage during the period under review. BeG vaccination, combined with ambulatory treatment of the cases discovered, is considered to" be the main factor responsible for the continuing decline in tuberculosis incidence, especially in that of extra pulmonary tuberculosis, observed in the Region. As a result of unrelenting vigilance, the malaria-free status of countries and territories where eradication has been achieved was main- tained. Satisfactory progress was made by the eradication programmes in Malaysia and the British Solomon Islands Protectorate. Parts of the northern states of Malaysia entered the consolidation phase; a substantial part of the British Solomon Islands Protectorate's western district is expected to reach this phase shortly. The gains achieved by the malaria control programmes were also maintained and there was increased involvement with the general health services. WHO was able to continue the regional malaria training pro- gramme for professional and senior technical staff by using the national training centres in Kuala Lumpur, Malaysia, and Manila, the Philippines. Problems and what needs to be done More progress could have been reported were it not for the presence of certain constraints which have impeded disease prevention and control programmes, particularly in the developing countries in the Region. Poor environmental health conditions, ignor~ce and poverty continue to be the important underlying factors of disease -xiv- ~- causation in many countries in the Region. There is a need for countries to accelerate environmental health activities - the provision of a safe and adequate water supply. adequate waste and sewerage disposal, control of insect vectors and rodents. etc. In a number of countries there is no central epidemiological or disease control unit and even if this does exist. it is often weak and undermanned. Disease control programmes are generally conducted by independent units. Statistical and laboratory support. which is vital for epidemiological studies and surveillance, is inadequate or lacking. A greater degree of coordination. cooperation and integration of communicable disease control activities, not only with the baSic health services but also with organizations and programmes involved with community development, is required. More efforts should be made to involve the people. especially those living in rural areas. in such activities. After all. the success of all health programmes depends upon the support of the people, who will only cooperate if they see there is a need for such activities. Non-communicable Diseases WHO assistance in the field of dental health was provided in the specific area of planning at country level. The dental manpower shortage is being tackled through the increasing utilization of dental auxiliaries. Attention is being given to dental education. Preventive measures are being stimulated with a view to reducing dental diseases. However. more attention needs to be given to ways and means of in- creasing the clinical productivity of individual dentists. The dentist should be able to delegate duties of a repetitive nature to dental therapists/hygienists. he should be assisted by efficient chairside assistants and have equipment which will enable operative work to be done in less time. Resolutions of the Regional Committee reflect the concern shown in many countries about the problems of drug dependence and abuse and have resulted in plans being made for an extensive regional study. Epidemiological stUdies have been undertaken in Malaysia and are planned for the Philippines. A further series of programmes designed to assess. prevent and control drug abuse is being prepared. Support has also been obtained from the United Nations Fund for Drug Abuse Control, which is aSSisting the establishment of a training centre in the Republic of Viet-Nam. More attention requires to be given to the collection of data and the exchange of information between countries on the problems of drug abuse and control. There is a need to build up national leadership in this field and to develop a strategy which will involve the community. The shortage of personnel is a serious problem in all fields. -xv- Environmental Health Aooomplishments Long-term assistance in various environmental health $ctivities was provided to 11 countries in the Region. The type of assistanoe given ranged from the preparation of master plans for sewerage and storm drainage to that of direot assistanoe in the training of national staff and guidanoe in the implementation of water supply development programmes. Short-term oonsultant staff also provided assistanoe to 13 countries in projects ranging from water pollution oontrol to the formulation of emergency water supply programmes. For the first time WHO was involved in a project executed by the Asian Development Bank dealing with water quality management problems and plans for the Laguna de Bay in the Philippines. Preparatory activities were completed for three new large scale UNDP-funded projects to be implemented in the Khmer Republic, the Republic of Viet-Nam and the Philippines. Problems and what needs to be done In general, the problems afflioting national environmental health programmes and aotivities assisted by WHO continued to be weak or indifferent environmental health servioe institutions, laok of trained and experienoed staff, and insuffioient financial resouroes for building the essential water supply and basio sanitary infrastruoture. For example, it is estimated that developing oountries in the Region will have to invest over US$ 3 billion in water supply and sanitary faoility improvements over the next decade if they are to make major progress in this field. Although most oountries are still striVing to overoome these basio traditional environmental health deficits, accelerated activities in major industrial oentres, such as Kuala Lumpur, Manila, Seoul, Singapore, eto., have led in some instanoes to massive, and diffioult to oorreot, air and water pollution problems whioh ory for attention and will require massive oapital investments if pollution is to be oontrolled. The environ- mental pollution problem is oompounded by the laok of comprehensive institutional bodies whioh can plan industrial development in parallel with plans for the oontrol of the physical environment. Governments need to direct more attention to the above problems since they can only be resolved ultimately by the national governments themselves. Biomedical and Environmental Health Aspeots of Ionizing Radiation Accomplishments Beoause of more pressing health problems, limited attention has been paid to the efficient utilization of physios and engineering in -xvi- 1 .. -- medicine in many countries in the Region. It is, however, encouraging to note that, during the period under review, a number of countries have decided to start programmes in the radiation health field and it is hoped that the activities initiated through these programmes will ultimately lead to well established medical physics and engineering programmes. Problems and what needs to be done The maintenance of medical equipment continues to be a problem in many countries and it is regretted that insufficient work has been done to improve the situation. It is common knowledge that thousands of dollars worth of expensive equipment remain unusable for want of repairs. It appears that the health authority in a number of countries does not realize that administrative and technical support needs to be given so that full use can be made of this equipment. While much of the main- tenance work can be done by persons with limited knowledge and experience in engineering, a few with higher qualifications are needed to make any prograrrme in this field effective. There is a need for government authorities, in cooperation with WHO, IAEA and other organizations, to explore further how medical physics and engineering programmes should be developed to meet the needs of individual countries. A simple transfer of existing pro- grammes from well developed to developing countries is in many cases not advisable since those programmes might have been established under different conditions. Qevelopment of Health Statistical Services Health statistical services at different administrative levels have been strengthened, the health and medical records systems of health centres and hospitals have been improved and systematic proce- dures introduced for the collection, processing, analysis and compila- tion of statistical data. However, some health administrations are slow to categorize the information they should collect and analyze. Until this is done, it will not be possible to make realistic assess- ments of the services rendered nor to plan effectively for fllture activities. Particular attention requires to be paid to t.he collec- tion of information on morbidity and mortality, and to the systematic organization of statistical reports, which will be suitable for inter- national comparison and will meet the req\lir~ments for national health planning and programme evaluation. * * * -xvl1- An important event during the period under review was the visit of a study mission oonsisting of staff membera trom WHO Headquarters and the Regional Offioe to the People's Republic of China. This enabled recommendations to be fo~ated covering possible' areas for oooperation and ways and means of achieving oooperation. It also opened the way for future contacts of a s1lllilar nature. -xv11i- Visit of the Regional Director. Dr Francisco J. Dy. to the College of Med- icine, Seoul National University, where discussions were held with Dean E. H. Kwon and the chairmen of the various departments on the university's scheme of continuing medical education and the establishment of a National Teacher Training Centre. During his visit to the Regional Office in Manila, the Director-General. Dr H. Mahler, called ·on the Philippine Secretary of Health. Dr Clemente Gatmaitan. Dr Mahler was accompanied by Dr Francisco J. Dy and Dr Stanis- las Flache. (lower photo) ,-; PART I. GENERAL STATEMENT OF ACTIVITIES IN THE REGION 1 STRENGTHENING OF HEALTH SERVICES 1.1 Planning and management of health services WPRjRC25/3 page 3 Many countries now have national development plans which incorporate health as a sectoral component. Country health planning in the developing countries has nevertheless encountered constraints from such factors as the inadequacy or absence of a central health planning machinery, the shortage of trained planning staff and imperfections in the planning methodology employed. Health planning generally oonsists of sequential phases: (1) an assessment of the oountry'S health situation and resources, resulting in the identifioation of problems requiring attention; (2) the determination of obJeotives to be pursued acoording to priorities; (3) the formulation of a plan to achieve these objectives within available resouroes; (4) the programming and exeoution of the plan, and the periodioal evaluation of progress during its imple- mentation, on which revisions and planning for the future are based. In many countries, partly because of the constraints encountered, the planning exercise results not infrequently in a comprehensive document whioh cannot be fully implemented beoause of shortage of resouroes and organizational as well as management difficulties. In order to make its assistance to oountries in the formulation and execution of health plans more effeotive, WHO is developing new approaches which, it is hoped, will overoome the difficulties now being faced. In the Organization's concept of country health prog- ramming, the main emphasis is on the identification of priority health problems so that realistic programmes can be drawn up. The available technology is then adapted so that full use is made of national and modern management methods to ensure that the programme is effectively and efficiently oarried out. Various new methods are being tried out in the field in cooperation with the governments concerned and it is hoped that the experience thus gained will make future planning a more systematic and effective process. In the meantime, WHO's assistanoe in the Region has oontinued to be direoted towards training and the provision of advisory servioes in the various phases and aspects of planning. In addition, studies are being oarried out on planning methodology in an effort to make it more applicable to the needs and oiroumstanoes of developing countries and territories. Training in planning Since 1968, WHO has organized annual planning courses for senior national health staff responsible for planning at the central WPR/RC25/3 page 4 level, administrators responsible for executing the national health plan or programme, and teachers in medical and public health schools. However, health planning entails a countrywide exercise requiring the participation of health staff of different disciplines at the different levels of the national administration. For this reason, a start was made in 1973 in training national health staff, particularly those occupying positions at the intermediate and local levels. The courses were programmed for six weeks and were conducted by a teaching staff consisting of the medical officer attached to the intercountry health planning advisory services project and two faculty members of the Institute of Public Health, University of the Philippines. Twenty- eight participants from Malaysia and two from the Republic of Viet-Nam attended the first course which was held in Kuala Lumpur. Malaysia from 18 June to 27 July 1973. A second course was held in Port Moresby, Papua New Guinea, from 13 August to 7 September 1973 and was organized on an area basis. There were 18 participants. The general objective of the two courses was to acquaint health staff with the concepts and teohniques of health planning. A third course was held in Manila, the Philippines, from 18 Maroh to 3 May 1974, with participants from the Department of Health. The responsibility for its organization rested with the Institute of Publio Health, University of the Philippines. The WHO medical officer attached to the inter- country project was one of the lecturers. UNICEF contributed to the costs of the participants. Further courses at the national level are planned. The regional course, normally held yearly, was cancelled in 1973 because an interregional course on planning, administration and management of lealth services was held in Manila from 8 October to 16 November. The University of the Philippines (Institute of Public Health and College of Public Administration), under contract with WHO, was given operational responsibility. The objectives of this course were " ••• to review critically the concepts and methods as well as the practical application of planning, administration and management of health services ••• " and "... to deve lop insights and promote the application of these concepts and methods in the light of conditions obtaining in the developing countries ••• " . There were 17 participants, five of whom were from the Region (Malaysia, Papua New Guinea, the Philippines, the Republic of Viet-Nam and! Singapore). while 12 came from other WHO regions (Ghana, India, Indonesia, Malawi, Nepal, Nigeria, Pakistan, Sierra Leone, Sri Lanka. Sudan, Tanzania and Turkey). The Regional Office assisted in planning the programme of the course, contributed teaching staff, and lent administrative support and services. The sixth regional course on national health planning started in Manila in June 1974. Thirteen partiCipants have already been nominated. Its objectives and the administrative arrangements are the Public Health Nursing Monthly visits of health workers from the Paunangi- su Training Centre ensure the regular check-up of mothers and children in villages of the .north Efa- te Training Centre. Lower photo shows Ms. J. Julian, WHO nurse and Nurse Winnie Ben. With WHO assistance, the Centre provides basic and refresher training in public health to New He- brides health staff. , , WPR;RC25/3 page 5 same as in previous years. A modification is, however, being introduced in the programme,. The concepts underlying country health programming and management, which employ techniques derived partly from systems analysis, will be incorporated into the framework of the national health planning exercise. Advisory services A health planning adviser reviewed the country health plan (1972-1975) in the Republic of Viet-Nam and made specific recommendations for remedial measures for consideration and incorporation in its mid-term revision. A Central Consultative Committee on National Health Planning was established in the Ministry of Health to promote a multidisciplinary approach. The Committee has met regularly to review project activities and to make recommendations on measures for action and study. Its membership consists of senior staff from the various divisions and units of the Ministry of Health. The WHO Representative, the WHO Senior Adviser to the National Institute of Public Health and the WHO Adviser to the national health planning project also take part. Recommendations made by the Committee for administrative or operational studies, which have implications not only for planning but are designed to improve the management of the health services - for example, studies to improve the utilization of health and medical services and the registration of vital and health statistics - have been adopted. Prior to the establishment of a coalition government in Laos, a WHO special mission headed by the Regional Director visited Vientiane in mid-December 1973. This followed an assessment of the country health situation and services by the WHO representative and visits by WHO regional staff. The purpose of the special mission was to review with the Government the progress of WHO-assisted programmes and to explore areas for future assistance. Although the review resulted in modifications to currently assisted projects, decisions on some aspects of future assistance could not be made until the Coalition Government had reformulated its health policy for the coming years. A return visit by the special mission was therefore agreed to, and is to take place after the country health programming exercise, which will be undertaken later this year in collaboration with WHO. A consultant was engaged soon after the visit to review in detail certain aspects of the WHO-assisted programme, with particular reference to the zone health services at present under trial, planned improvements through new constructions and renovations to the hospital system, and the proposal under consideration for the reorganization of the Ministry of Health and its services. The consultant noted the progress made in recent years despite the existing emergency situation. It is hoped that action will be taken on his recommendations as soon as the Coalition Government has defined its health policy. WPR/RC25/3 page 6 In the Khmer Republic, the mounting crisis resulting from the current conflict has necessitated the establishment of an ad hoc planning unit in the Ministry of Health to plan, coordinate-and oversee efforts to meet the medical and health demands of the population, especially in the now overcrowded capital city of Phnom Penh. WHO operational assistance has been authorized by the Director~General to meet the medical, nutritional and sanitary needs of the city and its environs. In Malaysia, the WHO team attached to the development of health services project collaborated in a review of the current plan and in the preparation of the health sectoral component of the third economic development plan. A consultant assisted the Government of Western Samoa in the formulation of the health sectoral component of its third economic development plan. The WHO medical officer assigned to the national health services development project is also involved in this activity. In December 1973, a review of the results of project formulation exercises employing systems analysis techniques was undertaken at a workshop held in Kuala Lumpur, Malaysia. This was Jointly sponsored by WHO Headquarters and the Regional Office for the Western Pacific. Participants from Indonesia, Kenya, Malaysia, the Philippines. Singapore and Thailand attended. The workshop recommended that WHO should continue with the development of project formulation methodology by applying it to new situations in other countries. It was further urged that general management expertise should be provided in the operation of long~term health programmes. Future project systems analysis (PSA) activities in the Region are envisaged in two areas: (a) continuation of the development of standardized procedures for the management of WHO-assisted projects and (b) further development of the management information system required to support the efficient management of the Organization's activities. Improvements and studies in health planning methodology The manual prepared under the auspices of the intercountry health planning advisory services project as a planning guide for trainees in their classroom and field exercises has been revised so that it may be used by national staff in their own countries. Following review by a consultant group on development and health planning, it will be issued for trial in the developing countries of the Region, and will be amended as necessary on the basis of the experience thus obtained. In the meantime, operational studies on staffing, procedures and norms/standards related to health and medical services are being WPRjRC25/3 page 7 undertaken in some countries of the Region. The results of the country health programming studies which are to take place in Laos are expected to provide additional information which will enable the Organization to make the health planning methodology of more practical use to the staff of countries undertaking planning. 1.2 Organization and delivery of health care To make health care services available to a greater segment of the population continues to be the main ~oal of national health administrations. The strategy was directed towards reducing, if not eliminating, the main constraints by making the most productive use of available financial resources, augmenting the number and improving the quality of trained personnel, and improving the organization and operation of the health services network at all levels. WHO nurse/midwives, as members of multidisciplinary teams, have assisted in planning, implementing and managing pilot training health areas to study alternative methods of delivering basic health services and training the manpower needed to staff peripheral health units. This is being done through country projects in Laos, New Hebrides, the Philippines and the Republic of Korea, and through the nursing component of the intercountry public health advisory services project in the British Solomon Islands Protectorate, Gilbert and Ellice Islands, Tonga and Western Samoa. Either a sanitary engineer or a sanitarian is assigned to the general health service projects in the British Solomon Islands Protectorate, Laos, the Philippines. the Republic of Korea and Western Samoa. In these countries, priority areas of activity are the improve- ment of water supplies, excreta disposal, solid waste management, food hygiene and the training of food handlers and other staff. There has been considerable activity in the field of hospital and hospital-related services. Long-term advisers in hospital administration are working in the Khmer Republic and Laos. Short- term conSUltants in specialized areas have been assigned to five countries. Increasing attention is being paid to developing and coordinating public health and hospital-based activities with a view to the overall improvement of the organization and delivery of health care. In the British Solomon Islands Protectorate, the Public Health Operations Committee, now called the Community Health Operations Committee, continued to meet regularly to discuss major policy matters and to review health programmes. At the district or intermediate level, district health teams have been organized to develop compre- hensive community health services. Staffing of the rural health units by male nurses has improved. In-service training for nursing and environmental sanitation and nursing staff continues. WPR/RC25/3 page 8 In Fiji, the established pattern of delivery of health services at the community level, especially in rural areas, is being reviewed in cooperation with intercountry project staff. A consultant in health manpower development will be assigned later in the year. In the Khmer Republic, improvements are being made in hospital housekeeping management and administration. A consultant studied the possibility of developing a basic records system in one of the large hospitals. Only partial implementation of his recommendations is feasible because of existing conditions. Funds were also provided by UNDP for training and services in medical rehabilitation. A medical consultant, after reviewing the current situation, submitted recommendations for the further development of the course for physio- therapists, the establishment of treatment services in Preah Khet Melea Hospital, the drawing up of a curriculum for courses on pros- thetics and orthotics, and the expansion of the national rehabilitation centre. Despite the existing constraints, the project is making good progress. In Laos, 16 health zones are now in operation under the super- vision of medical chiefs of zones. Under the Government's chrono- logical plan for the development of basic health services, medical assistants and auxiliary nurse/midwives are being given specialized training in community health and will deliver basic health services at the most peripheral level. An operational manual on field activities is being prepared. A syllabus for a two-year course for sanitary agents, planned for the scholastic year 1974/1975, has been drawn up. A hospital administration adviser is assisting in upgrading the management of the Mahosot Hospital, Vientiane, as well as that of other provincial hospitals. Particular attention is being given to improving medical records, developing management procedures and promoting a two-way referral system between the hospital and health centres. The WHO-assisted programme of education and training in medical rehabilitation continues. The WHO component was reviewed by a medical consultant in August-October 1973 and the project as a whole by a team of experts from WHO, the United Nations Office of Technical Cooperation, 110 and UNICEF in January and February 1974. If UNDP does not accept the recommendation for continued funding, WHO assistance will have to be terminated in February 1975. In Malaysia, one of the public health nurses assigned in 1973 has been posted to Sarawak to assist in reorganizing the system of delivering health services in the most remote areas and in strengthening the maternal and child health component of the basic health services; the other is based in Kuala Lumpur. Nursing staff in Peninsular Malaysia are being retrained to deliver basic health services at the peripheral level. The Government has taken action on the recommendations of the WHO consultant in hospital architecture assigned in 1972 and engaged a firm of architects , c , . WPR/RC25/3 page 9 to assist the national staff with hospital architecture and design. A WHO consultant was assigned for six months from October 1973 to March 1974 to assist the Government in developing plans for the school of physiotherapy which is to be established in the General Hospital. Kuala Lumpur. In the New Hebrides. activities at the North Efate demonstration and training area are progressing satisfactorily. Male nurses are being prepared to give preventive and curative services in isolated health posts and in-service training is being given to second- and third-year nursing students of the nursing school at the British Base Hospital in Vila. Health services at Paunanguisu have been upgraded. More student nurses and dressers are reoeiving public health training at the Paunanguisu Training Centre. Specialized activities are being coordinated and the malaria control programme is being integrated into the basic health services. An agreement was concluded between WHO and the Government of Papua New Guinea for the development of the general health services. WHO will assign a WHO medical officer who will assist in health plan- ning. administration and the coordination of WHO and UNICEF assistance. In the Philippines, no deoision has yet been made by the Provincial Government on the implementation of the health plan prepared for the Province of Rizal although considerable progress has been made by the project. A total of 56 primary care clinics staffed exclusively by retrained nursing/midwifery personnel are now functioning. The operations research study of the rural health units oarried out between January and November 1973, in which two WHO consultants assisted. revealed that 85,% of the servioes rendered by medical officers oould be effeotively oarried out by a retrained public health midwife. The new system is now operating so satisfaotorily that extension on a national soale is under consideration. In most countries and territories WHO assistance is also fooused on strengthening the looal health services. In the Republio of Korea a looal pilot area was organized at the ~ (subdistriot) level in Yong-in ~. where a trial on the integrated delivery of components of the basio health services is being carried out. Auxiliary health aides are being re-oriented from single-purpose to multipurpose work in health oare delivery. In the past, the single-purpose duties of the health aides have been oonfined to either tuberculosis control. maternal and child health. or family health. A oonsultant in hospital administration reviewed the administration. staffing pattern and referral systems in the base and peripheral hospitals in Tonga. Plans oonsistent with the resources of the oountry were formulated for phased development over a five-year period. WPR/RC25/3 page 10 In the last quarter of 19-{3, consultants in hospital and health centre design and the delivery of health care were assigned to the Republic of Viet-Nam to assist the Government in the reconstruction of health and medical care facilities and the restoration and develop- ment of the rural health centres. As an interim measure, a public health nurse is providing advisory services at all levels of the national health administration on the public health nursing aspects of the general health services, particularly those at the peripheral level. She is also participating in surveys and assessments of the health situation and available resources. WHO continues to advise and assist the Ministry of Health in training staff in hospital administration. A consultant assigned from August to October 1973, assisted the Governme.nt in drawing up a phased national plan for medical rehabilitation covering a six-year period. The health services development project in Western Samoa continues to make good progress. The new health records and reports forms being used on a trial basis are proving satisfactory. A study on staff activities in relation to training and functions has provided informa- tion which will be of considerable assistance in restructuring activi- ties and strengthening the delivery of health care at the community level. Tuberculosis control is now fully integrated into the basic health services. A WHO sanitarian continues to assist with a course for assistant health inspectors. A WHO consultant has again assisted the Government with the development of the central sterile supply unit in the Apia General Hospital. Countries of the Region are also showing an increasing interest in updating their health legislation to current conditions. A WHO consultant assisted in reviewing the health legislation in Malaysia and in drafting a revised Public Health Act. No further action can be expected until the Federal Government has taken concrete steps to assign overall responsibility for health to the Ministry of Health. Similar assistance will be provided to Brunei and Tonga later in 19-{4. In September 19-{3, the UNDP-funded \~O intercountry project on public health advisory services in the South Pacific was reviewed by a joint UNDP-WHO mission, which decided that, although the project was rendering valuable service to the small countries/territories of the South Pacific, it should no longer be funded by UNDP. Supported by funds from the regular budget of WHO, the project will continue to provide direct advisory services to governments in the area in the fields of public health administration and public health nursing. In rendering preparatory assistance, from October 1973 to March 1974, with funds provided by UNDP for an intercountry project in hospital management, design and maintenance, a consultant team comprised of a medical hospital administrator, a non-medical hospital .. " i WPR;tlC2513 page 11 administrator, a hospital architect and a teohnical officer in the maintenance and repair of hospit& equipment, visited a total of 12 countries in the Region. The consultants assessed the basic situation and the needs in the different countries for advisory services and training in their respective fields and identified possible training facilities which might be utilized or developed. Following their recommendations, a programme proposal to UNDP was drafted which envisages the provision of advisory services and the utilization of centres in the Region for the training of national professional and auxiliary staff in hospital management and the repair and main- tenance of hospital equipment. 1.3 Health laboratory servioes Assistance in planning, in the three aspects of implementation (administration, management, technical and operational) and in the training or improvement of the technical skills of the laboratory personnel was provided by either long-term staff or short-term consultantships. Fellowships were also granted for the training of professional staff or for participation in courses sponsored by WHO. In the Khmer Republic, WHO assistanoe was concentrated until recently on the training of laboratory technioians. TO date, 70 laboratory technicians have graduated and 49 are in training. In April 1974, a long-term laboratory adviser was assigned to Phnom Penh. He will be concerned with the management and organization of the national health laboratory service in general and of the health laboratories in the city of Phnom Penh, where eight out of the ten health centre side room laboratories foreseen were established during the period under review. In Laos, activities were conoentrated on strengthening the organization of the oentral health laboratory service. The two WHO teohnical offioers, besides providing operational assistanoe to the central health laboratory, were involved in intensive refresher training activities at the School of Laboratory Teohnicians. Aotivities are now being expanded to the regional level. A WHO oonsultant prepared a programme for the organization of a national blood transfusion service. Two WHO microbiologists are working in the Republic of Viet-Nam. One is assisting in the administration and management of the central health laboratory service and the other is working with the plague laboratory. A new central medical reference laboratory was officially established by ordinanoe in August 1973. This new laboratory has bacteriology, plague, immunology, ohemistry and cytohistopathology units. It undertakes quality control, the training of provincial health laboratory personnel, the produotion of diagnostio reagents, referral work relevant to the above-mentioned disciplines and some routine work. The central health laboratory servioe is now taokling WPR/RC25/3 page 12 the development of area (regional) health laboratories, five of which were planned during the period under review. A WHO consultant has also advised on the production of laboratory animals. In the South Pacific area, a WHO laboratory technician/instructor was recruited for Papua New Guinea, where he will help to train laboratory technologists. A WHO microbiologist aSSisted TOnga and Western Samoa in the organization and operation of their laboratory services. Within the framework of assistance to oountries where there are no long-term projeots, a WHO oonsultant assisted in strengthening the National Centre of Blood TransfUsion in Kuala Lumpur. He also conduoted a course for the chiefs of regional oentres. A oonsultant undertook an assignment in the Republio of Korea where the serologioal and baoteriologioal laboratory support given to the venereal diseases oontrol programme required strengthening. The serologioal laboratory at the Department of Pathology, Ministry of Health, Singapore, has been designated as a WHO Collaborating Centre for Venereal Disease Serology and Baoteriology. This oentre will have the following duties: (a) to provide referenoe reagents and controls for syphilis serology and referenoe oultures for ~. gonorrhoeae to related national oollaborating laboratories; (b) to perform FTA/ABS tests on problem cases for oountries and territories where a treponemal test is not currently available; (c) to arrange training and refresher training for national laboratory personnel; (d) to provide consultation services on request; <e) to assist oountries in organizing their own profioienoy and quality control programmes and, if requested, to act as a collaborating laboratory for the proficiency testing study. Australia, Fiji, Guam, Hong Kong, Japan, MalaYSia, New Caledonia, the Republio of Korea, the Republio of Viet-Nam, Singapore and Western Samoa are now partioipating in the regional profioienoy testing programme for venereal disease serology. The interregional programme of quality oontrol in clinio bioohemistry organized by WHO Headquarters has oontinued. These quality oontrol programmes are organized with the assistanoe of the Center for Disease Control, Atlanta, Georgia, United States of Amerioa. The first draft of the direotory of medioal and allied laboratories in countries and territories of the Western Paoifio Region has been sent to governments for review. Attention was also given to the produotion and oontrolof biologioal substanoes. Eleven batohes of smallpox vaccine from the Khmer Republio, New Zealand and the Philippines were sent to the WHO Collaborating Centre for Smallpox Vacoine, the Netherlands, so that their safety and quality could be oross-checked. The teohniques being used in the Republic of Viet-Nam for the production of smallpox vaooine were assessed and standard methods of quality oontrol introduced. Assistanoe was also provided in oonnexion with the large-soale produotion of toxoids and bacterial vaooines. J • r 1- . . WPR!RC2513 page 13 Samples of the first batches of rabies chicken embryo vaccine produced at the Alabang Serum and Vaccine Laboratory, the Philippines, were sent to the WHO Collaborating Centre for Rabies, Pasteur Institute, Paris, for double control before large-scale prodUction starts. In Hong Kong, a new Institute of Immunology has been established. WHO will assist in its development by providing a consultant. 1.4 Family health Since the family is recognized as the basic unit of society, the wellbeing of that society is dependent on that of the family and its members. Consideration of the family as a whole has strengthened the concept of family health which has gained increasing acceptance among countries and territories in the Region. Priority areas at the present time are maternal and child health, family planning, health education and nutrition. The services offered cover the treatment and prevention of diseases as well as the promotion of health. This concept of family health is expressed in the assistance being provided for mothers and children by WHO. It was therefore decided that the regional family planning field advisory services project should become a regional family health field advisory services project. 1.4.1 Maternal and child health and family health The integration of maternal and child health and family planning into the framework of basic health services is now widely accepted in the Region. During the period under review, there were WHO-assisted maternal and child health/family planning projects in the Gilbert and Ellice Islands, the Khmer Republic, Laos, Malaysia, the Philippines, the Republic of Korea, the Republic of Viet-Nam, Tonga and Western Samoa. Assistance was also given to the British Solomon IslandS Protectorate, the New Hebrides and Papua New Guinea in the formulation of project requests to UNFPA. The staff of the regional family health field advisory projeot continued to provide advisory services to ongoing maternal and child health/family planning projects in the Philippines, the Republic of Viet-Nam and Western Samoa. Assistance in introducing family planning into the basic curricula of nursing schools was provided to the Republic of Korea. The Institute of Public Health, the Philippines, received similar assistance. Advisory and financial assistance for the operation of a national workshop was provided to Western Samoa. The family planning programme has been progressing well in the Gilbert and Ellice Islands. A good acceptance rate was observed during the reporting period and the target of persuading one-third of fertile women to use contraceptives was achieved. With the aim of interesting more post-partum mothers in child spacing, vaccines were provided for the immunization of infants as their mothers' attendance at the clinic WPR/RC25/3 page 14 for this purpose provided a further opportunity to talk to them about family planning. In the Khmer Republic, a pilot unit was established at the PKM Hospital and the WHO medical officers gave teaching assistance on family health to the School of Medicine in Phnom Penh. Maternal and child health and nutrition are receiving particular emphasis. The integration of maternal and child health and family planning into the basic health services has been achieved in the Sikhay and Saifong demonstration health zones in Laos. Refresher courses have been held with the assistance of the WHO project staff. In addition, a WHO sociologist is carrying out studies on the social aspects of family planning. The development of health education, which is a priority in future efforts, is now under way with the assistance of a WHO health educator assigned in early 1974. a new category of health worker - auxiliary nurse/midwife - is being trained to provide primary health care with emphasis on maternal and child health/family planning at the peripheral level. Malaysia completed a nine-month course of training which was attended by 10 public health nurses and two organizers, who have since been assigned to five regions with responsibility for the training of auxiliary staff (assistant nurses and midwives working in the rural areas). Fellowships were provided to enable them to have further study in Singapore, the Philippines and the Republic of Korea. In addition, the Ministry of Health held a seminar on the role of specialists in the promotion of family health in Penang in August 1973. In the Philippines, 10 phase III hospitals joined the maternity_ centred family planning project, so that 25 hospitals are now providing maternal and child health and family planning services. A study on the integration of maternal and child health and family planning into the basic health services in Bohol province is being developed by the Government, WHO and The Population Council, New York. UNFPA is assisting the national family planning programme in the Republic of Korea. This is centred on the development of an urban maternal and child health/family planning programme, the implementation of a maternity-centred family planning programme in 102 hospitals, and the in-service training of family planning workers. Three hospitals are now participating in the maternity-centred family planning project. A new maternal and child health services project was also implemented. The Singapore family planning project is progressing satisfactorily. The Regional Adviser on Statistics and the WHO medical officer attached to the maternal and child health/family planning programme in Malaysia assisted the Government to make an evaluation of the programme. . , < • '-~ Family Health Ms. Feagai Eves (left), a staff nurse at the government hospital, explains how the IUD works before a group of women at the Mother's Centre in Apia, Western Samoa. In photo below, Ms. M.T. Rasolo of the Health Office in Suva, Fiji, talks about the pill to women in the village of Lami. ; WPR/RC25/3 page 15 In Tonga, a WHO health educator is working closely with the national medical officer who is now fully responsible for the administration of the maternal and child health/family planning project. District nurses based in the maternal and child health clinics give services at the peripheral level. There are 17 such clinics and it is expected that the number will be increased to 26, so that every district with a population of 1000 or more will have its own olinic. All current methods of contraception are being used and prescribed by the district nurses. Educational programmes have also been strengthened and the subject has been included in school health curricula. The plan of operation for a family planning project in the Republic of Viet-Nam was signed by the Government in July 1973. A WHO public health nutritionist was assigned to the project in September 1973. The medical officer. public health nurse and statistician of the regional family health field advisory services project have assisted in developing activities and formulating a plan of work. • The maternal and child health/family planning project has been given priority by the Government of Western Samoa. Public interest in and support for family planning are increasing gradually. The family planning advisory committee meets regularly and is most active. The WHO medical officer is assisting in all aspects of family planning. including training. education and olinical activities. All supplies and equipment from UNICEF and WHO under UNFPA funding have arrived and the oompletion of the building of the demonstration and training centre is in sight. Particular attention is being given to group educational activities. A seminar on the medical and surgical aspects of family planning was held in Tokyo in October 1973. The Japanese Government served as host and made available the facilities of the Ministry of Health and Welfare. Twenty-one participants from 17 countries and territories attended. A regional seminar on the role of nurses and midwives in family planning activities in various settings will take plaoe in September 1974. 1.4.2 Nutrition The principal nutrition problems of the Region remained unchanged. Indeed in some areas they have become exacerbated. for instance in the Indochinese Peninsula as a result of war conditions. in the South Pacific area owing to the urban drift, and in general, because of escalating food prices resulting from the adverse supply and demand situation. The work of creating national expertise to facilitate the inte- gration of nutrition into national family health services has continued. This has been satisfactorily aohieved in Singapore. A nucleus of expertise noW exists in the Khmer Republic, Laos, Malaysia, Papua New Guinea, the Republic of Korea and the Republio of Viet-Nam, all of which WPR/RC25/3 page 16 have been given WHO assistance during the year through advisory services or fellowships. The relatively large numbers of nutritionists in the Philippines have enabled assistance to be confined to specialized fields such as the treatment of goitre, nutrition eduoation and the effeot of malnutri tion on mental health. In the South Paoifio, help with nutrition matters is now being provided by a staff member attaohed to the inter- oountry public health advisory services project, and future collaboration wi th the South Pacific Commission, which is commencing a long-term project in the area, is anticipated. The nutritionist attaohed to the family health field advisory services project has continued to inject nutrition into the educational activities of the team. As nutrition is also the concern of disciplines other than health, collaboration has continued with such organizations as FAO, UNICEF, the World Food Programme and the Mekong Committee. In particular, the importance of countries having national food and nutrition policies and national colllllli ttees to coordinate the work has been emphasized. In a few countries, steps have been taken in this direction, but much remains to be done. 1.1+.3 Health education In response to the interests and needs of countries, specific emphasis has been given wherever feasible to the expanding role of health education as an integral part of WHO-assisted programmes. The design of health education within suQh activities may best be viewed as a blended and integrated input of training and advisory services, each component being an endeavour to strengthen further the programme it serves. During the year, continued stress has been placed on health education training through a variety of projeots and programmes, high-lighted by a seminar on the training of health workers in health education, held from 23 July to 3 August 1973 in Manila. At the country level, the advisory services of a health education specialist continued to be provided to the National Institute of Public Health, Republic of Viet-Nama In the Philippines, health education staff from the Regional Office assisted in coordinating numerous planning sessions with representatives from institutions which train health educators and from government employment agenCies, with a view to developing a more effective national programme for the preparation of health education specialists. The strong support given to the training of health education personnel through fellowship programmes continued. 'rhe return of fellows to pOSitions of leadership in Malaysia, the Philippines, and elsewhere during 1973-1974 has strengthened the health services generally. Child partakes of meal during a nutrition demonstration at the Luang Prabang MCH clinic (Laos). "Healthy development of the child is of basic importance; the ability to live harmoniously in a changing total environment is essential to such development." - WHO Constitution Mother and child on their way to a village dispensary in Maprik, Wewak. (Papua New Guinea). , . .. WPR,tRC25/3 page 17 During the visit of the Regional Health Education Consultant to Malaysia and Papua New Guinea, special emphasis was placed on national training needs, and guidance was given for the further development of health education manpower. Nearly all Member States in the Region have been assisted through regional and country workshops conducted by the intercountry advisory team on the development of educational materials for family health. A workshop on the development of educational and information materials on family health held in Tonga from 4 to 18 October 1973 was organized primarily for the countries and territories of the South Pacific area. Materials developed in previous national and regional workshops on family health education with emphasis on family planning have been widely disseminated and utilized at the country level. The significant role of health education in family planning was further demonstrated at the first regional seminar on family life education also held in Tonga from 24 to 31 October 1973. UNESCO participated in this seminar which focused upon the importance of the design of school curricula in population education. Assistance was also given to two national seminars in Tonga. The contribution of WHO to other national efforts in family health and family planning included the organization of two national courses on health education in family planning in Western Samoa in April 1974. During the year, the role played by health education has been particularly emphasized in programmes concerned with the health and well being of the family as a unit, as this is the basis for all effective health promotional activities. 2 HEALTH MANPOWER DEVELOPMENT One of the highlights has been the continued development of the Regional Teacher Training Centre at the University of New South Wales, Australia, and its consolidation into a functional regional centre which has stimulated a number of countries to plan for the development of national centres. The building of the new National Institute of Public Health in Saigon continued, despite problems of shortage of building materials and inflation. The construction of phase I, which is already in an advanced stage, is expected to be completed in the latter part of 1974. Short-term consultants continue to be a mainstay of WHO assistance. Some difficulty, however, is still being experienced in the recruitment of consultants for French-speaking countries and to improve this Situation, WPR~C25/3 page 18 the use of contractual services by arrangement with individual institu- tions is likely to increase in the future. In the area of nursing/ midwifery education, assistance continues to be given at various levels, ranging from that of basic programmes to the postbasic level. The fellowship programme also continues to contribute substantially to the total programme of WHO assistance. While the numbers of actual fellowships in themselves have not changed significantly from the last year, efforts are being made to improve the quality of the individual fellowships in relation to the specific objectives relevant to the home situation of each fellow. 2.1 Health manpower planning The first regional seminar on health manpower planning was held in Manila from 24 to 28 September 1973, with 21 participants. The seminar produced a list of action priorities which participants, upon return to their home countries, could utilize in pursuing the matter ·of health manpower planning with their national administrations. A greater awareness of the important implications of manpower planning is reflected in requests which have come from Fiji, Malaysia, and the Republic of Viet-Name 2.2 Training of auxiliary health personnel There is evidence that Member countries in the Region are giving greater attention to the role that auxiliary health personnel can play in the delivery of health services. The WHO seminar on the medical assistant scheduled for October 1974 should provide an excellent forum for discussion of this important topic. Fiji is considering the introduction of this category of health personnel and WHO will assist the Government to carry out a feasibility study on the subject. 2.3 Educational methodology and technology Since the Regional Teacher Training Centre in Sydney became operational in 1973 it has held five workshops. Initially, these were directed to senior staff members such as deans of medical schools, but two held in the first half of 1974 have been single-topic focused workshops in the area of evaluation and curriculum development. PartiCipants have not been limited to medical practitioners, but have come from a number of diSCiplines involved in the delivery of health care. In addition to the workshops held in Sydney, a national workshop was held in Malaysia from 30 October to 3 November 1973, short-term consultants being provided from the existing faculty of the Centre. There were 36 participants. .. The major goal of WHO as- sistance in Papua - New Guinea is to help develop the country's health man- power. Advisory services have been extended to up- grade training institu- tions for health person- nel, such as these i n photographs taken at the Paramedical College i n Madang. WPR/RC25/3 page 19 As planned, the activities of the centre are now moving more towards the national level and there are already advanoed plans for the establishment of national teacher training centres in a number of countries, to be developed with WHO assistance. Short-term consultants oontinued to be provided by WHO to assist in the direction of the workshops in Sydney and, in addition, to help in developing the centre's faculty. The plans to establish a master of health scienoe eduoation programme have been approved by the university authorities and student enrolment in this programme is expected to commence in 1975. Technical Advisory Committee on Nursing A significant event during this period was the convening of the Teohnical AdVisory Committee on Nursing in Deoember 1973, whioh met as a result of a resolution adopted by the Committee at its twenty-second session. l The Committee looked at the current preparation and utilization of nursing/midwifery personnel in countries/territories in the Region, and prepared guidelines on possible approaches toward the solution of problems of training and utilization of nursing/midwifery personnel adapted to the needs and resouroes of the countries/territories. Proposals to the Organization were also formulated on the programmes and aotivities Which might be developed to assist countries/territories to plan for and to implement the nursing and midwifery eduoation and servioe systems they need and oan support. A major theme in the guidelines and proposals emerging from the meeting 1s the need to practice a multi- disciplinary approach at all levels and in all aspects of planning for the implementation and organization of health care delivery systems. 2.4 Direot assistanoe to countries The WHO adviser assigned to the Fiji Sohool of Medicine has established a oourse for the teaching of pathology to medical students in Fiji. In addition, assistance was provided to postgraduate courses as well as to oourses for laboratory personnel. The war situation in the Khmer Republic has disrupted the teaohing programme in the School of Medicine in Phnom Penh. The fellowship programme continues to be the dominant component in the WHO programme for the Sohool, which is making every effort to deal with the shortage of health manpower. The WHO publio health nurse educator continued to assist in the development of an urban oentre for the training of various oategories of health personnel, inoluding medical, nursing, midwifery and sanitarian students. Assistance in the teaching of public health nursing at the national school of nursing and midwifery also continued. Consultant assistanoe was provided to the bureau of administration of nursing and midwifery servioes in the Ministry of Health. ~esolution WPR!RC22.R20, Handbook of Resolutions and DeCisions of the Regional Committee for the Western Pacifio, 1974, 8th ed., seotion 1.5.8, page 67. WPR/RC25/3 page 20 In Laos, WHO is assisting the Government in reviewing the present curriculum of the medical course as well as that for medical assistants, in order to increase the relevance of their training to the country's health needs. Four long-term advisers continue to provide assistance, principally of an operational nature, but the adviser in the teaching of preventive medicine now has a national counterpart who recently returned from a WHO-sponsored fellowship. A further 18 students qualified as state diploma nurses during the year, bringing to 29 the total number of nurses who have qualified in the WHO-assisted three-year nursing education programme. Five Lao diploma nurses are assisting the WHO team in the teaching and development of the nursing education programme. The University of Malaya now offers three postgraduate programmes, namely master of science in public health, master of science in psycho- logical medicine and master of science in pathology. WHO assistance has been limited to the first. A WHO nurse educator continued to assist the University in developing postbasic courses for nurses in administration and teaching. A third oourse, to prepare midwife teaohers, is being introduoed in June 1974. A national nurse educator completed her master's degree study on a WHO fellowship in 1973 and has since resumed her position in the University's postbasio nursing education unit. A WHO consultant assisted the Dean of the newly-established Faoulty of Medicine in the National University in developing the medical curriculum. A WHO nurse educator continued to assist the basic nursing education programme in New Hebrides. Practical experience in public health nursing, provided in assooiation with the WHO-assisted development of health servioes project, has been introduoed for students in the second and third years of the programme. WHO continues to give substantial assistance to the National Insti tute of Publio Health in Saigon, Republic of Viet-Name The first class of 31 public health technicians graduated in 1973. Fuller details of the projeot are given under "Summaries of Selected Projects" (Part II, pages 94.105). A WHO nurse eduoator continued to assist the basic nursing education programme in Western Samoa. 2.5 Fellowships programme Although in the latter part of 1973 the fuel crisis produced worldwide repercussions, the fellowship programme itself was not greatly affeoted. A somewhat disturbing trend has been the great increase in the number of ohanges requested by governments to the budgeted programme. It is appreCiated that with long-term planning, some changes are inevitable, but on the other hand, to ensure the continued smooth -Nursing Education Student nurses in New Hebrides are shown in photos with Ms E. Will. a WHO nurse educator. WHO is assisting in a five-year programme to strengthen nursing education in the country. WPR/RC2513 page 21 running of the operation, it has been suggested that countries make their requests for changes well in advance and at the beginning of each year when the Regional Office normally asks governments for modifications they wish to make to existing provisions. Nevertheless, the Organization wishes to maintain as much flexibility as possible so that governments may continue to utilize the fellowship programme in such a waY,as to make it relevant to their needs and stated priorities. A second edition is being prepared of the Registry of Training Courses Available for Health Personnel in the Western Pacific Region. As in the case of the first edition, it is intended to be a guide to Member countries regarding the possible placement of their fellows. Tables appearing on pages 23-32 give details of the number of fellowships awarded as well as other relevant data. 2.6 Intercountry programmes In spite of the stated interest of several Member countries in sending students to the one-year diploma programme at the Anaesthesiology Centre for the Western Paoific in Manila, only three oandidates actually took up their study in 1974. Some did not qualify for admission because of language deficiency. WHO assistance to the centre continued in the form of short-term consultants and honoraria for local lecturers. Assistance in strengthening basic nursing and midwifery education programmes was oontinued through the interoountry nursing advisory servioes projeot for the South Pacifio. Intercountry assistance in the field of postbasic nursing and midwifery education oommenced in February 1974. A consultant in internal medicine was assigned to the Faculty of Medicine, University of Papua New Guinea, for a period of eight months. A long-term adviser in the teaching of maternal and child health will also be provided. The first course for the diploma in health service administration, prepared with the assistance of a WHO staff member, started in February 1973 and ended in December of the same year. All the students who attended the course have now taken up administrative posts within the national administration. The second course started in February 1974 with 12 students only, since it was found difficult to provide individual attention and supervision to more than that number. A WHO nurse educator continued to assist in the development of postbasic nursing education programmes to prepare teachers and supervisors, and a diploma programme in nursing education began in October 1973. In June 1974, a second WHO nurse educator joined the project and will assist in preparing a diploma programme in nursing administration. Short-term conSUltants in the field of health care administration and public health administration undertook assignments at the Institute WPR/RC25/3 page 22 of Public Health, University of the Philippines, and the WHO fellowship programme has been expanded to assist in the development of the faculty. In the Republic of Korea, WHO continued to provide assistance to the master of public health and the certificate in public health nursing programmes of the School of Public Health, Seoul National University. Assistance was also given to the nursing/midwifery programmes provided by the National Institute of Health. UNICEF assistance, provided since 1967 to the certificate oourse in public health nursing, was terminated during the year but the course is to continue. Since its inception, a total of 243 nurses have qualified. In the master of public health programme, 36 nurses have now graduated, 20 of them majoring in publio health nursing. An audiovisual research centre has been set up in the Seoul National University with equipment given by WHO. It is intended that this centre will act as a resource centre for all medical schools in the country. Assistance to the Faculty of Medicine, University of Singa~ore was devoted to the fields of nutrition and occupational health. In 1973 the University started a master of science in occupational health programme. The diploma in public health has also been changed to a master of science in public health. The WHO nurse educator who has been working in Tonga since 1969 completed her assignment in December 1973. There are now four trained national teachers in the nursing school, two national clinical instructors and a total student enrollment of 78 spread over the three years of the programme. Assistance was provided to the University of Hue by a short-term consultant in the teaching of social paediatrics. Fellowships have also been awarded to the teaching staff. 2.7 Group educational activities Seventeen intercountry educational meetings and courses were held during the year as listed in the Project List, Part III. WHO financed the attendance of 323 participants at these meetings. A total of 100 participants attended 33 interregional seminars and courses. An activity of special significance in February 1974 was the meeting of deans of medical schools hosted by the University of New South Wales in Sydney. Twenty deans and two observers sent by the Australasian - New Zealand Association of Medical Association attended. The meeting provided a useful forum for the deans to exchange views and discuss common problems in the field of health manpower development. Among the particular topics discussed were the teaching of behavioural SCiences, physician migration and education technology as related to teacher training centres. I z o .... CD .." OQ '" .... CD .. = (") .... '" Q.. CD CD >< .... CD = .. -o = '" :E; '" ... Q.. ., = '" 8 ". CD ... .... = OQ '" co Khmer Republic Viet-Nam. Republic of Malaysia Philippines Korea. Republic of Singapore Papua New Guinea Western Samoa Japan TTPI Cook Islands Fiji Australia BSIP New Hebrides Hong Kong American Samoa Laos Tonga Niue New Zealand French Polynesia Gilbert and Ellice Islands Guam o t- o '" o ~ '" o ~§I~ ~~~~~~~I~ t- 00 t- .., t- .., ~ t- 0 t- 0 <XI <XI 00 01> o en o .." Z g.o o~ I ~ ~ ..., It Z el s:: to t"1 I'd 0 .,., .,., t"1 .... .... 0 ~ CI) "" ~ () 0 el Z o-i I'd ~ ~ ~ ~ I'd (1) ...... I'd NC") W N ...... l.n N ...... -I:-w (\ BREAKDOWN OF SOURCES OF FUNDS FOR FELLOWSHIPS AWARDED FROM 1 JUNE 1973 TO 31 MAY 1974 • ~ -CJ Regular UNDP UNFPA UNFDAC· 1.340/0 1.070/0 ·United Nations Fund for Drug Abuse Control. ~ .... : .. CJ ,. TYPES OF STUDIES ARRANGED 87.97% 12.030/0 Fellows Attending Programmes Tailored to Suit Individual Requirements Fellows Attending Group Educational Activities Organized by WHO , . ~ ~ aq ::<I ~--.. Nf!i VlN --.. lJ1 N --.. C'>W 0.80"/0 0.26"/0 0.80"/0 0.53"/0 4.28"/0 6 .15"/0 PROFESSION OF FELLOWS 1 • 8 7"/0 .. - .. - - - - I 14.98"/0 Physician Nurse Sanitarian Laboratory Technician Dentist, Dental Assistant Hospital Administrator Statistician Health Educator Radiographer, Radiologist Others WPR/RC25/3 page 27/28 41.45"/0 1.340/0 - - - - - - - - FIELDS OF STUDY OF FELLOWS Strengthening of Health Services Family Health Health Manpower Development WPR/RC25/3 page 29/30 Communicable Diseases Prevention and Control Non-Communicable Diseases Prevention and Control Prophylactic and Therapeutic Substances Promotion of Environmental Health Health Statistics WPR/RC25!3 page 31/32 PLACES OF STUDY 37.170/0 55.080/0 7.750/0 - In Countries within the Region only tt';',,>! In other Regions only c::J In the Western Pacific and other Regions BREAKDOWN BY REGION OF ORIGIN OF FELLOWS CONSIDERED FOR LONG- AND SHORT- TERM STUDY IN WPR 1 9 7 3 200 180 160 140 120 100 80 60 40 20 o o 20 40 AMRO 5 EMRO 2 EURO 2 AFRO , - Note: The number of fellowships processed during this year has been greatly reduced in view of the closure of the Malaria Eradication Training Centre (METe) in Manila on 30 June 1973. 1 9 7 60 80 100 4 140 160 -L- 2.8 United Nations Fund for Population Activities (UNFPA) WPR/RC 2,) 13 page 33 Assistance to the School of Public Health, Seoul National University, in the teaching of family planning, population dynamics and human reproduction will end in 1974. An intercountry project, namely the teaching of family planning, population dynamics and human reproduction in medical schools, provided a short-term consultant to undertake teaching assignments in this field in two Member countries. The final activity for this project will be a seminar to evaluate its impact, scheduled for 1975. A guide for the teaching of population dynamics, human sexuality and family health in the nursing and midwifery curricula was published in the Philippines, with the assistance of a WHO nurse educator and a short-term oonsultant. Referenoe materials and equipment for teaching this subject were also provided to 14 nursing schools and 11 midwifery schools. Assistance was provided to a workshop in family planning for teachers in nursing/midwifery sohools held in the Republic of Korea from 23 July to 1 August 1973 with 51 partiCipants. Fellowships will be awarded as a follow-up of this workshop, the second to be held with WHO assistanoe. 3 COMMUNICABLE DISEASE PREVENTION AND CONTROL 3.1 Epidemiological surveillance of communicable diseases Although mass campaigns have reduced to some extent the incidence of communicable diseases in oertain oountries, a signifioant level of success has not yet been achieved. In the developing countries of the Region they continued to exaot a heavy toll in morbidity and mortality, causing considerable economic loss as well as loss of manpower. The need for the development of epidemiological services in such countries is evident as it is difficult to obtain information on the incidence and prevalence of communicable disease, partioularly in the rural areas where the health servioe infrastructure is still inadequate. Long-term projects on the epidemiological surveillance of communioable diseases oontinued to be supported by the OrganiZation in the Khmer Republio, Malaysia, the Republic of Korea and the Republic of Viet-Nam and a similar project will soon commence in Laos. Difficulties in recruiting staff, insufficient local staff, and other administrative problems are some of the constraints impeding the development of programmes in this field. To meet local staff deficienCies, fellowships were awarded by the Organization for training in the epidemiology and control of oommunicable diseases. WPR/RC25/3 page 34 3.2 Malaria 3.2.1 General review In general, the antimalaria programmes progressed satisfactorily. The countries and territories from which malaria has been eradicated remained free from the disease. An opportunity to perfect further the malaria vigilance operations was offered when a minute focus in Australia's offshore Torres Strait Islands was detected and eliminated. The malaria eradication programmes in the British Solomon Islands Protectorate and Peninsular Malaysia reached the consolidation phase in some of the initial operational areas. In the Philippines, plans for pilot studies on vigilance for areas in the pre-maintenance phase were consolidated. The continued support given to the project in Sabah under the extensive control programme for the eastern states of Malaysia, resulted in a decrease in malaria incidence. In Sarawak, the favourable situation was maintained. Attack operations were oommenced on Efate Island, Condominium of the New Hebrides. International assistance was given to the programme and the national malaria training centre in Papua New Guinea. Considerable attention was paid to projects in the Indochinese peninsula but progress was slow and many did not advance beyond the planning stage. A pilot project was proposed for a selected area of Portuguese Timor using indoor spraying with residual insecticides. The International Malaria Eradioation Training Centre closed at the end of June 1973. SUbsequently the regional malaria training programme for professional and senior technical staff was accommodated at national training institutions, with the cooperation of the governments concerned. A regional course on malaria epidemiology took place in November/December 1973 at the Public Health Institute, Kuala Lumpur, Malaysia. Arrangements were made for two regional courses to be held in 1974 in Kuala Lumpur and Manila. A WHO interregional seminar on in vitro testing of ~. falciparum sensitivity to chloroquine was held in Kuala Lumpur in November 1973. WHO teohnioal assistance was also provided to an orientation seminar on malaria for senior general health staff of Peninsular Malaysia, held in July 1973 in Kuala Lumpur. A similar seminar will be held in Port Moresby, Papua New Guinea in July 1974. The riparian oountries of the Lower Mekong Basin held a second technical meeting on malaria, sponsored by the Mekong Committee Seoretariat with teohnioal assistanoe from WHO, in Khon Kaen, Thailand, from 6 to 8 August 1973. Disoussions focused on the measures to be taken to prevent malaria outbreaks in Mekong Committee projects and on the two major technioal problems in the area caused by the presence of A. balabacensis and chloroquine-resistant strains of P. falciparum. The Sixth South-West Pacific Malaria Conference was held in Honiara, British Solomon Islands ~- WPR/RC25/3 page 35 Protectorate. in May 1974. It offered the opportunity to exchange experience and technical information and to discuss common difficulties. Cooperation in the fields of malaria and public health between the health authorities of Peninsular Malaysia and Thailand continued. Apart from meetings held in Penang and Kuala Lumpur. operational officers working in the border districts coordinated their activities through frequent meetings on the border. Sabah and Sarawak held their annual malaria coordination meeting in March 1974. The practice of exchanging information with Brunei and Peninsular Malaysia continued. 3.2.2 Progress of work in the malaria projects 3.2.2.1 Countries belOnging to the northern zone Hong Kong Since there were no indigenous cases of malaria in 1973. Hong Kong has remained free of the disease for the last six years. Sixteen cases reported during 1973 all proved to be imported. Routine anti-mosquito measures were continued in areas where epidemiological investigations had shown them to be necessary. Japan The malaria-free status was maintained. Steps were taken to strengthen vigilance activities by creating a malaria vigilance committee. Leading scientific institutions are represented on this committee. Maoao Vigilance activities were continued by the antimalaria service. These included larviciding. dieldrin indoor spraying in the rural areas along the border. and entomological studies. During 1973. an isolated vivax infection was found in an inhabitant of Coloane Island. Republic of Korea Malaria appears to be oonfined at present to remote rural areas involving a total of about one million people. If the same intensity in case-reporting has been maintained. there appears to have been a very rapid decline in malaria inoidence over the past few years; while 10 000 cases were reported in 1971, the numbers declined to 5700 in 1972 and 747 in 1973. Malaria case detection and treatment were carried out by health oentre staff as a fully integrated aotivity, and the authorities expect that with further general sooioeconomic development, and the inoreased use of pesticides in agriculture, the disease may well disappear from the country in the foreseeable future. WHO continued its assistance through fellowships. WPR/RC2513 page 36 3.2.2.2 Countries belonging to the central zone Brunei Vigilance activities included the screening of imported labour and the investigation of cases clinically suspected to be malaria notified through hospitals and clinics. In the remote areas, active case detection covering about 17 000 people was maintained. Eight thousand people living along the border with Sarawak and in the filariasis focus were protected by regular indoor spraying with DIJl'. No cases of malaria were reported during the period under review. Peninsular Malaysia By 1973, the phased malaria eradication programme, which commenced in 1967, had extended to 10 of the 11 states of Peninsular Malaysia, eight of which were in the attack and two in the preparatory phases. In 1974, the remaining state of Johore entered the preparatory phase, and the state of Perlis entered the consolidation phase. The WHO assessment team which visited Peninsular Malaysia in 1973 observed that the prevailing epidemio- logical situation, and certain operational and administrative obstacles encountered in carrying out spraying and surveillanoe activities, had prevented other areas in the north from entering the consolidation phase, despite the considerable progress reoently made in strengthening operations. Efforts were made to strengthen fu~er ooordination and oooperation with the general health services in this semi-integrated programme, particularly at state level. At the periphery, cooperation with government health and medical institutions was highly satisfactory and this is expected to become even closer as a result of the newly adopted policy of converting the midwifery clinics into community health clinics. All the state malariologist posts were filled during the period under review resulting in further improvement of staff situation. At the intermediate level, the situation remained unsatisfactory, particularly with respect to the need for senior microsoopists and the recruitment of addi tional public health inspectors for existing vacancies. It was noted that the temporary nature of many of the key positions at this level led to a quiok rate of turnover and reduced performance. The use of DDr emulsion instead of DDr w.d.p. substantially promoted the acoeptance of spraying, thereby inoreasing 'ooverage. Although ohloroquine-resistant strains of P. faloiparum oontinued to cause concern, espeoially in the northern districts, ohloroquine remained the drug of choice for routine use. Additional attack measures were instituted in an effort to remove the remaining obstacles in the refractory focus on the island of Penang. As larger areas came under the attack phase, imported cases from within the country became less of a problem. t Sabah and Sarawak, Malaysia WPR/RC25/3 page 37 As a result of antimalaria activities in the two states, the disease is now a minor public health problem. It is estimated that between 200 000 and 400 000 cases of malaria are prevented annually. This favourable situation can only be preserved through sustained control activities and adequate provisions being made for the continua- tion of present activities and for further improvements where feasible. The project in Sabah aimed at strengthening field activities, particularly indoor spraying with DDT. Mass drug administration at the time of spraying was also instituted in extensive areas. Growing resistance to indoor spraying in some areas made it necessary to use DDT emulsion; it was possible to maintain the overall coverage at nearly~. There was a modest but significant reduction in the number of malaria cases during 1973. The state-wide malaria control programme in Sarawak continued satisfactorily. The total population where homes were regularly sprayed increased from 243 000 in 1972 to 304 000 in 1973. In large areas a biannual spraying cycle was adopted instead of an annual cycle. As a result, the situation improved considerably, particularly in the First Division. In the rest of the state, surveillance operations, including focal remedial measures, were sufficient to maintain the status~. Difficulties are presented by the long border with malarious Kalimantan, Indonesia, some operational imperfections, and the inaccessibility of some areas. Ultimate progress towards eradica- tion depends largely on the further development of the rural health services which playa major role in malaria surveillance operations. By means of passive case detection, the rural health infrastructure was responsible for discovering 7~ of the total number of malaria cases during 1973. Following the disoovery in July 1972 in Beaufort on the west coast of Sabah, of ~. falciparum infections resistant to chloroquine, other resistant cases were found in Tawau and Iabuan and an isolated resistant case was encountered in a Kota Kinabalu suburb. This indicates that resistance of P. falciparum to chloroquine may now be widespread in Sabah. In Sarawak, the number of chloroquine-resistant cases observed has so far been limited to two, both of which were detected in Limbang and had been imported from Tarakan, Kalimantan, Indonesia. Philippines The Government continued to give priority to the malaria eradication programme. The budget was substantially increased, largely to provide for the oommodities still necessary following the withdrawal of USAID assistance on 1 July 1973 and the exhaustion of the interim contribution received from UNDP. WPR/RC25/3 page 38 In accordance with the recommendations of the multidisciplinary team which assessed the programme in 1973, a strategy was adopted by which eradication will be the goal for most of the country and intensive control measures will be applied in the remaining limited areas where eradication is at present not practicable. Special emphasis was given to maintaining achievements in the pre-maintenance phase areas, and efforts continued to involve existing medical and health faoilities to a greater extent in malaria case detection. Village-to-village oanvassing was introduced on a trial basis in some low reoeptivity areas and was instrumental in disclosing a number of hidden foci. The provinces of Ilocos Sur and Marinduque were seleoted as suitable areas for further pilot studies on the integration of the malaria service into the general health service. Studies were also carried out to determine the receptivity of various areas in order to work out the required intensity of vigilanoe operations in the pre-maintenance phases. During 1973, 84 769 cases of malaria were detected. This increase over the 1972 figure (36 315) was due to improved detection mechanisms in areas no longer in the attack phase and to massive population movements into these areas from those still under attack measures. Since existing surveillance methods proved unable to cope with the investigation of this increased inCidence, spraying coverage was extended. The anti-gambiae campaign in Palawan was reviewed at a special meeting in November 1973. It was decided that the vigilance measures which had been in force in the endangered area since 1972 could be lifted. Special field studies were conducted on the occurrence of chloroquine- resistant strains of .f. falciparum. Towards the end of 1973, the ~ vitro technique of testing chloroquine resistanoe was instituted. Plans were finalized for a WHO-supported study of the nature and distribution of chloroquine resistance in the Philippines, in which both ~ ~ and in vitro testing techniques will be used. It is anticipated that the experience gained and the facilities available will be of assistance in promoting similar studies on this important subject in other countries of the Region. Singapore Vigilance activities included the exhaustive epidemiological investigation of malaria cases notified by hospitals, general practi- tioners, clinics, the Armed Forces, and laboratories. In addition, entomologioal vigilance determined the receptivity of various areas, and information and advice was given on the prevention of vector breeding and on chemoprophylaxis for groups at special risk. The general health services continued routine anti larval measures covering two-thirds of the island, and maintained the existing drainage system. DUl' house spraying was limited to active foci. Among the 347 cases detected during 1973, 261 were imported, mainly from Indonesia and Malaysia, WPR/RC25/3 page 39 and 78 were reported to be indigenous or suspected to be so. Since it is impossible under the present circumstances to prevent the intro- duction of individual cases from neighbouring countries, particularly into Singapore's off-shore islands, the situation during the past years has been considered highly satisfactory. The influx of cases from Malaysia is expected to decrease, once the state of Johore enters the attack phase. 3.2.2.3 Countries belonging to the western zone Khmer Republic Operations remained severely affected by the war situation. The antimalaria project, which forms a division of the Epidemiology and Communicable Diseases Service, continued oase detection and treatment through the passive oase detection posts in 12 operational zones. DDT indoor spraying operations protected about 45 000 people in the zones of Battambang, Pailin, Kompong Thorn and Kompong Som. laos Antimalaria activities in Vientiane Province, which contains about 13% of the total population of the country, were slightly expanded. Spraying operations, which have been carried out at the Nam Ngum dam site since 1969 and which protected about 15 000 people, were expanded into two more malarious districts, raising the total population proteoted by DDT indoor spraying to 42 000. These operations oontinued to be extremely effeotive and reduced the incidenoe of malaria in the areas oovered to a negligible level. UNDP and WHO assistanoe will be given to a malaria control project planned to start in 1974. Substantial bilateral assistance i8 expected to be provided by the Governments of Japan and the United States of America. It is planned gradually to expand spraying operations in areas of special socioeconomic importance, and to establish treatment posts throughout the country through which antimalarial drugs will progressively become available. Republic of Viet-Nam Since 1966 the policy has been to provide an acceptable level of malaria control under the prevailing condi tiona and to maintain an antimalaria organization oapable of expanding and intensifying aotivities as soon as the situation permits. During the period under review, working conditions remained difficult and insecurity hampered the extension of operations. Nevertheless, during 1973, 1.7 million people were protected by DDT indoor spraying operations. Malaria case-detection through hospitals, dispensaries and maternal and child health clinios, resulting in presumptive treatment of fever cases and radical treatment of microscopically confirmed cases, was carried out in most of the coastal areas. Through these operations, the spread of malaria was WPR,IRC25/3 page 40 ' , generally contained: the slide positivity rate in 438 730 bloodsmears examined was 2%. In anticipation of more favourable circumstances and to ensure the continuity of technical assistance after USAID withdrawal from the programme, a request was submitted to UNDP for the necessary international and bilateral assistance for maintaining and gradually expanding current operations, with emphasis on training aspects and on research into certain technical difficulties encountered in the Indochinese peninsula. This programme is expected to become operational during the second half of 1974. WHO continued to provide fellowships for staff of the antimalarla service. 3.2.2.4 Countries and territories belonging to the south-west Pacific zone Australia The maintenance phase continued in mainland Australia. A small focus of 10 cases was detected in the Torres Strait Islands, seven through routine passive case-detection activities and the remaining three during the subsequent epidemiological investigations. Focal remedial measures were instituted and key island health personnel were given guidance on malaria control. In the receptive area of the Australian mainland, 21 cases of malaria were detected in 1973, all of which proved to have been imported. In the nonreceptive area, 159 cases were reported. British Solomon Islands Protectorate The independent assessment team which visited the project in ]973 estimated that more than 90 000 malaria infections were being prevented annually. With strong Government support, the project continued to make substantial progress. Spraying operations which have covered the entire population at risk since mid-1972 continued satisfactorily. '1'he discontinuation of spraying in a major part of the Western District in 1974, involving about 20 000 people or 11% of the total population at risk, is under consideration. In preparation for this, the areas under surveillance were reviewed. refresher courses were organized for supervisors, intensive mass drug administration was instituted in the residual foci, and the application of focal remedial measures was aocelerated. The Central Distriot, North Guadaloanal, remained the main problem area. For a number of reasons the situation there deteriorated during 1973 and the disease reached epidemic proportions in some localities. Intensified spraying and drug distribution on a mass soale were instituted. WHO assistanoe was strengthened by the assignment of an epidemiologist from July 1973 and further teohnical assistance was provided during early 1974. In Nggela, the other problem area, operations were intensified. In the Malaita and Eastern Districts, the results of the serial paraSite surveys were generally favourable. Aotive oase detection was gradually introduced on Malaita. Malaria Control Malaria activities in the field and in the laboratory in Laos where WHO is helping the Government to build administrative and technical facili- ties for an anti-malaria programme. " WPR,lRc25/3 page 41 The major constraints, apart from difficult logistics, remained administrative in nature. Lack of competent personnel in the intermediate echelons and a quick rate of turnover due to insecurity continued to create difficulties. The independent assessment team recommended that a full-time administrative officer should be assigned to the project and that means should be sought of procuring commodities in time to avoid endangering the continuity of operations. The WHO staff were actively involved in assisting the development of the rural health services so that they will be able to play an important role in the later phases of the programme. It was not possible to extend the rural health services to village level. and thus provide adequate coverage of the population, because of shortage of manpower, although the total number of posts envisaged has been established. Condominium of the New Hebrides After the necessary preparations, including the oollection of baseline epidemiological and entomologioal data, health eduoation of the oommunity, the updating of geographical reconnaissance data and the training of spray orews, the first round of DDT indoor spraying on Efate Island and the offshore islets was carried out at the end of 1973 and early 1974. The overall coverage was 97% of a total population of 6200. Hospitals and clinics on Efate Island had earlier been involved in passive case detection, whioh contributed greatly to the establishment of detailed baseline data. The delimitation of malarious areas was further promoted through monthly active case detection followed by a preliminary investigation of confirmed cases. These activities were most valuable in determining malaria receptivity in various localities which appeared to differ widely. On the outer islands, a number of parasite surveys were conducted in order to obtain a more comprehensive picture of the epidemiological situation. Hospitals have started to report the microscopic diagnoses made in their laboratories and have agreed to submit bloodsmears for cross-checking to the central malaria laboratory in Port Vila. Dispensaries with good communication facilities to the capital have also started to submit bloodsmears for microscopic examination to the central malaria laboratory. Geographical reconnaissance was completed on Santo in preparation for the commencement of spraying opera- tions in the south-eastern part of the island. The health manpower situa- tion, difficult communications and administrative limitations appear to be the major obstacles to the rapid elimination of malaria from the islands. Papua New Guinea A total of 1.4 million of the 2.6 million inhabitants were protected by the extensive control project which continued to reoeive high priority and generous support. The oontribution to the project of the general health services was inoreased by the training and guidance prOvided to health extension officers and other rural health workers in malaria control activities: passive case detection produced about one-third 'vi PR/RC25/3 p?c"e 42 of the total number of bloodsmears submitted. The independent assessment team, which visited the project in 1973, recommended that because of the lack of skilled personnel, any substantial expansion of the operational areas should be undertaken only after further strengthening of the staffing pattern at the top and the higher field echelons. Expansion of operations, therefore, was limited to the remaining unprotected areas of Chimbu and parts of Madang. UNDP assistance commenced in 1973, and WHO's direct support of the national malaria training centre helped to overcome the major problem of training sufficient competent technical staff to carry out the routine operations in this extensive project. The centre was transferred from Kundiawa to Madang. It is envisaged that in future it will also be able to absorb the training needs of neighbouring territories in the area. 3.2.2.5 Other countries and territories belonging to the Pacific zone In 14 countries and territories and four island groups in the Pacific, included in.the Supplementary List of the WHO Official Register for malaria-free areas, malaria was historically never endemic, because malaria vectors were absent. It is of interest to note that in Guam and the nearby islands of the Trust Territories of the Pacific Islands, several anopheline species have now been identified. Tnis may indicate that the importation of malaria vectors into Micronesia and Polynesia may no longer be only a theoretical possibility. 3.3 Parasitic diseases other than malaria The intercountry filariasis team visited several countries and territories in the South Pacific. In Western Samoa, during the 18-month period after completion of the second round of mass drug administration with diethylcarbamazine and a dosage of 6 mgjkg of body weight monthly for 12 months, the microfilaria rate was 0.19% among a total of 11 506 persons examined. Before the commencement of the second round of treatment, the rate was 1.74%. A consultant made an independent assessment in July 1973 and recommended that a more rapid and effective search for positive cases needing treatment should be undertaken. A third round of mass drug administration is not recommended for the time being. More field trials should be undertaken on the control of breeding sites ot Aedes po1ynesiensis, including the effect of insecticides in crabholes which serve as important breeding sites i'!"r--some·areas. Assistance was given to the evaluation of the mass drug admini~ tration programmes in the Gilbert and Ellice Islands and l\Iiue. T:1.e Government of Tonga is planning to initiate a fl1ariasi3 control programme in 1975. A visit was made to New Hebrides to determine thF prevalence of filariasis before the commencement of DDT spraying for antima1aria WPR/RC2513 page 43 purposes, so that an assessment may also be made in the future of the influence of DDT spraying on filariasis control, as both diseases have the same vector species. Aedes cooki has been regarded as the only veotor in Niue. Of 435 mosquitoes dissected, only three were found positive with first or second stage larvae. In Fiji, the gonotrophic cycle (the interval between two blood meals) of Ae. po1ynesiensis was estimated at 3.5 days by the mark-release-capture method with dye solution. 3.3.1 Intestinal parasitic diseases Ascariasis and anoylostomiasis are common in many developing countries of the Region. Assistance was requested by the Government of Guam for the control of intestinal parasitism. A consultant was provided. 3.3.2 Schistosomiasis The intercountry schistosomiasis project terminated at the end of 1973. A malacologist assigned to the project for three years to investigate the intermediate host of Schistosoma japonicum on Khong Island in IAos, confirmed that Li thog1yphopsis apert& is the principal species of snail acting as intermediate host in~e island (see Part III for details). The national project on schistosomiasis control in the Philippines, which has been in existence since 1965, will be assisted by the World Food Programme and WHO. The Organization will provide consultants in malacology, epidemiology and sanitary engineering to help the Government establish measures for the control of the disease and institute subse- quent assessments. Due to the, as yet, unsettled political climate, there was no way to clarify the existing schistosomiasis situation in Khmer Republic, another country where the disease is known to be endemic. 3.4 Smallpox eradication One imported case4 was reported in Japan. '!he patient was a 49-year old Japanese travel agent. He had been vaccinated on 7 December 1973 before travelling in India between 5 and 17 January, where he visited a number of cities where smallpox wa~ endemic. ~He returned to Japan on 17 ~.N~ .. ~. Five days after his arrival, he developed fever with headache-and chills. Two days later, he developed a skin rash on his face, trunk, axilla and limbs. Small- pox was clinically diagnosed on 28 January and the patient was isolated at the Tokyo Municipal Ebara Hospital. The diagnosis was subsequently confirmed by the fluorescent antibody test and electron microsoopic examination of pustular materials. WPR;RC2513 page 44 Control measures, including the isolation of members of his family and disinfection and vaccination of all contacts, were immediately undertaken. No secondary case was detected. 3.5 Bacterial diseases 3.5.1 Cholera Although the incidence of El Tor cholera in the Philippines decreased considerably over that in 1972, about 2000 cases were reported in 1973 and some have continued to be reported in 1974. Outbreaks were also reported in the Republic of Viet-Nam and the Khmer Republic. The number of cases reported in the Region during the period 1 January - 30 May 1974 was as follows: Cases Deaths Khmer Republic 96 1 Malaysia Sarawak 6 0 Peninsular 40 1 Philippines 210 5 Singapore 8 0 Viet-Nam 103 2 Total number in the Region - 463 9 -=- .. An interregional seminar on cholera control with emphasis on environmental sanitation was held in Manila and Bacolod, the Philippines, from 26 November to 6 December 1973. Malaysia and toe Republic of Viet-Nam also sent participants. The main objective of the seminar was to decide how attention could be focused on the importance of environ- mental sanitation measures, such as a safe water supply, adequate waste disposal and vector control, in the control of the disease. A community survey using such an approach was demonstrated in Bacolod. Two participants from the Region, one from the Philippines and the other from Malaysia, attended an interregional seminar on oholera vaccines. held in Bombay, India, from 4 to 15 March 1974. 3.5.2 Plague WPR/RC2513 page 45 During the period 1 January - 18 May 1974, a total of 924 cases, including 73 deaths, were reported in the Republic of Viet-Nam. It is, however, not possible to determine the exact number because of the unstable cease fire situation. A WHO epidemiologist and a sanitarian have continued to assist the Government of the Republic of Viet-Nam in the control of plague, in strengthening the quarantine services, and in rodent and flea control. During the period under review, the Khmer Republic reported the occurrence of plague in Svay Rieng, the same area where an outbreak occurred last year. 3.5.3 Enteric infections Typhoid fever Typhoid fever is an important health problem in view of its high morbidity and mortality in some oountries in the Region. The objective of the first regional oourse on bacterial infeotions of the gastro- intestinal traot held in Manila from 18 to 26 February 1974 and in Saigon from 11 to 19 Maroh 1974, was to review and disseminate knowledge on enteric diseases, particularly typhoid fever. Twenty-four participants from 15 English-speaking countries and territories attended the course in Manila and 15 participants from six French-speaking countries attended that in Saigon. Details are given in Part II. Shigellosis Shi~ellosis is the most common bacterial infection of the intestines in the Region. A regional survey on prevalent serotypes and their sensitivity patterns to drugs was undertaken by the National Institute of Health, Tokyo. The results suggest that there may be serotypes and drug- sensitivity patterns characteristic to each area or country of the Region. Vibrio parahaemolyticus is known as an important cause of food poisoning in the Region. Its bacteriology and clinical symptoms, as well as the treatment of the acute food poisoning which it causes, were discussed in detail during the courses on bacterial infections. 3.5.4 Diphtheria-pertussis-tetanus Diphtheria and pertussis are the most common respiratory diseases of bacterial aetiology among children in nearly all the developing countries of the Region. The Government of tre Philippines has requested· WHO assistance in establishing a national immunization programme against the diseases. An immune status survey has been planned in connexion with the programme and the assistance requested will be given late in 1974 by providing a short-term consultant. WPR/RC25/3 page 46 3.6 Mycobacterial diaeases 3.6.1 Tuberculosis A number of conceptual changes have been introduced in the field of tuberculosis control during the past 25 years. It was estimated that by the end of 1973 mo~ than three hundred million people had been vaccinated with BeG in programmes stimulated and supported by WHO in the Western Pacific Region. ~is shows beyond doubt that BeG vaccination is safe and simple to apply on a large scale, thus serving as a spearhead for a case-finding/treatment programme. According to information gathered, BeG vaccination has also reduced the problem of tuberculosis in a number of developing countries, by effedting a sign1ficant change in the epidemiology of the disease. Controlled studies, also stimulated and supported by WHO, have shown scientifically that ambulatory chemotherapy of tuberculosis with the currently available highly effective drugs is not only as effective as institutional treatment but is practicable on a large scale even in countries with limited resources. It has similarly been demonstrated that the more elaborate and costly diasnostic procedures are not essential for aneffeotive case-finding/treatment tuberculosis control programme, so long ae systematic sputum collection and microscopic examination of stained sputum specimens can be carried out. With the more soph1sticateddiagnosticradiological and laboratory and treatment facilities reserved for emergency cases in the developed centres where they exist, it is now feasible for an effective BeG vaccination case-finding/treatment tuberculoSis control programme to be carried out in countries with limited resources even in the more remote rural areas. Experienoe with a number of programmes in several developing countries has been that mortality from tuberculosis decreases markedly as a result of an effective case-finding/domiciliary treatment tuberculosis control programme. So much so that death from tuberculosis and the need to rehabilitate tuberculosis patients may be considered unusual. In remote rural areas where the majority of tuberculosis patients live, such programmes can be oarried out satisfactorily by auxiliary health workers provided they are adequately trained and supervised. Although considerable progress in the control of tuberculoSis has been made in a number of countries in the Region, it remains the oonsensus that the available knowledge and experience accumulated during the past two decades have not yet been accepted universally nor applied as is desirable. Although the eduoation of the public may be a factor partly responsible for this phenomenon, another Is the strong resistance whioh often comes from the olinician, whose interest is primarily in relieving the suffering of the individual patient. , "<- BeG Vaccination Integration of tuberculosis control work into the general health services throughout the country is the objective of a WHO-assisted project in West- ern Samoa. Photos show vaccination of infants in a village. WPR/RC25/3 page 47 Furthermore, field workers at the periphery must be adequately trained in the techniques of tuberculosis control, as mus-: supervisors and health administrators, in order to secure efficient wider coverage on a continuing basis. At the national level, a specialized team of tuberculosis workers is still needed in the ministry of health to share the training and supervisory responsibilities, and also to advise on policy making, and the planning, organization, implementation and evaluation of the tuberculosis control services. Without such a transitional stage, the integration of tuberculosis control into the general health services cannot be successfully achieved. By the end of 1973, WHO assistance to the national tuberculosis control programme of the Republic of Korea was completed. In many respects, this project is an excellent example of how international assistance can be efficiently utilized with fruitful results in a relatively short time. The project received assistance from seven agencies, including WHO and UNICEF, and during the implementation period, the Government per capita expenditure increased from 1.7 US cents in 1962 to 13.7 us cents in 1973, an increase of 706%, which reflects the Government support given to the project. During the twelve year period, 1962-1973, more than 23.2 million infants and children were vaccinated with BeG, or over 60% of the population in the age groups involved. The number of patients under treatment during the past five years was maintained at about 150 000 per year as compared with 28 000 in 1962. All activities were discharged through the government health centres and sub-centres of which there are more than 1500. From the results of two random sample prevalence surveys carried out with an interval of five years, it was estimated that the number of infectious cases of tuberculosis had been reduced from 257 000 in 1962 to 145 000 in 1973, that is a reduction of 42.5% during the l2-year period. National tuberculosis programmes continued to be implemented along the same lines in other countries. In the Khmer Republic, the expansion plan unfortunately did not materialiZe because of the continued warfare. Project activities were confined to Phnom Penh, Battambang and Kendal provinces. In the Philippines, organized tuberculosis services were extended to 18 additional provinces during the year. Twenty-seven provinces will have organized tuberculosis services by the end of 1974. The reorganization of the Philippine Tuberculosis SOCiety has resulted in a considerable improvement in cooperation between this voluntary agency and the government tuberculosis service. In the Republic of Viet-Nam, the tuberculosis control services were extended to six additional provinces, bringing the total of provinces with such services to 14 by the end of 1973. During the WPR/RC25/3 page 48 year, 1.47 million infants and children were vaccinated with BCG, 70% more than in 1972; 35 060 patients, of whom 9384 were found to be sputum-positive cases, remained under domiciliary chemotherapy. In Western Samoa, the tuberculosis service has been completely integrated into the general health services. It took two years to achieve this and continued supervision by the staff of the tuberculosis unit of the Ministry of Health will be needed in the years to come to ensure the effective control of the disease. A total of 10 218 children were vaccinated with BeG and 27 sputum-positive cases of tuberculosis were found during the year. All newly discovered and relapsed cases were hospitalized for a short period and 80% of them were converted within six months of chemotherapy. At the end of 1973, 379 patients, of whom 154 were sputum-positive, remained on chemotherapy. During the period under review, members of the regional tuber- culosis advisory team visited Guam, Malaysia, Papua New Guinea, the Philippines, the Republic of Korea and the Trust Territory of the Pacific Islands. It was generally observed that steady progress was being made by the tuberculosis control services in these countries/ territories, although there is still room for improvement in most of them. The 1973 WHO/Japan tuberculosis course ended in October. Fifteen participants from nine countries attended, including eight from the Western Pacific Region. After a four-month period in Japan, all the participants visited the programme in the Republic of Korea. The second country visit was either to Malaysia or to India, depending on the country of origin of the participants. Those from regions other than the Western Pacific went to India in most cases. The ninth course started in Tokyo on 2 June 1974 with 17 partiCipants from 10 countries. The fourth 'NHO/SPC refresher course on tuberculosis and leprosy, took place in Papeete (Tahiti) from 2 to 22 May 1974. This course is held at intervals of five years. One medical officer in charge of the tuberculosis and leprosy control programmes from each of the 10 terri- tories in the Pacific and for Western Samoa attended. Tuberculosis was the subject for the first two weeks and leprosy for the last. Remodelling of the premises and other activities were undertaken by the BeG Vaccine Production Laboratory at Alabang, Philippines, in preparation for the arrival of the equipment to be supplied by ill~ICEF. With the assistance of two WHO conSUltants in this highly specialized field, UNICEF was able to finalize the order for the freeze drying, automatic sealing and washing machines in March 1974. It is hoped that these essential pieces of equipment will be received by the end of 1974 so that normal production can conmence in mid-1975. .. .. " 3.6.2 Leprosy WPR/RC25/3 page 49 As with tuberculosis, the principles of phasing out institutional treatment and expanding domiciliary chemotherapy were followed in general by the Organization in the control of leprosy. During the year under review, WHO advisory services were extended to the British Solomon Islands Protectorate, Laos, the New Hebrides, the Republic of Korea and the Republic of Viet-Nam. In the British Solomon Islands Protectorate, the assignment of the WHO leprosy adviser was completed in September 1973. After an intensive survey in the endemic areas, it was concluded that leprosy remains a health problem of some importance in the Protectorate. The higher proportion of tuberculoid cases, both among the newly discovered and those in the active register, indicates that there is a relatively high resistance to leprosy. However, Judging from the distribution of patients by age, contact history and lepromatous lesions, trans- mission of the infection seems still to be active. During the adviser's assignment, over 70 nurses and dressers were trained in the diagnosis and chemotherapy of leprosy. Consequently, more cases have continued to be discovered. With the continued support of the Lepers' Trust Board, Inc., of New Zealand, the WHO leprosy adviser was transferred from the British Solomon Islands Protectorate to the New Hebrides in October 1973 for an assignment with the Condominium leprosy control programme. A plan of work for the first year was prepared soon after his arrival in Port-Vila. Standards of diagnosis and treatment in accordance with WHO recommendations were introduced. Existing known cases of leprosy were reviewed and the treatment being given to them revised when necessary. The medical assistants, nurses and dressers at district hospitals on different islands were trained in leprosy case-finding and supervisory home treatment. A central register for leprosy cases was set up at the rural health centre in Port-Vila. In Laos, a WHO consultant estimated, after a stay of one month, that the prevalence of leprosy for the whole country was probably in the order of one to four (1-4) per 1000 and the highest endemicity seemed to be in the Pakse area. Over 800 known cases were receiving active chemotherapy out of a total of 1753 in the register. The consultant believed that under the present circumstances there are more urgent health problems than leprosy. During the 12-month assignment of a WHO consultant to the Republic of Korea, which terminated at the beginning of November 1973, all the staff of the national leprosy programme have received either refresher or basic training. A new approach to case-finding, based on the mobilization of case-workers to work intensively in groups of three or four at village level, was introduced and became WPR/RC25/3 page 50 operational in the project areas. High-risk communities were selected as areas where these intensive village surveys were to be carried out during the remaining two months of 1973 and the whole of 1974. From an analysis of the available epidemiological data, the results of the resurvey of five villages in Wolsung Gun, Kyeongsang Pukdo, and his observations during field visits, the consultant concluded that there was at present statio and low-level transmission of leprosy infection throughout the project areas in the Republic of Korea. He thought, however, that there was no reason for complacency; years of hard work lay ahead before definitive results would be achieved. In the Republic of Viet-Nam, a WHO consultant, after an assign- ment of three months, concluded that leprosy was still a serious health problem, with an estimated prevalence of four to eight cases per 1000 population. The present resources and organization of the leprosy services are not adequate however, to achieve control of the disease in the foreseeable future. If sufficient assistance is forthcoming from both WHO and the voluntary agencies, the leprosy control service might be reorganized by 1976. Fo~ the coming two years, a pilot project in Ba-Xuyen, the continuation of school surveys in Saigon, and the creation of a treatment centre there for children with leprosy were recommended. Voluntary assistance continued to be given by the German Leprosy Association (DAHW) and the Order of Malta to the leprosy programmes in the Philippines and the Republic of Korea, and by the Lepers' Trust Board, Inc., of New Zealand to the projects in the British Solomon Islands Protectorate and the New Hebrides. 3.7 Virus diseases 3.7.1 Poliomyelitis Intensified poliomyelitis surveillance has continued in Malaysia and Japan. An outbreak in Malaysia subsided during the period under review, although sporadic cases have continued to occur. A substantial number of poliomyelitis cases were reported during the period under review in the Khmer Republic, the Philippines, and the Republic of Viet-Nam, where it has not been possible to cover all susceptible children with vaccination. 3.7.2 Japanese encephalitis The incidence of Japanese encephalitis in Japan has continued to be extremely low. There was a sign of an endemic setback in two provinces in the Republic of Korea following four successive years of low incidence. In other parts of the Region, such as the Republic of Viet-Nam, outbreaks have been reported, although the etiology of the cases has not been confirmed by laboratory investigation. 3.7.3 Dengue haemorrhagic fever WPR;RC2513 page 51 Large outbreaks of dengue haemorrhagic fever occurred in the Khmer Republic, Malaysia, Singapore and the Republic of Viet-Nam. In the Republic of Viet-Nam and Malaysia, 14 000 cases with 1000 deaths and 1000 cases with 45 deaths were reported respectively. In view of the rising incidence of dengue haemorrhagic fever and current confusion in clinical as well as aetiological diagnosis, the first meeting of a newly established technical advisory committee was held in Manila from 5 to 7 March in cooperation with WHO Headquarters and the WHO Regional Office for South East Asia. Nine temporary advisers, consisting of virologists, epidemiologists, clinicians and public health officers concerned with dengue haemorrhagic fever, were invited to discuss various aspects of the disease. Guidelines were prepared for the diagnosis and control of dengue haemorrhagic fever and recommendations made on future research. 3.7.4 Haemorrhagic fever (Korean type) The outbreak of Korean haemorrhagic fever in the early summer of lY73 was insignificant. During the period October to December, however, a total of 394 cases were reported from seven of the 10 endemic areas in the Republic. An ecological and virological survey of field mice in the northern endemiC areas was organized by the WHO Vector Ecology and Control Research Unit. 3.7.5 Trachoma A high prevalence of trachoma has been reported in schoolchildren in some islands of the Trust Territories. The possibility of WHO providing a consultant to give advice on diagnostic and preventive measures is under consideration. ).7.6 Infectious hepatitis The number of viral hepatitis cases continued to increase in Australia, New Zealand and some South Pacific islands. 3.7.7 Influenza During the period under review, outbreaks of influenza affected several countries in the Region. Close variants of A/port Chalmers/ 1/73. A/England/42/72 and B/HK/5/72 have been isolated. The exchange of information among WHO collaborating influenza centres in the Region has played an important role in forecasting and controlling such epidemics. WPR/RC25/3 page 52 3.8 Venereal diseases and treponematoses Recent changes in the age and socioeconomic patterns of venereal diseases have been almost worldwide. During the period under review, WHO assigned consultants to Laos and Papua ~ew Guinea. A oonsultant will be assigned to the Republio of Viet-Nam later this year and will give partioular attention to the laboratory aspects of the programme. 3.9 Veterinary publ.ic· health Fiji requested WHO assistanoe in connexion with the diagnostic and laboratory aspects of leptospirosis. A WHO oonsultant undertook a leptospirosis survey in Tbnga and assisted in developing diagnostic teohniques sui table for the country. She reported a high prevalence among children, based upon the results of serological examination of 800 blood samples. The existence of several serotypes was suggested. Assistance was also provided to Western Samoa in connexion with a survey to determine those zoonoses whioh represent a danger to publio health, with partioular reference to food prooessing. 3.10 Vector biology and control 3.10.1 Vector control in general Advice and assistance were provided for the establishment of a vector control unit in the Ministry of Health of Malaysia, and a short-term consultant will be aSSigned to assist in working out a detailed programme for the unit and for an Aedes aegypti survey on a nation-wide basis. A proposal was made to the Government of Papua New Guinea that it should establish a Similar unit. 3.10.2 Aedes aegypti survey and control Systematic surveys in the RepubliC! of Viet-Narn have coveroed most of the provinces. In each one, a rural and an urban area were selected and surveyed during the dry and rainy seasons. A Breteau index (the number of positive water containers with Ae. aegypti larvae per 100 houses) of 858. obtained in Go-Cong, south of Saigon was the highest recorded in the world so far. Control trials proved that treatment with Abate 1% sand granules at 1 ppm remafns effective for three months. Assistance was provided in initiating surveys of Ae. aegypti and its closely related Stegomyia species in the British Solomor Islands Protectorate, New Hebrides and Papua New Guinea. During an outbreak of dengue haemorrhagic fever in Malaysia, technical advioe and assistanoe were provided in carrying out ultra-low-vo1ume aerial spraying with malathion. During a similar epidemic in the Republic of Viet-Nam, advice was given on the control of the vector mosquitoes. • WPR/RC25/3 page 53 Guidelines for vector surveillance and control were prepared during the meeting of the technical advisory committee on dengue haemorrhagic fever held in Manila in March 1974. 3.10.3 Vector control training Assistance was given in planning and conducting national courses on vector and rodent control in the Republic of Korea and in the Republic of Viet-Nam. Field training for public health inspectors was conducted in several localities in Papua New Guinea and for rural health assistants in Sabah, Malaysia. 3.10.4 Safe use of pesticides Information was presented on the use of pesticides for the control of insects of public health importance in the Region during the FAO-sponsored seminar on the safe, effective and efficient utilization of pesticides in agriculture and public health in Asia and the Far East held in Bangkok. 4 NON-COMMUNICABLE DISEASE PREVENTION AND CONTROL 4.1 Cancer It is widely accepted that the various types of human canCers are influenced directly or indirectly by extrinsic factors, which collectively account for more than three-quarters of the cases. For this reason, it is believed that the majority of human cancer is potentially preventable. It is in this aspect that the Organization is particularly interested. There has been active planning during the year for a regional meeting of a working group on cancer in 1975. It is hoped that the group may be able to determine the aetiological factors of certain types of cancer highly prevalent in the Region. In order to reach fruitful conclusions, uniform definition, diagnosis and recording must be agreed upon and applied. The coverage and quality of diagnostic services should be improved and there must be a uniform procedure for the classification of recognized canoer cases into different groups, thus permitting an estimate of the incidence of the disease to be obtained. During the year under review, the only consultantship in the field of canoer was provided to the Philippines. Since the establishment of a oancer register in 1968 at Rizal Provincial Hospital, over 700 cases had been registered up to the end of 1973. The most common site of cancer among males was reported to be the blood (leukaemia), followed by stomaoh, liver, lung and bucoal cavity. In females, the most common site was the breast, followed by thyrOid, cervix uteri, the blood (leukaemia) and buccal cavity. A population-based cancer registry WPR/RC2S;' page 54 and a mass screening prcgramme for the early detection of cancer are expected to be established in the coming year. 4.2 Cardiovasoular diseases When the morbidity, disability and mortality from atherosclerotio diseases - coronary heart disease, oerebrovascular, aortio, renal vasoular and peripheral vascular diseases - and those resulting from infections are combined, there is no doubt that cardiovasoular diseases have become the main health problem in many countries. They constitute, therefore, one of the principal ohallenges to medical and publio health services. The extensive researoh data available concerning the problem strongly indicate that major progress in controlling cardiovascular diseases oan only be made by primary prevention, that is the prevention of infection leading to valvular damage and by reduoing the first clinical episodes by preventing atherosclerosis and its complications. This will be the main strategio thrust of an international 'effort to oontrol oardiovascular diseases in the years ahead. Many studies oonduoted over the past 30 years have demonstrated assooiations between oertain baoterial, bioohemioal, physiological and environmental faotors and the development of oardiovasoular diseases. Numerous risk factors for these diseases have been identified, suoh as a diet high in saturated fat-cholesterol-calories, elevated blood lipids, hypertenSion, cigarette smoking, hyperglycaemia, obesity, sedentary living, psychosocial tensions and a positive family history of. such diseases. The control of these diseases, therefore, calls for a coordinated multidisoiplinary effort by the general health services, with the aotive participation of nutritionists and health eduoation specialists, and the help of cardiologists. Preparations are being made for the second regional seminar on the control and prevention of oardiovascular diseases, which is to be held early in 1975. Following oompletion of the oardiovascular disease survey in Tonga in 1973. a cardiology servioe with a register of patients with cardiovascular diseases was organized at Vaiola Hospital in Nuku'alofa. 4.3 Metabolic diseases Following the oompletion of a diabetes survey oonducted in Tonga in conjunotion with a cardiovasoular diseases survey, all cases discovered in Nuku'alofa have been followed up and treated. A diabetes register was set up at the Vaiola Hospital. A diabetes manual, prepared with the assistance of the WHO consultants, was translated and published~ SuperviSion of domiciliary treatment was provided by the members of the long-established national tuberculosis team. 'Ihe creation of diabetic clinics in the other two groups of islands is being organized by the Government. WPR/RC25/3 page 55 A preliminary survey of metabolic diseases in French Polynesia was carried out by a WHO consultant for six weeks beginning at the end of July 1973. It was discovered that the number of cases of gout or diabetes mellitus (particularly the former) diagnosed and treated in the hospital had shown a dramatic increase during the period between 1962 and 1972. The increase was apparently synchronous with an increased number of "plethoric syndromes", i.e., florid appearance, obesity, hypertension and occasionally heart failure. A quantitative approach is, however, not yet possible because of the lack of the necessary records. Systematic population surveys or blood chemistry are yet to be oarried out. From the limited data on patients or blood donors available at the Mamao HOspital, all the indices, particularly that on serum uric acid, seemed to point to a normal range very muoh higher than that oustomarily found in Europe or North Amerioa. A follow-up visit of the same oonsultant to oarry out further investigations into this problem is planned. 4.4 Dental health The l'.egional dental health programme is being developed as planned. During the period under review, visits were made by the interoountry dental health adviser to Fiji, HOng Kong, Papua New Guinea, the Philippines, the Republic of Korea and the Republic of Viet-Nam. In Fiji, the advisory services oovered the training and utilization of dental therapists and the upgrading of dental education. The interoountry dental health adviser was also invited to partioipate in a national dental health seminar and to advise on dental therapist training. A WID short-term consultant assisted ·In upgrading clinical and laboratory skills for both undergraduate and serving dentists. In HOng Kong, Papua New Guinea, and the Republic of Korea, the training and utilization of operating dental auxiliaries in connexion with the delivery of dental services were actively studied. The upgrading of dental eduoation also received attention in Papua New Guinea. In the Philippines, the implementation of the reoommendations of previous short-term consultanta is being followed up. In the Republic of Viet-Nam,a WHO dental therapist tutor is assisting the development of a dental auxiliary training programme. In January 1974, the Regional Office conducted a review of the development of dental health services sinoe 1961 in relation to ongoing programmes. Proposals for future activities in the Region were also considered. Emphasis was laid on the development of such preventive measures as would lead to a reduction in dental diseases and the integration of dental activities within the general health service, where possible. WHO assistanoe has been provided in two multiphased periods, coinciding with its general programme of work covering a speoific WPRjRC25/3 page 56 period. The first period. completed in 1972. was ccncerned with fact- finding and general planning; the seoond. and present period, is ooncerned wi th speoific p1ann1ng at oountry level. the implementation of reoommendations on dental health. manpower. eduoation (including development of training currioula) and the introduction of measures for the effeotive delivery of national dental health services. In aooordanoe with resolution EB53.R,30 adopted by the Executive Board at its fifiy-third session. countries in the Region are being actively enoouraged to ensure the prOvision of water tluo~idation to communities where praotioable. and. where not practioable. to introduoe other methods of using fluorides for the prevention of dental caries. In this connexion. the use of weekly or daily solutions (0.2 or O.O~) of sodium fluorides, espeoially for captive groups such as school- children. is beins enoouraged. Close collaboration is being~1ntained with the Asian Pacific Dental Federation and the International Dental F~deration. 4.5 Mental health Mental health oontinues to have a relatively low priority in the health servioes of many oountries in the Region. particularly those whioh have to deal with more overt health problems with scarce staff and resources. wm> assistance during the year has, therefore. been oonfined to eduoational actirl ties. '!be highlight was the second regional seminar on mental health: teaching of psychiatry in medioal schools. 'E:I1s was held in Manila from 15 to 21 January 1974 and was attended by 19 participants from medioal schools in nine oountries. Reoommendations were made on the content. means and method of psychiatric training for medical students and on how this could best be integrated into the total ourriculum. Some oountries in the Region also sent participants to a oourse in psychopharmaoology for teachers in medical schools. held in Denmark from 21 April to 11 May 1974. and to a seminar on the organization of mental health services. in Addis Ababa, from 27 November to 4 Deoember 1973. 4.6 Prevention and control of alooholism and drug depende~oe and abuse In response to a resolution adopted by the Regional C(!)mmi ttee at its twenty-third session (resolution WPR/.RC23.R8)1 there has been lsee Handbook of Resolutions and Deoisions of the Regional Committee for the Western Paoifio, 1974. 8th ed., section 1.7.4, page 109. Dental Therapists Training, Viet-Nam A WHO tutor (Ms S.T. Khoo) and her counterpart (Ms Nguyen Thi Thiem) demonstrate an operative procedure to dental nurse technician trainees at the Dental Auxiliary Training School in Saigon (top photo). Below, a view of the dental conservation room which was newly established by the Government on WHO advice. WPR/RC25i3 page 57 an increase in activity in this field during the year. A two-man intercountry team collected epidemiological data in Malaysia and made detailed recommendation for the establishment of a national training programme which could, in the future, also serve other oountries in the Region. The first steps in implementing these recommendations are now being taken. The team also made preliminary contacts in the Philippines, and it is planned to complete this portion of the activity before the end of 1974. Contact has been established with the United Nations Fund for Drug Abuse Control, whioh has provided funds for fellowships and a oonsultant to assist in the establishment of a national oentre for the treatment and rehabilitation of drug dependents in the Republio of Viet-Name Information on drug abuse programmes has been exohanged wi th the WHO Regional Offioe for South-East Asia. As a first step in ooordinating activities, participants from two countries in the Western Paoific Region will be invited to take part in a seminar on the epidemiology of drug abuse planned to take place in Jakarta in October 1974. A questionnaire designed to gain a first subjective view of drug abuse in the Region was ciroulated to all Member oountries. The responses are now being analyzed and will be presented to the twenty- fifth session of the Regional Committee. 5 PROPHYLACTIC AND THERAPEUTIC SUBSTANCES Specifioation and quality control of pharmaceutical preparations In the Khmer Republic, recruitment of a consultant in the control and production of pharmaceutical products was suspended due to the existing emergency in the country. The situation has now improved and it is expected that the project will be implemented later this year. Recruitment difficulties prevented the assignment of a consultant to the Republic of Viet-Name It is now hoped to implement this consultantship in the latter part of this year. 6 PROMOTION OF ENVIRONMENTAL HEALTH There was no appreciable change in the content or trends of WHO assistance to countries from that reported for the preceding period. In addition to purely environmental health projects, there were several multidisciplinary ones in which advioe in this field was given in the framework of development of health services or manpower development. The programme continued to be funded mainly from the WHO regular budget, but there was also an important contribution from UNDP. Supportive material assistanoe was also provided by UNICEF. WPR/RC25/3 page 58 The long-term intercountry programme in environmental health, first proposed in 1970, was reviewed and expanded in 1973. The pro- gramme, shown on page 59, consists of group educational activ1.ties, such as seminars, working groups, training courses and conferences, and of advisory services in the fields covered by the various sub- programmes. Implementation continued on schedule, but additional sources of funds to complement the regular budget will have to become available from 1975 onwards in order to execute the programme in its entirety. At the end of 1973, Member countries were asked whether they would give endorsement in principle to the whole series of activities. All replies received until 30 April were in the affirma- tive. Assistance was given in the implementation of WHO global activities under WHO Headquarters' medium-term programme, mainly through the c;:ollection of teohnical data and information from Member countries and the identification of regional tnlent to review draft documents prepared by Headquarters. In the field of occupational health, a national seminar on the organization of industrial health services for small industries was held in Malaysia. The interest of governments in developing programmes in the field of radiation health is growing. Assistance was given through intercountry programmes which have been fo1.md. to be an effioient approach to support the development of radiation protection and radiation medicine services, as well as programmes in the maintenance of medical equipment. 6.1 Provision of basio sanitary measures In the Cook Islands, a WHO engineer assisted the Government to develop plans for water supply, drainage, and sewerage schemes to serve the Island of Rarotonga. In Guam, the nature and objectives of the proposed assistance in water supply planning were identified through a preparatory mission. In the Khmer Republic, assistanoe was held in abeyanoe for the major part of the reporting period. Planning was, however, carried out for the installation of additional public outlets in the water distribution system of Phnom Penh and its surroundings, in order to make water accessible to the large numbers of displaoed persons in the neighborhood. In Laos, a comprehensive proposal was prepared for medium-term expanded UNICEF assistance in the provision of sanitary facilities to hospitals, maternity and child health oentres, schools, orphanages, etc., as well as for rural water supplies. I . C: Environmental health A biologist collects water from the Philippines Laguna de Bay for laboratory study and analysis. WHO is parti- cipating in a UNDP/ADB study for Laguna de Bay water re- sources development. Photo below shows workers at the water seal latrine workshop in Leulumoega district, Western Samoa. WHO is helping the Government in its effort to construct water seal latrines in the villages • . 't " \. " • PROMOTION OF ENVIRONMENTAL HEALTH - LONG-TERM INTER-COUNTRY PROGRAMME WESTERN PACIFIC REGION 1970 1971 1972 1973 1974 1975 1976 1977 1978 PROGRAMME PLANNING AND DIRECTION a V R.O. -f:s v V V PROVISION OF BASIC SANITARY ~~ MEAS\JI!ES Overall fofunicipal Rural PRE-INVES'lJIEIIT PLAllllING FOR G BASIC SANITARY SERVICES COII'l.1«lL OF ENVIRONMENTAL POLWTIOIi AND HAZARDS V V 5 /\ .... V ~ e .. +' ~ ® .... ~ < .... .... 0 .. 5 6---...... --V---- ----~ ./11: I SEMI ® ..... ~ "' .... .,.. 0 -:.-.. ::\$ ~ ® ..... 0 .. \l l~J .,'" • .. W .... oil e -'% ESTlUlLISII£II'l' AND S'mElIl'1'lEllIMl OF ENVIRom£NTAL lI!ALlli SERVICES "Z.~ SEM AND INSTI=O~ :.. .... FOW STANDARDS PROG_ (7 • RIlL and. WIF exclu:led. V ~ B ICON I 9 Q 0 ~ Consultant Long-term Seminar Conference Working Training Regular Proposed. for UI£P Mission Adviser Group Course \ Budset F1mding ..: Revised May 1974 1979 1980 1981 I CON 1 \J j S V ~ ~ ~ ~ e ~ 8 , . I' , -0 :0::: ill -U cq ::u <1)~ ,J] (") ~ ;\) IJl ,.;J WPR/RC25/3 page 60 In Malaysia, a WHO engineer continued to provide assistance to the Ministry of Health in the organization and conduct of a course for training rural sanitation personnel and the setting up and operation of a rural water supply development programme. A l2-year rural water supply and latrine oonstruction programme amounting to over M$lO million has been proposed for Sabah. Assistance was also provided in the elaboration of a rural piped water supply development programme for Peninsular Malaysia. In the Philippines, under the development of the health services project in the demonstration area of the province of Rizal, the construction of public water supplies and individual water-seal latrines was promoted, as well as quality control of well waters. In the Republic of Korea, assistance was provided to the Ministry of Construction in the planning and execution of several large urban water supply schemes, including a project to ensure an adequate water supply for the Seoul Metropolitan Area. Two WHO engineers provided assistance to the large rural water supply development programme of the Ministry of Health and Social Affairs. WHO collaborated with FAO in the execution of sanitary engineering activities which form part of the UNDP-assisted "Upland Development and Watershed IVIanagement" project. In the South Pacific Area, the WHO intercountry environmental health advisory servioes project provided technical assistanoe to the British Solomon Islands Proteotorate, the Gilbert and Ellice Islands, Western Samoa, Fiji, the New Hebrides and Tonga in developing designs for rural water supply schemes and other sanitation facilities which were assisted by UNICEF. In the British Solomon Islands Protectorate, WHO assisted the Government to elaborate a proposal to UNDP for the provision of funds to help set up a oourse for the training of assistant health inspectors. In the Gilbert and Ellice Islands, a new project was implemented to assist the Government to organize and oarry out environment sanitation activities and projects in the rural areas. In the Trust Territory of the Paoific Islands, assistance was given in planning and oonduoting a one-month course for water treatment plant operators. In the Republic of Viet-Nam, a proposal for UNICEF assistance was formulated similar in nature to, bUt larger in scope than, that reported above for Laos. Through the environmental health advisory services projeot, assistanoe was given to the implementation of the oountrywide sanitary hamlet programme. A study of the technical and organizational measures needed to improve solid wastes management in the Saigon Gia Dinh metropolitan area started towards the end of the reporting period. " . 6.2 Pre-investment planning for basic sanitary services WPR/RC25/3 page 61 In Laos, preliminary feasibility studies were made for the development of water supply systems in a typical river town and in three hill towns. In the Khmer Republic, the implementation of the operational phase of the UNDP-assisted water supply, sewerage and drainage project for Phnom Penh was held in abeyance for several months. Consul ting firms were short-listed at the beginning of 1974 and submitted their proposals at the end of April. Recruitment aotion for the WHO project manager was reactivated during the first quarter of 1974. The project is expected to become operational during the second half of 1974. In Singapore, WHO has been assisting the Government to elaborate a master plan for the development of olosed storm water drainage facilities and sohemes which would inoorporate designs for the capture of storm water for reuse. This planning projeot was funded by UNDP and will run for two years. In the Republio of Viet-Nam, the UNDP-assisted water supply and sewerage project, soheduled to start operation in February 1974. has experienced some delays because of recruitment difficulties. 6.3 Control of environmental pollution hazards Activities continued to be implemented in accordance with the long-term interoountry programme and with requests received from governments. A oonsultant will be assigned to Guam later this year to assist in improving laboratory services and facilities for water pollution control. In the Philippines, WHO assisted the Asian Development Bank (ASDB) in the publio health aspeots of the UNDP-assisted Laguna de Bay water resources development study. The WHO technical offioer on water pollution assigned "to this project provided a broad range of teohnical services focused on the public health requirements which are a prerequisite for developing this fresh water body into a potential source of additional water supply for Metropolitan Manila. He also assisted in the formulation of a proposal for the oontinuation of the water quality oontrol studies with international assistance after the ourrent ASDB-executed study terminates in August 1974. In the Republio of Korea, planning was completed to provide long- term advisory servioes and teohnical assistance to the Ministry of Health and Social Affairs in organizing and implementing an air quality monitoring network and a national programme for the oontrol of air pollution. . WPR;RC25/3 page 62 In the Republio of Viet-Nam, a oonsul tant prepared a draft Clean Air Aot for the oonsideration of the Government. Concurrently, assistanoe was given on water pollution control planning and on the basic requirements needed for the formulation of a projeot document to request UNDP assistanoe in planning and implementing a medium-term national pollution oontrol programme. 6.4 Health of working populations Assistanoe is being expanded to meet the growing need for occu- pational health servioes in oountries and territories of the Region. In the Khmer Republic, the reoruitment of a oonsultant to assist the Department of Health and the Department of Labour in establishing an oooupational health programme has been deferred in view of the present emergenoy situation. In Malaysia, a long-term advisory servioes projeot is expected to become operational this year with the objectives of strengthening the organization responsible for ocoupational health, developing a national programme to proteot workers against oooupational hazards in the light of ourrent and future requirements, and establishing a national oocupational health oentre to undertake action researoh, training and demonstration. A national seminar was held in February 1974 to review the si tuation of small industries in the oOW'ltry and to recommend measures for their improvement. In the Philippines, a oonsultant will be provided for a period of six months as a follow-up of previous international assistanoe to assess industrial health servioes in the oountry and formulate a plan for the development of industrial health servioes in line with the growing industrialization in the oOW'ltry. Assistanoe to the Republic of Korea and Singapore is in the form of fellowships. The first regional oourse in occupational health will be held towards the end ot the year at the Sohool of Hygiene and Tropical Medioine, University of Sydney. The course, whioh aims at providing introduotory training in the field of occupational health to medical offioers oonoerned with the health and welfare of workers, should cover a six-week period and is expeoted to be attended by approximately 20 participants from oountries and territories in the Region. A oonsultant in industrial hygiene is being recruited and will visit five oountries/territories in the South Pacific to assess the present situation regarding the provision of health and safety measures in small industries. .- " Top photo shows workmen laying a main sewer in Singapore's Woodlands' New Town. Below, a primary sedimentation tank at the Woodlands'treat-, ment plant. UNDP and WHO assisted Singapore in the planning and study for these sewerage facilities. ,. -~' WPRjRC25/3 page 63 6.5 Biomedical and environmental health aspects of ionizing radiation The uses of radiation and radioisotopes for medical and other purposes are highly developed in some countries of the Region. However, in several other countries even the most essential basic X-ray diagnostic applications need improving and strengthening. In general, radiation medicine services are improving but much remains to be done to upgrade them, particularly in rural areas. One major problem in radiation medicine is the shortage of adequately trained radiological technicians for the proper operation and care of equipment. This leads to rapid deterioration of equipment, unsatisfactory results, and neglect of even the basic requirements for radiation protection. A programme is therefore being developed to assist countries in training such technicians. During the period under review, the British Solomon Islands Protectorate and the Philippines were provided with assistance under the intercountry programme. Another major problem is the maintenance and repair of radiation apparatus and accessories. Progress in the solution of this problem has so far been slow, mainly due to the shortage of trained staff or even lack of candidates with an appropriate educational background. However, although in most countries only initial steps have been taken to establish maintenance and repair services for medical equipment, the interest of governments in setting up such services is growing and the possibilities of attracting candidates for training are improving due to the increasing number of graduates from technical schools. On the basis of the experience gained through the operation of the inter- country maintenance and repair of X-ray and other laboratory equipment project, preliminary plans were made to expand the assistance provided in this field. These includes the establishment of a regional training centre and the expansion of assistance to cover the maintenance of equipment in other medical fields. In order to check the dosimetric procedures in connexion with the clinical applications of radiation, the IAEA/WHO postal dose inter- comparison programme continued with the participation of 43 institutions in eight countries. Assistance in setting up national reference centres for radiation dosimetry was also provided to a number of countries. Assistance is being given in the development of national radiation protection services to meet the growing concern in several countries of the Region regarding man's exposure to radiation, particularly in connexion with the medical uses of radiation and radioisotopes. The service for monitoring personnel occupationally exposed to ionizing radiation continued. The Gilbert and Ellice Islands, the Khmer Republic, Laos and Tonga are being provided with dosimeters and infor- mation on the results of the measurements on a monthly basis. WPR/RC25/3 page 64 The degree of the exposure of populations to radiation from natural sources is still unknown in several areas. A programme of assistance to national institutions in measuring and assessing such irradiation is being developed. The Republic of Korea and Singapore are participating in the first phase of this programme. 6.6 Establishment and strengthening of environmental health services and institutions In Laos, under the development of the health services project, advice was given on the organization of an environmental health seotion within the Prefecture of Vientiane. Plans were made for a two-year training oourse for assistant health inspeotors. Preparations were also oompleted for the start of a four-year environmental health advisory servioes projeot in 1975. In Malaysia, WHO oontinued to provide advioe and teohnioal assistanoe to the Ministry of Health in the development of national environmental health programmes and to support institutional maohinery for oarrying out these aotivities. In Papua Hew Guinea, long-term assistanoe is being provided to the Heal th Department in the development of a oomprehensi ve environmental health servioe, inoluding advioe on the improvement of the course for the training of health inspectors. In the Republio of Viet-Ham, assistanoe was given in the planning and execution of environmental health programmes on a national scale and in the training of environmental health staff. Assistance was also provided in the planning of a national seminar on the environment, soheduled to be held in Saigon in July/August 1974. 6.7 Food standards programme Activities oontinued as part of the overall environmental health assistance in Laos, the Philippines and the Republic of Viet-Nam. Planning has been completed for a new project to assist the Ministry of Health and Social Affairs in the Republic of Korea . to develop activities and methods to improve the national food programme. In the South Pacific Area, assistance was provided to Fiji, Tonga, and Western Samoa in the organization and conduot of food handlers' course and on other activities relative to the control of food hygiene standards in these countries. 7 DEVELOPMENT OF HEALTH STATISTICAL SERVICES WPR/RC25/3 page 65 Vital and health statistios services in many of the developing countries and territories of the Region need to be strengthened if they are to provide the information required for assessing the health needs of the people and for formulating realistic national health plans. During the period under review, continued efforts were made to assist governments in developing their health statistioal services at various levels of the health administration, improving their health and medical reoords systems, partioularly in health oentres and hospitals, and introduoing more systematio prooedures for the oolleotion, prooessing, analysis and compilation of health statistioal data. The WHO statistioian attaohed to the interoountry project assisted in strengthening the recording and reporting of health events in the Cook Islands, Tbnga and Western Samoa. The statistician of the interoountry fa~ily health field advisory servioes projeot assisted in improving the recording and reporting system in the Gilbert and Ellice Islands and participated in the' assessment of the family health programme. In Malaysia, a system for the oolleotion of morbidity statistios from hospital admissions and outpatient olinic oases, as well as from peripheral health unit:s,was organized with the assistance of the WHO statistioian attached to the epidemiology and statistics project. A monitoring system for the prompt deteotion of unusual oocurrenoes of oommunioable diseases through weekly reporting of notifiable diseases was also established. The data oollected during the recent poliomyelitis and oholera epidemios have been used by the Government in planning and evaluating their oontrol programmes for these conditions. Assistance was also given in oonnexion with the reorganization of the medical records in the field of maternal and ohild health. In the Republic of Korea, the central statistical unit in the Ministry of Health and SOCial Affairs has been strengthened. Simple forms for recording and reporting the activities of multipurpose health workers at health centre and suboentre levels were drafted in order to facilitate the integration of medical and health care services at the periphery. In the Republio of Viet-Nam, technical assistance was given in the colleotion of the health statistioal information required for the formulation of the five-year health plan. This inoluded measures for improving methodology to permit more the .. accurate and complete collection of vital statistioal data in a pilot area and for oonduoting a survey on the utilization of health and medical oare resouroes. The WHO statistioians attached to the intercountry health statistios and reoords projeot, the regional tuberculosis advisory team WPR/RC25/3 page 66 and the regional family health field advisory services project devoted part of their time to the collection of internationally comparable health information. Training, particularly the in-service training of health personnel, was an essential component of all WHO-assisted projects in health statistics. 8 COOPERATION WITH OTHER ORGANIZATIONS 8.1 Cooperation with the United Nations and related agenc,ies WHO continued to work in olose relationship with several organizations on matters of mutual ooncern and interest. Economic Commission for Asia and the Far East (ECAFE) Although the post of WHO 11a1son officer in Bangkok was vaoated in May 1973 with the departure of the staff member ooncerned, the office of the WHO Representative/Bangkok continued to provide the neoessary liaison with ECAFE until the vacant post was filled in January 1974. WHO was represented at the follOwing meetings organized by ECAFE: (a) Meeting of the Regional Group for Asia and the Far East of the Advisory Committee on the Applioation of Soienoe and Teohnology to Development, Bangkok, 6-8 August 1973. (b) Fifteenth Session of the Asian Advisory Committee, Bangkok, 15-21 August 1973. (c) First Session of the Sub-Committee on TOurism and Facilitation of International Traffic, Bangkok, 24 September - 1 October 1973. (d) Meeting of the Representatives of Countries and Inter- Governmental Bodies Active in the Field of Human Environment in the ECAFE Region, Bangkok, 2-5 October 1973. (e) Tenth Session of the Water Transport Sub-Committee, Bangkok, 31 October - 7 November 1973. (f) Meeting of Permanent Representatives to ECAFE and Other Representatives Designated by Members of the Commission, Bangkok, 3, 4 and 6 December 1973. (g) Conference of Asian Statisticians, Twelfth Session, New Delhi, India, 10-22 December 1973. - , , ". '- WPR/RC2513 page 67 (h) Regional Workshop on Adult Education and Family Planning, Singapore, 17-21 December 1973. (i) Meeting on Evaluation of Educational Materials Used in Family Planning Programmes, Bangkok, 7-11 January 1974. (j) Seminar on the Role of Surveys and Studies for Family Planning Programme Management and Development, Bangkok, 28 January - 9 February 1974. (k) Seminar on the Improvement of Rural Housing in Asia and the Far East, Bandung, 4-15 March 1974. (1) Thirteenth Session of the United Nations Economic Commission for Asia and Far East, Colombo, Sri Lanka, 27 March - 8 April 1974. Mekong Committee, Bangkok Coordination with the Mekong Secretariat was effectively maintained through the WHO Liaison Officer with ECAFE and the Office of the WHO Representative in Bangkok. A WHO consultant sanitary engineer was recruited for a period of eleven months, starting in October 1973, for attachment to the Mekong Committee. In February 1974, he visited the Regional Office as well as the riparian countries in the Western Pacific Region as part of his general briefing. The Second Malaria Technical Meeting for the riparian countries in the Lower Mekong Basin was held in Khon Kaen, Thailand, in August 1973. The attendance of four staff members from the Western Pacific Region, two from the Regional Office and one each from Khmer and Laos, was financed by WHO. The follOwing meetings organized by the Mekong Committee were attended by WHO staff members: (a) Sixty-third Session (Special) of the Mekong Committee, Bangkok, 24-26 October 1973. (b) Technical Meeting on Food and Nutrition Monitoring in the Mekong Development Areas, Bangkok, 11-16 November 1973. (c) Sixty-fourth Session (Plenary) of the Mekong Committee, Bangkok, 30 January - 4 February 1974. (d) Sixty-fifth Session (Special) of the Mekong Committee, Sri Lanka, 27 March - 8 April 1974. United Nations Development Programme (UNDP) At both the regional office and country levels, close contact has been maintained with the UNDP Resident Representatives in the development and implementation of UNDP country programmes. WPR/RC25i3 page 68 The UNDP Governing Council, at its June 1973 session, postponed consideration of country programme for the Republic of Viet-Nam until a later date, in view of the Government's decision to formulate a new national development plan covering an eight-year period. However, pending the ultimate approval of the country programme, individual projects financed by UNDP are being developed and it is envisaged that five projects in the health field will start during 1974, with WHO as executing agency. At the January 1974 session of the Governing Council, the country programme for the Gilbert and Ellice Islands was approved. No health projects were included. The June 1974 meeting of the Governing Council took place in Manila, this being the first occasion on which the Council had met in a country in the Western Pacific Region. Several countries have reached the stage of preparation for their second country programmes. Those tentatively scheduled for consideration by the Governing Council in 1975 and 1976 are the British Solomon Islands Protectorate, Fiji, Laos, Singapore and Tbnga. In the case of Laos, WHO provided a country health brief and the WHO Representative and field staff participated in the preparatory discussions on the development of the new programme. During the year, annual reviews of on-going country programmes were held in the British Solomon Islands Protectorate, Fiji, the Khmer Republio, the Philippines, and the Republic of Korea, with WHO Repre- sentatives and field staff partiCipating in each instance. UNDP's new procedures for project monitoring, review and reporting, which had been under consideration for some time, were promulgated in September 1973. The system, involving the use of a new report format, calls for reports at intervals of six months and in this connexion arrangements have been made with the majority of Resident Representatives to synchronize the submission of reports at the end of June and end of December. Also, with the introduction of the new UNDP system, the opportunity was taken to realign the reporting schedule of projects funded under the regular budget so that reports for all projects, irrespective of funding, are made at the same time. An interesting feature of the new UNDP system is the scheduling of periodic tripartite reviews of individual projects. WHO staff members have already participated in a number of such reviews and have commented favourably on their usefulness. WHO is cooperating fully with UNDP in its efforts to improve programme delivery. This matter was brought to the attention of the twenty-fourth session of the Regional Committee, which adopted resolution WPR/RC24.R3 on "Coordination within the United Nations system: General , - . ' ". WPR/RC2513 page 69 matters" calling on all governments to cooperate with WHO in its effort to strengthen the planning and implementation of health programmes assisted by UNOP. Some difficulties are still being encountered by the Regional Office in the implementation of intercountry projects because of delays in the final approval and allocation of funds. Certain changes in channels of communications between UNOP and WHO have taken plaoe, requiring that all correspondence between WHO and UNOP on country programming and country projects be addressed by the UNOP Resident Representative to the relevant WHO Regional Office, through the WHO Representative, where appropriate. In the case of approved intercountry projects involving countries in one WHO region, the UNDP designates a resident representative to act as the oontact point with the relevant WHO Regional Office. Newly appointed Resident Representatives for Papua New Guinea, the Philippines, the Republic of Korea and the Republic of Viet-Nam visited the Regional Office during the year for briefing on WHO's programme. The UNOP Office in Tokyo closed on 30 June 1973 and the UNOP Office in Sydney on 31 December 1973. Suitable arrangements for the handling of WHO fellowships in Sydney have been made with the Government of Australia. United Nations Fund for Population Activities (UNFPA) WHO has maintained its close working relationship with UNFPA through contacts with the UNOP Resident/Regional Representatives and the UNFPA Coordinators in the formulation and implementation of UNFPA- funded country programmes. However, some difficulties have been enoountered because of the growing trend whereby UNFPA may provide direct assistance to governments by channelling approved funds through UNOP Resident/Regional Representatives at the request of the governments. The recruitment of staff for UNFPA-funded projects is also difficult due to uncertainties resulting from the delayed approval and allocation of UNFPA funds, which are often allocated on a yearly basis. However, as the formulation of long-term programming has been improved, the degree of UNFPA financial assistance in the Region is increasing. The amount of UNFPA funds approved for WHO-assisted projects in 1974 is $1 907 271, against $1 311 436 in 1973. Food and Agriculture Organization (FAO) During the year, collaboration with FAO continued through the exchange of routine reports at regional office level and through personal contaots in the field. While each Organization continues to develop national services with regard to nutrition, the main area of common interest has been encouragement to governments to create national WPR/RC25/3 page 70 food and nutrition policies. FAO, which has assumed a leading role in this area, convened a meeting on the subject in New Delhi, India, in February 1974, to which several countries in the Western Pacific Region sent participants. International Labour Organization (1LO) The Senior Occupational Safety and Health Officer of lLO's Regional Office for Asia in Bangkok visited the Regional Office in November 1973 to explore the possibility of developing regional activities, primarily in the field of occupational safety and health. 1LO provided a consultant to the national seminar on the organization of industrial health services for small industries which liHO sponsored in Malaysia from 18 to 26 March 1974. The seminar set out to explore and discuss means by which preventive services in ocoupational health could be made available to the small industries of Malaysia and to develop reoommendations for implementing a preventive programme that could be sumitted to national and international organizations. 1LO, as well as WHO, also participated in the United Nations rehabilitation mission which reviewed the rehabilitation of the physically handicapped project in Laos from January to February 1974. WHO was represented at the 110 Sixteenth Session of the Asian Advisory Committee held in Kuala Lumpur, Malaysia, from 2 to 10 May 1974. United Nations Children's Fund (UNICEF) As in the past, at both Regional Office and field levels, WHO and UNICEF cooperated closely in their respeotive programmes of assistance to countries in the field of health. WHO was represented at the Eleventh Regional Staff Meeting of UNICEF in Bangkok from 18 to 23 June 1973 and at the Experts' Preparatory Workshop on the Work Plan of the Asian Centre for Social Welfare and Development (jointly oonvened by ECAFEjUNICEF and the Philippine Government) in Manila, Philippines, 18-25 February 1974. Plans for a WHOjUNICEF joint study of alternative approaohes to meeting basic health needs are under way and the Regional Office will participate with WHO Headquarters in collecting data and supplying comments. United Nations Educational, Scientific, and Cultural Organization (UNESCO) Close interagency cooperation was maintained with UNESCO in several fields. . , WPR;RC25/3 page 71 Detailed information on education and training components of WHO-supported projects in Malaysia was supplied to UNESCO as part of a joint interagency study on programming in education and training for the Administrative Committee on Coordination (ACC) Sub-committee on Education and Training. WHO also cooperated with UNESCO in undertaking a survey of foreign medical students enrolled full-time in medical schools listed in the World Directory of Medical Schools. A health education specialist was recruited by WHO for the joint WHO/UNESCO family planning community research and training project, Institute of Mass Communication, University of the Philippines, Quezon City. The consultant's work is under the general supervision of the Project Manager, with the technical supervision of WHO as the associated agency. A consultant from UNESCO assisted in the WHO-sponsored seminar on family life education, South Pacific, held in Tonga from 24 to 31 October 1973. WHO was represented at the following meetings sponsored by UNESCO: (a) National Seminar - Workshop on Man and the Biosphere, Manila, Philippines, 1-3 August 1973. (b) Eighth Biennial Conference on Population Problems in the Second Development Decade, Manila, 6-8 September 1973. (c) UNESCO Regional Seminar on Training Abroad, Kuala Lumpur, 3-8 December 1973; (d) UNESCO Experts' Meeting, Davao City, Philippines, 23-27 April 1974. International Bank for Recoristruct·ion and Development. (IBRD or World Bank) In the course of a mission to the Philippines in July 1973, members of an IBRD team visited WPRO to be briefed on WHO's programme of assistance to the Philippines. A copy of the "Joint Memorandum on Bank/WHO Population Activities" intended to assist and guide staff of the two organizations in carrying out their respective functions in the area of human reproduction, family planning and population dynamics has been distributed widely to all WHO regional offices as well as to WHO representatives and country liaison officers. WPR/RC25/3 page 72 World Food Programme (WFP) WHO continued to assist the World Food Programme by, advising on components of its projects with possible health implications. Projects affecting the following countries were dealt with, namely, the British Solomon Islands Protectorate, Fiji, the Philippines, the Republic of Korea and Western Samoa. In November 1973, WHO also participated in the interim evaluation of the WFP project "Control of Schistosomiasis Through Agro-engineering Methods" in the Philippines. 8.2 Intergovernmental organizations 8.2.1 Asian Development Bank (ASDB) WHO was represented at the Seventh Annual Meeting of the Board of Governors of the Asian Development Bank held in Kuala Lumpur, Malaysia, from 25 to 27 April 1974. In the area of programme cooperation with the Bank, WHO continued to participate in the ASDB-executed Laguna de Bay Water Resources Development project through the provision of a water pollution adviser and consultants in special fields. 8.3 With other Organizations 8.3.1 South Pacific Commission (SPC) WHO, principally through the WHO Representative/Suva and field staff in the South Pacific area, maintained close contact with the SPC in connexion with the Commission's various health activities. The Organization was represented at the following meetings of the Commission: (a) Joint East-West Centre/SPC Training Course on Vital Statistics Methods, Suva, 9-27 July 1973. (b) Thirteenth South Pacific Conference, Agana, Guam, 11-21 September 1973. (c) SPC Meeting on Dengue Fever, Honolulu, Hawaii, 15-16 January 1974. (d) Fifth Conference of Directors of Territorial Health Services, Port Moresby, 11-15 February 1974. Preparations are under way for a joint WHO/SPC seminar on filariasis and vector control proposed to be held in Apia, Western Samoa, from 1 to 10 July 1974. , > '- WPR/RC25/3 page 73 8.3.2 Southeast Asian Medioa1 and Health Organization (SEAMHO) 8.3.2.1 Establishment of SEAMHO At the Second Meeting of the Intergovernmental Group on the Establishment of SEAMHO. Tokyo. 2-7 July 1973. at which WHO was represented. a final draft oonstitution for the establishment of SEAMHO was agreed upon and, following the meeting, the document was circulated to the countries involved. The draft was then considered at the Eighth Ministerial Conference for Economic Development of Southeast Asia held in Tokyo from 11 to 13 October 1973. at which time it was anticipated that the Ministerial Conference would agree upon the text and that the member countries present would sign the document. thus enabling SEAMHO to be established. However, the signing of the Constitution was deferred after some oountries at the Conference voiced concern that SEAMHO might be duplicating the work of WHO. No further advice has been received so far regarding the signing of the document. A meeting of Ministers of Health of SEAMHO member countries has also been envisaged, after acceptance of the SEAMHO Constitution, to look into the question of programme details of the new organization. However, in view of the present uncertainty. no definite plans for this Ministers' meeting have yet been formulated. 8.3.2.2 Second Southeast Asian Conference on Medical and Health Information Activities. Tokyo, 20-22 November 1973 WHO was represented at the Conference, which was sponsored by the International Medical Foundation of Japan. Tne meeting aimed at providing an exchange of information on health information systems in the prospective SEAMHO member countries. In February 1974. following on the Conference, a team of Japanese officials representing the International Medical Foundation of Japan visi ted WPRO during a tour to potential SEAr'iliO member countries, for the purpose of surveying medical information systems in the countries. The survey is a preparatory step before the establishment of the South- east Asia Medical Information Centre, eventually to be sponsored by SEAMHO. 8.3.3 Other joint work The Organization was represented at the following meetings: (a) International Health Conference "Health in Cities" (organized by the International Epidemiological Association in Sydney). Sydney, Australia, 15-17 August 1973. WPR/RC25/3 page 74 (b) Annual Conference of Australasian Association for Medical Education, Canberra, Australia, 16-18 August 1973. (c) Twenty-second General Assembly of the International Federation of Medical Students' Associations (IFMSA) , Singapore, 19-31 August 1973. (d) National Seminar on World Population, Canberra, ~ustralia, 23-25 August 1973. (e) Expert Group Meeting on Standards and Legislation for Social Welfare Services, Seoul, Korea, 29 August - 1 September 1973. (f) Asian and Western Pacific Regional Conference on Social Welfare, Seoul, Korea, 3-7 September 1973. (g) 22nd International Tuberculosis Conference of the International Union Against TuberculOSiS, Tokyo, Japan, 24-28 September 1973. (h) Regional Seminar on Institution-Industry Cooperation in Engineering Education and Training, Manila, Philippines, 15-18 October 1973. (i) SEAMEO-TROPMED Technical Meeting on Food and Nutrition Monitoring in the Mekong Development Areas, Bangkok, 14-16 November 1973. (j) Second Review of the United Nations Development Advisory Team (UNDAT), Suva, Fiji, 23-24 November 1973. (k) Seminar on Population and National Development with Emphasis on a Developing Country, Saigon, Republic of Viet-Nam, 18-20 February 1974. (1) Asian Congress of Paediatrics, 30 April - 4 May 1974. (m) Sixth South-West Pacific Malaria Conference, Honiara, British Solomon Islands Protectorate, 6-11 May 1974. 9 CONSTITUTIONAL, LEGAL, FINANCIAL AND ADMINISTRATIVE DEVELOPMENI'S 9.1 The Regional Committee The twenty-fourth session of the Regional Committee for the Western Pacific was held in Wellington from 28 August to 4 September 1973. The . ' - ' . ' Officers of the Regional Committee's 24th Session held in Wellington are from left: Dr Phouy Phoutthasak (rapporteur); Dr D. Singh (vice-chair-- man); Dr C.N.D. Taylor (chairman) and Dr Francisco J. Dy, WHO Regional Director. The Rt. Honourable Norman Kirk, Prime Minister of New Zealand spoke a t the formal opening ceremony. Others in photo are: Hon. R. J. Tizard, Minister of Health, New Zealand; Dr H. T. Mahler, WHO Director-General; Dr H. J. H. Hiddlestone, Director-General of Health. New Zealand; D r Francisco J. Dy, WHO Regional Director, and Mr Franklin Cruz, chairman, 23rd Session of the Regional Committee. WPR;RC2513 page 75 meeting was attended by the representatives of 17 Member States, including those responsible for territories in the Region, and of Papua New Guinea, an Associate Member. Representatives of the United Nations, UNDP, UNICEF, the South Pacific Commission and 15 nongovernmental organizations in official relations with WHO were also present. The Director-General attended the session. An afternoon was set aside for the celebration of the twenty-fifth anniversary of the World Health Organization. Statements were made by representatives of 14 Member States and the Associate Member, and by the Director-General. The Annual Report of the Regional Director for the period 1 July 1972 to 30 June 1973 was reviewed. The Committee examined the proposed regional programme and budget estimates for 1975 and requested the Regional Director to transmit them to the Director-General. The Committee expressed the hope that governments would cooperate with WHO in its effort to strengthen the planning and implementation of health programmes assisted by UNDP. It reviewed reports on the action taken in connexion with previous resolutions of the Committee on the quality of drinking-water and food on international flights, and adopted resolutions urging the Director- General to bring to the attention of Member States the need to maintain and enforce WHO standards for potable water on airlines, and requesting him to bring the matter of the control of the food served on international flights to the attention of the Executive Board so that urgent attention could be given to bringing up to date the WHO Guide to Hygiene and Sanitation in Aviation (1960) and to establiShing international standards in this connexion for application both on the ground and in the air. The Committee requested the Regional Director to obtain from Member states information on the nature and extent of drug dependence, and the availability of treatment and rehabilitation centres in their respective countries. The Committee expressed its satisfaction at the establishment of the regional teacher-training centre in the University of New South Wales, Australia, and expressed the hope that the fullest possible use would be made of the Centre by the countries of the Region. The Committee confirmed that its twenty-fifth session would be held in Kuala Lumpur and decided that the twenty-sixth session would take place at the Regional Office in Manila. It was decided that annual sessions of the Regional Committee could be held in another country at the invitation of a Member State, but that this should not happen in two consecutive years and that all other sessions would be held at the regional headquarters. WPR/RC25i3 page 76 The theme of the Technical Discussions was "'!he role of the hospital in the comnnmity and the financing of hospital-based medical care". '!he topic "Control of veotor mosquitoes of dengue haemorrhagic fever" was selected for the Technical Discussions in 1974. 9.2 Regional Office 9.2.1 Organizational structure There have been some modifications in the organizational structure of the Regional Office during the period under review: (a) responsibilities have been reassigned among the three regional advisers in oommunicable diseases, resulting in the suppression of one post (formerly responsible for tuberculosis and leprosy, cardiovascular diseases, oanoer and other chronio and metabolic diseases) and the creation of a new post of regional adviser on chronic diseases; (b) the Translation Unit has been transferred from the Director of Health Services to the Chief, Administration and Finanoe. '!he above ohanges are refleoted in the revised "Structure of the WHO Regional Office for the Western Pacific as at 30 June 1974" appearing as Annex 2 of this report. 9.2.1.1 Regional offioe staff New posts of conferenoe seoretary/administrative assistant (health manpower development), administrative assistant, budget clerk, clerk (personnel) and clerk-stenographer were established, the last four being provided under UNFPA funds. Recruitment was completed for the posts of regional adviser on communicable diseases, administrative officer (Bureau of Health Services), regional adviser on health laboratory services, director of health services and personnel officer. '!he posts of assistant budget and finance officer, regional adviser on oommunicable diseases and editor will be filled later in 1974. 'Ihere are four vacant posts: regional adviser on health manpower development, regional adviser on maternal and child health, regional adviser on health education and regional adviser on strengthening of health services. 9.2.1.2 WHO Representatives The post of WHO representative, Philippines, established in January 1973, has not yet been filled. The post in Saigon was filled by the reassignment of a regional offioe staff member when the former incumbent was reassigned outside the Region. The post in Phnom Penh was filled by the reassignment of a project staff member. 9.2.1.3 Project staff WPR/RC25/3 page 77 During the period under review, 23 project posts were filled either by recruitment or reassignment. A total of 148 selection committees were held between 1 July 1973 and 30 April 1974. One hundred and two short-term consultants were recruited. '!he total period of their assignment was 249 man-months. 9.2.2 Salaries and allowances 9.2.2.1 Staff in the general service category A survey of local salary and employment conditions in Manila was made in February and March 1974 and a new salary soale has been reoommended; the Direotor-General agreed that the effective date for the new scale, when established, would be 1 Maroh 1974. 9.2.3 Regional Office building 9.2.3.1 '!he Conferenoe Hall '!he Conference Hall was used for 15 oonferences and seminars. These were either sponsored by WHO or were of an international oharaoter which met the established oriteria for the use of WHO conferenoe faoilities. 9.2.3.2 Repairs and maintenance An additional guard house was ·construoted. In addition, rooms for storage of garden equipment and oanteen supplies and for wastepaper were oonstruoted. The lawns were planted with Korean carpet grass. The wet stand-pipe fire proteotion system was installed. The fire alarm system was also extended. A fire-resistant door dividing the lounge and the main Conferenoe Hall was also installed. A diesel- operated water pump for fire proteotion was procured and connected to the wet standpipe system. General renovations and maintenance were carried out. 9.2.4 Regional Obligations and expenditures Pages 79 and 80 of this report contain a statement and a graphic presentation of the obligations incurred for the Region for the period 1950-1973. A comparison of implementation in relation to funds available from the regular budget of the Organization for the fiscal years 1971, 1972 and 1973 shows 97.7% implementation in 1971, 87.42% in 1972 and 89.52% in 1973. The low rate of implementation in 1972 and 1973 resulted from direotives from the Direotor-General not to obligate certain funds as follows: WPRjRC25/3 page 78 Undelivered programme in the province of Taiwan (China) "Activities not related to any specific Subject Heading" "Activities not related to any specific Subject Heading" $622 353 Taking into consideration the above-mentioned amounts which could not be delivered, the implementation rates in 1972 and 1973 are 96.7~ and 97.37% respectively. :iEAR 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 WPR/RC25/3 page 79 OBLIGA'l'!ONS ~CURRED BY THE WORLD HEALTH ORGANIZA'l'!ON WES~RN PACIFIC REGIONbi 1950-1973 (Expressed in millions of US Dollars) OBLIGA'l'!ONS Regu1:g; ~.n .... , 2 UNDP UNFPA Total 0.32 - 0.32 0.39 0.10 0.49 0.46 0.48 0.94 0.60 0.47 1.07 0.62 0.53 1.15 0.74 0.58 1.32 0.75 0.54 1.29 1.05 0.57 1.62 1.54 0.69 2.23 1.94 0.62 2.56 2.15 0.60 2.75 2.19 0.54 2.73 2.44 0.84 ,.28 2.59 0.74 ,." 2.84 0.90 3.74 3.14 0.81 t 3.95 3.58 1.06 Y 4.64 4.05 0.75 ~ 4.80 4.39 1.13 §I 5.52 4.90 0.79 t 5.69 5." 0.82 !V 0.01 6.16 6.06 0.84 0.30 7.20 6.68 0.71 0.58 7.97 7.52 0.96 1.07 9.55 bI Figures extraoted from OUigial Bogordl Nos. ~, 41, 47, 54, 62, 70, 78, 85, 93, 101, 109, 117, 126, l~, 142, 150, 159, 167, 175, 183, 191, 200, 208 and 214 F1nano1al Reports and Reports of the External Aud1tor to the World Health Assembly. gj Inoludes Voluntary Fund for Health Promot1on, Funds-1n-Trust and Re1mbursable Funds. ~ Inoludes the UNDP/SF oomponent obllgat1on of $1728. Y Inoludes the UNDP/SF oomponent ob11gat1on ot $56 417. ~ Inoludes the UNDP/SF oomponent ob11gat1on of $287 073. §I Ino1udes the UNDP/SF oomponent obllgat1on of $429 632. V Inoludes the UNDP/SF oomponent obl1gat1on of $319 764. !V Inoludes the UNDP/SF oomponent obligat1on of $196 811. Millions of US$ 10,00 9,00 8.00 GRAPH OF OBLIGATIONS INCURRED BY THE WORLD HEALTH ORGANIZATION 1/ _ Total obligation Regular budget g! WESTERN PACIFIC REGION 1950 - 19'73 (Expressed in Millions of US Dollars) 7.00 -I UNDP~/ 6.00 5.00 4.00 3.00 2,00 1.00 - UNFPA ..... ......... ,. ..... -------------------------- --------------------- ,,-,' ',,--------- 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 19'72 19'73 !JFigures extracted from OFFICIAL RECORDS Nos, 34,41,47, 54, 62, 70, 78, 85, 93, 101, 109, 117, 126, 134, 142, 150, 159, 167, 175, 183, 191, 200, 208, and 214, (Financial Reports of External Auditor to the World Health Assembly). yIncludes Voluntary Fund for Health Promotion, Funds-in-Trust and Reimbursable Funds. YIncludes the UNDP/SF component obligations of $1, 728 in 1966, $56,417 in 1967, $287,073 in 1968, $429,632 in 1969, $319,764 in 1970 and $196,811 in 1971. '0 :lE; ~::ll (J)~ g'~ \.11 ~ 10 PUBLIC INFORMATION WPR/RC25/3 page 81 WHO group educational meetings are becoming increasingly important from the public information viewpoint. The-y continue to attract national and international news media ooverage, resulting in their being regularly reported in the Region's press, radio and television networks. The conclusions and reoommendations of these meetings are broadcast immediately by the mass media services. During the first three-quarters of the period under review, the Public Information Unit collected a total of 4484 column inches of newspaper outtings on WHO news items from several oountries in the Region. As regular news clipping is done as a routine in only two countries, there was an appreciable amount of newspaper reporting on WHO that was not included. On an average, more than 40% of the news items publi shed were reproductions of WHO news releases. During the period, 28 news releases were issued in connexion with 14 WHO educational meetings. A total of 56 news releases, 4 press notes and 19 features were issued, including special photographic features on malaria in Papua New Guinea. An article on health practices in New Zealand was written for World Health. - World Health Day Amidst the troubled conditions in Phnom Penh, the Khmer Republic celebrated World Health Day. Streamers on the theme, "Better Food for a Healthier World" were displayed in the streets. Four messages were broadcast three times during the day: those of the Minister of Health, the President of the Khmer Red Cross, the Regional Director, and the French version of the Regional Director's message read by the WHO Representative. In Malaysia, exhibitions and various displays were organized at every state and district level. In Kuala Lumpur, an exhibition at the National Museum placed special emphasis on the WHO-assisted applied nutrition project. Other activities organized by the Ministry of Health included radio and television broadcasts, newspaper advertise- ments, the publication of posters and pamphlets and the cancellation of stamps by the postal department. The first screening of the World Health Day film, "Better Food for a Healthier World" was held on 7 April in Kuala Lumpur. World Health Day articles were translated into Korean and printed in booklet form, which was distributed allover the Republic of Korea. On 7 April, a celebration was sponsored ,jointly in Seoul by the Ministry of Health and Social Welfare and the City of Seoul. The main speakers were the Minister of Health, the Mayor of the City and the WHO Representative. WPR!RC2513 page 82 An exhibition using WHO photographs was set up in the hall of the Institute of Health for the whole month of April as part of the observance of World Health Day in Singapore. In New Hebrides, a radio interview with a WHO staff member followed the broadcast of messages from the Director-General and the Regional Director. Magazine and newspaper articles on nutrition and an editorial on World Health Day were published in Manila newspapers during the month of April. Regional Committee Exhaustive preparations, in Wellington and in Manila, contributed greatly to the successful press, radio and television coverage of the twenty-fourth session of the Regional Committee in Wellington. A publicity build-up started in New Zealand several months before the meeting. Among the important information activities were radio interviews of New Zealand officials who had served as WHO conSUltants. The Director-General and the Regional Director gave a press conference on their arrival in Wellington and on the eve of the meeting, the WHO twenty-fifth anniversary film was televised on all channels throughout New Zealand. Twenty-fifth anniversary booklet A 44-page illustrated booklet on 25 years of international health work in the Western Paoific Region was published. It was distributed during the Regional Committee's celebration of WHO's twenty-fifth anniversary and later to all Member governments, health ministries, news media services and other public information outlets in the Region. The initial printing was 5000 copies of the English text and 1000 of the Frenoh. PhotOgraphs and exhibits An album of photographs of WHO-assisted projects in Laos was presented to the Prime Minister of Laos. The New Zealand Department of Health and WHO collabor~ted in a photographic display for the Regional Committee. In addition to an exhibit at the site of the meeting, a display was set up in the commercial area of Wellington. After the meeting, the WHO exhibit was displayed in the prinCipal cities of New Zealand. .. . , Visitors WPR/RC25/3 page 83/84 From 1 July 1973 to the end of April 1974, 1137 students and various professional visitors oame to the Regional Offioe to enquire about WHO, listen to talks on the Organization and ask for material. A total of 152 written requests for material were reoeived and answered during the same period. 11 WHO PUBLICATIONS In an attempt to disseminate information on WHO publications as widely as possible, and so far as praoticable, through sales, a special scheme for the distribution and sale of WHO publications to health workers and institutions was established in the Regional Office some years ago. This enables interested persons to pay for WHO publications in their local currency. Reduotions in prioe, which vary in accordance with the oountry ooncerned, are also given if publications are ordered in bulk. Subscriptions covering all WHO publioations are also available at ooncessional rates. All persons who have shown interest in a particular field are regularly advised about any forthcoming publications in that field. Despite this publicity, WHO publications are not being read as widely as the Organization would like. An increasing number of WHO publications are being translated and distributed in other languages. As far as the Western Pacific Region is concerned, 34 Technical Report Series, 9 Public Health Papers, 6 Monograph Series and 5 Out-of-Series are now available in Japanese. In addition, the International Classification of Diseases, 8th reviSion, Volume I, has been translated into Korean; 2 Monograph Series and 2 Technical Report Series are available in Vietnamese and 1 Out-of-Series is available in Portuguese. Another 13 WHO ~Jblications are in the process of translation into Japanese. It is hoped that other governments will be interested in following the example of Japan, thus mnkin3 available to their own health workers translated texts of WHO publications. A complete list of what is now available in other languages as far as the Western Pacific Region is concerned is given in Annex 3. PART II. SUMMARIES OF SELECTED PROJECTS . " WPR,lRC25/3 page 86 SUMMARIES OF SELECTED PROJECTS A complete list of projects current during the year will be found in Part III. The following selected projects are described in fuller detail. Planning for Sewerage Development and Water Pollution Control in Singapore Nutrition Advisory Services, Singapore National Institute of Public Health, Republic of Viet-Nam First Regional Course on Bacterial Infections of the Gastrointestinal Tract, Manila and Saigon (18-26 February and 11-19 March 1974) First Meeting of the Teohnical Advisory Committee on Dengue Haemorrhagic Fever, Manila (5-7 March 1974) 1. Title and project number Source of funds Partioipating agenoies ProJeot implementation dates 2. Projeot baokground WPR/RC25/3 page 87 Planning for Sewerage Development and Water Pollution Control in Singapore (Singapore 3302) UNDP Government, WHO, UNDP August 1970 - July 1973 The oity of Singapore started constructing its main sewerage system in 1912 when it had a population of about 325 000. By 1969, the improved and expanded main public sewerage system was serving an estimated one million persons and covered about 31 square miles (13% of the oountry's land area). An additional 150 000 persons were then being served by secondary sewerage systems. The balanoe of the population was served by septic tank systems and a conservancy system. Starting in 1968, the Government scheduled a large sewerage develop- ment programme with an initial budget of S$70.4 million for the first five-year period. Beoause of cost inflation and an accelerated rate of implementation, the annual construction rate has substantially exceeded the original budget. By 1972, the annual oost of sewerage facility constructions was about S$29 000 000. In suoh a small oountry (235 square miles), with the seoond highest population density (9000 per square mile) in the world, effective land use planning and management is of oritical importance. With the assistanoe of UNDP, the Government thus oompleted the preparation of a master plan for physical development for the whole of Singapore oalled the Singapore Conoept Plan. The Government decided that a master plan for the development of sewerage faoilities keyed to the Concept Plan was needed to guide the integrated development of sewerage faoilities. There was also inoreasing industrial activity with resultant increased outputs of wastewaters and consequently, pollution of rivers and coastal waters. As these problems were obviously related to the availability of sewerage and wastes treatment facilities, these aspects were to be examined as a part of the study project. Accordingly, the Government requested UNDP and WHO to assist in the execution of a study project to elaborate a master plan for sewerage development. The sewerage master plan to be prepared by the project would encompass the large northern portion of Singapore. This area measures about 42 000 acres or about 33% of the Republic's land area. No public sewerage system existed in 1969 in the area covered by the master plan. WPR/RC25/3 page 88 3 . Objectives 3.1 As stated in the plan of operation (a) To assist the Government to prepare a long-range master plan for the development of sewerage faoilities whioh is ooordinated with present and proJeoted plans for physioal development in Singapore. (b) To assist the Government to prepare plans for the expansion of sewerage systems for whioh funds have been budgeted under the 1968-1972 sewerage development programme. (c) To oonduot studies on river and ooastal water pollution with a view to developing a programme and plans for the abatement and oontrol of water pollution. 4. Action taken A WHO sanitary engineer, who served as the team leader for the study project, was assigned from August 1970 to July 1973. National counterpart resources provided by the Government consisted of two engineers, three draftsmen, several surveyors as needed, and secretarial and office facilities. It also prepared a complete set of topographic maps for the project area. Two WHO short-term conSUltants were also provided: (a) a consultant on coastal water quality, who advised on the appropriate framework for formulating coastal water quality standards and related problems of water quality management in general; and (b) a consultant on water pollution control, who made a general evaluation of the status of wastewater treatment and advised on guidelines and wastewater control measures which may be considered in planning future facilities, particularly in respect to industrial wastes. Reference books and engineering equipment amounting to S~;lOOO were also provided. 5. Problems encountered The only major problem encountered in the execution of the study project was the shortage of national engineers. This factor made it impossible for the Government to assign a sufficient number of engineers to the project and resulted in the need to extend its operation by one additional year. . . 6. Commitments of the participating agencies The following assistance was provided by WHO: (a) a sanitary engineer (b) two consultants (c) supplies and equipment 3 years 3 man-months US$lOOO WPR/RC2513 page 89 The following resources were provided by the Government: (a) (b) (c) (d) (e) (f) (g) (h) engineers 2 draftsmen 3 surveyors as required secretarial assistance - as required transport for field surveys office accommodation all local oosts connected with the projeat one complete set of topographic maps (100 sheets) all other mapping work. 7. Evaluation and The project was carried out as planned although the duration of the undertaking had to be extended by one year because of the Government's inability to assign a sufficient number of engineers. All the activities scheduled for implementation were carried out successfully and the master plan completed. The master plan includes a preliminary design of all the proposed main trunk sewers required to serve the study area: (1) the Lim Chu Kang area lying to the west of the KranJi reservoir; this area will ultimately contain ltJout 20 000 people; (2) the Kranji-Woodlands system which will serve the Woodlands New Town area and its environs and is expected ultimately to handle domestic and industrial wastes for a total of 750 000 people; (3) the Seletar region system, with a design capacity to handle domestic and industrial wastes generated in the region (ultimately expected to be equivalent to wastes for 850 000 people). Reports dealing with aspects of coastal water quality standards and wastewater pollution management were prepared by two WHO consultants. These reports examined, inter alia, the effects of wastewater discharges into surface and coastal waters and the wastewater control measures to be considered in planning and operating wastewater facilities. WPR/RC25/3 page 90 The design period for the master plan is 50 years and was based on the year 2020 population forecast adopted by the Singapore Concept Plan. The master plan was presented in bound volumes comprising 150 sheets of plans with a scale of 1:2500 each, representing 500 acres, and 150 profiles, eaoh showing approximately 4000 feet of main sewer. The plan is divided into stages for phased implementation and the costs of each stage have been estimated. The total construction cost for implementing the whole master plan was estimated to be US$200 million at 1973 price levels. The Government has commenced the construction of the Stage 1 segment of the Woodlands area, inoluding an interim waste treatment plant with a oapacity to serve 25 000 persons. The oonstruction cost was estimated to be about 3$12 million. Preparation has also been started on the implementation of portions of the Seletar scheme. 1. Title and project number Source of funds Participating agencies Project implementation dates WPRjRC2513 page 91 Nutrition Advisory Services (Singapore 5601) Regular Government, WHO, FAO, UNICEF 1968-1973 2. Project background Previous stUdies in Singapore had shown that there was growth retardation, especially among young children of low-income groups. Nutritional anaemias and some vitamin deficiencies had also been reported. It was therefore decided to institute measures to improve the nutrition status of the population. Singapore is a city state of approximately 586 square kilometres. It is densely populated, with 3550 persons per square kilometre. Seventy- six per cent. of the inhabitants are of Chinese origin, 15% Malay and 7% Indian. The Republic is multilingual and the school system provides four language streams: English, Mandarin, Malay and Tamil. 3. Objectives The aims of the project were: (a) to carry out studies on the etiology and epidemiology of nutritional disorders and their effects on health; (b) to work out procedures for the assessment of individual dietary intakes of the more vulnerable groups (particularly infants, toddlers, pregnant and lactating women); (c) to define and initiate measures, through health, educational, agricultural and other channels, to improve the general food and nutritional situation in the community; (d) to develop the necessary training programme to accomplish these objectives. 4. Action taken The methods agreed upon were: (a) organization of nutrition surveys; (b) studies on individual dietary intakes; (c) nutrition training of health, education and other community workers; (d) nutrition education and demonstration, particularly through health and education agency channels. WPR/RC25/3 page 92 4.1 Staff -- WHO provided the services of a medical nutritionist as a short-term consultant in 1968 and, thereafter, until the end of the project, a public health nutritionist. Initially, there was only one national counterpart who had training in nutrition. However, a nutrition unit was established within the Ministry of Health in May 1971 and the staff gradually built up until it consisted of 2 doctors, 2 public health nutritionists, a health education officer (at present undergoing training), 4 staff nurses, an executive officer, a clerical assistant, and supportive staff. 4.2 Surveys The first survey was conducted in 1968, based on 31 maternal and child health centres. This showed that l~ of the Chinese, 4~ of the Malay and 32~ of the Indian children aged from 12 to 47 months were graded as undernourished by anthropometric criteria. This was followed in 1970-1971 by a cross-sectional study in which the social and dietary backgrounds of a geographical sample of well-grown and poorly-grown children were investigated. This provided initial data on which staff training and remedial action could be based. To expand this further, a special study was made of all malnourished cases admitted to the Outram Road General Hospital during one oalendar year and this was contrasted with a control group which was not malnourished. In 19J3, a survey of sohoolohildren was conducted in order to determine their eating patterns and from this, deduce the need for a school-meals soheme. This also served as a baseline evaluation for WFP project No. 725. Preparations were also undertaken for a survey among industrial workers. 4.3 Servioes The Nutrition Unit served the multiple functions of gathering the basio data, training staff engaged in general health services, particularly maternal and ohild health, and directly providing for the care and follow-up of referred malnourished cases. Praotioal nutrition demonstrations were introduoed in all maternal and ohild health oentres. All nursing offioers and staff nurses from sohool health clinics and maternal and child health centres were trained at 12 one-week oourses at the Nutrition Unit. Evaluation of these activities in the MCH oentres was oarried out by Nutrition Unit staff in order to improve their methods and effectiveness. Growth charts were introduced on a pilot soale. Two oourses (4 weeks and 6 weeks) on nutrition and dietary investigation were given to maternal and ohild health and school health staff, teaohers, and field investigators. In addition, the subject was introduoed into the training of publio health nurses, paediatric nurses, midwives, family planning workers, medico-sooial workers, health inspectors, teaoher trainees, and medical stUdents. WPR/RC25/3 page 93 The direct services provided to the population by the Nutrition Unit now consist of follow-up of all severe cases of malnutrition referred by the maternal and child health service, with special advice and care until they have improved sufficiently to return to the regular maternal and child health centre. Hospitalized cases discharged to the Children's Convalescent Home are also followed-up in the same way. 4.4 Supportive servioes Assistance was received from UNICEF in the form of transport, equipment, books, teaching aids, and milk powder. Acceptability tests of wheat soya blend were conducted for the World Food Programme (WFP) and school staff were trained in its use in order to assist in the initiation of a WFP proJect, "Institutional Feeding of Preschool and Schoolchildren". 5. Evaluation Baseline data were successfully collected on both the prevalence of malnutrition and its epidemiology. The continued collection of data by national staff is assured, as they have been given the requisite training and practical experience. Dietary intakes and socioeconomic information were collected in order to allow proper training of the staff mainly concerned with the vulnerable groups, namely the maternal and child health service. A nutrition unit staffed entirely by experienced nationals now exists in Singapore. It has the capability of carrying out both the staff and line functions necessary for the continued improvement of the project. Plans already exist for its further expansion. The requisite in-service training was given during the period of the project to all relevant staff. The main emphasis now is on the inclusion of nutrition teaching in basic training and this was initiated for several categories of workers. Further efforts will, however, need to be made. In the School of Nursing, the teaching depends on hard-pressed hospital dietitians and naturally centres on therapeutic diets rather than on home-based problems. In the medioal faculty, a full-time lecturer in nutrition is badly needed. WHO has already assisted the University of Singapore in improving nutrition training. In the School of Home Economics, the curriculum has been slightly improved but urgently needs adapting to the local situation. WPR./RC25!3 page 94 1. Title and proJeot number Source of funds Partioipating agenoies Project implementation dates National Institute of Public Health Viet-Nam 6401 (VNR/HMD/02) Regular Voluntary Fund for Health Promotion WHO, UNICEF Canadian International Development Agency (eIDA) 1969 - present 2. Projeot baokground A major problem £aoln~ the development of health servioes in the Republio of Viet-Nam has been the acute shortage of adequately trained health personnel. This pressing situation led to the proposal to set up the National Institute of Public Health (NIPH), designed to serve as the centre for the planning, standardization, organization, coordination, implementation and evaluation of health training programmes. In view of the complex nature and magnitude of the proposed projeot and the existing economio and manpower situation in the country, international assistanoe through WHO was sought. The interest shown by potential donors of funds in administration by WHO acted as a great stimulus to the project's development. 3. Objectives The main purpose of the Government, with the assistance of WHO, is to establish a national institute of public health, with the following objeotives: (a) to provide a high standard of training of health personnel geared to the needs of the country as a means of advanoing the practice of public health and particularly the development of health services in the Republic of Viet-Namj (b) to undertake studies on public health and to disseminate the knowledge thus gained; (c) to undertake, upon request of the Ministry of Health, and within the limit of its resources, operational activities and to provide servioes, not otherwise available, health programmes and for demonstration purposes; (d) to coordinate various health training programmes of the Ministry of Health. .. WPR/RC2,)/3 page 95 This set of specific objectives is at present under review with ~he aim of providing a clearer delineation of the various functions and responsibilities of the Institute. 4. Project action taken 4.1 Assessment of needs, resources and constraints Studies undertaken by the Government with the assistance of a WHO consultant in 1966-1967 revealed that of all the categories of health personnel employed in the Government health services. the greatest deficiency was in health technicians and assistant health technicians, as unfortunately there had been no institutions offering training for these categories for several years. Another particularly urgent need identified was the lack of teaching staff for the two national midwifery schools and for midwifery supervisors. The studies also demonstrated an urgent need for refresher and orientation training for health personnel already in service. The national resources available in terms of manpower and funds to develop a training institute were inadequate at the time of the inception of the project and it was considered that WHO assistance over a period of 10 years would be required. While the major constraints were shortage of national manpower and economic resources, other difficulties experienced in implementing the programme were the difficult security situation in the country and the worldwide inflation, which has been particularly marked in Viet-Nam. 4.2 Organization of the Institute By virtue of the Prime Minister's decree (see 4.7 (a)), the Director of the h~PH has the rank of Director-General and the Deputy Director that of Deputy Director-General. By the Health Minister's decree (see 4.7 (b)). the NIPH has three main technical departments, one each for public health, laboratories and public health training. The departments are divided into a number of bureaux • Two committees were established to assist the Director. (a) coordinating Committee Under the chairmanship of the Minister of Health, this committee lays down the policy guidelines and working principles of the NIPH. coordinates various forms of assistance extended to the Institute, and periodically evaluates its activities. WPR/RC25!3 page 96 (b) Technical Committee Jointly chaired by the Director of the NIPH and the WHO Senior Adviser to the NIPH, this committee formulates the de.talled plan of work of the Institute and deals with various technical matters that arise. 4.3 Premise s 4.3.1 The Ministry of Health provided the NIPH with temporary accommodation in 1969. The Institute moved from there to another temporary site at the Faculty of Medicine, University of Saigon, in July 1971. These premises were repaired and refurnished at the expense of WHO. In 1969, land was allocated for the construction of a permanent building, but in 1971 the site became unavailable. Finally another site of 46 000 sq.m was allotted in October 1971, although part of this area was occupied by buildings of a municipal abattoir and by a number of squatters. The entire complex of premises for the NIPH will comprise a teaching and laboratory block, an administrative block, library, dormitories, a separate teaching block with auditorium, an animal house and a cafeteria. Work on the arohitectural master plan was started in mid-1969, detailed planning was finalized and approved in 1972, and construction work began in January 1973. The entire construction operations have been divided into three phases, and phase I - despite several unforeseeable delays - is nearing completion in 1974. An extension of phase I to cover part of the original phase II, particularly the urgently required dormitories, is under negotiation. Considerable financial contributions have been made towards the project by the United States of America, the Netherlands and New Zealand (see 6.1). All these funds have been administered by WHO. 4.3.2 Buildings at one of the selected field training and demonstration centres (see 4.6.1) have been donated by Canada. Construction at three sites in AnGiang province started in August 1972 and was completed in September 1973. 4.4 National staff The first appointment was that of an acting Direotor in July 1969. Since then the number of professional staff has grown to the present strength: Phys 10 1ans ................. 9 Pharmaoists .....•..•.••.... 12 Health technicians ••..•.•.. 10 Nurse teohnicians •••••••••• 5 Nurse (B.Sc. in Nursing) ••• 1 ~- I ~ ... ; --- WPR;"'nC25/3 page lO3 Direct contributions were made by Canada (CIDA) in 1972 for the construction of physical facilities at the field training and demonstration centres in An-Giang province (US$410 000) and for operational costs of a Canadian team for five years (US$990 000) (see 4.3.2 and 4.5.2). 6.2 Assistance - national The national budget for the NIPH is shown in the table below: Operating Salaries and supplies and Construction Year allowances sundry[service + equipment Total VN$ VN$ VN$ vN$ * 3 000 000 2 000 000 5 000 000 1970 1971 1972 1973 8 000 000 5 000 000 2 000 000 15 000 000 15 188 000 11 000 000 6 000 000 32 188 000 20 600 000 14 000 000 8 000 000 42 600 000 7. Evaluation 7.1 The main purpose of the project (see 3) The main purpose of the project - the establishment of a National Institute of Public Health by the Government of Viet-Nam with assistance of WHO - has been accomplished. The Institute is operational in temporary quarters and discharges its principal function, the training of national health personnel, as effkient1y as possible under the present difficult circumstances. -r.2 The specific objectives of the NIPH (see 3) (a) The standard of training provided by the Institute can, with good reason, be considered to be much higher than in any programme of the same kind offered before its establishment. The programmes have been geared to the needs of the country, not only in theoretical instruction but particularly by the extensive provision of practical field experience to the trainees. (b) Studies in public health have been initiated but have not yet reached the stage where new knowledge obtained has been disseminated and used for practical application in the organization and delivery of the health services of the country. * Exchange rates were: 1 US$ - 118 VN$ in 1970, 275 in 1971, 425 in 1972 and 500 in 1973. WPR/RC25i3 page 104 (c) A variety of operational activities have been undertaken and services have been provided with good effect to communities. other national agencies and other units within the Ministry of Health. (d) Although the coordination of the various health training programmes has not yet come into full effect. promising starts have been made. e.g. by the Institute's contributions to a revision of the midwife technician ourrioulum and by the provision of training for midwifery instruotors. 7.3 Targets As already indioated. initial delays in the project's implementation ooourred to a large extent due to the faot that the general situation in the country did not improve as quiokly as expeoted. Aotually. most of the targets have now been met with the exception of the completion of construction of phase I of the buildings. which is. however, imminent. Full staffing of the Institute is not yet completed, but existing gaps have been filled by employment of part-time teaohers. 7.4 Needs of the health servioes (see 4.1) (a) Publio health technicians In 1966, the Government employed 290 public health technioians (including those specialized in sanitation or health education). According to the then existing staffing pattern for peripheral health services, 200 posts were unfilled. This need must have increased since 1966 because attrition will have taken place and the demands of the health services have risen, whereas no public health technicians were produced until 1973 when the first class trained at the NIPH graduated. The NIPH's contribution to filling this serious gap has only just started but will be more noticeable from year to year as new classes graduate. (b) Public health assistant technicians In 1966, the figures for this category were: in employment 500, posts not filled 500. Since 1971, when the first batch graduated, the NIPH has produced 249 public health assistant technicians. As compared with (a) above, this achievement is much more impressive. The higher number of trainees in this case is due to the fact that the duration of the course is one year only and that two courses are started every year. • I r , I ~ I (c) Midwifery instruotors and supervisors WPR/RC25/3 page 105 No figures are available on the need. It would, however. appear that 20 and 61 graduates respectively will certainly have helped considerably to fill existing gaps. (d) Orientation and refresher courses No attempts have so far been made to evaluate the impact of these activities on the quality of health services. 7.5 Summary of evaluation In the light of the facts given in the foregoing, it is reasonable to state that the project is being successfully implemented ani has made satisfactory progress. despite delays and holdups caused by factors beyond the control of the participating agencies. WPR/RC25i3 page 106 1. Ti tIe and project number 1.1 Source of funds 1.2 Project implementation dates 2. Projeot background First Regional Course on Baoterial Infections of the Gastrointestinal Tract, 18-26 February 1974 - WPRO 1601 Regular Manila, 18-26 February; Saigon, 11-19 Maroh 1974 The bacterial infections of the gastrointestinal tract are still a major disease problem in view of their morbidity and prevalence, particularly .in the developing countries of the Region. As oauses of infections, Salmonella, Shigella, Vibrio parahaemolyticus and enteropathogenic ~. ~ may play an important role. In addition, there are a considerable number of acute undifferentiated diarrhoeal diseases which include children's diarrhoea, travellers' diarrhoea and acute diarrhoea in hospital nurseries. It should be noted, however, that the majority of undifferentiated diarrhoea cases admitted have been left etiologically unclarified. From the therapeutical point of view, specific treatment with anti- microbial drugs is available for a great many bacterial infections of the gastrointestinal tract. However, the adequate use of medicaments cannot be expected unless the causative agents of the diseases have been identified. Needless to say, the improvement of environmental sanitation should be the basis of all the effective measures to protect people from the infections. 3. Objectives To inform participants on: (a) the situation in the Region in regard to the bacterial infections of the gastrOintestinal tract other than cholera; (b) the new knowledge available on their clinical aspects, diagnosis and treatment; (c) the recent laboratory techniques; (d) the preventive measures, more specifically improvement in environmental sanitation. 4. Action taken The course for English-speaking partiCipants was held in the Regional Office. There were 24 participants from American Samoa, British Solomon Islands Protectorate, Cook Islands, Fiji, Gilbert and Ellice Islands, Guam, Hong Kong, Japan, Papua New Guinea, Philippines, Republic of Korea, Singapore, • .. WPR/RC25/3 page 107 Tonga, Trust Territory of the Pacific Islands and Western Samoa. The course was assisted by three temporary advisers, a lecturer and 2 WHO staff members from field projects in the West Pacific Region who acted as secretariat. The course for French-speaking participants was held in Saigon at the National Institute of Public Health, which provided a conference room, office accommodation and secretarial assistance. It was attended by 15 participants from French Polynesia, Khmer Republic, Laos, New Caledonia, New Hebrides and Republic of Viet-Nam. Two temporary advisers, a oourse director and 3 staff members from the field projeots cooperated in the course operation. A number of field visits were organized for the participants at each venue. 5. Summary of sessions There are wide variations in the availability of laboratory services and in the curative and preventive measures related to bacterial diseases of the gastrointestinal tract among countries and even within a country of the Region. A series of lectures and discussions was utilized to focus attention on practical approaohes to tackling the problem, taking into consideration the limited resources available. The clinical features of the various infections of the gastrointestinal tract, including typhoid fever and toxin-produced diseases such as staphylococcal and olostridial food poisoning, were elaborated with reference to differential diagnosis, treatment and specific preventive measures. It was noted that measures as simple as faecal smear of differential leucocyte count may serve to exclude viral, parasitic and non-specific etiologies of diarrhoeal diseases from bacterial infections. Whenever possible, the etiology of diarrhoeal diseases should be confirmed in the laboratory. In addition to ordinary diagnostic tests, vi-phage typing for Salmonella typhi and colecin typing for Shigella sonnei are being employed in a number of laboratories of the Region for particular epidemiological follow-up • With regard to environmental sanitation, emphasis was laid on safe water supply and sanitary disposal of human waste. Relevant examples of how these goals could be achieved were demonstrated during the field visits. The importance of food sanitation was also stressed. The significance of vector control as an integral part of environmental sanitation was well elaborated. There was active participation at both venues, as evidenced by many questions and intensive exchange of comments. 6. Evaluation The analysis of the results of the questionnaire survey indicated that the administrative aspect of the oourse operation was rated as satisfactory by 81.4% of the replies and the technical aspects by 92.2%. The main objectives are, therefore, considered to have been met. WPR/RC2513 page 108 1. Ti tle and project number 1.1 Source of funds 1.2 Project implementation dates 2. Project backgrOund First Meeting of the Technical Advisory Committee on Dengue Haemorrhagic Fever - '!lPRO 1901 Regular 5-7 March 1974 After the first report of dengue haemorrhagic fever (DHF) in Manila in 1954, the disease spread further. An epidemic was reported in Bangkok in 1958. followed by others in Thailand as well as several other countries in the Western Pacific and South-East Asian Regions. In 1964, a joint seminar was held by SEARO and WPRO in Bangkok to review the public health problems created by the mosquito-borne haemorrhagic fevers. The outbreaks seemed to subside after 1964, except in Thailand where they recurred with a higher intensity every two years. In 1972, Thailand saw its largest DHF epidemic, with a reported number of 23 782 oases and 685 deaths. In 1972/1973, Indonesia moved from an endemic to an epidemic DHF status (over 8000 cases). DHF epidemics resumed in Malaysia. the Republic of Viet-Nam and Singapore in 1973. Over 15·000 cases were reported from these countries. Since 1971, epidemics of classical dengue - some with a certain number of haemorrhagic cases - reappeared in South Pacific Islands, Papua New Guinea. New Caledonia, New Hebrides, Society Islands, Gilbert and Ellice Islands, Fiji and Niue Island. During the last 5 years, WHO assigned 2 experts in the clinical or epidemiological aspects of DHF to a number of countries in the two Regions. Consequently, a wealth of information on existing DHF status has been gathered. In accordance with the opinions shared by the consultants, WHO Headquarters, South-East Asia Regional Office and the Regional Office for the Western Pacific agreed that a small workshop composed of the consultants and other experts in specific technical aspects of DHF should be held in 1974 in order to cope with the ever-spreading trend of DHF in Asia and the Pacific region. 3. Objectives (a) to review the existing epidemiological status of DHFj (b) to review the clinical and etiological criteria for DHF diagnosis currently employed in each country with a DHF problemj (c) to review the progress made recently in research related to immunology, virology, entomology, control and treatment of DHFj (d) to establish a common strategy covering the two Regions for the epidemiological and vector surveillance of DHFj ,., WPR/RC2513 page 109 Cel to update existing technical guidelines for the diagnosis, treatment and control of DHF; (f) to advise on the future direction of relevant researches; (g) to investigate ways and means for interregional collaboration in exchange of information and logistic supplies. 4. Action taken Eight experts from India, Indonesia, New Zealand, the Philippines, Singapore, Thailand and the United States of America met in Manila from 5-7 March 1974. Five staff members of WHO, one from Headquarters, two each from the South-East Asia Regional Office and the Western Pacific Regional Office, acted as secretariat. The Committee discussed fully how it could prove most valuable in assisting the countries which have been struggling to control DHF epidemics. First of all, it was recognized that in many DHF areas, there are major deficiencies in the capability of physicians to diagnose DHF accurately and treat it properly. The Committee agreed that for confirming clinical diagnosis, a more rapid procedure than virus isolation, such as the haemagglutination-inhibition (HI) test, will be required. Swift etiological confirmation is crucial to organizing a vector control programme in good time. The Committee recognized that the number of laboratories in the two Regions capable of undertaking arbovirus serology is barely sufficient. The WHO collaborative study on the provision of standard antigens and antisera was noted and it was agreed that this would lead to improved quality of sero-diagnosis data, as well as relieving laboratories of their already excessive load. The Committee admitted the existing difficulties in organizing a universal DHF surveillance programme, since it requires the coordinated skills of most of the varied components of a nation's health services. I It was agreed, however, that major objectives of DHF surveillance are: (a) rapid detection of outbreaks or endemic cases in order to apply control measures at an early stage, and (b) recognition of the ecological variables which are responsible for a large epidemic. Many countries in both regions publish periodical epidemiological bulletins. The Committee, while acknowledging the significance of such comnlunications, recommended that a more uniform basis should be provided in collecting data. In regard to vector surveillance, it was noted that standardization of vector survey methods is necessary so that data from different countries are comparable. WPR/RC25/3 page 110 With regard to control, the Committee agreed that "source reduction" or elimination of breeding sites of the domestic vector, ~ aegypti, had proved its value when made mandatory or when carried out on a voluntary basis. Adequate piped-water supply should be provided to replace or at least to reduce the use of water storage containers. The Committee noted that vector density would be suppressed for a 4-month period by 5 sequential ultra-low-volume applications of technical malathion at 15-20 day intervals. Treatment priority should be given to the periods shortly preoeding expected outbreaks. In an emergency, two ground applications spaced 10 days apart should be immediately launched. At all stages in the Committee's discussions, the need for training was emphasized. Keeping the knowledge of physicians, laboratory workers, epidemiology and veotor control officers up-to-date is of the utmost importance, yet manageable within the existing framework. Short training courses were suggested for this purpose. The Committee also suggested that another interregional seminar would be of great value. Concerning urgent needs in research, the Committee concluded that further international collaborative studies were necessary on pathogenic mechanisms and treatment of DHF. Protocols will be worked out by a small group to be reviewed by the Committee. The Committee prepared new technical guidelines for distribution on specific subjects as follows: (a) clinical diagnosis and treatment, (b) laboratory diagnosis, (c) prevention and control of epidemios, (d) epidemiological surveillance. The Committee finally recommended that its next meeting be held early in 1975 to assess progress. • d PARI' III. PROJEOl' LIST I J .. WPR!RC2513 page 112 PROJECTS IN OPERATION FROM 1 JULy 1973 TO 31 MAY 1974 This part of the Report contains a list of the projects - country and intercountry - that were in operation during the whole or part of the period from 1 July 1973 to 31 May 1974. It does not include projects in which the only WHO assistance given during the period was technioa1 advice from headquarters or the Regional Office, or projeots concerned only with the award of fellowships. The dates following the project title indicate the duration of assistance to the projeot, whether suoh assistance is continuous or intermittent. For projects not completed during the period under review, the date of estimated termination has been given where possible. For projects - or phases of projects - completed during the period, details of the assistanoe provided by the Organization and a brief desoription of the work done between the dates indicated are given. For continuing projects such details have not as a rule been included. As in former Annual Reports, an attempt has been made to summarize the immediate results of completed projeots and, where the nature of the work has permitted, to show the extent to which the objectives of the projects have been achieved. The abbreviations used for sources of funds are as follows: R WHO regular budget UNDP United Nations Development Programme UNFPA United Nations Fund for Population Activities Voluntary Fund for Health Promotion VC VD VL Special Account for the Cholera Programme Special Account for Miscellaneous Designated Contributions (general) SpeCial Account for the Leprosy Programme Names of any other agencies or entities cooperating in a project are given in parenthesis after the source(s) of funds. .. .. i Technical Advisory Committee on Nursing Manila. 10-14 December lq11 Education AMERICAN SAMOA WPR/RC2513 page 113 Assistance has been limited to fellowships and participation in intercountry group educational activities (see WPRO 1204, 1601, 4104, 6002. 9605 and 9607). AUSTRALIA Assistance has been limited to fellowships and participation in intercountry group educational activities (see WPRO 2004, 4104, 4402, 4501, 5401, 6002, 6003, 6401. 9602 and 9607) •. BRITISH SOLOMON ISLANDS PROTECTORATE 2001 Malaria eradication programme (1970-78) R UNOP - To erad- icate malaria from the country. This project follows the malaria eradication pilot project (1961-64) and the malaria pre-eradication programme (1965-69). 4001 Basic health services (1965-78) R UNOP UNICEF - To expand and strengthen the network of local health services and train auxiliary health personnel. Assistance was also provided under WPRO 1301, 2003, 3001, 4001, 4301 and 4401. (See also WPRO 1204, 1601, 4101 and 4302.) COOK ISLANDS 3001 Environmental health engineering advisory services (1973-75) UNOP - To develop plans for sewage disposal systems and for an improved water supply system for the island of Rarotonga, and water supply projects for the other islands, as well as programmes and standards for improved housing, and other sanitation activities. Assistance was also provided under WPRO 4901. (See also WPRO 1204, 1601, 9605 and 9607.) WPR/RC25/3 page 114 FIJI 4201 Health laboratory services (1974- period under review assistance was limited term advisory services will start in 1975. 6201 Fiji School of Medicine (1972-81) School of Medicine. ) R During the to fellowships. Long- R To strengthen the Assistance was also provided under WPRO 2201, 3001, 4001 and 5501. (See also WPRO 1204, 4101, 4302, 6002, 6003, 9602, 9605 and 9607.) FRENCH POLYNESIA 8201 Advisory services on metabolic diseases (July-Sept. 1973) R A consultant assisted in investigating the etiology and distribution of metabolic diseases, in particular gout and diabetes, and submitted recommendations on their prevention and management. Further assistance is planned. (See also WPRO 1601.) GILBERT AND ELLICE ISLANDS 3002 Sanitation and health education (1974-77) R To improve environmental health in the rural areas by developing rural water supply schemes, constructing water-seal latrines, and undertaking other sanitation activities at village level; to establish a training programme for sanitation staff and auxiliary workers; and to establish a health education programme to motivate the rural dwellers to adopt hygienic practices. 9601 Family health (1971-75) UNFPA UNICEF To organize and make available to the whole population services related to human reproduction and fertility, including services for spacing and limita- tion of births and for treatment of subferti1ity, and to carry out a programme of information and education of the public. Assistanoe was also provided under WPRO 2201, 3001, 4001, 4201, 4401 and 9603. (See also WPRO 1204, 1601, 4101 and 9605.) , GUAM WPR!RC25 13 page 115 2401 Control of intestinal parasitism (1-30 April 1974) R - A consultant was provided to assist the Government in carrying out a preliminary survey of intestinal parasites; to investigate their epidemiology and ecology and the influence of social, economic, and man-made environmental changes on their prevalence; to assess their relative significance as a basis for evaluating priorities in the communicable disease control programmes; to advise on (a) the plan- ning of control programmes at national and local levels, (b) control of the intermediate hosts and vectors, (c) mass chemotherapy, and (d) problems connected with environmental biology and sanitation. Assistance was also provided under WPRO 1201 and 4404. (See also WPRO 1204, 1601, 4101, 4104 and 4501.) HONG KONG 3101 Treatment of agricultural wastes (Jan.-Feb. 1974) UNOP A consultant reviewed proposals for the treatment of agricultural wastes in Hong Kong and advised the Agriculture and Fisheries Department on the setting up of trial treatment schemes for pig and poultry manure. A return visit will take place in 1975. Assistance was also provided under WPRO 5501. (See also WPRO 1601, 4104, 4302, 4501, 6003 and 9602.) JAPAN Assistance has been limited to fellowships and participation in intercountry group educational activities (see WPRO 1202, 1601, 4101, 4104, 4402, 4501, 5401, 6002, 6003 and 9602). KHMER REPUBLIC 1201 TUberculOSis control (1965- ) R UNOP To set up the nucleus of a national tuberculosis control service, with emphasis on preventive measures, and to carry out a control programme. WPR/RC2513 page 116 The WHO Representative has provided advice to the Government in connexion with this project, as long-term staff were withdrawn because of the emergency situation. 2001 Malaria control (1962- ) activities in order to protect and to promote the development training malaria personnel for organization and involving the detection and treatment. R ~P To extend antimalaria the people living under malaria risk; of an integrated health service by the provincial and district health rural health services in malaria case- 2901 Epidemiology and health statistics (1966- ) R VC To establish in the Ministry of Public Health an epidemiological and health statistical service responsible for planning and evaluating national disease control programmes; to study local epidemiological patterns of causes of morbidity and mortality as a basis for the formulation of such programmes; to reorganize the health statistics systems in hospitals, health centres, dispensaries and other health care institutions; and to train health service personnel in epidemio- logy and health statistics. 3001 Environmental health advisory services (1968- R To establish a public health engineering unit in the Ministry of Public Health and coordinate its work with the work of other units of the Ministry; and to draw up and implement country-wide environmental health programmes. The project was without long-term advisory staff during the period under review because of the emergency situation. 3202 Preparation of a master plan for Phnom-Penh (water supply, sewerage and drainage studies) (1972-75) UNDP To formulate a plan for improving urban health in Phnom-Penh and its environs through the provision of adequate quantities of safe water for domestic and other uses and of measures for the proper collection, treatment and disposal of waste water and the satisfactory removal of stormwater. 4201 and 4202 Health laboratory services (1968-78) R ~P - To organize laboratory services to meet the needs of the health and medical serVices, strengthen and develop the resources of the Institute of Biology, improve laboratory services in the hospitals in Phnom-Penh and in the provinces and in urban and peripheral dis- pensaries, and train laboratory staff. 4301 Medical services administration (1971-77) R To strengthen and adapt the existing medical care services, particularly hospital institutions, to the requirements of the emergency; to coordinate the medical and health care services to enable them to respond better to current demands; to formulate a country programme, to be implemented in stages, for the balanced development of the health and medical care services; and to train the necessary personnel. I l WPR/RC2513 page 117 4801 Rehabilitation of the phYsically handicapped (1971-77) R UNDP _ To establish a unit that could later become a school for training physical and occupational therapists and set up a national rehabilita- tion service. 6401 Education and training of health personnel (1971- ) R- To develop and strengthen the centres for the training of all categories of health personnel and to develop a community health centre to serve as a model for oentres to be established later in other parts of the country. 9601 Family health (1973-79) R UNFPA UNICEF - To develop and strengthen (i) family health oare, inoluding .. ternal and ohild health, fam1ly planning and nutrition oare, as part of the basic health services; (ii) maternity, family planning, paediatric and nutrition services in hospitals; and (iii) the family health aspects of the basic, postbasic, in-service and refresher training of all oategories of health personnel concerned. Assistance was also provided under WPRO 3201 and 5501. (See also WPRO 1601, 4104, 4302, 4501, 5401, 6002, 6003 and 9602.) IAOS 1101 Venereal disease control (Nov. 1973 - Feb. 1974) R - A consultant assessed the nature and extent of the venereal disease problem; reviewed the faoilities available for their diagnOSis, treatment and control; made reco_endations aimed at strengthening the venereal disease epidemiological services, and prepared guidelines for future action. 1301 Leprosy control (Nov.-Dec. 1973) R - A oonsultant &asisted in the collection of data on the leprosy oases so far detected and on the means available for oontrolling the disease, and prepared guidlines for a medium-term programme that could be used as a basis for expanding activities. possibly with international assistance. 2001 Malaria oontro1 (1969- ) R - To build up the administra- tive and operational faoilities of the Central Malaria Service to the level required to carry out an anti_laria proara-e, in the first place in the Vientiane plain. 4001 and 4002 DevelOpment of health services (1968-79) R UNDP UNICEF - To develop and strengthen the general health services, beginning in Vientiane Province. which will serve as a pilot area; to organize a oentral advisory body to review the organization. programmes and coordination meohanism of the health services; and to formulate and carry out a programMe for training health manpower. 4201 Health laboratorz servioes, Vientiane (195}-77) R UNICEF- To establish a public health laboratory service and train laboratory personnel. WPR/RC25/3 page 118 During the period under review, a consultant also provided assistance in connexion with the establishment of blood transfusion services. 4301 Organization of medical care (1974-80) R To strengthen and adapt existing medical care services, particularly in the hospital system, to the requirements of the present situation; to promote effective cooperation between the medical and health care services; and to use effectively, through the formulation and continuing assessment of a suitable overall medical care programme, available resources to meet current needs. 4401 Nursing education (1962- UNOP UNICEF (USAID) (Asia Found~tion) (Colombo Plan) To set up a school of nursing and midwifery for training personnel for the country's hospital and health services, which are to be extended and improved. 4801 Rehabilitation of the physically handicapped (1967-75) UNOP (UN Office of Technical Cooperation) To assess the eA~ent of the problem of the physically handicapped, plan and operate rehabilita- tion facilities and train staff for them, and review legislation dealing with the physically handicapped. 4991 Vital and health statistics advisory services (1968-78) R To establish a vital and health statistics service in the Ministry of Public Health and to train staff. 5601 Nutrition advisory services (1968-78) R UNICEF To improve nutritional levels in the community and to coordinate, under a national nutrition policy, all health aspects of food and nutrition work carried out by international and national governmental and non- governmental agencies. 6201 Royal School of Medicine (1967-78) faculty of the Royal School of Medicine. R - To strengthen the 9601 Family health (1971-78) UNFPA UNICEF VD To provide effective maternal and child health care and advice on family planning with the ultimate objective of securing a higher standard of living for the family as a whole. Assistance was also provided under WPRO 2101, 3201, 4102 and 9603. (See also WPRO 1601, 2004, 4104, 4501, 6002, 6003 and 9602.) MALAYSIA 2001 Malaria eradication programme, Peninsular Malaysia (1967-82) R To eradicate malaria from the country. ,> WPR/RC25/3 page 119 2002 Malaria control, Sabah (1967-82) R To improve the control of malaria with the aim of eventually eradicating the disease. A review of the programme in 1972 showed that the present epidemio- logical situation and the state of development of the rural areas of Sabah do not make it feasible to eradicate malaria in the foreseeable future, and that the objective should be redirected to maintaining the gains already achieved by improving control operations and promoting greater involvement of the general health services in the antimalaria campaign. 2003 Malaria control, Sarawak (1961-78) R To maintain the gains already achieved by continuing antimalaria operations through- out the malarious areas; to provide health assistance, particularly to the groups engaged in developing natural resources; and to continue the training of basic health service personnel and voluntary agents for work in the malaria programme. The project was redefined on the basis of the recommendations of a WHO team that reviewed the programme in 1971. 2901 Epidemiological services (1971- ) R To establish. in the Division of Communicable Disease Control, Ministry of Health. an epidemiological and statistical service responsible for planning and evaluating national disease control programmes; to study the local epidemiology of causes of morbidity and mortality as a basis for the formulation of such programmes; to improve liaison and coordination among the Ministry's communicable disease control. medical records and health statistics services, the laboratory services (particularly the Institute of Medical Research) and other peripheral government units concerned with disease control; and to train staff in epidemiological work. 3001 Environmental health advisory services (1966-76) R UNICEF To develop a national environmental health scheme. to implement sanitation projects, including water supplies for rural communities. through the health authorities and other governmental agencies. and to train sanitation staff. 4001 Development of health services (advisory services) (1964-75) R UNICEF - To strengthen and expand the basic health services and train personnel according to a consolidated plan which includes phasing,of expansion and the development of uniform standards through- out the country. 4101 Health legislation (Feb.-April 1974) R A consultant assisted the Ministry of Health and other government agencies in a review of a draft public health act and a study of the existing public health ordinances and regulations, with a view to their updating and harmonization with the new Act,. and to determining the means by which they can be uniformly applied throughout the country. He also assisted in identifying and asseSSing the need for additional legislative or regulatory provisions in the light of the country situation. WPR/RC25/3 page 120 4201 Institute of Medical Research (Aug.-Oct. 1973) R A consultant assisted in starting a training programme in general blood bank organization and technical procedures for laboratory technicians and medical officers, and helped to set up a donor panel and a rare-group file. Further assistance is planned. 4801 Rehabilitation of the physically handicapped (Oct. 1973 - March 1974) R A consultant assisted in drawing up guidelines for the development of the school of physiotherapy. These included advice on staff and student selection, and on the preparation of a curriculum that can be implemented with the resources available. 4901 Medical records (Sept. 1973 - March 1974) R A consultant assisted in a review of the medical records of the maternal and child health services, and in the formulation of a standard system of records for use at all levels, of a plan for utilizing clerical assistance for record-keeping at health centres, and of a programme of training in medical records. 5202 National seminar on the organization of industrial health services for small industries, Kuala Lumpur (Feb. - March 1974) R TWo consultants assisted in organizing a national seminar during which the health situation in small industries was reviewed and the possibility of finding practical solutiom to the problems of providing them with health services, taking into account available resources, was studied. There were 40 partiCipants and the seminar was attended by a representative of ILO. 5601 Nutrition advisory services (1967-77) R UNICEF (FAO) To plan and carry out nutritional surveys in a pilot area where an applied nutrition programme is being launched, develop nutrition education and supplementary feeding programmes, and train the personnel needed for implementing and evaluating the health aspects of the programme. 6201 Assistance to the University of Malaya (1965- R To strengthen the teaching staff of the Faculty of Medicine of the University of Malaya, particularly in the fields of preventive medicine, public health, nursing and medical recording. 6203 Assistance to the National University, Faculty of Medicine (Nov. 1973 - Feb. 1974) R A consultant advised the Dean of the Faculty of Medicine on the development of the faculty and particularly on curriculum design, teaching/learning methodology, student/teacher evaluation and the organization of the Faculty of Medicine, including its relationship to the other faculties of the University and the Ministry of Health. -. WPR/RC25/3 page 123 6401 Education and training advisory services (1971-76) R - To plan, implement, and evaluate various types of courses in training institutions under the jurisdiction of the Division of Medical Training and other institutions designated by the Government for the purpose of training government personnel. Assistance was also provided under WPRO 1201, 5501 and 9604. (See a.lso WPRO 1204, 1601, 2004, 4101, 4104, 4501, 5401, 6002, 6003, 9602 and 9607.) PHILIPPINES 1201 Tuberculosis control (Nov. 1973 - April 1974) R UNICEF A consultant reviewed the provincial tuberculosis control programme" and assisted in conducting courses for provi'1cial tuberculosis coordinators. 2001 Malaria eradication programme (1958- R UNDP (USAID) To eradicate malaria from the country and prevent its re-establish- mente 3203 Laguna de Bay water resources development (1972-74) UNDP/ Asian Development Bank Following consultant services provided earlier in the year, in November 1972 a consultant reviewed the proposals of the consulting engineering firms invited to participate in the study for the development of the Laguna de Bay water resources and, in May 1973, the plan of study submitted by the firm selected. A WHO adviser was appointed in 1973. 4001 General health services development (1969-77) R UNICEF To improve the organization and administration of the health and medical care services, undertake national health planning in the context of overall planning for development, review health manpower education and training schemes, and develop working relationships between the national health administration and other agencies, both public and private, that are concerned with health. 4501 Research, development and training in family planning com- munication, Institute of Mass Communication, University of the Philippines (1973-74) UNFPA/UNESCO A health education specialist is advising on the production of model communication medical materials for training, assisting in the introduction of new approaches in family planning communication, and in training family planning staff in the principles and techniques of interpersonal and mass communication. WPR/RC?5/3 page 124 5602 Nutrition advisory services (Jan. - Feb. 1974) R A consultant team, consisting of a medical cffic~r and a psychologist, \~as provided for a period of 5tX wfJekz to assist in a review of past and current studies in the Philippines on the impact of protein- celorie malnutrition on mental development and of tr-e benefits of supplementary f:;)eding programmes; to ass€ss the need and feasibility of a s~udy of the effect of iodine supplementation on mental de'relopment in an ii.rea "here endemic goitre is highly prevalent; 'lnd to advise on the need for further studies in the field of nutritio~ and mental development and upon such ether matters as may be requested by the Department of Health. 6401 University of the Philippines (1971-81) R To strengthen the staff of the University of the Philippines, in particular that of the Institute of Public Health, which is the only school of public health in the country and which serves as a regional training centre and is used by WHO in the organization of courses on national health planning. 8101 Cancer control (Dec. 1973) R A consultant assisted in evaluating the community cancer control programme in Rizal Province in view of its importance as a possible model for the establishment of cancer control activities throughout the country. Consultant services were provided under this project between 1967 and 1969. 9603 Maternity-centred family planning (1971-75) UNFPA UNICEF To develop the staff and facilities of 25 teaching hospitals and associated teaching institutions with a view to the inclusion of maternity-centred family planning training and service in their work. 9604 Nursing education in family planning (1971-75) UNFPA To organize national workshops to prepare faculty members to introduce family planning in basic nursing curricula. During the period under review, supplies and equipment were provided to 14 schools and colleges of nursing and 11 midwifery schools, all of whom participated in the two workshops held in May and June 1973. The effects of the workshops have also been followed up by the WHO public health nurse assigned to the intercountry family health field advisory services project (WPRO 9603) and her national crunterpart, who have visited 58 schools and colleges of nursing and midwifery. 9605 Assistance to the teaching programme of the Institute of Public Health, University of the Philippines, in family plannin§, human reproduction and population dynamics (1971-73; May 1974) UNFPA WHO provided continuing assistance for the operation of one further training course for hospital staff. To date, about 75% of the staff in twenty-five hospitals of the maternity-centred family plan- ning project have been trained. WPR/RC25/3 page 125 Assistance to the Institute terminated in 1973 as the Department of Health decided to transfer the responsibility for training to the Regional Tra1ning Centre. However. a carryover of unused funds allowed a follow-up workshop which was held from 6 to 10 May 1974, involving family planning doctors and nurses from seventeen of the hospitals. Assistance was also provided under WPRO 1201. i901. 4003. 4703, 5501 and 9603. (See also WPRO 1202. 1601, 2004. 4101. 4104. 4402. 4501, 5401. 6001. 6002. 6003 and 9602.) REPUBLIC OF KOREA 1201 Tuberculosis control (1962-73) R UNDP UNICEF To implement a compreheqsive national tuberculosis control programme thus reducing the problem of tuberoulosis. Provided: a medical offioer for 10 years, a nurse for 5 years and periodio visits of the members of the interoountry tuberoulosis advisory team. The strong support given to this project by the Government is reflected in the marked and steady increase in its budget from the equivalent of US$320 204 in 1962 to that of US$2 340 471 in 1973. or an increase of 631~ in eleven years. Together with the assistance received from voluntary agencies and foreign agencies. including that from WHO,and UNICEF, the per capita expenditure on the programme has increased from the equivalent of 1.7 us cents in 1962 to 13.7 us cents in 1973. or an increase of 706~ in 11 years. The programme activities. following a short pilot trial in the capital city of the applicability and acceptability of the newly developed control methods. were rapidly expanded to the whole country and channelled through the 192 existing government health centres. In 1967. the activities were further decentralized to eup/myun level. Apart from the direction provided at central level by the Ministry of Health and Social Affairs and a supervisory team of five or six specialized staff in each province. all the field activities were carried out by trained auxiliary workers. During the 12 year period. a total of 23.2 million infants and children were vaccinated with BOG. i.e •• an average of two million persons a year which was about twice the IUJDber of births in the country each year. Quality control of the vaccination has also been carefully guarded through periodic assessment activities in the provinces. Tuberculosis case-finding has relied greatly on sputum microscopy of persons with prolonged respiratory symptoms. The number of tuberculosis patients on domiciliary chemotherapy increased from 28 732 in July 1962 to 148 030 in October 1973. an increase of 415%. WPR/RC25i3 page 126 Tuberculosis prevalence surveys based on a randomly selected sample population were conducted in 1965 and 1970. The prevalence of pulmonary tuberculosis cases confirmed by microscopy and/or culture examinations was 7.4 per 1000 population, aged five years and over in 1970 and 9.4 per 1000 in 1965. representing a reduction of 21% within a period of 5 years. If this rate had been applied evenly throughout the l2-year period, it is estimated that the number of infectious cases of pulmonary tuberculo$is in the country would have decreased from approximately 257 000 in 1962 to 145 000 in 1973; a 43.5% reduction in 12 years in spite of the population growth. The apparent success of the project has not led to complacency. The Government fully realizes the fact that 60% of the estimated total number of cases of pulmonary tuberculosis have yet to be discovered and included in the treatment programme. Continued vigilance and further expansion df activities are expected in the coming years, with the WHO regional tuberculosis advisory team providing advisory services as required. 1301 Leprosy control (Aug. 1972 - Feb. 1973; May - Oct. 1973) R VL UNICEF A consultant assisted the Ministry of Health and Social Affairs in implementing the recommendations of previous conSUltants and advised on the measures required to coordinate the work of different agencies and integrate it into the general health services. Staff of the leprosy control programme and graduates of the medical and allied health professions were trained in control methods. 2901 Epidemiology and statistics advisory services (1968-78) R To organize and develop a central epidemiological service and a disease intelligence network in the Ministry of Health and Social Affairs; to improve the collection, recording and utilization of health statistics; and to coordinate health laboratory services with the epidemiological services. 3201 Advisory services on community water supply and sewerage (1972-77) R To plan and implement a comprehensive urban and rural water supply and sewerage programme. 3202 Upland development and watershed management (Jan. 1972 - Sept. 1973) UNDP /FAO A WHO sanitary engineer worked with the community development component of the project for 18 months, during which time several piped water supplies were constructed and various physical improvements effected in villages of the project area. 3701 National course on vector and rodent control (15-27 April 1974) R Assistance was given in connexion with a two-week refresher course for staff responsible for vector control at the provincial level. WPR/RC25/3 page 127 4001 General health services development (1963-77) R UNICEF- To develop the public health services in the demonstration province (Chungchong Namdo) and the local health services in other provinces; and to train local health personnel at the Division of Training of the National Institute of Health. 4201 Health laboratory services (May - July 1974) R A consultant is evaluating the VORL technique carried out at the National Institute of Health, Seoul, training staff in this technique and assisting in setting up the FTA/ABS technique. Assistanoe is also being given in the organization of VDRL 3erology units at the intermediate level. the preparation of control sera of graded reaotivity, and the organization of a profioienoy testing programme direoted by the National Institute of Publio Health. Attention will also be given to the colleotion and transportation of specimens for the diagnosis of gonorrhoea. and the methodology for the oulture and identification of ~. gonorrhoeae. 5104 Maternal and child health servioes (1974-77) R To strengthen, develop and promote maternal and child health services as part of the general health services at all levels; to carry out field studies with a view to increasing the coverage of basic maternal and child health care; and to strengthen the training in maternal and child health care of all categories of health personnel concerned. 6401 Education and training of health personnel (1969-78) R UNFPA UNICEF To provide education and training for health and medical workers, including undergraduate and p0stgraduate training for physicians and basic and postbasic training for nurses, sanitarians and other health workers. 9601 Workshops in family plannin for teachers in nursing/midwife schools 1971-7) UNFPA To organize workshops for teachers in nursing/midwifery schools with the object of securing well- qualified staff for the teaching of family planning and its integra- tion into the basic curriculum. The second workshop, with 51 participants, was held in July and August 1973. The WHO public nurse educator assigned to project Republic of Korea 6401 acted as consultant. (The first workshop was held in July 1971.) 9602 Maternity-centred family planning (1973-75) UNFPA To develop the staff and facilities of teaching hospitals and associated teaching institutions with a view to the inclusion of maternity- centred family planning training and service in their work. (Tech- nical assistance for this project is provided through the intercountry family health advisory services project WPRO 9603.) WPR/RC25/3 page 128 Assistance was also provided under WPRO 1201, 5501 and 9603. (See also WPRO 1202, 1601, 2004, 4101, 4104, 4402, 4501, 5401, 6001, 6002, 6003, 6401 and 9602.) REPUBLIC OF VIET-NAM 1201 Tuberoulosis oontrol (1958-77) R (UNOP until end 1972) UNICEF To set up a national tuberoulosis control programme as a permanent part of the baaic health aervioea. 1301 Leprosy control (Deo. 1973 - Feb. 1974) R A consultant reviewed and analyzed the existing data on leprosy cases and the resources available for the control of the disease, and proposed guidelines for the extension of the national leprosy control service. 2901 Epidemiological surveillance and quarantine (1970- ) R To develop epidemiological services at the central and regional levels, strengthen the application of the International Health Regulations (1969) and train staff for these purposes. 3001 Environmental health advisory services (1966- R To strengthen the environmental sanitation servioe in the Ministry of Health and introduce improvements in public water supply, human excreta disposal, refuse disposal, food hygiene and vector oontrol in urban and rural areas. 3101 National pollution control programme (March 1974 - )"UNDP- To formulate an' implement a phased oountry-wide environmental pollution control programme; to prepare legislation and institutional arrange- ments for the implementation of the programme; and to establish a system of regional monitoring and laboratory faoilities. 4001 General health services develo,.ent (1974 - } R A consultant in public health nurainl is providing advisory services at all levels of the national health administration on the public health nursing a ... cts (praotice and supervision) of the general health services, aasisting the development of the general health services, with particular referenoe to theae funotioning at the peri- pheral level in rural areaa, and participating in surveY's and assess- ment ot the health situation and available resources. 4101 National health planning (1972- R To strengthen the national health planning unit in the Ministry of Health, formulate a national health policy and a national and manpower plan, and train staff. WPR/RC25/3 page 129 4201 Health laboratory services (1964- R UNICEF To establish a central health laboratory service and train health laboratory workers; and, later, to organize regional and peripheral health laboratory services. 4202 Production and control of biologicals (1972-79) R To improve the production and control of biologicals (especially cholera, typhoid and plague vaccines), the management, breeding and care of laboratory animals, and the production and control of freeze-dried smallpox vaccines. 4301 Hospital design (Sept. - Dec. 1973) R Two conSUltants (a medically qualified hospital administrator and a hospital architect) were provided to assess the extent of the technical needs for reconstruction of hospitals and district health centres and to establish guidelines for this work. They also assisted in establish- inga mechanism for consultation among the assisting agencies in order to ensure the adoption of standards for construction design and for equipment, and made recommendations on the future development of hospital and health care facilities. 4801 Rehabilitation of the physically handicapped (Aug. - Oct. 1973) R A consultant reviewed facilities and ongoing programmes for medical rehabilitation, including the programme for training various categories of rehabilitation personnel, and submitted recommendations. 4901 Vital and health statistics advisory services (1969-75) R To organize an efficient and up-to-date system of collecting and recording vital and health statistical data so as to produce vital and health statistics that will meet national and international needs; and to train personnel in the administration and operation of a national health statistical service. 5501 Training of dental auxiliaries (1974-79) R To strengthen the organization fo~ the delivery of dental health services; to develop dental programmes for dental services; to consolidate and develop training programmes for operating and non-operating dental auxiliaries; and to stimulate community awareness and participation in dental health. 6001 Medical education (1972-77) R To strengthen various aspects of the curricula of schools of medicine, with particular attention to preventive medicine and public health. During the period under review, a consultant in paediatric education was assigned to the University of Hue. WPR/RC25/3 page 130 6401 National Institute of Public Health (1969-82) R VD UNFPA To build up a national institute of public health which will serve as a centre for the planning, standardization, organization, coordination, implementation and evaluation of training programmes for various categories ot medical and health workers. (See pages 94-105 for a full description of this project.) 9601 Family health (1973-77) UHFPA UNICEF - To strengthen family health services by improving the health care of mothers and children and providing married couples with information and services for the planning of their families. Assistance was also provided under WPRO 3201 and 9603. (See also WPRO 1202, 1601, 2004, 4101, 4104, 4302, 4402, 4501, 5401, 6001, 6002. 6003 and 9602.) SINGAPORE 1001 Communicable diseases advisory services {1972-76) R - To develop and strengthen the epidemiological service of the Ministry of Health, study the epidemiology of the main causes of morbidity and mortality (particularly communicable diseases), develop pro- cedures for the investigation, prevention, diagnOSis and control of certain diseases, and train staff in epidemiological work. WHO assistance is limited to consultants and fellowships. 3302 Planning for sewerage development and water pollution control (1970-73) UNDP - See pages 87-90 for a full des- cription of this project. 3303 Closed storm drainage system design (1973-75) UNDP - To draw up plans for closed storm drainage. pumping and water storage schemes to serve new developments and other selected areas; and to prepare a preliminary plan for a closed storm drainage and storm-water capture scheme to replace the existing open drain system serving the developed areas of Singapore. 5601 Nutrition advisory services (1968; 1970-73) R UNICEF (FAO) - See pages 91-93 for a full description of this project. 6301 Development of medical specialties (1971-75) R - To establish and organize specialist units in hospitals and to train in advanced techniques staff to man these units. WPR/RC25/3 page 131 During the period under review assistance was limited to the award of fellowships. 6401 University of Singapore (1968-76) R To strengthen the teaching staff of the Faculty of Medicine of the University, parti- cularly in the fields of preventive medicine, public health and organization of medical care. Consultant services in other fields and fellowships were provided between 1952 and 1966. Assistance was also provided under WPRO 1901, 4003, 4404, 5501 and 9603. (See also WPRO 1202, 1601, 4104, 4501, 6002, 6003 and 9602.) TONGA 4301 Hospital administration (1968-70; Nov. 1973 - Jan. 1974) R To develop a system of hospital operation and management that will enable the Nuku'alofa hospital to meet the medical care needs of the population more effectively. 4401 Nursing education (1969-73) R To strengthen the basic nursing curriculum of the Queen Salote School of Nursing; to improve the quality and quantity of nursing and midwifery personnel needed to meet the demands of the expanding health services; to evolve a body of nursing legislation suitable for the Kingdom of Tonga. Provided - a nurse educator and four fellowships. The project was developed in two phases: Phase I, 1969-70, when stUdies of community health needs and resources were undertaken; a survey of the functions of nurses at the Vaiola Hospital, in the old building, was made; and the 3-year curriculum was revised to include stUdies in public health nursing practice. In Phase II. 1971-73. the survey of the functions of nurses was repeated in the new Vaiola Hospital to assess any change in the role of the nurse in the new setting; and in preparation for the introduction of team nursing, a study was made in respect to levels of patient dependency needs. In cooperation with hospital nursing staff assistance was given to introduce and sustain a programme of in- service education. During Phase II also. work began on the drafting of a proposal for a Nursing Act. Throughout the period of assistance regular reviews were made of the nursing curriculum: a revised curriculum was then implemented in 1973 to provide for greater correlation between theory and practice. WPR/RC25/3 page 132 While the enactment of nursing legislation has still to be achieved, project aims relating to the strengthening of the basic nursing curriculum have been realized. When WHO assistance ended, there were four trained national teachers and two national clinical instructors in the nursing school; and a total student enrolment of 780 It is anticipated that the development of the in-service education programme for sisters and staff nurses will be continued and expanded. 9601 Maternal and child health/family planning (1972-76) UNFPA UNICEF VD To organize and implement a family planning programme within the health services, particularly in the maternal and child health clinics, and to train the necessary staff. Assistance was also provided under WPRO 2902, 3001, 4001, 4201, 4401, 4901 and 9603. (See also WPRO 1204, 1601, 4101, 4104, 4501, 9602, 9605 and 9607.) TRUST TERRITORY OF THE PACIFIC ISLANDS Assistance has been limited to fellowships, participation in intercountry group educational activities (see WPRO 1204, 1601. 4101, 4104. 4302. 4501. 9602 and 9605) and advisory services under the intercountry programme (see WPRO 1201, 3201 and 4404). WESTERN SAMOA 1201 Tuberculosis control (1971-74) R To consol!date and assess the tuberculosis control service in the demonstration area of Leulumoega; to standardize the methods and procedures used by all districts; and. ultimately to integrate the tuberculosis control services into the general health services throughout the country. 2201 Filariasis control (2-31 July 1973) R A consultant reviewed the progress in filariasis control, made an epidemiological assess- me~t with special reference to microfilarial rates and denSities, evaluated the field trial of vector control, and submitted recom- mendations with regard to the mass drug distribution programme and to future activities. Nursing Education Nursing students in Western Samoa in classroom and practical demonstration work. A WHO nurse educator (Ms. E. Brister) is helping the Government to improve the standard nursing and midwifery education and services. WPR!RC2513 page 133 4001 National health servioes development (1967- ) R UNDP UNICEF - To develop and strengthen the organization and operation of the general health servioes, particularly at district and local levels; to improve the operation of the rural health programme; to organize in-servioe training for medical and allied personnel; to conduct epidemiologioal studies on the most important causes of morbidity and mortality in the oountry; and to plan disease control programmes as part of the general health services. 4101 National health planning (May-June 1974) R - A consultant assisted in assessing the aooomplishments of the health sector under the country's ourrent development plan; in organizing a planning unit in the Ministry of Health which will meet the requirements of the planning process; and advised and participated in the drawing up of the health sectoral plan to be incorporated in the Government's forthcoming overall development plan. 4301 Hospital administration (3-17 May 1974) R UNDP - The consultant, who made a study of the workload of the proposed central sterile supply department in 1973 in the Apia General Hospital, made a return visit to assist in improving the management of the department and in drawing up and initiating a teaching programme for the staff. 4401 Nursing eduoation (1972-74) UNDP - To improve the standard of nursing and midwifery education an~ aervioes. 9601 Maternal and child health/family planning (1971-76) UNFPA UNICEF - To organize a family planning programme, including advioe on the spaoing and limitation of births and the treatment of sub- fertility, and train the neoessary staff; to oonduot surveys on the influenoe of high fertility and high birthrate on the health of mothers and ohildren; and to undertake operational researoh on methods of meeting the country's family planning needs. 9602 National seminar on health eduoatlon in tamily planning (Aprl1 1974) UHFPA - Two seminars on health eduoatlon in family health were organized in Aprll, with the obJeotive of strengthening the oommunlty approach to health programmes by inform1ns, eduoating and motivating the public to adopt desired health praotioes. Particular emphasis was given to gaining the oommunlty's point ot vie~ and its response to health servloes, espeCially in the areas of tamily planning, nutri- tion, sanitation and maternal and ohild health oare. Assistanoe was also provided under WPRO 2201, 2902, 3001, 4001, 4201, 4901 and 9603. (See also WPRO 1204, 1601, 4101, 4501, 9602 and 9605.) WPR~C25/3 page 134 WPRO 0901 Public health advisory services requests from oountries of the Region nexion with the planning of long-term (1961- R To meet for advisory services in con- projects or with specific problems. The following assistance was provided during the period under review: A oonsultant was appointed from 6 May to 19 July 1974 to assist and participate in the course in basic immunology, organized at the WHO Immunology Research and Training Centre, Singapore. 1201 Regional tuberculosis control team (1961-80) R - To assist countries of the Region in assessing their tuberculosis programmes. During the period under review, the team members, either individually or as a team, visited Guam, Malaysia, Papua New Guinea, the Philippines, the Republic of Korea and the Trust Territory of the Pacific' Islands. 1202 Tuberoulosis courses, Tokyo (17 June-24 Oct. 1973) R To train national workers in the application of modern methods of tuber- culosis control and stimulate the provision of practical training and demonstration in national institutions. Eighth course There were 8 participants from Japan, the Philippines, the Republic of Korea and Republic of Viet-Nam, and 7 from the Eastern Mediterranean and South-East Asia Regions. Provided - 7 temporary advisers, instructors (from Japan), the cost of post-course country visits for all participants, reference material and the services of a consultant and a WHO staff member as lecturers. The ninth course started in June 1974. There were 6 partiCipants from the Philippines, Republio of Korea, Republic of Viet-Nam and Singapore, and 11 participants from the Eastern Mediterranean and South- East Asia Regions. Provided - a oonsultant, 6 temporary advisers and the cost of post-course country visits for all participants. 1204 Sixth oint WHO PC course: tuberculosis and leprosy, Papeete (2-22 May 197 ) To provide refresher training for medical officers in charge of tuberculosis and leprosy control activities in the countries and territories in the South Pacific area. 'n1.ere were 11 partiCipants from American Samoa, British Solomon Islands Protectorate, Cook Islands, Fiji, Gilbert and Ellice Islands, Guam, New Hebrides, Papua New Guinea, Tonga, Trust Territor,y of the Pacific Islands and Western Samoa. Provided - 4 consultants and the cost of attendance of the participants. - .. . . , . w PR/RC 2513 page 135 1206 Regional BeG vaccine laboratory, Philippines (1973- ) R UNICEF To develop and expand the Alabang BeG vaccine laboratory into a regional laboratory for the production of freeze-dried BeG vaccine for countries and territories of the Region. l}Ol Leprosy control advisory services, (~972- R VL To assist in assessing the leprosy problem in countries of the Region, in strengthening leprosy services, and in training personnel. British Solomon Islands Protectorate (Sept. 1972 - Sept. 1973). A consultant assisted in carrying out an evaluation to determine whether leprosy is still an important public health problem. Leprosy apparently still remains a health problem in the Protectorate. Recommendations for active leprosy control measures were made. New Hebrides (Oct. 1973-75). To assess the leprosy situation in the Condominium; to intensify case-finding, case-holding and treatment procedures; to train health staff, particularly those at district level, in leprosy case-detection; to integrate the leprosy control service into the activities of the rural health services; and to promote health education of the public. particularly in the endemic areas. 1601 First regional course on bacterial infections of the gastro- intestinal tract, Manila and Saigon (18-26 Feb. and 11-19 March 1974) R See pages 106-107 for a full description of this project. 1901 First meetin Committee on De e Haemorrhagic Fever, R See pages 108-110 for a full description of this project. 2004 Malaria training project ( 1973- ) R - To train profesdcnal and auxiliary personnel for national malaria services. During the period under review, a special course in advanced malaria epidemiology was held at the Public Health Institute, Kuala Lumpur, from 2 to 15 December 1973. There were 19 participants from Australia. Laos, Malaysia, Papua New Guinea. the Philippines, the Republic of Korea and the Republic of Viet-Name Provided - a consultant and cost of attendance of participants. 2101 Schistosomiasis survey, 'Khiner Repubnc~ana laos (1971-73) R To assess the distribution and importance of schistosomiasis in the area; to identify the snail intermediate hosts and establish their distribution and the mode of disease transmission; and to formulate and recommend measures for preventing the spread of infection. taking into account such factors as population movement. irrigation schemes and other activities connected with the development of the Mekong River Basin. Prov~ded - a consultant in the ciinical and diagpostic aspects of schistosomiasis for 2 months and a malacologist for 2~years. WPR/RC25i3 page 136 In 1968-1969. the presence of cases of schistosomiasis on Khong Island. Laos. and in Kratie. Khmer Republic. was reported by WHO survey teams. However, no definite conclusion was drawn regarding the specific intermediate host. A clinico-parasitological survey on Khong Island, Laos, during 1973 revealed that (1) the disease predominantly attacks those under 20 years; (2) over 5~ of egg-positive cases showed enlarged liver and spleen, the rest could be subclinical; and (3) the positive cases have a high alkaline phosphatase value. otherwise blood chemistry is normal. The study thus revealed that severe forms of schistosomiasis are present in Laos. A systematic survey of molluscan fauna and experimental infection studies revealed no Oncomelania species despite the abundance of snail species. It also confirmed that Lithoglyphopsis aperta is the inter- mediate host of schistosomiasis in the area. The distribution of L. aperta was found to reach from the Khmer border north to MuangSone Kone southeast of Savannakhet. The southernmost limit is assumed to be between Kratie and Stung Treng. L. aperta is aquatic, not amphibious as Oncomelania, and fluviatile. Its-life span is 15-1B months. Its activity ceases at a temperature below 16 Dc and can not be restored follOWing freezing at -Boc. In the area studied, eggs are laid between February and April. Young snails are observed from March to May. Old~. aperta do not take part in reproduction. Due to the fluviatile habit of L. aperta, the risk of transferring it in artificial still water seems remote. On the other hand. the control of ~. aperta would present quite a problem as the efficiency of molluscicidal operation is considered to be low. There is need for further stUdies to determine more effective control meaaures. taking into consideration the characteristics of the snail and other conditions obtaining in the affected areas. 2201 Filariasis advisory services (1971-75) R To assist govern- ments, especially in the South Pacific area, in studying the epidemio- logy of filariasis and in carrying out or evaluating programmes for controlling the disease. During the period under review. assistance was provided to the Gilbert and Ellice Islands and Western Samoa. 2992 Epidemiological and surveillance services (1972-Bl) R To assist with epidemiological surveys. the strengthening of epidemiolo- gical and laboratory services. the establishment of disease intelligence networks, the inVestigation and control of outbreaks of communicable diseases such as cholera El Tor and other diarrhoeal infections. and the study of special disease problems in the South Pacific area. The following assistance was provided during the period under review: ~-' ( ,....,;..... . . WPR,lRC25/3 page 137 Fiji (Jan. - Feb. 1974). A consultant reviewed the diagnostic and laboratory procedures for leptospirosis, advised on training needs, the type of survey which should be carried out to determine the local epidemiology and epizootology, and the treatment measures required. Tonga (July - Aug. 1973). out a survey of the incidence of diagnostic procedures suited to and preventive measures. A consultant assisted in carrying leptospirosis and in developing the country, and advised on treatment Western Samoa (Aug. - Sept. 1973). A consultant assisted in determining the extent of the problem posed by certain zoonoses of public health importance and studied certain communicable diseases in the transmission of which animals playa part • 3001 Environmental health adVisory services, South Pacific area (1965-77) UNDP - To assist countries and territories in the area to improve community water supplies and environmental sanitation in general. During the period under review, assistance was provided to the British Solomon Islands Protectorate, Fiji, Gilbert and Ellice Islands, New Hebrides, Tonga and Western Samoa. 3201 Provision of basic sanitary measures (1968-77) R - To assist gQvernments in carrying out studies on water supply, sewerage and other environmental health programmes, and in developing such programmes. The intercountry sanitary engineer made the following visits: Khmer Republio (8-13 April 1974). To make a survey of the population, estimated at 162 500 persons, living in areas without a community water supply and to advise on the necessary aotion to be taken in order to prevent the spread of water-borne diseases. Laos (8 July - 18 Aug. 1973). To make a preliminary study of a water supply scheme for Tha Deua town located along the Mekong River 30 kilometres downstream from Vientiane. (14 Jan. - 16 March 1974). To prepare preliminary feasibility engineering studies on water supplies for 3 of the medium-sized provincial capitals: Sayaboury, Houei Sai and Keng Kok, as a basis for negotiating bilateral aid. Proposed legislation for the control of the quality of drinking water was also discussed with the Ministry of Health. WPR/RC25i3 page 138 Malaysia (22 Sept. - 17 Nov. 1973). To prepare preliminary feasibility studies for sewerage for Butterworth, Penang State, and for Bangi New Town being established in the State of Selangor. The studies were to include, ~~, the basic layout of the sewerage system, proposals for wastes disposal and treatment, preliminary construction cost estimates and a phased programme for project imple- mentation. Consultant services were also provided to the following countries: ~ (18-30 March 1974). A consultant identified the nature and objectives of the assistance requested in water supply planning. Malaysia (2 Sept. - 2 Nov. 1973). A consultant assisted the Ministry of Health in organizing a course on food and restaurant sanitation for public health inspectors, the main objective being to improve the level of food sanitation in Malaysia with particular attention to public eating and food.handling establishments. Trust Territory of the Pacific Islands (12 March - 4 June 1974). A consultant assisted the Public Works Department in organizing a course for waterworks operators and in preparing a detailed programme and syllabi for the course. He also participated in the lectures and demonstrations. ViSits were made to district centres to advise on methods for improving the operation of existing water supply systems. Republic of Viet-Nam (26 Aug. - 23 Sept. 1973). A consultant assisted the Ministries of Health and Education in formulating a phased programme for the improvement of the water supply and wastes disposal systems of provincial hospitals, maternity and child health centres, schools, orphanages and similar institutions, and rural communities, as a basis for UNICEF assistance. 4001 Public health advisory services, South Pacific (1962-63; 1965- ) UNDP (South Pacific Commission) To assist countries in the area in strengthening and developing their general health services, parti- cular attention being given to maternal and child health work integrated into the general health services. During the period under review, individual members of the team visited the British Solomon Islands Protectorate, Fiji, Gilbert and Ellice Islands, New Hebrides', Tonga and Western Samoa. 4003 Project systems analysis (1973-78) R The systems analyst assigned to the project is providing management assistance to ongoing WHO-assisted projects. This assistance was provided to the WHO Rep- resentative in Laos with regard to programme management; the general health services development project in the Philippines (4001) in connexion wi th a~ study on the effectiveness of new primary care clinics; and to a similar proJect in the Republic of Korea (4001) for the preparation , .~ " . WPR/RC25i3 page 139 of a plan of work for limited implementation of integrated basic health services. Assistance was also provided in connexion with a workshop held in Malaysia from 12 to 18 December 1973. The objectives of the workshop were to review the feasibility of utilizing the project systems analysiS method in project formulation; to outline major changes, approaches or techniques in the method to make it more practical and effective; and to develop strategies for transferring the method and implementing the proposals. There were 9 participants from Malaysia, the Philippines and Singapore, and 5 partiCipants from the African and south-East Asia Regions. 4101 Training in the field of health planning (1968-77) R To acquaint national health administrators with the general principles of national planning for socioeconomic development and familiarize them with the principles ane methods of national health planning within the framework of such development planning and as an integral part of health administration. Two courses on national health planning were conducted during the period under review: one in Malaysia (18 .June to 27 July), with 28 local partiCipants and 2 from the Republic of Viet-Nam, and the other in Papua New Guinea (13 August to 7 September), with 18 participants from the British Solomon Islands Protectorate, Fiji, Gilbert and Ellice Islands, Papua New Guinea, Tonga, Trust Territory of the Pacific Islands and Western Samoa. PrOvided - 2 consultants, the cost of atten- dance of 20 participants, the services of a staff member and teaching material. The sixth regional course started in Manila in June 1974 with 13 participants from Guam, Japan, Malaysia, Papua New Guinea, the Philippines, the Republic of Korea., the Republic of Viet-Nam, Tonga and Western Samoa. 4102 Advisory services on national health planning (1968-77) R To assist governments, not otherwise receiving long-term assistance in planning, in formulating national health and manpower plans as part of their national development plans. During the period under review, assistance was provided to Laos. 4104 First regional seminar on health manpower plannin Manila (24-2 Sept. 1973) R To review the current health manpower situation in the context of overall development planning in the countries and territories of the Region. the methods used for assess- ment of manpower requirements and the administrative and legislative arrangements for national health manpower planning; to discuss the training of health manpower; and to seek conclusions for better organization, development and utilization of countries' health man- power resources. There were 21 participants from American Samoa, Australia, Guam, Hong Kong, Japan, the Khmer Republic, Laos, Malaysia. New Zealand, Papua New Guinea, the Philippines, the Republic of Korea, the Republic of Viet-Nam, Singapore, Tonga and Trust Territory of the WPR~C2513 page 140 Pacific Islands and observers from the College of Medicine, University of the Philippines, Manila. Provided - 3 consultants, 2 temporary advisers and the cost of attendance of the participants. 4201 Health laboratory services (1971- ) R To assist in the organization and development of public health laboratory services, coordinated with other laboratory facilities, that can support epidemio- logical work, rural health services and sanitation projects. During the period under review, the long-term adviser attached to the project made visits to the Gilbert and Ellice Islands, Tonga and Western Samoa. 4301 Training in maintenance and repair of X-ray and other laboratory equipment (1969-77) R - To assist governments in assess- ing the needs regarding the maintenance of radiological equipment. advise on the organization of maintenance services, and assist in training X-ray operators in the installation, servicing and maintenance of X-ray equipment and in the proper use of radiographic and photo- fluorographic equipment. The WHO technical officer was in Malaysia from September 1973 to July 1974. A consultant in radiography was assigned to the British Solomon Islands Protectorate from September to December 1973 to train radiological technicians in the operation and care of medical X-ray equipment. He also made recommendations on the training manuals and reference books required and on how radiation protection measures could be improved. 4302 Regional centre for the training of anaesthetists (1970-80) R VD - To assist in the operation of a regional centre in Manila for training anaesthesiologists for the countries in the Region. Eight fellowships were awarded to candidates from the British Solomon Islands Protectorate, Fiji, Hong Kong, the Khmer Republic, the Republic of Viet-Nam and Trust Territory of the Pacific Islands. 4304 Hospital design and management (Oot. 1973 - March 1974) UNDP A team of four conSUltants (in hospital design, hospital administration, hospital management, and the repair and maintenance of hospital equip- ment) visited countries of the Region to assess the situation before preparation of detailed project proposals for UNDP consideration. 4401 Nursing advisory services, South Pacific (1967-77) R To assist countries and territories of the area in strengthening nursing education and administration and in developing nursing services. r - '-:.-- Inter - Regional Course on Plan- ning, Administ~ ration and Man-- agement 0 f Health Services, Manila, 8 October to 16 November 1973. First Regional Seminar on Air Pollution - Manila. 22-28 May 1973 First Regional Seminar on National Health Manpower Planning Manila, 24-28 September 1973 Workshop on the Development of Education and Information Materials on Family Health Tonga', 4-18 October 1973 WPRJnC25/3 page 141 During the period under review, the WHO nurse educator provided assistance to the British Solomon Islands Protectorate, Gilbert and Ellice Islands, New Hebrides, Niue and Tonga. 4402 Technical advisory committee on nursing, Manila (10-14 Dec. 1973) R The above committee was convened on the basis of resolution WPRjRC22.R20, adopted by the Regional Committee at its twenty-second session, to formulate guidelines on the action which might be taken to provide and strtngthen nursing and midwifery services in national health programmes. ~e committee was composed of seven nursing experts (temporary advisers) coming from Australia, Japan, Malaysia, New Zealand, the Philippines, the Republic of Korea and the Republic of Viet-Nam. Provided - 3 consultants and the cost of attendance of the committee members. 4404 Nursing education (1974-78) R To advise and assist national health administrations in the development of basic and postbasic nursing midwifery education programmes. This will include advice and assistance in the strengthening and development of existing nursing/ midwifery education programmes; and the need for, and introduction of. new ones. In cooperation with the staff of national health administra- tions and the staff of other interested WHO-assisted projects, to study the feasibility of establishing an intercountry training centre for postbasic education in nursing and midwifery to meet the needs of countries having only a small number of students; and in the event that such a centre is considered feasible, to advise and assist in its planning and implementation. The nursing adviser attached to this project visited Guam, Singapore and the Trust Territory of the Pacific Islands during the period under review. 4501 Seminar on the training of health workers in health education, Manila. (23 July - 3 Aug. 1973) R To promote planned and systematic development of health education and related social sciences as a part of the curricula of the schools and institutions in the Region that are responsible for the education of professional and auxiliary health personnel. There were 16 participants from Australia, Guam, Hong Kong, Japan, the Khmer Republic, Laos, Malaysia, New Zealand, Papua New Guinea, the Philippines, the Republic of Korea, the Republic of Viet-Nam, Singapore, Tonga, Trust Territory of the Pacific Islands and Western Samoa, and observers from UNICEF, UNESCO and the Silliman University Medical Center, Dumaguete City, Philippines. Provided - 2 consultants, 2 temporary advisers and the cost of attendance of the partiCipants. ISee Handbook of Resolutions and Decisions of the Regional Committee for the Western Pacific, 1974, 8th ed., section 1.5.8, page 67. WPR~C25~ page 142 470, Radiation health advisory services (1973- ) R - To assist governments in the organization, management and operation of radiation medioine and radiation protection services, training programmes in radiation health, and the collection and analysis of data on radioactive pollution of the environment. The following assistance was provided during the period under review: A oonsultant was assigned to the Philippines for 9 months to assist in the development of a programme for training of radiological teohnioians. He also participated &s a tutor in 4 refresher courses. Preparations were made to assist countries in the calibration of field dosimeters and in determining output from radiation sources, in establishing a basic national radiation dOSimetry service and in training staff on how to assess the doses given to patients. 4901 Health statistics and records (1971-76) R - To assist governments to develop a system of basic health statistics and records to meet the needs of the oountries concerned and facilitate inter- national oomparison; and to train personnel. During the period under review, assistance was provided to Cook Islands, Tonga and Western Samoa. 01 Seoond re 10nal seminar on mental health: teachi of Esychiatry in mediQal sohools. Manila (15-21 Jan. 197) R - To review the ourrent practioes in the teaching of undergraduates in the Region, to determine the objectives of teaoh1ng psychiatry in the undergraduate medical curriculum, the appropriate role of behavioural soiences and the teaQhing of psychiatry. Three working papers were prepared for the activity. namely. "Models of Psychiatric Education". "The Relevance of Traditional Psychiatric Concepts in the Teaching of Psychiatry in the Western Pacific Region", and the "Teaohing-Learning Process". There were 19 participants from Australia, Japan, the Khmer Republ1Q, Malaysia, New Zealand, Papua New Guinea, the Philippines, the Republio of Korea and the Republio of Viet-Name There were also 4 oD.ervers. Provided - 3 consultants and the cost of attendance of the partioipants. At the end of the seminar. a 11st of action priorities was drawn up refleoting the needs of the teaoh1ng of this subJeot 1n the Region. 5501 Dental health advisory services (1972-75) R - To advise on the establishment or strengthening of national dental health services. partioularly those for preventive dentistry, on the basis of data gathered from national surveys, and to assist in setting up or improving programmes for training dental auxiliaries. Educational Activities Photos show participants at the First Regional Training Course on VD Sero- logy and Bacteriology held in Singapore (top photo) and the Regional Semi- nar on the Teaching of Psychiatry in Medical Schools held in Manila. WPR/RC25/~ page 143 During the period under review, the dental health adviser provided assistance to Fiji, Hong Kong, the Khmer Republic, Malaysia, Papua New GUinea, the Philippines, the Republic of Korea and Singapore. 6001 participation on educational meetings (1964- ) R One-week fellowships were awarded to a candidate each from Australia and papua NAW Guinea for attendance at a conference on the control of food-borne diseases, prinCiples of food hygiene practice and food standardization in Singapore. Five II-week fellowships were awarded to candidates from Malaysia, Republic of Korea, Republic of Viet-Nam and the Philippines for attendance at a course in basic immunology in Singapore. 6002 Regional teacher-training centre for health personnel, University of New South Wales, Sydney, Australia (1971-81) R UNDP To assist in establishing and developing a regional teacher-training centre for health personnel at the medical faculty of the University of New South Wales, and national centres in selected countries of the Region. The following intercountry activities were undertaken during the period under review: Workshop for teachers in medical schools in the South Pacific (1-16 Sept. 1973) - 16 participants from Australia, FiJi, New Zealand and Papua New Guinea; workshop for teachers in medical education (11 Nov.-8 Ot=c. 1973) - 19 participants from Australia, .Japan, the Khmer Republic, Laos. Malaysia. New Zealand, Papua New Guinea, the Philippines, Republic of Korea and Republic of Viet-Nam; workshop on curriculum development (23 March-6 April 1974) - 16 partiCipants from Australia, Japan, the Khmer Republic. Laos, New 7,ealand. Papua New Guinea, the Philippines, Republic of Korea. Republic of Viet-Nam and Singapore. Provided - consul tant service~, and the cost of attendance of participants from outside Australia. In addition. consultant services were provided for the national workshop .in medical education held jn Malaysia from 30 October to ) November 1973. 6003 Third regional seminar on education and training: meeting of deans of medical schools. Sydney (12-18 Feb. 1974) R There were 20 partiCipants from Australia, Fiji, Hong Kong, Japan, the Khmer Republic. laos, Malaysia, New Zealand, Papua New Guinea, the Philippines. Republic of Korea, Republic of Viet-Nam and Singapore. Provided- 2 consultants. 3 temporary advisers and the cost of attendance of the partiCipants. 6401 Institutions for the training of health personnel (1966- R WPR/RC25/3 page 144 7303 Epidemiological pilot study on drug abuse (1973- R VD A team consisting of a public health administrator and a consultant experienced in the field of drug dependence and abuse, commenced the study in Malaysia. 9602 Seminar on the medical and surgical aspects of family planning, Tokyo (2-8 Oct. 1973) UNFPA To provide information on developments in methods of contraception and research on contraceptive procedures; to discuss the methods used in national family planning programmes in the participating countries; and to formulate conclusions to serve as a guide for the selection and use of contraceptive methods. There were 21 participants from Australia, Fiji, Hong Kong, Japan, the Khmer Republic, Laos, Malaysia, New Hebrides, New Zealand, Papua New Guinea, the Philippines, Republic of Korea, Republic of Viet-Nam, Singapore, Tonga, Trust Territory of the Pacific Islands and Western samoa, and observers from the Ministry of Health and Welfare, Japan, Family Planning Federation of Japan, Japan Medical Association, International Planned Parenthood Federation, and the United States Agency for International Development. Provided - 3 consul tants, 3 temporary advisers, the cost of attendance of the participants, financial assistance to Host Government and the services of e staff members. 9603 Family health field advisory s~rvic~ (1971-76) UNFPA To provide advisory services to governments in connexion with the strengthening and development of family planning programmes ~nd their integration within the framework of the basic health services. Special emphasis will be given to planning, organization, education and training. During the period under review, individual members of the team visited the Gilbert and Ellice Islands, Laos, the Philippines, the Republic of Viet-Nam, Tonga and Western Samoa. The following additional assistance was also provided under this project: Republic of Korea (Feb.-May 1974). Two consultants were provided. The first advised the Ministry of Health on the development and strengthening of the hospital family planning programme, in particular on aspects of supervision and guidance, on the continued training of the personnel involved, and on cooperation of the hospitals with the nearby health centres. The second advised the Korean Institute of Family Planning on the development of training programmes for supervisory categories of staff. Assistance was also given in strengthening and developing the field practice component of the family planning training courses. Singapore (20 March-13 April 1974). The family planning programme, including the training aspects, was evaluated, the evaluation mechanism as an integral part of the family planning programme was strengthened, and advice given on the type of research activities which might be carried out. . , , ' WPR/RC25/3 page 145/146 9604 Teach! of family planning, human reproduction and population dynamics in medical schools 1972- ) UNFPA To assist in developing a systematic and coordinated approach to the teaching of family planning, human reproduction and population dynamics in medical schools of the Region. Assistance was provided to Malaysia (April~May 1974) and is now being provided to Papua New Guinea .(June-August 1974). 9605 Advisory team on the development of educational materials for family health (1972- ) UNFPA - To assist national health and other departments in the production and distribution of simple information material on family health, including family planning, maternal and child health, and nutrition. The project consists of workshops, and following the workshops, visits of ~ advisory" team to partioipating oountries. The first workshop was held in Manila in February 1972, the second in Tonga from 4 to 18 Ootober 1973. There were 13 participants from Amerioan Samoa, British Solomon Islands Proteotorate, Cook Islands, Fiji, Gilbert and Ellice Islands, Papua New Guinea, Tonga, Trust Territory of the Paoifio Islands and Western samoa and observers from the South Paoifio Commission, International Planned Parenthood Federation, UNESCO and UNFPA. Provided - 2 consultant, a temporary adviser and the cost of attendance of the partioipants. During the period under review, the team provided assistance to national workshops and seminars held in Malaysia and Western Samoa. 9607 Seminar on family life education, South paoifio, To a (2 -31 Oct. 1973) UNFPA - To orient educators from countries and territories of the South Pacific area in the field of family life education. There were 14 participants from American samoa, Australia, Cook Islands, Fiji, Papua New Guinea and Tonga and observers from the International Planned Parenthood Federation, South Pacific Commission, UNFPA, UNICEF and the University of the South pacifio. Provided - 2 consultants (temporary advisers), the cost of . attendance of partioipants, supplies and equipment, and the services of staff members. f The designations on this map do not imply the expression of any opinion on the part of the Regional Director concerning the legal status of any country or territory. or the delimitation of its frontiers. , Guam 0t;:j Map of the WHO Region for the Western Pacific Trust Terr:i tor), of the Pac.ific '51;'006 Na~ru &il~rt I,. ellic.e·~ New,,·~ Hebr"ides·~ • ~"!.'. Is. TOkelau". W,lIiS .nd" F' ... tuna WESTER"'SAMoA~· .. "meriCdn Samoa . t::J ..... F"JI 'p N~tJ.... French . .;" COOk .: Polynesia . 15.· New CaJedoni. T",,\~ I,. II 0 0 NOTE: Shaded areas are outside the WHO Region for the Western Pacific. p z ~ >< ~ "0 :c: I» '" I)q :xl CD ?a- ~() ~IU -DIJ'I ~0 ';!j -STRUCTURE OF THE WHO REGIONAL OFFICE FOR THE WESTERN PACIFIC AS AT 30 JUNE 1974 r Director-General 1 --------- Regional Committee ,--- (ASsistant Director of Health Services I Liaison and Reports Officer 1 Assistant Director of Health Services I I Assistant Director of Health Services I -l Regional Director @I Country Liaison 1 I Officer 1 Assistant Director of Health Services I L------ -- --- I 1 IpUbliC Information Officer Chief, Administration and Finance I IAdministration and 1 I Finance Officer Reg!onal Advisers Regional Advisers Regional Advisers in: In: 1 in: Y Heal;; Man- Regional Advisers in: Budget and Finance Officers Administrative '1 Trans.lation ServIces Officers Off,cers Strengthening 'Chronic Diseases Maternal and of Health Communicable power Child Health/ Services Diseases Development Family Plannin~ Environmental Nursing Health Nutrition Statistics Malaria Health Education Health Laboratory Services Vector Biology and Control 11 Health Manpower Development Advisers (HMDs) are also responsible for the Library Services of the Regional Office. ?:J Seven WHO Representatives, with offices located in: Fiji (Suva). Khmer Republic (Phnom Penh), Laos (Vientiane), Malaysia (Kuala Lumpur), the Philippines (Manila), the Republic of Korea (Seoul), the Republic of Viet-Nam (Saigon), The office in Suva is an area office and covers also American Samoa, Australia, British Solomon Islands Protectorate, Cook Islands, French Polynesia, Gilbert and Ellice Islands, Nauru, New Caledonia, New Hebrides, New Zealand, Niue, Papua New Guinea, Timor, Tokelau Islands, Tonga, Wallis, Futuna and Western Samoa. That in Kuala Lumpur covers also Brunei and Singapore. The one in the Philippines covers also Guam, Hong Kong, Japan, Macao and the Trust Territories of the Pacific Islands. y One Country Liaison Officer located in Western Samoa (Apia) under the supervision of the WHO Representative, Fiji (Suva). > ~ I\) '0 ~ ~!il "':it ..... 0 Vll\) ..... Vl ~~ Vl I\) ,> . ' TRANSLATED WHO PUBLICATIONS ISSUED BY OTHER PUBLISHERS IN THE WESTERN PACIFIC REGIONl Monograph Series 2 7 21 39 40 41 42 Maternal Care and Mental Health by J. The Cost of Sickness and the Prioe of Health by C.E.A. Winslow The Rural Hospital by R.F. Bridgman Exoreta Disposal in Rural Areas and Small Communities (Extraots only) by E.G. Wagner and J.N. Lanoix Child Guidance Centres by D. Buckle and S. Lebovici Principles of Administration Applied to Nursing Servioe by H.A. Goddard Water Supply for Rural Areas and Small Communities by E.G. Wagner and J.N. Lanoix Cardiovasoular Survey Methods by G.A. Rose and H. Blaokburn Publio Health Papers 8 30 The Role of Immunization in Communicable Disease Control by R. Cruickshank, G. Edsall, J. de Moerloose and V.M. Zhadnov Noise: An Ocoupational Hazard and Public Nuisanoe by A. Bell WPR;1!C25/J page 153 ANNEX 3 Language Japanese Japanese Japanese Vietnamese Japanese Japanese Vietnamese Japanese Japanese Japanese lPublications translated and issued by publishers to whom tranala~1on rights had been granted by WHO. The Organization does not aooept responsi- bility for these translations or undertake their distribution • WPR/RC25/3 Annex 3 page 154 Public Health Papers (continued) 33 42 43 44 48 * 50 The Physiological Basis of Health Standard for Dwellings by M.S. Goromosov The Principles and Practice of Screening for Disease by J.M.G. Wilson and G. Jungner Problems in Community Wastes Management by H.M. Ellis, W.E. Gilbertson, O. Jaag, D.A. Okun, H.I. Shuval and J. Sumner The Prevention of Perinatal Morbidity and Mortality Report on a seminar Principles of Health Planning in the USSR by G.A. Popov Planning and Programming for Nursing Services Mass Health Examinations Approaches to National Health Planning Evaluation of Community Health Centres by Milton I. Roemer Hospital Legislation and Hospital Systems Technical Report Series 55 156 * Public Health Administration First report of the Expert Committee Methodology of Planning and Integrated Health Programme for Rural Areas Second report of the Expert Committee on Public Health Administration Health Education of the Public First report of the Expert Committee Training of Health Personnel in Health Education of the Public Report of the Expert Committee In press. Language Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese '- ' -.J Technical Report Series (continued) 194 215 225 230 250 251 254 301 319 320 367 Local Health Service Third report of the Expert Committee on Public Health Administration Planning of Public Health Services Fourth report of the Expert Committee ort Public Health Administration Public Health Aspects of Housing First report of the Expert Committee Calcium Requirements Report of an FAO/WHO Expert Group Urban Health Services Fifth report of the Expert Committee on Public Health Administration Cancer Control First report of an Expert Committee Public Health Responsibilities in Radiation Protection Fourth report of the Expert Committee on Radiation Protein Requirements Report of a Joint FAO/WHO Expert Group WHO Expert Committee on Leprosy Third report University Health Services Fourteenth report of the WHO Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel The Use of Human Immunoglobulin Report of a WHO Expert Committee Epidemiological Methods in the study of Chronic Disease Eleventh report of the WHO Expert Committee on Health Statistics Treatment and Disposal of Wastes Report of a WHO Scientific Group WPR/RC25/3 Annex 3 page 155 Language Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Vietnamese Japanese Japanese Japanese Japar:ese WPR/RC25/3 Annex 3 page 156 Technical Report Series (continued) 406 410 429 432 439 440 456 459 469 472 Morbidity Statistics Twelfth report of the WHO Expert Committee on Health Statistics Principles for the Clinical Evaluation of Drugs Report of a WHO Scientifio Group Researoh into Environmental Pollution Report of Five WHO Soientific Groups Planning and Evaluation of Health Education Services Report of a WHO ExPert Committee Urban Air Pollution with Particular Reference to Motor Vehicles Report of a WHO Expert Committee Statistics of Health Services and of Their Activities Thirteenth report of the WHO Expert Committee on Health Statistios Researoh in Health Education Report of a WHO Scientific Group National Environmental Health Programmes: Their Planning, Organization and Administration Report of a WHO ExPert Committee Programmes of Analysis of Mortality Trends and Levels Report of a Joint United Nations/WHO Meeting Training in National Health Planning Report of a WHO Expert Committee WHO Expert Committee on Leprosy Fourth report Cerebrovascular Disease. Prevention, Treatment and Rehabilitation Report of a WHO Meeting Statistical Indioators for the Planning and Evaluation of Public Health Programmes Fourteenth report of the WHO ExPert Committee on Health Statistics Language Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Vietnamese Japanese Japanese ,>- Technical Report Series (continued) 480 481 485 493 * 499 506 * 507 510 * 517 * 519 * 522 * 536 * Personal Health Care and Social Security Report of a Joint ILO/WHO Committee The Development of Studies in Health Manpower Report of a WHO Scientific Group Solid Wastes Disposal and Control Report of a WHO Expert Committee Human Development and Public Health Report of a WHO Scientific Group WHO Expert Committee on Smallpox Eradication Second report Organization of Local and Intermediate Health Administrations Report of a WHO Expert CODlDittee Air Quality Criteria and Guides for Urban Air Pollutants Report of a WHO Expert Committee Psychogeriatrics Report of a WHO Scientific Group Statistical Principles in Public Health Field Studies Fifteenth report of the WHO Expert Committee on Health Statistics Reuse of Effluents: Methods of Wastewater Treatment and Health Safeguards. Report of a WHO Meeting of Experts Cell-mediated Immunity and Resistance to Infection Report of a WHO Scientific Group Energy and Protein Requirements Report of a Joint FAO/WHO Ad Hoc Expert Committee Bioavailability of Drugs: Pharmacokinestic Aspects Report of a WHO Scientific Group In press. WPR/RC25/3 Annex 3 page 157 Language Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese WPR;RC25/3 Annex 3 page 158 Other Publications * * * Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death Seventh revision, Volume I Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death Eighth revision, Volume I International Pharmacopoeia First edition, Volumes I, II and Supplement International Standards for Drinking Water Third edition European Standards for Drinking Water Recommended Laboratory Methods for the Diagnosis of Plague Bulletin, WHO, 14, 1956 Health Hazards of the Human Environment Oral Health Surveys. Basic Methods Fundamentals of Exercise Testing by K. Lange Andersen, R.J. Shephard, H.Denolin, E. Varnauskas and R. Masironi, in collaboration with F.H. Bonjer, J.R. Rutenfranz and Z. Fejfar Dictionary of Epilepsy * In press. 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