Twenty-seventh annual report of the Regional Director to the Regional Committee for the Western Pacific covering the period, 1 July 1976 - 30 June 1977

WPR/RC2.S-t3---.. - -· }'lease retutn to WPRO/Library W.ORLD -HEALTH ·oRGANIZATIO~- -- REGIONAL-. OFFICE FOR THE WESTERN PACifiC .Flea8e return -~o \VPRO/Library TWENTY-SEVENTH ANNUaL REPORT · (1 J.uly 1976_ -. SO June 19'1-7) OP THE REGIONAL DIRECTOR TO 'tHE ~-· .. - ' ... -~- ·-· . ·- REGIONA_L COMMITTEEFOR THE WESTERN PACJFIC. _- · TW~NTY-· EIGHTH SESSION · ll .. ' ..,. 1 - ORGANISATION MONDIALE , WORLD HEALTH ORGANIZATION DE LA SANTE REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU R£GIONAL DU PACIFIQUE OCCIDENTAL REGIONAL COMMI'rrEE Twenty-eighth session Tokyo 6-12 September 1977 Provisional agenda item 9 WPR/RC28/3 Corrol 13 July 1977 ENGLISH ONLY TWENTY-SEVENTH ANNUAL REPORT OF THE REGIONAL DIRECTOR TO THE REGIONAL COMMITTEE FOR THE WESTERN PACIFIC Corrigendum Page 59, Section 12.3.2, second paragraph, second and third lines: delete "12-16 September 1977" and replace by "28 November- ) December 1977" Page 101/102, Annex 1 - Structure of the WHO Regional Office for the Western Pacific on 30 June 1977: Footnote 2/, third line, insert "Solomon Islands" between Samoa and-Tokelau Islands. THE WORK OF WHO IN THE WESTERN PACIFIC REGION TWENTY-SEVENTH ANNUAL REPORT OF THE REGIONAL DIRECTOR TO THE REGIONAL COMMITTEE FOR THE WESTERN PACIFIC Covering the period, 1 July 1976 - 30 June 1977 World Health Organization Regional Office for the Western Pacific Manila, Philippines June 1977 WPR/RC28/3 The follo~ing abbreviations are used in this report: ASDB CARE ESCAP FAO IAEA IBRD lEA ILO IMF SEAMHO SEAMIC SPC UNDP UNDRO UNEP UNESCO UNFPA UNICEF UNIDO USAID WFP Asian Development Bank Cooperative for American Relief Everywhere Economic and Social Commission for Asia and the Pacific Food and Agriculture Organization of the United Nations International A1:om:tr: Energy Agency International Bank for Reconstruction and Development ("World Bank") International Epidemiological Association International Labour Organisation International Monetary Fund Southeast Asian Medical and Health Organization Southeast Asian Medical Information Centre South Pacific Commission United Nations Development Programme Office of the Disaster Relief Coordinator Un:l.ted Nations Environment Programme United Nations Educational, Scientific and Cultural Organization United Nations Fund for Population Activities United Nations Children's Fund United Nations Industrial Development Organization United States Agency for International Development World Food Programme -ii- - ·. I CONTENTS INTRODUCTION ••••••••••••••••••••••••••••••••••••••••••••••••• ix 1. 2. 3. 4. 5. PART I. GENERAL STATEMENT OF ACTIVITIES IN THE REGION GENERAL PROGRAMME DEVELOPMENT ••••••••••••••••••••••••••• 3 1.1 General programme planning and development ••••••••• 3 1. 1. 1 1. 1. 2 1. 1. 3 1. 1.4 Training in health planning and management •• Country health programming •••••••••••••••••• Operational research •••••••••••••••••••••••• Other collaborative efforts ••••••••••••••••• 3 3 4 4 1.2 Research promotion and development ••••••••••••••••• 4 1.3 Information systems programme •••••••••••••••••••••• 6 GENERAL HEALTH SERVICES ••••••••••••••••••••••••••••••••• 6 2.1 Health services development •••••••••••••••••••••••• 6 2.1.1 Hospital administration ••••••••••••••••••••• 7 2.2 Primary health care and rural development •••••••••• 8 FAMILY HEALTH ........................................... 9 3.1 Maternal and child health and family planning •••••• 9 3.2 Nutrition •••••••••••••••••••••••••••••••••••••••••• 11 3.3 Health education ••••••••••••••••••••••••••••••••••• 13 HEALTH MANPOWER DEVELOPMENT ••••••••••••••••••••••••••••• 4.1 4.2 4.3 4.4 4.5 Health manpower planning ••••••••••••••••••••••••••• Training of health personnel ••••••••••••••••••••••• Educational methodology and technology ••••••••••••• Meetings for the exchange of information ••••••••••• Fellowships programme •••••••••••••••••••••••••••••• COMMUNICABLE DISEASE PREVENTION AND CONTROL ••••••••••••• 5.1 Epidemiological surveillance ••••••••••••••••••••••• 5.2 Malaria •••••••••••••••••••••••••••••••••••••••••••• 5.2.1 General review •••••••••••••••••••••••••••••• 5.2.2 Progress of work in individual countries or areas •••••o•••••••••••••••••••••••••••• -iii- 15 15 15 17 18 19 20 20 31 31 32 6. 5.3 CONTENTS Parasitic diseases other than malaria •••••••••••••• 5.3.1 5.3.2 Filariasis ••••••• 0 ••• •••••• 0 ••••••••••••••• Schistosomiasis •••••••••••••••••••••••••••• 5.4 Expanded programme on inununization ••••••••••••••••• 5.5 Bacterial and virus diseases •••••••·~··••••••·••••• 5.5.1 5.5.2 5.5.3 5.5.4 5.5.5 ).5.6 5.5.7 5.5.8 5.5.9 5.5.10 5. 5. 11 Gastrointestinal diseases •••••••••••••••••• Typhoid •••••••••••••••••••••••••••••••••••• Streptococcal infections ••••••••••••••••••• Leprosy •••••••••••••••••••••••••••••••••••• Tuberculosis •••••••••o••••••••••••••••••••• Sexually transmitted diseases •••••••••••••• Respiratory infections excluding tuberculosis •o••••••••••••••••••••••••••• Influenza •••••••••••••••••••••••••••••••••• Poliomyelitis •••••••••••••••••••••••••••••• Dengue fever/dengue haemorrhagic fever ••••• Viral hepatitis •••••••••••••••••••••••••••• 5.6 Veterinary public health/zoonoses •••••••••••••••••• 5.6.1 Rabies ..................................... 5.7 Vector biology and control ••••••••••••••••••••••••• 5. 7. l 5.7.2 5.7.3 s. 7.4 5.7.5 Control services ••••••••••••••••••••••••••• Training ••••••••••••••••••••••••••••••••••• Regional seminar on the safe use of pesticides ••••••••••••••••••••••••••••••• Field investigations ....................... Vector control units ••••••••••••••••••••••• NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL ........... 6.1 Cardiovascular diseases •••••••••••••••••••••••••••• 6.2 Oral health •••••••••••••••••••••••••••••••••••••••• 6.3 Mental health ••••••••••••o•••••••••••o••••••••••••• 6. 3. 1 Prevention and control of alcoholism and drug dependence •••••••••••••••••••••• 6.4 Biomedical aspects of radiation •••••••••••••••••••• 6.5 Health of working populations •••••••••••••••••••••• 7. PROPHYLACTIC, DIAGNOSTIC AND THERAPEUTIC SUBSTANCES ••••• 7.1 Drug policies and management ••••••••••••••••••••••• -iv- ... _ 16 36 36 56 37 37 37 37 38 38 39 40 40 40 40~ 40 41 41 41 41 41 41 41 41 t,.z 42 42 ~~ '3 43 43 44 -,- 44 t.f., 8. 9. 7.2 7. 3 CONTENTS Biologicals ••••••••••••••••••••••••••••••••••••••• Health laboratory technology •••••••••••••••••••••• PROMOTION OF ENVIRONMENTAL HEALTH ....................... 8.1 8.2 8.3 8.4 8.5 Provision of basic sanitary measures •••••••••••••• Pre-investment planning for basic sanitary services ·~··•••••••••••••••••••••••••••••••••••• Control of environmental pollution and hazards •••• Establishment and strengthening of environmental health services and institutions •••••••••••••••• Food safety programme ••••••••••••••••••••••••••••• HEALTH STATISTICS •••••••••••••••••••••• 0 •• •••••••••••••• 44 45 47 47 48 48 so so 51 10. WHO PUBLICATIONS •••••••••·•••••••••••••••••••••••••••••• 52 11. HEALTH INFORMATION OF THE PUBLIC •••••••••••••••••••••••• 52 12. COOPERATION WITH OTHER ORGANIZATIONS •••••••••••••••••••• 54 12.1 Cooperation with the United Nations and related agencies •••••••••••••••••••••••••••••••• 54 12. 1. 1 12. 1. 2 Economic and Social Commission Asia and the Pacific (ESCAP) United Nations Children's Fund for 54 (UNICEF) ••••••••••••••••••••••••••••••• 55 12. 1. 3 12. 1.4 12.1.5 12.1.6 12. 1. 7 12.1.8 12. 1. 9 12. 1. 10 United Nations Development Programme (UNDP) ••••••••••••••••••••••• United Nations Environment Programme (UNEP) ••••••••••••••••••••••• United Nations Fund for Population Activities (UNFPA) ••••••••••••••••••••• World Food Programme (WFP) ••••••••••••••• Food and Agriculture Organization of the United Nations (FAO) •••••••••••• United Nations Educational, Scientific and Cultural Organization (UNESCO) ••••• International Bank for Reconstruction and Development (IBRD or World Bank) ••• International Labour Organisation (ILO) •• 12.2 Cooperation with intergovernmental organizations ••••••••••••••••••••••••••••••••••• 12.2.1 12.2.2 Asian Development Bank (ASDB) •••••••••••• South Pacific Commission (SPC) ••••••••••• -v- 55 56 56 57 57 57 57 57 57 57 58 CONTENTS 12.3 Cooperation with other organizations and agencies •••••••••••••••••••••••••••••••••••• 12.3.1 Southeast Asian Medical and Health Organization (SEAMHO) Southeast Asian Medical Information Centre (SEAMIC) ••••••••••••••••••••••••• 12.3.2 United States Agency for International Development (USAID) ••••••••••••••••••••• 59 59 59 12.4 Other joint work •••••••••••••••••••••••••••••••••• 59 13. CONSTITUTIONAL AND LEGAL DEVELOPMENTS, FINANCIAL AND ADMINISTRATIVE DEVELOPMENTS ••••••••••••••• 60 13.1 The Regional Committee •••••••••••••••••••••••••••• 60 13.2 Regional Office ••••••••••••••••••••••••••••••••••• 63 13. 2. 1 13.2.2 13. 2. 3 13. 2.4 Organizational structure •••••••••••••••••• Salaries and allowances ••••••••••••••••••• Regional Office premises ••••••••••·••••••• Regional obligations and expenditures ••••• PART II. EVALUATION SUMMARIES OF SELECTED PROJECTS ENVIRONMENTAL HEALTH ADVISORY SERVICES, MALAYSIA 63 64 64 67 (MAA../SES/001) •••••••••••••••••••••••••••••••••••••••••••••••• 73 NURSING EDUCATION, PAPUA NEW GUINEA (PNG/HMD/002) ............ 79 EDUCATION AND TRAINING ADVISORY SERVICES, PAPUA NEW GUINEA (PNG/HMD/004) ••••••••••••••••••••••••••••••• 82 REGIONAL WORKING GROUP ON BASIC HEALTH SERVICES (ICP/HSD/010) •••••••••••••••••••••••••••••••••••••••••••••••• 85 ORAL HEALTH ADVISORY SERVICES (ICP/ORH/001) •••••••••••••••••• 90 ANNEXES 1 STRUCTURE OF THE WHO REGIONAL OFFICE FOR THE WESTERN PACIFIC ON 30 JUNE 1977 ••••••••••••••••••••••••• 101 2 TRANSLATED WHO PUBLICATIONS ISSUED BY OTHER PUBLISHERS IN THE WESTERN PACIFIC REGION • • • • • • • • • • • • • • • • 103 -vi- CONTENTS TABLES AND GRAPHS NL~BER OF FELLOWS BY COUNTRY OR AREA, 13 ~~y 1976 - 15 MAY 1977 ••••••••••••• ., •••••••• .,............... 21 BREAKDOWN OF SOURCES OF FUNDS FOR FE'U.O\.JSHIPS AWARDED FROM 13 ~y 1976- 15 ~y 1977 ••••••••••••••••••••••• 23 TYPES OF STUDIES ARRANGED, 13 ~y 1976 - 15 ~y 1977 ••••••••••••••••••••••••••••••o••••••••••••<>•••••• 23 PROFESSION OF FELLOWS, 13 ~y 1976 - 15 MAY 1977 ............................ 0 • • • • • • • • • • • • • • • • • • • • • • 25 FIELDS OF STUDY OF FELLOWS, 13 MAY 1976 - 15 MAY 1977 ................................................... PLACES OF STUDY OF FELLOHS, 13 MAY 1976 - 27 15 1'-fAY 1977 ••••••••·••••••••••••••••••,..••••••oeoo••••••••••••• 29 TABLE OF OBLIGATIONS INCURRED BY THE WHO WESTERN PACIFIC REGION, 1967-1976 •••••••••••••••••••••••••••••••o•••• 68 GRAPH OF OBLIGATIONS INCURRED BY THE WHO lvESTERN PACIFIC REGION, 1967-1976 •••••••••••••••••••••••••••••••••••• 69 The designations employed and the presentation of the !nateria1 in this report do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organiz3tion concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimination of its frontiers or boundaries. Where the designation "country or area11 appear::; in the headings of tables, it covers countries, territories, cities or areas. -vii/viii- ,C INTRODUCTION Satisfactory progress was made in general programme development during the year, particularly in relation to research and information systems. A significant step in research promotion and development was the establishment of the Regional Advisory Committee on Medical Research (RACMR) to advise on future research activities. Three RACMR task forces - for health services research, for research in cardiovascular diseases and for research in parasitic and other commt.micable diseases - were set up and made recommendations. A review was made of the organization and functions of the Institute for Medical Research, Kuala Lumpur, Malaysia, with a view to its eventual designation as a WHO regional centre for research and training in tropical diseases. It was found that some of its departments will need to be strengthened for this purpose through further WHO collaboration and fellowships. Another study underlined the importance of providing logistic support and incentives to stimulate multidisciplinary research on ~ japonicum infection in the Philippines. A'WHO medical officer with specific responsibility for research promotion and development in the Region was appointed. ;·~th regard to information systems, it is clear from the cooperative efforts of WHO with Member governments that sound programme planning and management requires adequate information on the resources available for attaining targets and on present, medium- and long-term trends. Information is also needed for the evaluation of activities implemented in relation to those planned. Both the WHO and the national information systems will have to be strengthened for these purposes. A number of steps have been taken to improve. the situation. Information cannot replace sound planning, programming, management and evaluation; it can only support it. Nevertheless it is felt that one of the common denominators in the efforts of organizations to rationalize development, particularly in the health field, is the establishment of health information systems with emphasis on functional output of data, where they are needed, rather than input for central processing which has been the tendency up to now. For WHO, such systems definitely seem better attuned to the evolving needs of country health and medium-term programming. Thus the development of adequate information systems is a major concern for WHO, both in its internal functioning and in its cooperation with Member governments. Following reorganization which is now in progress, a new internal information system is being developed and is expected to be formally introduced in WHO in January 1978. The system will include country, programme and project profiles showing the organization and purpose of WHO's activities at the different levels. In addition, the orderly information thus obtained from the regional contributions to the programme profiles will provide the nece$Sary basis for formulating a -ix- medium-term programme for the Region, derived from the WHO Sixth General Programme of Work covering a specific period (1978-83). At the same time, to ensure an adequate flow of information into the system, a new reporting system is under study and will also be implemented next year. Activities to strengthen information systems at the country level included cooperation with Malaysia in developing a comprehensive information system to support the planning and management of health programmes at all echelons of the Ministry of Health. Similar efforts are under way in the Philippines where the Government is implementing an integrated health development programme (1974-1977) with emphasis on streamlining of activities. For all the above innovations training is an essential requirement. Thus WHO has sponsored courses for its own staff and nationals and plans to hold more on the same lines in the years to come. A major trend in strengthening general health services in the developing countries of the Region is the promotion of primary health care. Under an intercountry project established for the purpose, national dialogues and workshops were organized with the aim of adapting the new policy to local conditions and improving the delivery of health services to underserved areas. Problems in managing such services and ensuring c9mm0nity participation were identified and will be further discussed at the regional conference on primary health care to be held in Manila in November 1977. There were several important developments in family health. Frontline health workers are now assuming broader responsibilities and providing wider coverage in health care, with the benefit of modest training and active community involvement. There is increasing recognition of the interrelationship between maternal and child health, nutrition, infection and basic sanitation and between health and socioeconomic development. As in other fields of health care, this has led to better appreciation of the need for an integrated approach, with operational links between the family health and general health services, increased collaboration between the health and other sectors involved in community well-being and streamlining of resources generally. The above approach is being applied in a number of countries. In Papua New Guinea aid post orderlies are being trained for broader duties, including motivation of the community, prevention, diagnosis and treatment of simple diseases and distribution of condoms and oral contraceptives. Similarly, midwives in Malaysia and the Philippines are being prepared for functions beyond attendance at deliveries; in their new role they will serve as primary health workers endeavouring to meet the health needs of all members of the family. Although the integrated approach to health care through the use of multipurpose workers has gained wider acceptance, much further thought will have to be given to determining the specific needs and hazards which apply to the family as a unit, determining priorities for dealing -x- . , with them, developing easy-to-learn techniques so as to enhance the skills of the village health workers involved, giving them much needed supervision and encouragement, promoting cotim\lmity support and strengthening systems for programme information, monitoring and evaluation. This is no small challenge. In the field of nutrition,· progress was made in training staff, integrating nutritional work into routine field services and introducing su. rv. eillance. systems. Supplementary feeding, althou.ghra stop-gap measure, continued to expand, .while procedures for vitamin A . and iodine fortification were investigated and relevant programmes formulated. / A major challenge in combatting malnutrition, a multifactoral problem, is to combine the efforts of the different agencies concerned with social and economic development. ~ck of such coordination hampers the formulation of national food and nutrition policies and programmes. High-level coordinaUng and supervisory bodies should therefore be set up with access to policy-makers and support by trained stafL · · These trends in the development' of health services highlight the importance of community involvement, not merely in terms of passive acceptance of ~dvice and services but of active. and dynamic participation in heaith planning and management and marshalling of local resources to expand health care. Success in enlisting community support depai.ds especially upon the ability of froptline health workers to incorpora·~e health educational and motivational efforts in their daily activities. Efforts were therefore made to develop simple and practical means of training health and allied workers for this purpose, while studies were undertaken to determine the factors which influence public response to malaria control, oral rehydration and immunization. Though the facilities for preparation of health education specialists have expanded substantially in recent years, practically none of the institutions in the Region are in a position to provide concurrent field training to reinforce the classroom instruction. Combining theory with practice is particularly important in an area like health education, where the learning of skills and a community- oriented outlook is so vital and it is thus to. this aspect of the training that special attention will be paid in the coming years. At the same time continuing efforts will be made to relate health education more directly to conditions in the developing countries. In the area of health manpower development some progress can be recorded in the training activities undertaken during the year . Particular attention was paid to teacher training. Although the Regional Teacher Training Centre for Health Personnel, Sydney, Australia, and nati,onal centres in the Philippines and the Republic of Korea have been in .operation .for .a number of years, there is still a major task ahead in.the further deveiopmerit of self-reliance iri Member countries and the planning, .implementation and evaluation of educational programmes for health workers. In the past, emphasis was given to -xi- improvement of educational technology as such, but it is now realized that educational changes cannot be maintained without corresponding modification of the institutions where they are introduced and that such changes are of little value unless they are fully relevant to national health care requirements. Moreover, unless interventions to facilitate change are made as soon as the need is recognized, the motivation for change may well be lost. Much flexibility is therefore required in the formulation of educational strategies. At country level the Organization continqed to collaborate in conventional health manpower training. However, as the capacity of most countries to undertake their own programmes has increased substantially in recent years, it is expected that the WHO services will be reoriented. In nursing, for instance, it is probable that future cooperation will be aimed at developing systems of continuing education in various clinical areas, including public health nursing, as well as supportive areas such as teaching and administration. Greater willingness by countries to accept the valuable contribution of middle-level health workers in the provision of health care has also been observed. Apart from the medical assistant prog~a~ in Fiji, the Gilbert Islands started a course in January 1977 that provides one year's training to selected nurses, enabling them to function as medical assistants. All the above observations underline the importance of sound manpower planning. Since the implementation of any health programme calls for skilled staff, these must be trained according to the service requirements. It is in this area that operational research may give good results, somettmes pointing to a need for staff of new categories or orientations. Collaboration was extended to New Zealand in the fields of health manpower planning and health service reorganization and from this it became clear that the WHO input should not be exclusively limited to developing countries but can also be usefully directed to developed ones. Many countries are now engaged in national health planning. To achieve specified targets and optimize the use of scant resources there must be close coordination among the various agencies concerned with planning, production and financing of health wo~kers as well as those making use of their services. Country health programming will include health manpower planning, on which more studies may therefore be expected in the future. In the field of communicable disease prevention and control high priority was given to tmmunization while other measures to control the diseases prevalent in the Region continued. The primary atm of the expanded programme on immunization is to protect infants and young children against tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis and measles. The planning and implementation of the programme in the Philippines stands out as a good example of international collaboration. With support from WHO and UNICEF, as well as a substantial input ~rom the Government of the -xii- Netherlands, the Philippine Department of Health drew up a nationwide immunization plan covering all the diseases under the programme except measles and is expanding its BCG and DPT vaccine production capacity to meet the needs. Poliomyelitis immunization will initially cover areas where outbreaks have occurred. Several other governments expressed interest in taking part in the programme and some are making an inventory of their existing immunization services as a first step. Development of the programme has again drawn attention to the scarcity of well qualified and trained epidemiologists in the Region and the need for adequate laboratory support. Problems connected with the cold chain also need to be solved. A simple oral rehydration treatment for the widespread problem of diarrhoeas is now available to health services, following confirmation of its effectiveness. The Lao People's Democratic Republic and the Philippines decided to promote this treatment on a large scale and other Member governments may wish to introduce it. Although a steady fall in the tuberculosis infection rates in the Region was recorded in the past decade, the decline has been rather slow in some countries. Most of the governments have a national tuberculosis programme, in many cases well integrated into the general health services. However the quality of service must improve considerably if faster progress is to be made in controlling the disease. There is also a need for more effective training and supervision of tuberculosis workers and evaluation of the programmes. The importance of an integrated nationwide approach to leprosy control, based on case-finding and treatment carried out by the general health services, is recognized. For this purpose health workers were trained at various levels in collaboration with the International Federation of Leprosy Associations and in several countries an integrated control programme has been launched. Invaluable assistance continued to be given by voluntary agencies for leprosy control in the Region. Some contributions were channelled through the WHO Voluntary Fund for Health Promotion thus facilitating the organization of control services in accordance with internationally approved principles. Through sustained support by governments, gains achieved in the antimalaria programme were generally preserved and a slight improvement was registered in the overall situation. Alongside the more traditional fields of cooperation, increased attention was given to means of solving some of the major technical problems in the national and regional programmes, including studies on chloroquine resistance, use of alternative insecticides, application of supplementary vector control measures and alternative approaches to overcoming some of the operational difficulties faced. It is expected that the Organization's cooperation in this applied research will receive greater emphasis in the years to come. National committees on dengue haemorrhagic fever and on schistosomiasis were established in the Philippines to make research proposals. -xiii- A filariasis research project was started in Samoa with support from the Japan Shipbuilding Industry Foundation and the Japanese OVerseas Cooperation Volunteers; the aim is to identify certain epidemiological and entomological features of the disease which would be of value in planning practical and economical measures, particularly for vector control. Cooperation with a number of governments continued in surveillance and control of Aedes aegypti, field activities and training of staff for vector control units. In spite of the acknowledged difficulty of controlling houseflies and rodents, control was being undertaken in some countries. The search for more effective measures must be continued. Shortage of professional manpower, as well as lack of funds for recruitment of staff and purchase of equipment and insecticides, remain major problems for vector control in the Region. In this respect the importance must be reiterated of establishing vector control units in all health departments, to be responsible for planning and implementation of control programmes, preparation of technical guides, training of personnel, purchase of equipment and supplies, and testing of new equipment and insecticides. The attention of Member governments was again drawn to the problem of sexually transmitted diseases and in particular to the occurrence of a beta-lactamase producing strain of ~ gonorrhoea (penicillin resistant) in parts of the Region. The epidemiological and treatment implications of the new strain warrant serious consideration. WHO cooperated with a number of countries in strengthen- ing services for laboratory diagnosis and control of these diseases. In the Region noncommunicable disease prevention and control is a matter of growing concern for both the developed and the developing countries. Greater attention is being paid to the chronic diseases, including cardiovascular conditions. Studies on the epidemiology of these diseases and the organization of community-based control measures were undertaken in many countries. Further training is needed on the etiology, epidemiology, diagnosis and treatment of the diseases to facilitate the development of more effective and practical control methods. In the area of oral health, interest was generated not only in the ~plementation of national preventive dentistry programmes but also in the teaching of preventive dentistry within undergraduate and postbasic dental courses. A significant development in the latter respect was the formulation of Guidelines on Dental Health Education of the Public by a working group of experts in Kuala Lumpur in October 1976, which should stimulate further support of national programmes in the Region. Particular interest in educational technology was shown in the Republic of Korea where a first workshop for upgrading the undergraduate dental curriculum was held at the National Teacher Training Centre for Health Personnel with participants from five dental schools. -xiv- Emphasis in mental health was mainly on improving the training of professional staff and integrating mental health care in the general health services. At the same time measures to prevent and control drug abuse and alcoholism continued throughout the year. A working group on early intervention programmes in drug abuse, meeting in Manila in December 1976, reviewed the possibilities for action in this area. A number of accomplishments can be recorded with regard to health laboratory technology as well as some problems and the solutions found to deal with them. The major accomplishment was the further strengthening of national health laboratory services, particularly in coordination and management. Procedures, recording and reporting were standardized, quality control and proficiency testing developed, and new tests and techniques relevant to local needs introduced. Collaboration with epidemiological surveillance services was improved, particularly in specimen collection and the performance of certain laboratory tests. Services were further expanded towards the periphery, with emphasis on public health aspects. Remodelling and reorganization of the vaccine production facilities at the Philippine Department of Health's Serum and Vaccine Laboratories continued. Once the work is completed, the Laboratories could become a regional centre for the supply of several types of vaccine. Foremost among the problems faced are unbalanced development of services, weak diagnostic facilities, inadequate delivery of activities to the periphery and insufficient laboratory support of communicable disease control programmes. There is also a need for the laboratories to become more involved in the work of the epidemiological and surveillance services. Organization also poses problems. Management and coordination of activities and standardization of techniques all require further strengthening. In some places shortage of supplies and equipment, as well as congestion of laboratory space, are major difficulties. It is regrettable that some standard methods, already introduced, have had to be discontinued owing to shortage of materials. Manpower too remains a problem in terms of numbers as well as adaptation of training to the real needs. Training will continue according to the established policies. Finally, with the expansion of immunization programmes, efforts must be made to strengthen the laboratories responsible for quality control of vaccines and to ensure adequate screening of all those used, including imported products. The pattern of WHO technical cooperation in the promotion of environmental health continued to change due to the emergence of new problems, new perception of old problems and shifts in national priorities. -xv- Soae governaents introduced major policies supported by increased budgets thus giving .aaentua to water supply programmes for urban and rural communities. Nevertheless, progress bas been uneven ano the disparity in the provision of this essential service between urban and rural areas is widening in some instances. OVerall the larger developing countries are allocating more funds for water supplies as compared with sewerage. Thb is partly because resources are limited but also because 1110st goveru.ents still do not regard sewerage as an essential service. Thus develo,.ent of this sector continued to be modest and a stronger effort will be required of WHO in promoting sound Dational policies and progr-s. In Malaysia and the Repub lie of Korea aational water supply and sewerage sector studies are already under •Y with support fra~a WRO/IBIU) cooperatiw progra.aes. Environmental pollution probleaa continued to increase in scale and variety, arousina widespread public interest ancl causing governments to take •re forceful action to develop the necessary institutional machinery ano set up control progr._s. But ~ •ny cases the national progr-s launched up to now have been hesitant, inadequate or lacking in direction. Thus a sustained WRO contribution of broad scope will be required to deal with the extreaely complex policy, technical and econoaic aspects of these prograaes. The efficacy of this contribution is necessarily reduced owing to the large number of national agencies with responsibility for various aspects of the environment and the even larger nuaber of international agencies which participate in the prograuaes. Nevertheless VBO is becoming more involved in envir ..... ntal pollution assesStleDt and control as well as water supply and sewerage sector developaent. In future it is expected t.aa further attention will be paid to training of environmental .. npower Which is still in short supply, thus hampering progress. Finally the Jleaional Office carried out a study to ascertain the need and feasibility of establishing a regional centre for environmental health sciences to supp~t the WHO progr..-e and pra.ote technical cooperation among de'ftloping countries in the Region. In the area of health statistics preparation of country health information profiles continued. Many governments cleared the draft profiles su~tted to thea, updated the inforaation and approved their distribution to other govera.ents in the Region. * * * During the course of the year the work of coordinating the special assistance beina provided to the Lao People's Democratic Republic and the Socialist Republic of Viet N .. bas gained momentum. A gratifying de¥elopment bas been the transfer of the Office of the WHO Representative from Bo Chi Minh City to Hanoi; a new WHO Repre- sentative will take up his post in Hanoi in July 1977. -xvi- ·r For the first time, following the adoption by the Regional Committee of resolution WPR/RC27.R8, this report does not include a list of projects operational during the reporting period, although if any representative to the Regional Committee requires information on an individual project it can quickly be made available to him. This is in conformity with the trend whereby the Organization is seeking to develop new programming processes at the country level as a consequence of which projects will increasingly become integral parts of broader programmes for national health development. It is also related to development of the global WHO information system which will come into operation in January 1978 with the aim of facilitating the formulation, management and evaluation of the WHO programme. -xvii- The Japan Shipbuilding Industry Foundation through its chairman, Mr Ryoichi Sasakawa, contributed the equivalent of US$2 million to WHO. Dr L. Hesselvik, former Director of Health Services accepts the contribution from Mr Sasakawa on behalf of the Director-General. During his visit to Manila, Mr Sasakawa visited WHO for discussions with Dr John Hirshman, Director of Health Services (right). At centre is Professor Kenzo Kiikuni, Managing Director of the Sasakawa Memorial Health Foundation. PART I. GENERAL STATEMENT OF ACTIVITIES IN THE REGION 1. GENERAL PROGRAMME DEVELOPMENT 1.1 General programme planning and development WPR/RC28/3 page 3 Collaborative activities continued to expand, particularly through the intercountry health planning and management project which provides training and advisory services in the following areas: planning and programming, project formulation and management, operational research, information systems development, and economic analysis. Under the project, assistance is also given to WHO Regional Office and field staff in developing management approaches to evaluate and increase the effectiveness of the WHO programme. To meet growing demand a programme management officer will be stationed in Suva, Fiji, to provide manage- ment support to Member governments and WHO staff in the South Pacific area and Papua New Guinea. 1.1.1 Training in health planning and management -·-, / The regional and national health planning courses conducted since 1972 by WHO in collaboration with the Institute of Public Health, University of the Philippines, were evaluated by a consultant. On the basis of the recommendations made it was decided to continue the training with some modification of the content, methods of instruction and strategy for transfer of knowledge, in the light of past experience. Collaboration with the Institute will continue, although efforts will be made to develop links with establishments in other countries and thus build up a network of centres able to support these activities. A new management training programme was launched in collaboration with the staff development and training programme of WHO Headquarters and the intercountry health planning and management project. A four- week resident course was held in Manila in October 1976 with 24 participants consisting of both ministry of health officials and WHO staff from the South-East Asia and Western Pacific Regions. The training was designed to develop the behavioural, conceptual, technical and managerial skills of the participants. Support was provided to the WHO/Japan tuberculosis course, Tokyo, 2 June-9 October 1976, in the form of a two-day session on operational efficiency in health services and a one-day session on the rationale ~~ and develop~ent of a national health management information system. 1.1.2 Country health programming In 1976 country health programming (CHP) was initiated in Fiji and Samoa. In Fiji the initial phase took place in the first half of 1976 with support by the health economist on the WHO regional office , staff. The next phase was carried out in September and October in collaboration with a medically qualified consultant. To date no schedule has been set for the final phase. In Samoa the first phase, WPR/RC28/3 page 4 a situational analysis, lasted three weeks in November and December 1976; the second phase commenced towards the end of the reporting period. In the above activities, as in any CHP exercise, a key factor of success is the composition and role of the national advisory committee on country health programming, since it is essential that high-level authorities from all ministries concerned with health activities be involved in the process. 1.1.3 Operational research In the Philippines the second phase of the operational research study of the rural health services was completed. The purpose of this study is to develop an effective management system with components of supervision, supply and information monitoring to support the restrpctured health service delivery system. Cooperation with the Research Institute of Tuberculosis, Tokyo, Japan, continued in conducting operational research which will be of value not only in reformulating the tuberculosis control strategy but also in providing material for participants in the WHO/Japan tuberculosis course. In the Republic of Korea a study was undertaken to develop and improve health service design developed in collaboration with WHO and UNICEF for use in the delivery of health care to the rural population. In the process a national operational research team was formed which could become a nucleus of national expertise for studies in other fields. A number of operational research studies in the Region contributed to development of the regional programme on health services research. 1.1.4 Other collaborative efforts Discussions were held with the Korean Health Development Institute, Seoul, to identify future areas of collaboration with WHO and plan the participation of Institute staff in the current operational research activities of the Ministry of Health and Social Affairs. Under the intercountry promotion of primary health care project, support is provided in developing managerial techniques for planning, updating, evaluating and monitoring health care programmes at village level. Activities in this field are, for instance, under way in the Philippines. 1.2 Research promotion and development During the year, a number of activities took place in connexion with the Regional Advisory Committee on Medical Research (RACMR). It is recalled that RACMR has the function of advising the Regional WPR/RC28/3 page 5 Director on research activities for consideration by the Regional Committee. It is composed of outstanding research scientists from countries and areas in the Region. To ensure coordination and closer working relationships, a member of the Advisory Committee on Medical Research (ACMR) of WHO Headquarters was also a member of RACMR. At its first session RACMR formulated its terms of reference, laid down criteria for selection of priority areas for research, advocated the development of a biomedical research information system and created task forces for health services research, as well as research in cardiovascular diseases and in parasitic and other communicable diseases, with the function of preparing comprehensive proposals including budget estimates in the above fields for consideration by the Regional Committee and funding agencies. The task force for health services research met in Manila from 30 November to 6 December 1976. It considered the definition, scope, approaches, methodologies and problems related to such research and appropriate solutions. A second meeting was held, also in Manila, on 21 and 22 April 1977, to assign priorities to the areas identified for research and to consider specific proposals for activities in the priority areas, together with tentative budget estimates. The task force for cardiovascular diseases research identified three areas of importance, namely rheumatic fever and rheumatic heart disease, hypertenRion, stroke and coronary risk factors. It advocated visits by consultants to assess problems and facilities and identify personnel engaged in such research. It also called attention to the need for training in cardiovascular epidemiology. A consultant studied means of strengthening the Institute for Medical Research, KUala Lumpur, Malaysia, with a view to its eventual designation as a regional centre for research and training in tropical diseases. A need for upgrading of certain units in the Institute through the provision of consultant services and fellowships was noted. A highlight in the consultant services on research during the year were those provided to the Philippines to study the feasibility of setting up a multidisciplinary research programme on Schistosoma japonicum infection in that country, which is the only major focus in the world today. It was reported that apart from limited drug trials which are giving some promising results, as well as circumoval precipitation test studies, no significant work on schistosomiasis due to~ japonicum has been done in recent years. Trained investigators to do the research are available; but they need to be mobilized through the provision of research support and incentives. It was strongly recommended that WHO collaboration be sought for such a programme as a means of strengthening the regional research capabilities. Other consultant services were provided to study special problems in the Region such as gastrointestinal infections and malaria. A filariasis research project was started in Samoa with a generous grant from the Japan Shipbuilding Industry Foundation (see Section 5.3.1). WPR/RC28/3 page 6 A full-time medical officer was appointed for research promotion and development, to be based at the WHO Regional Office. The appoint- ment should help to speed up progress in this field and contribute to solving of the many outstanding health problems. 1.3 Information systems programme Collaboration continued with Malaysia and the Philippines in developing national health information systems. Both analyses and conceptual designs have been completed and current activities focus on development and testing of the systems. The Region is contributing to development of the WHO information system through the preparation of country, programme and project profiles and improvement of WHO internal reporting and evaluation. (". · Concurrently, revised planning and evaluation techniques are being /l)) applied in operations which will be of value in formulating WHO's "'~-_.,.·' medium-term programmes. A workshop was held for WHO staff stationed in the South Pacific to orientate them on the objectives, content and role of the WHO info~tion system as a tool for further improvement of WIO project management and to ensure optima. response in solving some of the problems anticipated tn imple.enting the system. 2. GENERAL HEALTH SERVICES As required for development of the WHO information system, profiles of programmes and projects for health services development and primary health care were prepared. Considerable attention was paid to the promotion of primary health care and related activities. 2.1 Health services development In the Lao People's Democratic Republic sociological aspects of the planning and delivery of health services were studied. A medical officer was assigned to collaborate with the health authorities in strengthening two-way referral between the various levels of health services, as one means of supporting the primary health care system now being developed. In the New Hebrides more emphasis is being given to the delivery of health services at intermediate and peripheral levels. Regular meetings took place between the local WHO staff and officials of the British, French and Condominium health services to discuss coordination. Pilot activities are under way in North Efate demonstration area and in periurban dispensaires in Vila where the existing health services are being reorganized and extended. In Papua New Guinea the medical records and reporting systems are being rationalized. In line with the trend towards decentralization of the health administration, collaboration will be reorientated to WPR/RC28/3 page 7 the provincial level where WHO staff will work with provincial health officers in strengthening community health services and training nurses and other health workers in this field. In the Philippines the findings of an operational research study are being applied to develop a restructured rural health service in which midwives with further training will be placed in charge of primary health care clinics at the periphery. Manuals for each category of health worker involved have been updated and strengthening of systems of supply, information and supervision continues. Technical guidance of the midwives is being improved through inservice training of their supervisors. A two-year course for sanitary inspectors was elaborated and awaits formal government approval. New regulations for the revised Code on Sanitation were prepared. Finally a national seminar-workshop on the teaching of mental health/psychiatric nursing was held, reflecting a growing concern for community mental health in the country. In the Republic of Korea baseline data for operational research were collected and a continuing education programme for myun (district) health workers was established. The study in Yong-in gun (county) on the delivery of services by retrained multipurpose myun health workers, and their supervision from health centres, was completed. The findings are being studied by the Government and a decision will shortly be made on whether to extend or adapt the system in other parts of the country. An important development was the start of collaboration with the recently established Korea Health Development Institute, particularly in the planning and development of services in three areas of the country where the Institute is establishing projects. A study is under way in Samoa to determine which of the duties of district nurses may safely be delegated to village health workers. As a result of a change of government policy district nurses are not to be given increased clinical, administrative and teaching responsibi- lities as originally envisaged; these duties will now be carried out by medical assistants trained either in Fiji or partly in Samoa itself. Activities in the Solomon Islands were undertaken in three main areas: preliminary drafting of a Paper on Health Policy; further development of the teaching and demonstration area in order to upgrade services provided by the clinics and enable student nurses and midwives to receive practical training in public health nursing; and training of sanitary inspectors and strengthening of the services they provide. Under the intercountry public health advisory services, South Pacific, project WHO cooperated with a number of health authorities in the planning and management of health services, paying particular attention to strengthening services at peripheral level in line with the primary health care approach. 2.1.1 Hospital administration The Lao People's Democratic Republic is giving greater priority to medical rehabilitation than was initially envisaged in the country WPR/RC28/3 page 8 health programme. A WHO medical officer (rehabilitation) collaborated in training at the orthopaedic Centre, Vientiane. Consultant services were provided to strengthen the regionalization and administration of the network of hospitals and define their role within the national health services. Cooperation under the hospital administration project in Samoa proceeded as planned. Activities included the commissioning of the new X-ray, operating and physiotherapy blocks at the new National Hospital and the development of services at Foaluga District Hospital, Savai'i. In addition nonmedical administrative procedures were reviewed, supervision and training provided and draft manuals prepared. In Singapore further progress was made in the national hospital redevelopment programme. Delays beyond the control of either the Government or WHO were encountered in the extremely complex develop- ment of OUtram Road General Hospital particularly with regard to design, programming of construction, supervision of subcontractors and cost control. An instruction manual for operational and maintenance staff was prepared. 2.2 Primary health care and rural development The Lao People's Democratic Republic continued to implement a primary health care system manned by village health workers with administrative supervision from local health committees and technical supervision from and referral to the national health services. Professional staff are being trained or retrained in procedures for technical supervision and support of the village health workers. In the New Hebrides the training of villagers selected by local councils, who will serve as sanitary workers and play an active role in rural development, is now firmly established. In Papua New Guinea the training and duties of all categories of health personnel are being studied, particularly with a view to making the aid post orderly more effective as a primary health care worker and to upgrading supportive and supervisory functions within the health services. An important development in the Philippines, influenced by a number of health projects including that supported by WHO in Rizal Province, is the Government's decision to train "barangay" health workers. Agreement was reached on the participation of all the government departments and allied institutions involved. It is envisaged that these workers will function in both remote rural and congested urban areas under technical supervision. In Samoa, following a study of the activities of district nurses, plans are being made to strengthen the primary health care system in collaboration with women's committees, traditional birth attendants and other village workers. Health care delivery in a village of Papua New Guinea's Western Highlands. "Each Member State should develop a health service that is both accessible and acceptable to the total population, suited to its needs and to the socio-economic conditions of the country, and at the level of health technology considered necessary to meet the problems of that country at a given time". - 26th World Health Assembly; WPR/RC28/3 page 9 In the Solomon Islands, following the adoption of a Paper on Health Policy, authority is being delegated from the centre with important provisions for development of primary health care and train- ing of village health aides in areas where they are needed. An intercountry promotion of primary health care project became operational in October 1976. Current activities focus on organization of the regional conference on primary health care due to take place in Manila, 21-24 November 1977. In preparation for the conference two national seminars were held in the Philippines and arrangements made to hold others in Fiji, Papua New Guinea, Republic of Korea, Samoa, Solomon Islands and Tonga. All the national activities are receiving support from UNICEF. An important event during the year was the meeting of the regional working group on baste health services, Manila, 21-29 September 1976, being a first joint undertaking in the Region of WHO and the International Epidemiological Association. It was attended by a multidisciplinary group of 16 members and emphasis was placed on primary health care throughout the discussions (see also Part II "Evaluation summaries of selected projects", pages 85-89). Two countries of the Region, Samoa and the Socialist Republic of Viet Nam, were selected for study by the UNICEF/WHO Joint Committee on Health Policy in view of the innovative procedures they are developing in the field of primary health care. 3. FAMILY HEALTH There is continuing concern about improving the coverage of health services where they do not reach the bulk of the population. As the care of mothers and children is considered a key factor in the expansion of services, particularly to underserved areas, efforts are being made to broaden the scope of the work of midwives which has traditionally been concerned only with the delivery of babies. Midwives in Malaysia and the Philippines are now taking primary health care services to the people. They are thus involved in child care, immunization and health care for all family members as well as advice on contraception, prenatal services and attendance at deliveries. An important feature of their new role is giving traditional birth attendants a new orientation through further training and supervision. 3.1 Maternal and child health and family planning A seminar on the delivery of maternal and child health care and family planning within primary health care was held in Manila from 14 to 20 September 1976, with 24 participants from the Region. The participants agreed that the prevailing morbidity and mortality among children and women of childbearing age were due to many factors and noted that problems were faced with regard to staff training and deployment, and the content of services provided. They pointed out that, in seeking solutions, account must be taken of the interaction of nutrition, infection and fertility regulation. The need for a multiseetoral approach was also emphasized since the health services WPR/RC28/3 page 10 on their own have neither the responsibility nor the capacity to meet all the requirements in reducing the prevalence of malnutrition and communicable diseases and the hazards of reproduction; it was reiterated in this connexion that the improvement of health forms part of overall community development. Under the intercountry family health field advisory services project, cooperation was provided to 11 governments in training staff through the holding of national educational meetings and the provision of fellowships and supplies. Cooperation in country projects took a variety of forms, reflect- ing the diversity of the needs. A fellowship was awarded for study of developmental paediatric programmes in Europe and the United States of America, aimed at further improvement of the well established Child Health Service of Western Australia. In the Cook Islands and Fiji family planning made good progress. In the Cook Islands, where the programme started in 1976, the total number of acceptors on the main island of Rarotonga by the end of March 1976 represented 45-50% of the total target population. The government aims to strengthen the training and supervision of health personnel as well as education and motivation for the programme. In Fiji construction of a national and international training centre for family planning commenced. Present activities focus on manpower development and identification of the existing needs in the teaching of family health. In the Gilbert Islands training was intensified for maternal and child health aides and for medical assistants who are expected to solve some of the manpower problems in the outer islands. The New Hebrides continued to place emphasis on staff training and education of the public, particularly persons active in community development such as women's club leaders. Attention was also given to the develop- ment of a family health reporting system and evaluation of the rural health services. Training with a family planning component was undertaken in Papua New Guinea, Philippines and Samoa. In Papua New Guinea the programme reached its target in 1976. In the period 1975-76, 394 nurses and health extension officers were trained and 545 aid post orderlies, out of the total 1500, attended family health courses. The orderlies' tasks now include treatment of common skin, respiratory and diarrhoeal diseases. Their role in promoting fertility regulation contributed to the expansion of family planning clinics. The number of new acceptors of family planning during the fiscal year 1975-76 was 10 478, representing an increase of 41.7% from the previous fiscal year. In the Philippines, midwives were trained in the insertion of intrauterine devices (IUDs) in an effort to increase acceptance of effective contraception. In Samoa, training of registered nurses in IUD insertion was also encouraged as it was found that such training of six nurses had resulted in a significant increase of acceptors at Mat~rnal and child health services in Malaysia reach more than 65% of 'all mothers and children. WPR/RC28/3 page 11 the district hospitals where the nurses were posted. An evaluation of the activities was carried out in November 1976 recommending continued financial and technical support from UNFPA and WHO through 1978 and preparation by the Government to take over full responsibility for the work by the end of 1978. In the Solomon Islands and Tuvalu the emphasis was on training and promotion in family planning. In the former, work began in introducing family health into the nursing school curricula and preparing the family health and nutrition sections of the Solomon Islands Rural Health Manual. Outstanding features of the family health programme are staff training and promotion of health education in this field. In Tuvalu training of island staff in family health was started. It is expected that delivery of family planning services will be improved through the provision of facilities and supplies to the outer islands. In Tonga the multisectoral approach in promoting fertility regulation was promoted in a four-day seminar on the theme "Social and economic consequences of rapid population growth in Tonga" attended by fifty leaders of government, church and private organizations, as well as principals of colleges. The seminar helped to create awareness of the role and consequences of population growth for the country's socio- economic development and recommended ways of strengthening collaboration between the different organizations in this sphere. The rate of accept- ance of contraception among married women of reproductive age is already 63.51. and the target set for 1980 is 751.. Research in fertility regulation was the main area of cooperation with the Republic of Korea and Singapore. Constraints in implementation of the programme include lack or inadequacy of information, which remains an obstacle to setting of realistic objectives and targets and hence to accurate planning and evaluation of the impact of activities. Also, although successful educational activities have been carried out, a mechanism is still needed which would ensure that the training is properly followed up and that it effectively results in better service. 3.2 Nutrition Anaemia continued to be a problem throughout the Region while protein-energy malnutrition remained common in some areas. Endemic goitre persisted, particularly in mountainous regions and hypo- vitaminosis A is being increasingly recognized as a threat. Although new surveys, for instance in Eastern Malaysia, the Philippines and the South Pacific, have provided confirmatory evidence that these problems exist, the continuous flow of data necessary to allow proper planning and evaluation is still defective; thus development of the multidisci- plinary efforts usually necessary for effective preventive action is hindered. Even when the gravity of the problem is fully appreciated, action is often impeded by western orientated training curricula for staff which pay scant attention to nutrition. WPR/RC28/3 page 12 As required for development of the WHO information system, a programme profile on nutrition was prepared. It sets out five main objectives on which the collaborative efforts of WHO and the Member States will be concentrated. Thus, in moving towards the creation of national food and nutrition policies and progra11!11les, work focussed on the development of surveillance systems, integration of nutritional activities into basic health services, and training. In promoting the control of specific nutritional deficiencies, emphasis was placed on fortification programmes and supplementary feeding of vulnerable groups. Activities included initiation of a pilot nutritional surveillance scheme in the Philippines as well as preparation of an outline nutrition plan, completion of an intervention trial which demonstrated the feasibility of vitamin A fortification, study of a national salt iodization programme and cooperation in training at postgraduate and primary levels. In Malaysia the main thrust was towards progressive expansion of the applied food and nutrition project coupled with train- ing of the necessary national staff and promotion of a nationwide breast-feeding campaign. Attention was also paid to training in the South Pacific. Papua New Guinea is developing a nucleus of staff through overseas fellowships and a new national diploma course, and is considering the appointment of a nutrition planner in the National Planning Office. Arrangements are being made to include ecological instruction in the existing training in Fiji. Finally, investigations were initiated on the possibility of developing a joint Master's course between the Universities of Queensland and the Philippines which would enhance the Region's training resources. On the research side, plans were made for the Republic of Korea to participate in a global anthropometric survey in such a way that it could be expanded to form a component of a nutritional surveillance system. This would complement the growing applied nutrition activities of the Office of Rural Development. Collaboration continued with UNICEF and FAO primarily in promoting field programmes, staff training and planning, and with the World Food Programme in studying the health aspects of feeding programmes to supplement deprived groups and enhance economic development projects in countries such as Fiji, Lao People's Democratic Republic, Philippines, Republic of Korea, Samoa and the Socialist Republic of Viet Nam. A new development has been the designation of the Nutrition Center of the Philippines as an Associated Institution of the United Nations University and the arrival of the first fellows. Contacts were made with ASDB concerning their second Asian Agricultural Survey including proposals for support of nutrition, maternal and child health and family planning packages. It cannot be claimed that there has been any dramatic impact on the problems of malnutrition in the Region which are considerable. However progress was made in some areas and capability and services expanded gradually. Moreover, with the increased attention paid to the rural poor by United Nations agencies and the growing acceptance of social rather than purely economic goals in national planning, prospects for the future should improve. 3.3 Health education WPR/RC28/3 page 13 Health education of the public remained an integral and vital part of all health programmes, increasing emphasis being placed on the need for motivation of the community not only actively to participate in and utilize health care but also to accept a share of responsibility in its management and delivery. The importance of consumer involvement has been brought into sharp focus with growing recognition of the primary health care approach. MOtivation of communities to adopt healthful practices poses a major problem. Persuasive messages and low-cost techniques are being developed Which will enable health and allied workers and leaders in the community to contribute in this respect, particularly in the utilization of community resources for strengthening health programmes. Increasing interest in studying health needs as perceived by the people, in order to gain individual and public confidence in support of health action, is also being observed in many parts of the Region. The important role of the media in promoting public cooperation in health programmes is recognized. In Papua New Guinea and the Solomon Islands support was given in developing educational materials, while audiovisual equipment was supplied to the Socialist Republic of Viet Nam. In Samoa two persons were trained in the preparation of radio programmes on health. Community involvement in health care is in fact part of a total integrated approach to health. In the Region such a trend is apparent in the field of health education in the pooling of person-to-person mass media and community organization efforts, to achieve a balanced and more comprehensive approach and in the shift from concern with a single problem such as family planning, sanitation or malaria to a broader view of health, linked with all related socioeconomic conditions. Examples of such pooling of resources were interagency seminars held in Fiji, Samoa and Tonga to encourage intersectoral collaboration and promote teamwork and better understanding among those working at the community level. In adopting the integrated approach to health, it is essential to ensure that frontline health workers at the field level assume expanded responsibilities for all health-related activities, including health education and motivation, as part of their daily routine. Attempts were made to develop simple and practical methods of training health and allied workers, school teachers and youth and community leaders for the purpose. For instance training seminars and workshops were held in the New Hebrides, Papua New Guinea, Solomon Islands and Tonga to provide a better understanding of the relationship between infection control, nutritional status, environmental health, maternal and child care and fertility regulation. Another important feature of the integrated approach to health is the inclusion of a specific education component within health care programmes and the strengthening of such components where they exist. Efforts on these lines were made wherever feasible. In Malaysia WPR/RC28/3 page 14 health education activities for drug abuse prevention were actively developed. Health education within the malaria programme was further strengthened in Papua New Guinea. Planning of such activities is under way in the Philippines along with nuaerous other health promotional activities, including studies on the health education aspects of the oral rehydration and expanded immunization programmes and the establishment of mothers' clubs which are expected to play a useful health role. In Bohol Province, Philippines, consultant support was given to promote community involvement in family health and welfare programmes. In Tonga a seminar on family health was held for community leaders. Whatever form of approach is adopted, however, training remains a prime need and is fully supported by WHO through the provision of fellowships, consultant services and other means. Efforts are made to prepare specialists in health education and to incorporate this discipline into the basic training of professional and auxiliary health personnel. In Malaysia a postgraduate course was established, paying particular attention to field training. The Institute of Public Health of the University of the Philippines was supported in developing the behavioural science and research aspects of its health education curriculum. Services were provided to Papua New Guinea in strengthen- ing its diploma course in health education which prepares nongraduates to serve as district health education officers and also provides train- ing for health educators from the South Pacific. A diploma course is also conducted at Wellington Teachers' College, Wellington, New Zealand. Recently a postgraduate course in health education was started at Claremont Teachers' College, Western Australia, and the possibility of using it for trainees from other parts of the Region is being explored. Although institutions for training health education specialists have expanded substantially in the Region, practically none have as yet developed facilities to reinforce classroom teaching through concurrent field practice, which is particularly important in a discipline like health education with its emphasis on the development of a community-orientated outlook. Thus it is to field training that special attention will be paid in the coming years. The institutions must also prepare case studies on successful and not so successful experiences under conditions similar to those in the developing countries and areas. A careful analysis was made of recent health education develop- ments in the Region to determine future trends and the need for further support. It confirmed that the present orientation as described above is sound and should be maintained in the next few years. 4. HEALTH MANPOWER DEVELOPMENT 4.1 Health manpower planning WPR/RC28/3 page 15 In this field WHO emphasizes to governments the importance of drawing up plans which take into account the national needs, priorities and resources and of establishing effective functional coordination between the agencies which provide health services and those which train the necessary manpower. A working paper on such coordination, prepared for the consultation on integrated health services and manpower development, Geneva, 6-8 September 1976, was made available to Member States in the Region.l Activities at country level included cooperation with the Lao People's Democratic Republic in making an inventory of the staff available in the country, formulating plans for training up to 1986 so as to provide manpower to fill gaps in the remodelled health services, establishing a new staff category of medical assistant and conducting regular refresher courses. In the Gilbert Islands the training of medical assistants commenced as planned. At regional level WHO cooperated with USAID through participation in the Agency's meeting for evaluation of the Medex programme, convened at the University of Hawaii in February 1977. 4.2 Training of health personnel While being most interested and involved in innovative approaches to the training of auxiliary personnel, WHO continued to collaborate in conventional health manpower development. In Fiji WHO continued the assignment of two full-time lecturers in pathology and paediatrics to the School of Medicine. Their presence has enabled the School to upgrade teaching in these subjects and thus fill an important gap in the health care system. It is hoped that a Fijian physician, due to complete his training in pathology under WHO sponsorship later this year, will assume the responsibilities currently fulfilled by one of the lecturers. A WHO medical officer continued to support the three-year programme for medical assistants. The entire second year of training is now given at Lautoka on the island of Viti Levu where, in addition to a newly opened general hospital, there are fairly accessible health centres. A full-time national coordinator of education is due to be appointed in the near future to work with the WHO medical officer. It is expected that Fiji will admit non-nationals to the programme and candidates from Samoa and the Solomon Islands are already available. The first class of students will graduate at the end of 1977. lRoemer, M.I. services and health HMD/77.1 Annex 1). National experience in coordination of health manpower development (unpublished WHO document WPR/RC28/3 page 16 In the Gilbert Islands support was given in formulating the curriculum of a one-year clinical training programme for graduate nurses enabling them to function as medical assistants. The tasks to be performed by the nurses were carefully defined and the teaching will be completely task-oriented. Intermittent WHO staff support is envisaged for the future in addition to some supplies and equipment. Provision has been made for continuing education of the graduates. In the Lao People's Democratic Republic staff from Claude Bernard University, Lyons, France continued, under WHO sponsorship, to give instruction in medical chemistry, histology, physiology and neuro- psychiatry. A WHO consultant cooperated in the teaching of community health, paying particular attention to field training and stressing the importance of relating the learning experiences to local conditions. In nursing, the curriculum of the basic state diploma course was revised and programmes were established to improve the skills of instructors. Two consultants began a review of the present medical course at the University of Papua New Guinea with the atm of developing a curriculum better adapted to the country's health service needs and resources. This is expected to be a long process for which further WHO consultant support is foreseen, the assignments being intermittent so as to enable the national staff to implement certain strategies in the intervening periods. Another Wll> staff member worked with the faculty of the College of Allied Health Sciences, Port Moresby, in preparing nurses for teaching and administrative positions and community service (see also Part II "Evaluation su.maries of selected projects", pages 79-81). The education and training advisory services project was amalgamated with that of general health services development and thus the WHO staff member to be assigned will have both teaching and service responsibilities. Consultants reviewed and participated in instruction at the Institute of Public Health, University of the Philippines, particularly the health service administration, health education and sanitary engineering components of the Master of Public Health course. The difficulties identified were mainly budgetary but there are instances where existing but scattered resources could be better deployed. WHO cooperated in nursing curriculum development in the Gilbert Islands, New Hebrides, Samoa and Tonga. By now nearly all the countries/areas in the Region have their own basic nursing education programme. In December 1976 four WHO-sponsored trainees from Fiji, Hong Kong, Papua New Guinea and Tonga and four nationals of the Philippines, resident outside the Greater Manila area, completed the one-year course at the Regional Centre for the Training of Anaesthetist& in Manila. Five WHO-sponsored trainees from Fiji, Gilbert Islands, Hong Kong, Tonga and the Trust Territory of the Pacific Islands as well as five nationals of the Philippines are enrolled in the 1977 course. Interviews of three course graduates now working as anaesthesiologists indicated that the training meets a definite need. Apart from sponsorship of trainees WHO provides teaching support in the course. . ' WPR/RC28/3 page 17 Seven senior public health adminis.trators from countries in the Region and two staff members from the Regional Office visited China from 16 to 30 October 1976 to observe the basic health services. 4.3 Educational methodology and technology Activities at country level made fair progress. Two countries have established national teacher training centres and several others may be ready to do so. Also, while it is true that much remains to be done in rational planning of education and training for health workers, there were many encouraging developments throughout the Region. For example the Fiji School of Medicine defined the competencies in paediatrics required of its medical graduates and a curriculum based on this definition was approved by the school authorities. Similarly, task-oriented teaching in the new medical assistant programme in the Gilbert Islands will allow sounder assessment of the skills of the graduates so that specific weaknesses can be easily identified and additional training provided. Intercountry activities focussed on the Regional Teacher Training Centre for Health Persortnel, Sydney, Australia (RTTC). From the standpoint of organization RTTC has been able to increase its full-time staff through a grant from the W.K. Kellogg Foundation, which in turn has augmented its capability to meet WHO requests for consultant and other services. UNDP maintained its support of the project in 1976 and 1977 in spite of continuing budgetary constraints. With regard to training within RTTC, three WHO-sponsored fellows from Fiji, Philippines and the Republic of Korea were accepted for the Master of Health Personnel Education Course. Since the admission requirements for this degree limit the access of middle-level health personnel, the possibility is being considered of organizing a diploma programme which could start in the 1978 academic year. RTTC held two workshops on its premises: one on instructional design from 5 to 18 December and one on midwifery teacher training from 30 January to 12 February 1977, each with 18 participants. RTTC staff provided support for national workshops on educational topics in Hong Kong, Malaysia, Philippines and Singapore. A total of 250 persons from 120 institutions in the Region have attended RTTC courses and workshops since its inception. Other activities included WHO cooperation, through a small grant, in the development of a self-instructional course in physiology by the British Life Assurance Trust Centre for Health and Medical Education, British Medical Association, London. The completed package, which is copyrighted, will be distributed to a number of medical schools in the Region which have indicated their interest. WHO provided reference books and bibliographic tools as well as equipment to the Central Medical Library, Hanoi, Socialist Republic of Viet Nam, in order to expand the Library's capacity for producing documents and abstracts in the national language. WPR/RC28/3 page 18 4.4 Meetings for the exchange. of information During the reporting period 12 group activities, with a total of 177 participants from the Western Pacific Region, were arranged and financed largely by the Regional Office. These activities comprised four workshops, four courses, three seminars and one meeting, eight being held outside the Regional Office. Details are given in the following Table. MEETINGS FOR THE EXCHANGE OF INFORMATION Title First regional seminar on the safe use of pesticides, Manila, 30 August- 3 September 1976 Working group on training in management programme for WHO and national health staff, Manila, 13 September-7 October 1976 Regiona 1 seminar on the deli very of maternal and child health and family planning within primary health care, Manila, 14-20 September 1976 Regional seminar on health laboratory services: blood transfusion services, Kuala Lumpur, 4-9 October 1976 Workshop for faculty from schools of nursing in the South Pacific on the integration of population dynamics and family health in the nursing curricula, Suva, 4-15 October 1976 Intercountry workshop on instructional design, Sydney, 5-18 December 1976 Workshop on group dynamics, Manila, 16-17 December 1976 Eleventh WHO/Japan tuberculosis course, Tokyo, 2 June-9 October 1976 Regional course on current trends and advances in the operation and assessment of antimalaria programmes, Kuala Lumpur, 6-30 July 1976 No. of participants 20 Western Pacific Region WHO staff - 8 National staff - 3 South-East Asia Region WHO staff - 4 National staff - 7 24 15 15 18 10 4 16 1-- Nursery at a Peking textile mill. Below, a class for barefoot doctors at the Kai-An commune in Nung-An County, Kirin Province. Health officials and WHO staff visited the People's Republic of China to observe basic health services in October 1976. Photograph shows the group in front of the Ministry of Health, Peking. Front row, from left: Dr J.B. Senilagakali (Fiji); Mr F.C. Go (WHO); Dr Chen Hai-Feng (People's Republic of China); Dr M. Kacic-Dimitri (WHO); interpreter; Dr Moses Tay Leng Kong (Singapore). Back row: Mr Wu (interpreter); Mr M. Sounnavong (Lao People's Democratic Republic); Dr J. Azurin (Philippines); Matron R. Tabua (Papua New Guinea); Dr E. bin Mohamed (Malaysia); Dr Tapeni Faaiuso (Samoa); Dr Chiao (team leader, People's Republic of China). MEETINGS FOR THE EXCHANGE OF INFORMATION (continuation) WPR/RC28/3 page 19 Title No. of participants Management course for WPRO administrative supervisory staff ("teamwork in office management"), Manila, 20-24 September 1976 Workshop on midwifery teacher training, Sydney, 30 January-12 February 1977 Meeting of directors or representatives of schools of public health in the African, Eastern Mediterranean, South- East Asian and Western Pacific Regions of WHO, Teheran, 3-10 March 1977 Tota 1 .................. . 19 18 7 177 Three of the activities were attended by participants from more than one WHO Region: namely the meeting of directors or representatives of schools of public health, with seven participants from the Western Pacific Region, the WHO/Japan tuberculosis course, with four from the Region and the training in management course with eleven from the .Region. Two of the courses mentioned were conducted under the WHO staff development and training programme, being specifically orientated towards the improvement of management skills: that is the training in management course for WHO and national health staff and the management course for general service staff of the Regional Office. The workshop on group dynamics was attended by personnel of the Regional Office. Apart from the above group activities, 16 interregional activities took place with a total of 43 participants from the Western Pacific. One such activity was the interregional teacher training workshop on the development of modular curricula for nurse/midwife educators held in Manila from 12 to 16 August 1976, with 11 out of the 15 participants coming from the Region. 4.5 Fellowships programme The graphs on pages 21-30 give the details of the numbers of fellowships awarded as •ell as other relevant information. The totals exclude awards to participants in meetings for the exchange of information which were of short duration or financed by interregional funds but include extensions of previous awards, e.g. for nationals of Democratic Kampuchea still studying in Europe and those who have completed their studies and are awaiting repatriation. Also included are extensions of previous awards to Vietnamese fellows awaiting WPR/RC28/3 page 20 repatriation after training in the Western Pacific and European Regions. No new awards were made for Democratic Kampuchea or the Socialist Republic of VietNam and only one for the Lao People's Democratic Republic. Arrangements were made for a number of fellows from the South- East Asia and other Regions to undertake studies in Western Pacific countries. The Registry of Training Courses Available for Health Personnel in the Western Pacific Region (third edition, January 1977) was issued to Member States. 5. COMMUNICABLE DISEASE PREVENTION AND CONTROL 5.1 Epidemiological surveillance Communicable diseases remain a public health problem of the first order. Of the diseases subject to the International Health Regulations, plague was reported only from the Socialist Republic of Viet Nam, while the incidence and distribution of cholera did not change significantly from that reported in previous years. It must be assumed that the disease remains endemic in several countries or areas of the Region. Twenty-five of the governments in the Region submitted current reports on notifiable diseases including diphtheria, pertussis, tetanus, poliomyelitis, measles and tuberculosis which are under the expanded programme on immunization. Apart from these routine reports, useful information was obtained by the Lao People's Democratic Republic, Philippines and New Hebrides from special studies on population-based disease patterns in collaboration with the Serum Reference Bank, Tokyo, Japan. It was found that hepatitis B cases were fairly prevalent in the New Hebrides and healthy diphtheria carriers were not uncommon in the Philippines. To facilitate surveillance, a questionnaire was issued for preparation of an inventory of laboratories maintaining live smallpox virus. No information has been received from three governments, but of those that replied only two reported holding stocks. WHO cooperated directly with the Lao People's Democratic Republic, Malaysia and a number of South Pacific governments in strengthening epidemiological services. At present there are few facilities for postgraduate training in epidemiology in the Region, while the provision of such training else- where poses a problem in that those trained do not always use their newly acquired skills in the national epidemiological services on Philippines Republic of Korea Malaysia Singapore Democratic Kampuchea Trust Territory of the Pacific Islands Fiji New Hebrides Papua New Guinea Hong Kong Solomon Islands Tonga Samoa Australia Japan American Samoa New Zealand Cook Islands Gilbert Islands Guam Tuvalu Socialist Republic of VietNam Niue Lao People •s Democratic Republic French Polynesia 0 NUMBER OF FELLOWS BY COUNTRY OR AREA 13 MAY 1976- 15 MAY 1977 WPR/RC28/3 page 21/22 10 12 11 11 9 9 8 7 20 18 30 40 50 60 70 Note: The total of 364 awards issued includes 30 extensions of previous awards. BREAKDOWN OF SOURCES OF FUNDS FOR FELLOWSHIPS AWARDED FROM 13 MAY 1976 - 15 MAY 1977 Ill II n I u IJ , ~ I w -liliiliili) -D I 11 . 4.··:·7: .. It IJI · ............. ,ltlflllllllllllllllllllllllllllllll ~·I II" 0. 6o/o , '• u II Regular UNFPA UNDP Others ~ D TYPES OF STUDIES ARRANGED 13 MAY 1976 - 15 MAY 1977 Fellows attending programmes planned to suit individual requirements Fellows participating in long-term activities organized by WHO (i.e. courses of more than one week duration) ] ~ CJQ:;d co- N~ WN -00 N- ~W 2,5o/o PROFESSION OF FELLOWS 13 MAY 1976 - 15 MAY 1977 0, 8o/o 1.1% noon fi:l:l:l:l:l:l:i:l i\W - 111111111111111111111 -WliJJ Physicians Nurses Sanitarians Laboratory Technicians Dentists, Dental Assistants Hospital Administrators Statisticians Health Educators Radiographers /Radiologists Physiotherapists Others WPR/RC28/3 page 25/26 .\®• E 3 -§¢§ FIELDS OF STUDY OF FELLOWS 13 MAY 1976 - 15 MAY 1977 14, 3"lo Health services Development FamilY Health WPR/RC28/3 page 27/28 Health Manpower Development coaununtcable Di•eue p,evention and conuol Ptophylactic, Dlagnootic and The<apeutlc Substanc<' \IBU\1\1 [ J Promotion of Environmental Health Health Statistics -L 10! l1 !I PLACES OF STUDY OF FELLOWS 13 MAY 1976 - 15 MAY 1977 In countries within the Region In other Regions In the Western Pacific and other Regions WPR/RC28/3 page 29/30 WPR/RC28/3 page 31 their return. Epidemiological assistants might be able to meet some of the needs and the possibility of training them in short courses will be explored. 5.2 Malaria 5.2.1 General review By and large the antimalaria programme continued to develop satisfactorily in the Region; the malaria situation showed a modest improvement, and in countries where the disease is no longer endemic the malaria-free status was maintained. The main event in training was the regional course on current trends and advances in the operation and assessment of antimalaria programmes for professional staff, Kuala Lumpur, 6-30 July 1976. At the national level, courses and seminars were held in the Lao People's Democratic Republic, Malaysia, Papua New Guinea and the Philippines, with cooperation from WHO. The Malaysia/Singapore/Indonesia border meeting on malaria, held in Jakarta in February 1976, was followed by a border meeting in Kuching, Malaysia, between the health authorities of Sarawak and West Kalimantan Province, Indonesia, in January 1977. Other annual coordination meet- ings on health matters including malaria were held between Malaysia and Singapore, and Malaysia and Thailand, as scheduled. The possibility of establishing a DDT production plant in the Socialist Republic of Viet Nam was reviewed by a UNIDO/WHO mission in September 1976. The desirability and feasibility of such a measure were confirmed. With regard to financing, a substantial contribution to the antimalaria programme was received from the Government of Switzerland, providing part of the requirements in 1976-77. Despite its financial problem UNDP provided support for projects in the Lao People's Democratic Republic, Papua New Guinea and the Solomon Islands. The Government of Australia continued to support projects in Papua New Guinea and that of the United Kingdom projects in the Solomon Islands. A variety of research activities was undertaken. Ultra-low-volume (ULV) ground application of malathion against ~ farauti in the Guadalcanal focus of the Solomon Islands has proved disappointing so far; however alternative measures are being investigated. In Kuala Penyu district, Sabah, Malaysia, a trial of house spraying with residual malathion and fenitrothion against local vectors was started in October 1976. As these products are non- deterrent and nonirritant to the vectors and are also airborne, it is anticipated that they will be more effective in destroying them than DDT. The Philippine Department of Health/WHO field project for in vivo and in~ testing of.chl~roquine resistant ~ falciparum was------ extended. Patchy distr~but~on of resistant strains in the country was WPR/RC28/3 page 32 confirmed. The susceptible strains appear to be less sensitive to the drug in areas where chloroquine resistance is common, as compared with those where it does not occur. The introduction of chlor~quine resistant strains into parts of Papua New Guinea posed an additional challenge. Under the WHO special programme for research and training in tropical diseases, current research in the Region was reviewed and the capabilities of the different institutions for carrying out coordinated malaria research, relevant to the regional programme requirements, were assessed. 5.2.2 Progress of work in individual countries or areas Australia The country remained malaria-free. All 34 cases reported in the receptive area north of latitude l9°S proved to be imported. Lao People's Democratic Republic Antimalaria operations regained momentum in the second half of 1976 with the resumption of pre- and post-operational parasite surveys and entomological investigations in Vientiane Plain. Mass drug administration was organized among 50 000 to 60 000 people in each round, providing exceptionally high coverage of 88% of the target population. Active case-detection on a monthly basis was also reinstated in the Nam Ngum dam area, covering about 11 000 people. Drugs were distributed to all provinces. The Government organized a short seminar on the promotion of antimalaria measures for provincial senior malaria technicians in Vientiane in August 1976, and a course for technicians was held in early 1977 with support by a WHO consultant. An ongoing study in Vientiane Province confirmed resistance of P. falciparum to the 4-aminoquinolines in at least 40% of cases. Malaysia (a) Peninsular Malaysia Since the introduction of the attack phase in Johore State in early 1976, 4.2 million people (40%) have been covered by house spraying, 3.6 million (34%) by urban or semiurban larval control and 2.7 million (26%) by consolidation measures. Following an independent assessment in october 1976 a further 1.3 million people were brought under consolidation measures as from January 1977, bringing the total thus protected to 4.15 million (39%). Changes in the overall incidence did not unfortunately keep pace with these developments, as the further decrease in malaria in the areas which recently entered the attack phase was offset by an increase due to land development schemes andmoving population groups, particu- larly in the areas bordering on Thailand. With adequate support and - flexibility of the operations these difficulties should be surmountable. WPR/RC28/3 page 33 WHO continued to cooperate in the conduct of annual seminars on malaria for medical and health officers at the Institute of Public Health, Kuala Lumpur. (b) Sabah and Sarawak In Sabah there was some decentralization and strengthening of manpower for malaria control at the sector and district levels, in some cases with the establishment of multipurpose teams to provide appropriate support. There was a slight but significant reduction in overall malaria incidence during 1976, as compared to the previous year; a trend which was confirmed despite an increase in the number of blood smears taken following the establishment of additional treatment posts in highly malarious areas. Nevertheless, there is still an urgent need for greater community participation in the spraying operations. In Sarawak implementation of the control programme continued, with a further decline of 16% in the annual number of cases to 1400, representing an annual parasite incidence of 1.2 per thousand for the State. A detailed review of the project was conducted in June 1976 in anticipation of the withdrawal of WHO staff in 1977. Coordination with the Indonesian health authorities on antimalaria operations along the border with Kalimantan Province should reduce the influx of malaria cases and further improve the malaria situation, particularly in the highly receptive first and second division of the State. An orientation session on malaria and the programme was held for medical officers from 25 April to 7 May 1977. New Hebrides The control programme made fair progress. On Efate and Santo (sprayed area) incidence is down to about 25% of the original level. Incidence in the sprayed area of Malekula is falling, although less dramatically due to a heavy influx of cases from the unsprayed part of the island. At present about 24 500 out of the total population of 100 000 are directly protected by the spraying operations and an additional 17 000 in urban areas indirectly protected. Major impediments to extension of the operations are difficult communications and a serious shortage of middle-level personnel. Participation of the general health services in case-detection is satisfactory: about two-thirds of the health establishments able to submit blood smears regularly are doing so, giving an annual blood examination rate of over 10%. Surveys are scheduled for 1977-78 with a view to instituting anti- larval measures at village level. WPR/RC28/3 page 34 Papua New Guinea Improvements are gradually being made in the organization and operation of the control programme. Both geographical reconnaissance and spraying operations were emphasized, although in some areas spraying was temporarily suspended in order to complete the reconnaissance and lay a sound foundation for future operations. Spraying was withdrawn from most of the highland areas where recepti- vity is low and institutional case-detection was organized to monitor the situation. By the end of 1976 the National Malaria Training Centre, Yagaum, had trained a sufficient number of field supervisors, as well as laboratory and field technicians, to cover the immediate manpower needs of the programme at provincial level. Orientation of medical and other health staff on malaria and the programme continued at training institutions with the preparation of malaria syllabi and a manual on malaria treatment. At the same time, active participation of the general health services in the programme was promoted through regional meetings of provincial health officers, visits to health units and other means. WHO cooperated in the health education component of the programme. Routine evaluation continued, mainly through surveys in indicator villages and passive case-detection, active case-detection being carried out only in Buin district. Entomological baseline data were collected in unsprayed areas of Central, Gulf, Madang and MOrobe provinces. It appeared that there was little change in the overall malaria situation, apart from a slight increase in incidence in some provinces probably due to transport difficulties experienced by the Department of Health. Chloroquine resistance in ~ falciparum was confirmed in the Kiunga area, Western Province, and Vanimo, West Sepik and isolated cases were reported from Wuvulu Island and Madang. Philippines In April 1976 the Department of Health, in consultation with WHO, adopted a new strategy for the malaria eradication programme whereby eradication will be continued in half the malarious part of the country while operations in the remaining area will be rationalized with increased participation of the rural health services. The integration trial undertaken in Marinduque and !locos Sur provinces continued with some modifications. The trial area was expanded to include the provinces of !locos Norte, La Union and Rizal. Staff of the general health services were given appropriate orientation on malaria through seminars and courses with WHO cooperation. It is apparent at this stage that some input by the malaria eradication service remains indispensable. It is, for instance, closely involved in delineating the receptivity of areas as a basis for vigilance operations in those which are to enter the maintenance phase. WPR/RC28/3 page 35 Malaria incidence showed a decline in most areas during 1976, despite an increase in the number of blood smears collected mainly through passive case-detection. With regard to the overall parasite formula there was a minor reduction in the proportion of ~ falciparum cases from 0.67 to 0.64. Singapore Receptivity to malaria due to A. sundaicus increased in connexion with massive construction works in coastal areas and land reclamation schemes. As some of the imported workers are parasite carriers, the occurrence of introduced and even indigenous cases seems inevitable. However the number of locally transmitted cases remained surprisingly small during the year and none proved to be truly indigenous, reflect- ing the strict vigilance that has been established. There were 251 cases in 1976 compared with 443 the previous year and of these 218 were imported, 30 introduced, 2 cryptic and 1 induced. Socialist Republic of Viet Nam As the disease is now under a quite acceptable degree of control in the north, attention is being directed to the malarious south, where priorities include the implementation of control and preventive measures through the general health services network, which is being extended to rural areas including agricultural resettlement schemes. Solomon Islands Spraying operations were withdrawn from additional islands. At the end of 1976, 149 600 people were living in the attack phase area (159 000 at the end of 1975) and 47 000 in the consolidation phase area (29 400 in 1975). Santa Isabel Island entered the consolidation phase in 1977, bringing the number of people protected by consolidation measures to 53 400, or 27% of the population. Arrangements were made to decentralize both spraying and surveil- lance operations, with considerable savings in transport costs. At the same time further pooling and integration of facilities with the general health services were undertaken. Increased community resistance to spraying was noted and as a result the operations in Central District and Malaita were slightly below standard. To combat this tendency the Government, with WHO cooperation, is improving the health educational component of the programme. The malaria situation improved generally, despite a shortage of qualified senior staff. However the overall improvement is offset by persistence of the Guadalcanal focus, which has remained refractory to additional measures (ULV spraying with malathion, larviciding and distribution of Gambusia fish, as well as DDT house spraying in 4-monthly cycles). Routine and special measures for elimination of this focus are therefore being intensified. The success of the entire project hinges on this operation. WPR/RC28/3 page 36 Other countries and areas No changes were recorded in the WHO supplementary list of nonmalarious areas. However A. litoralis, a proven malaria vector in parts of the Philippines and SSbah, Malaysia, has now been positively identified in Guam, where increasing numbers of anopheline species have been discovered in recent years. 5.3 Parasitic diseases other than malaria 5.3.1 Filariasis In Peninsular Malaysia a programme of filariasis control, mainly by drug treatment, has been carried out for some years. However drug treatment is not an ideal measure, particularly in areas where Brugia malayi transmitted by Mansonia has zoonotic ~plications. Research is therefore required on the ecology and control of this mosquito. In addition a statewide filariasis survey is planned in Sarawak, where information on the disease is lacking. Following a reported increase in the microfilarial rate after completion of mass drug administration in Samoa, plans were made to set up a research project in the country to study the dynamics of transmission at the present low level of microfilaraemia as well as appropriate control measures, with support from the Japan Shipbuilding Industry Foundation and the Japanese OVerseas Cooperation Volunteers. Under the intercountry epidemiological and surveillance services project, cooperation was provided in the South Pacific to the New Hebrides in revising its reporting system, to Niue in planning the postcontrol survey, to Samoa in analysing the results of the blood and entomological survey conducted in 1976 and to Tonga in organizing a nationwide control programme and training newly recruited staff. 5.3.2 Schistosomiasis In the Philippines WHO collaborated in FAO/IBRD/ASDB missions on the planning of land development schemes with a schistosomiasis control component. 5.4 Expanded programme on immunization Programme activities made a good start in the Philippines. Follow- ing the preparation of an inventory of existing facilities, a five-year plan was adopted providing for semi-annual rounds of DPT and BCG vaccination in a two-dose schedule. The sessions will be held in schools, with infants of 3-8 months receiving a first dose of DPT and those of 9-14 months a second dose plus one of BCG as a skin marker for future evaluatlon. Immunization against poliomyelitis will be included in areas known to be at high risk. Both DPT and BCG vaccine are produced locally; however production is not yet adequate to meet the immediate needs and supplies are therefore being obtained under bilateral assistance coordinated by WHO (see Section 7.2). - WPR/RC28/3 page 37 WHO cooperated with Malaysia in analysing difficulties encountered in establishing a cold chain for maintenance of vaccine potency. The Lao People's Democratic Republic adopted a two-year plan for BCG, DPT/DT and poliomyelitis immunization, with active WHO collaboration. The Cook Islands and Tonga stated their intention to join the programme. Australia, Hong Kong, New Hebrides, Samoa and Tuvalu expressed interest in participation and a favourable response is expected from other governments. The Regional Office is increasing its capacity for cooperation in the programme at country level by recruiting experienced field develop- ment officers and by broadening the scope of the Regional Tuberculosis Control Team's activities to include immunization against other diseases. 5.5 Bacterial and virus diseases 5.5.1 Gastrointestinal diseases In view of the large numbers of mild and moderately severe cases of gastrointestinal diseases of unspecified etiology that occur in the Region, efforts were made to promote the acceptance of an effective nonspecific therapy. A trial conducted in the Philippines confirmed a relative weight gain in children treated by oral rehydration as compared with the controls, It is felt that this therapy would be beneficial elsewhere but that its introduction, as in the Philippines, should preferably be preceded by acceptability trials. · Studies continue in the Philippines on the use of nonmedical workers for delivery of a prepackaged rehydration salt (Oresol), the replacement of sucrose by glucose in the salt and the effectiveness of oral rehydration when other drugs are excluded. 5,5.2 IYphoid In Samoa quadruple vaccine (DPT-Ty) was given to infants, and combined T•Ty to school entrants and school leavers, Together with health education and environmental sanitation, these measures have brought the disease under control; while there were 185 cases reported in 1966, only 4 were reported in 1974. An extensive vaccination programme was started in Tonga where the disease is a public health problem. 5.5.3 Streptococcal infections A small study in 124 Philippine school children showed that infection with group A, which is well known for its association with rheumatic fever, was less prevalent than infection with group c. WPR/RC28/3 page 38 · 5.5.4 Leprosy A major contribution for leprosy control was received from the Japan Shipbuilding Industry Foundation in addition to the long-term assistance from the German Leprosy Relief Association (DAHW), the New zealand Lepers' Trust Board Inc., the Order of Malta and other voluntary agencies. Results of tuberculosis/leprosy surveys conducted in American Samoa and the Independent State of Western Samoa were analysed, showing higher rates for leprosy than expected in the latter which therefore sought cooperation in strengthening its control programme as from May 1977. The leprosy service in Papua New Guinea was reorganized, starting with the training of general health workers in diagnostic and treatment techniques. A package proposal for cooperation in the Socialist Republic of Viet Nam leprosy programme was prepared, with pledges from the International Federation of Leprosy Associations and the Japan Shipbuilding Industry Foundation. The first shipment of equipment and supplies for the programme using funds provided by the Foundation arrived in January 1977 and a second delivery is expected in August 1977. 5.5.5 Tuberculosis During the past three decades a steady decline in tuberculosis morbidity and mortality has been observed in most parts of the Region, especially among the younger age groups. However the decline has not been impressive in some countries; and overall there has been a slowing down of the trend during the last decade despite large-scale applicat- ion of modern control techniques. For instance, the number of newly diagnosed bacteriologically positive cases has been decreasing very slowly or remained constant in most of the developing countries; in fact findings of the third tuberculosis prevalence survey in the Republic of Korea, released in 1976, showed no significant reduction in the occurrence of such cases. Thus there are no grounds for premature optimism or any relaxation of vigilance. Indeed the available information highlights the need for increased awareness of the danger and for strengthening of the existing services. Operational research to improve the control strategy is also required, Tuberculosis morbidity in the Region is gradually shifting towards those in the older age groups, especially middle-aged and elderly people who are financially, socially or otherwise handicapped. This changing epidemiological pattern has tempted planners to carry out mass BCG vaccination at an older age than at present. There is no doubt that some changes in approach are called for but discontinuation of BCG vaccination among preschool children, for instance, is a step that should be decided upon only after careful study of the tuberculosis pattern in the community. By now national tuberculosis programmes have been established in most parts of the Region and in many cases are fully integrated into the general health services. However there is still room for improve- ment in the areas of programme management, supervision, training and evaluation. - Oral rehydration for diarrhoea in children has been successful in Bacolod, Philippines. Mother shows the rehydration solution distributed through local leaders. Lower photograph shows inspection of records on distribution of rehydration solution. BCG vaccination and defaulter tracing of ambulatory patients are important aspects of the new approach to tuberculosis control in Papua New Guinea. I <r" WPR/RC28/3 page 39 WHO cooperation in strengthening and reviewing the programmes continues. A pilot control project was evaluated in Papua New Guinea before extension of the measures to other parts of the country. In the Republic of Korea the national control programme was evaluated during the second half of 1976 and a training and supervisory team was organized for retraining of key workers and improvement of the treat- ment service. In December 1976 a consultant assessed the work of the Regional BCG Vaccine Laboratory within the Alabang facilities of the Philippine Department of Health. It was found that the freeze-dried product is of good quality but that certain requirements will have to be met before the vaccine can be released for international use. A notable achievement was the establishment of the National Institute of Tuberculosis in the Philippines, co-sponsored by the Department of Health and the Philippine Tuberculosis Society Inc. and supported by WHO and UNICEF. The Institute will train general health staff in tuberculosis for further decentralization of control measures and conduct operational research on the practical problems encountered. The eleventh WHO/Japan tuberculosis course was held in Tokyo from June to October 1976, with five participants from the Western Pacific Region and 16 from other Regions. The twelfth course commenced on 16 June 1977. 5.5.6 Sexually transmitted diseases A beta-lactamase producing strain of ~ gonorrhoeae resistant to penicillin was identified in many parts of the Region, notably in Australia, Hong Kong, Japan, New Zealand, Philippines, Republic of Korea and Singapore, causing concern for the health authorities, which expect control measures to become even more difficult once the strain becomes widespread. WHO is collaborating actively with several countries and areas in promoting surveillance, strengthening the laboratory facilities needed for rapid identification of ~ gonorrhoeae in general and the resistant strain in particular, developing control services, training staff and disseminating information. In the Republic of Korea procedures for screening of high risk groups were reviewed. The incidence of reported syphilis continued to be high in a number of countries/areas including Hong Kong, New Caledonia, Papua New Guinea and Singapore. Excellent surveillance services in some of these countries/areas emphasize the problem. WHO cooperated with the Socialist Republic of Viet Nam in initiat- ing a systematic attack on sexually transmitted diseases which are still very prevalent in the southern part of the country. The Government of Australia made a significant contribution to this effort. WPR/RC28/3 page 40 The Western Pacific and South-East Asian regional conference on sexually transmitted diseases, Singapore, 6-9 January 1977, provided a good forum to discuss the new strain and other sexually transmitted diseases. 5.5.7 Respiratory infections excluding tuberculosis These infections are a major public health problem in all the developing countries and areas of the Region and especially in Papua New Guinea, the Philippines and some areas of the South Pacific. However as knowledge of their epidemiology (etiology, effect of climate, nutrition, etc.) is still lacking no significant advances have been made in controlling them. A joint WHO/SPC sub-regional training course on the epidemiology, prevention and treatment of acute respiratory diseases other than tuberculosis was conducted in Niue from 8 to 14 June 1977. 5.5.8 Influenza There were fairly widespread epidemics in the southern part of the Region in mid-1976 although no major antigenic shift in the prevalent virus strain was observed. The types found included A/Victoria/3/75, A/Port Chalmers/1/73 and virus B in some cases. An epidemic in Japan was associated with strains A/Tokyo/1/75 and A/Victoria/3/75. A new variant A/Victoria/112/76 was isolated in Australia and the Philippines. 5.5.9 Poliomyelitis Two outbreaks, with a total of 118 cases, occurred in the Philippines in the early part of 1977. One outbreak had a rather high case fatality rate of 56% (26 of 46 patients) but in both type•! virus was isolated. Under its expanded programme on immunization, WHO donated poliomyelitis vaccine and collaborated with the Government in preparing a strategy for poliomyelitis immunization (see Section 5.4). 5.5.10 Dengue fever/dengue haemorrhagic fever Transmission continued in a number of countries/areas of the South Pacific and the Cook Islands experienced an epidemic due to type 1 virus. In the northern hemisphere, reports of cases have come from Malaysia, Singapore and the Socialist Republic of Viet Nam which all have good surveillance systems. A WHO technical advisory group on dengue haemorrhagic fever was established in the Philippines to assist in the coordination of research and control activities. 5.5.11 Viral hepatitis Increased attention was paid to surveillance and possible approaches to control of viral hepatitis infections which are a cause of concern in many countries and areas. An interregional seminar on the subject was planned for the latter part of 1977 • - Poliomyelitis immunization (Malaysia) and DPT vaccination (Philippines). 5.6 Veterinary public health/zoonoses 5.6.1 Rabies WPR/RC28/3 page 41 The Philippines conducted a trial of systematic vaccination of dogs in the Visayas group of islands. Public cooperation was excellent and expansion of the vaccination to other islands is under discussion. One problem is that the available vaccine is insufficient for nationwide coverage, although production has increased. 5.7 Vector biology and control 5.7.1 Control services Cooperation continues in control of the vector mosquitos of dengue/dengue haemorrhagic fever in Fiji and Malaysia and training and field investigations in the Philippines and Samoa. A vector control unit is being established in Brunei. 5.7.2 Training The Republic of Korea conducted its annual two-week course on vector and rodent control as planned, while Fiji organized a three- week course for newly recruited staff who will form the nucleus of the country's vector control team. 5.7.3 Regional seminar on the safe use of pesticides The seminar was held in Manila from 30 August to 3 September 1976. Participants came from agricultural as well as health administrations. A major conclusion was that WHO and FAO should explore the feasibility of setting up a central consultative service on pesticides for the Region. 5.7.4 Field investigations Assessment of Aedes aegypti control continued. In Brunei good results were obtained in controlling the biting midge Styloconops spinosifrons which, although it does not transmit disease in humans, represents a nuisance on beaches and hinders the development of coastal areas and tourism in many parts of the Region. 5.7.5 Vector control units The establishment of vector control units in ministries or departments of health proved immediately beneficial. For example, the unit in Sabah, Malaysia, found Ae. aegypti in many new localities and trained public health inspectors in controlling this mosquito. The unit in Sarawak undertook a statewide Aedes control programme and is starting a filariasis survey. The unit in the Philippine Department of Health carried out an intensive survey of Ae. aegypti in Metropolitan Manila, conducted insecticide susceptibility tests and arrested a small outbreak of dengue haemorrhagic fever in Batanes Province by controlling the infective mosquitos with adulticides. The WPR/RC28/3 page 42 · departments of health in the Cook Islands, Niue and Tonga plan to set up units to deal specifically with dengue fever and filariasis as soon as professionally-trained personnel are available. 6. NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL 6.1 Cardiovascular diseases Following the seminar on the prevention and control of cardiovas- cular diseases held in Manila in 1975, there has been considerable activity in the countries that sent participants. In the Philippines studies on the prevalence of streptococcal infection, rheumatic fever and rheumatic heart disease were launched in the Metropolitan Manila area and Pangasinan Province, and a survey on hypertension and coronary heart disease was conducted at the community level in 14 "barangays". Priorities for nationwide activities will be established in accordance with the findings of these surveys. Japan is making preparations to open a National Circulatory Diseases Centre in Osaka in two years' time. Finally rheumatic heart disease registers were established in Samoa and Tonga. A task force on research in cardiovascular diseases was set up, as described under "Research promotion and development" (Section 1. 2). 6.2 Oral health A number of activities were conducted under the intercountry oral health advisory services project as follows: Consultants provided cooperation in Fiji, in a field trial on the assessment of requirements for treatment of dento-facial anomalies, in Malaysia, in curriculum revision for upgrading university training in preventive dentistry and in the Philippines, in means to improve the teaching of public health dentistry at undergraduate and postgraduate levels (see also Part II "Evaluation summaries of selected projects", pages 90-97). A working group on dental health education composed of 13 members (educators, practitioners and programme administrators) met in Kuala Lumpur from 11 to 22 October 1976 within the context of technical cooperation among developing countries. It formulated a series of functional rather than conceptual guidelines for use in the Region and gave examples of regional applications. A second regional course in public health dentistry was held for six weeks in June and July 1977 in Singapore and Penang, with 20 participants. Support was given to Fiji in conducting a national dental health conference and to the Republic of Korea in connexion with a workshop for teachers in dentistry. A mass dog vaccination trial was conducted on Guimaras Island, Philippines. Lower photograph shows Philippine Government officials (Dr J. Sumpaico and Dr C. Cordero) and WHO's Dr R. Lindner with a local leader who took part in the census of the island's dog population. The ultimate objective is to eradicate rabies in the Philippines. 6.3 Mental health WPR/RC28/3 page 43 There is a growing awareness among governments in the Region of the importance of mental health within the overall context of public health. Efforts were made to develop mental health services as part of the general health services and especially the primary health care network. Cooperation was provided to the Republic of Korea in formulating a national mental health policy and strengthening the existing services and to other countries in upgrading the training of mental health professionals at different levels. It is hoped that governments will develop more action programmes in this important field. 6.3.1 Prevention and control of alcoholism and drug dependence A working group on early intervention programmes in drug abuse was held in Manila from 2 to 9 December 1976. The report underscored the importance of setting up proper data collection and feedback systems, implementing low-cost field projects with built-in research and evaluation components, and developing practical models for community involvement. Cooperation was pursued with Malaysia in developing a national system for treatment and rehabilitation of drug abusers and with the Socialist Republic of Viet Nam in establishing a comprehensive programme on drug dependence. 6.4 Biomedical aspects of radiation Continued attention was paid to the development of radiodiagnostic services at the periphery, where problems cannot be solved simply by adopting methods used at large hospitals in densely populated areas. Technical cooperation was provided to the Cook Islands, Lao People's Democratic Republic, New Hebrides, Niue, Philippines, Samoa, Solomon Islands and Tonga in improving the maintenance and repair of medical radiology equipment. As far as the available resources permitted, other medical equipment was also given due attention. A scheme for developing medical equipment maintenance services, including curricula to train engineers and engineering technicians for such services, was drawn up with the Philippine authorities. WHO cooperated with Fiji, New Hebrides, Niue, Papua New Guinea, Philippines, Samoa and Tonga in strengthening radiography advisory services, improving the performance of the technicians presently operating X-ray equipment and adapting training to the needs. The IAEA/WHO postal dose intercomparison service for checking dosimetric procedures continued with the participation of 20 institutions in five countries/areas. The postal personnel radiation monitoring service was maintained for institutions in four countries/ areas, with a total of 360 individuals being monitored at monthly WPR/RC28/3 page 44 intervals. Trials of a postal dose intercomparison service for measurement of environmental radiation continued in collaboration with the Philippines. The programme to establish intercountry cooperation in standard dosimetry continued, support for the purchase of equipment being provided to two laboratories engaged in such work in the Philippines and the Republic of Korea. The dosimetry laboratory under the Radiation Health Office of the Philippine Department of Health was officially included in the IAEA/WHO network of secondary standard dosimetry laboratories in addition to the laboratory in Singapore already participating. 6.5 Health of working populations In Malaysia cooperation continued in strengthening the National Occupational Health Centre and setting up programmes to protect workers from occupational hazards. A number of surveys to collect baseline data on conditions and diseases in several occupational groups were carried out or planned. The Organization has collaborated with the University of Singapore in reviewing and modifying the curriculum for the Master's degree course in occupational hygiene. 7. PROPHYLACTIC, DIAGNOSTIC AND THERAPEUTIC SUBSTANCES 7.1 Drug policies and management Provision was made to send supplies and equipment to the Lao People's Democratic Republic and the Socialist Republic of VietNam under the programme of special assistance to these countries. Cooperation also began with the Lao authorities in measures relating to the introduction, utilization and control of pharmaceuticals. Other activities included preparation of the Technical Presentation on "National drug policies and management" for the twenty- eighth session of the Regional Committee and arrangements for a work- shop on the use of medicinal plants which will be held in Tokyo from 13 to 17 September 1977 and is expected to provide a basis for develop- ment of an expanded programme on drug policies and management, and pharmaceutical quality control. Visits were made to Fiji, Japan, Papua New Guinea and the Philippines for these purposes. 7.2 Biologicals The objective is to support communicable disease control programmes in the production and control of vaccines and basic biological reagents. ; Photographs taken at the Hsi Tchang Commune Hospital show barefoot doctors cleaning roots and cutting stalks of medicinal plants and, below, in the hospital pharmacy, weighing ingredients for traditional herbal prescriptions. /y WPR/RC28/3 page 45 Under the expanded programme on immunization, a five-year scheme was drawn up for expansion and modernization of the vaccine production facilities of the Philippine Department of Health's Serum and Vaccine Laboratories, Alabang, Luzon, using UNICEF equipment and supplies. Preparations are now under way. The main building is to be remodelled prior to the installation of fermentors for the vaccine production and fellowships have been awarded to train staff in production control and management techniques. When the work is completed it is expected that the Laboratories will become a regional centre for vaccine production and distribution. In addition to 300 000 doses of DPT vaccine there should be 300 000 doses of diphtheria-tetanus vaccine and 300 000 doses of .tetanus toxoid available in 1977. The DPT vaccine production capacity is expected to reach 4 million doses annually by 1981. In the meantime, to satisfy the needs of the expanded programme on immunization until large- scale production comes fully into force the Netherlands Rijks Instituut voor de Volksgezondheid will provide filled DPT vaccine in 1977 and bulk vaccine in 1978 and 1979 when the diluting and bottling equipment will have become operational. LEP rabies vaccine was also produced with cooperation from a WHO consultant on production and control and the organization of a trial on Guimaras Island. Batches of the vaccine passed control tests in the United States of America. When the additional facilities are in place, production of the vaccine should reach 500 000 - 600 000 doses per year by the end of 1977. 7.3 Health laboratory technology The objective of the programme is to cooperate in strengthening health laboratory services with emphasis on public health particularly through improved management of the services, development of suitable laboratory techniques and training of staff. In meeting this objective attention was directed to public health activities and support of communicable disease control programmes. Expansion of laboratory services towards the periphery continued. Peripheral laboratory work is of particular importance in the outer islands of countries and areas in the South Pacific where communication with the administrative centres is sometimes difficult. In Papua New Guinea the trend was taken further with the integration of peripheral laboratory work into the basic health services. A first batch of 15 medical laboratory assistants received one year of training for the purpose and have been posted to health centres. A similar type of training is provided in the Lao People's Democratic Republic and preparations have been made to introduce it in Fiji, New Hebrides, Solomon Islands and Tonga. Supervision and reference services for these workers are provided by the central laboratories. Information on proper collection, handling and transport of specimens in peripheral units was prepared and some simple tests were introduced at this level. Locally prepared manuals or instructions on the appropriate techniques are now available in Fiji, Papua New Guinea and Tonga. WPR/RC28/3 page 46 Steps were taken to improve management with particular reference to standardization of procedures and supplies, recording and reporting systems, supervision and coordination. Quality control was gradually improved and the proficiency testing programme in bacteriology continued in collaborati.on with the Center for Disease Control, Atlanta, Georgia, United States of America, with the participation of 13 laboratories in nine countries/areas. In Fiji, in addition to further standardization of work in the Central Laboratory, including the introduction of an efficient record- ing system, laboratory activities were strengthened in two divisional laboratories. The officers in charge were introduced to practical aspects of management. A central blood bank was set up in the Lao People's Democratic Republic and laboratory services were further extended to district hospitals and health centres. Collection of specimens and laboratory procedures were standardized and a laboratory manual was prepared. Consultant services were provided to Malaysia in analysing deficiencies in all aspects of the National Blood Transfusion Service and making recommendations for improvements and to the Republic of Korea in assessing the national health laboratory system with emphasis on provincial public health laboratories. In the New Hebrides integration of the public health and clinical diagnostic laboratory services was recommended to ensure more economi- cal and efficient operation of both. In Papua New Guinea the organization of the Environmental Health Laboratory, Port Moresby, was further improved and its work expanded while two regional laboratories were provided with water testing equipment. Tests for confirmation of syphilis and dengue fever infection were introduced. In Tonga it was proposed that the Central Health Laboratory be expanded to meet the public health needs. Laboratory procedures and the recording and reporting systems were standardized and weekly reporting on pathogens and antibiotic sensitivity patterns was introduced. Particular attention was paid to determining the laboratory tests that should be performed in support of communicable disease control and surveillance as well as those that can be done at the periphery. A regional seminar on blood transfusion services was held in Kuala Lumpur from 4 to 9 October 1976 with 15 participants as well as official and local government-sponsored observers. WHO provided three consultants to assist in the proceedings. Manpower development continued in accordance with the established principle that laboratory technicians should be trained in relation to service needs and in an environment similar to the one in which they will work. ..... - WPR/RC28/3 page 47 Two three-year certificate courses for laboratory technicians are now available, in Fiji and Papua New Guinea, and both receive a limited number of trainees from neighbouring countries. WHO staff participated in conducting the courses on a long-term basis. Support was provided to the Lao People's Democratic Republic in training fully qualified and auxiliary technicians and to Fiji, Papua New Guinea and Tonga in conducting refresher and inservice courses for laboratory technicians. 8. PROMOTION OF ENVIRONMENTAL HEALTH National authorities are showing increasing concern over pollution problems and the challenge of providing basic water supply and sewerage facilities. The problems are aggravated by the unremitting growth of urban areas and the need to accelerate development of the rural sector. There are many dimensions in the protection of environmental quality and the provision of appropriate services is thus reflected in the WHO programme of cooperation. WHO activities continued to be directed to fields that have been given priority or are expected to generate national support. An intercountry environmental pollution control project was established. Seven pre-investment planning projects, formulated in collaboration with national authorities for financing by UNDP in the amount of about US$4 million, were not carried out because of the last minute inability of that body to provide the funds. One of the activities thus affected, the design study of the Manila sewerage programme, is to be executed by the Government with an IBRD loan while alternative sources of funds are being explored for the others. WHO cooperated in ten projects; while seven consultants provided specialized technical support. 8.1 Provision of basic sanitary measures The objective is to cooperate in the development of water supply, excreta disposal and other sanitary services. Some national programmes made good progress, mainly in the field of water supplies. Except in a few cases, low priority was given to sewerage planning, construction and_services. Malaysia has embarked on major water supply and sewerage programmes aimed at total coverage of the population. Under the Third Malaysia Plan (1976-80) about M$350 million are allocated for water supply and M$153 million for sewerage (see also Part II "Evaluation sunmaries of selected project~', pages 73-78). The large-scale water supply programme in the Republic of Korea continued successfully. Since its inception in 1972 over 7000 piped systems have been installed, with UNICEF, CARE and WFP providing WPR/RC28/3 page 48 commodities and material and IBRD a loan. The programme to construct nightsoil treatment plants progressed with WHO cooperation in design, review and operation of the facilities. In the South Pacific, rural water supply and latrine construction continued with technical cooperation from WHO and material aid from UNICEF. Activities in Fiji were also funded by UNDP. Aside from shortage of funds, inadequate institutional capacity is a severe constraint in the development and maintenance of water supplies and sewerage, and emphasis is therefore given to improved training and management. WHO cooperated with Malaysia, Papua New Guinea and the Republic of Korea in this field. 8.2 Pre-investment planning for basic sanitary services The objective is to cooperate in planning for the provision and efficient operation of community water supply and wastes disposal facilities. A water supply and sewerage study was completed in Rarotonga, Cook Islands, and the Government was able to negotiate a NZ$1.5 million grant from the Government of New Zealand to finance the construction. WHO continued discussions with UNDP about possible funding for a sewerage project in Apia, Samoa. Extensive technical cooperation was provided to Malaysia in plann- ing urban sewerage and conducting a sewerage subsector review. An initial water supply and sewerage sector study was undertaken in the Philippines. To stress the importance of sound pre-investment planning and give those concerned an opportunity to exchange views and explore alternative strategies for sector development an interregional work- shop on national water and sewerage sector development was convened by WHO and IBRD in New Delhi from 22 November to 3 December 1976 and attended by managers from national sector agencies as well as five WHO engineers from the Region. Policies, problems and approaches were discussed and specific proposals made to improve planning and accelerate sector development. Collaboration with ASDB is particularly important in the water supply and sewerage sector as progress depends to a great extent on loans from the development banks. ASDB's loans to its Member governments in this sector had reached US$334 million by the end of 1976. 8.3 Control of environmental pollution and hazards The objective is to cooperate in programmes to preserve or restore environmental quality, especially in relation to the abatement of health hazards. -. - I ,... The first village sanitarian course held in New Hebrides. Participants are shown in the top photograph with officials of Port Vila and Dr Paul R. Lande, Chief Condominium Medical Officer. Below, village sanitarians in an environmental health survey on Efate Island.· WPR/RC28/3 page 49 Activities centred on the large developing countries where the problems are particularly severe and complex. National monitoring and control programmes, where they exist, are still in their infancy. Policies are in a state of flux due to absence or inadequacy of information systems and deficiencies in the institutional machinery. Government programmes have mostly been hesitant and inadequate. In general there is a need to update legislation, institute planning and more effective control, develop monitoring, train personnel, equip laboratories and standardize the sampling and analysis procedures. In the Republic of Korea two projects were established, one on air pollution and the other on water pollution. Under the UNDP-supported project on water quality management in Laguna de Bay, Philippines, the second year of field and laboratory studies was completed. WHO staff continued to cooperate in sanitary engineering aspects and limnology, with support by four consultants in ecological modelling, laboratory quality assurance, algal pond systems and water quality data storage/retrieval systems. The activities will continue to be supported by UNDP and WHO up to December 1977. The intercountry environmental pollution control project, established during the year, will provide technical cooperation in relation to air pollution, solid wastes management and manpower training. Progress was made in developing air and water quality monitoring programmes to be funded by UNEP and WHO; national stations were selected for air monitoring, a course was planned for the staff involved and equipment was supplied to Malaysia and the Philippines. WHO staff also collaborated in promoting local support for implementation of the regional water quality programme, Fish poisoning A WHO consultant on biotoxins in marine fish identified the dinoflagellate Diplopsalis sp. nob as the primary source of toxin in edible fish caught in coral reefs around many islands in the South and West Pacific. This dinoflagellate is frequently present in coral reefs but apparently proliferates when the ecology of the reefs is disturbed, Small fish feed on the dinoflagellate and, through the biomagni- fication process in the food chain, the toxin eventually enters larger fish in greater amounts and concentrations. The toxin cannot be removed by cooking or washing or be destabilised by heat. Reports on nearly 2000 known cases each year throughout the South Pacific indicate that human beings are highly sensitive to the toxin. Research on fish poisoning has been carried out for many years under the auspices of the Institut de Recherches M~dicales "Louis Malard~", Papeete, French Polynesia, and now that the dinoflagellate has been identified it will continue on the medical and ecological aspects of the problem. WPR./ RC28 I 3 page 50 In areas where coral reefs have been disturbed or destroyed it was recommended that biological surveys be undertaken to monitor the presence and growth of the dinoflagellate. At present there is no known method for control of this organism but ecological measures are being investigated; these may include growth control by the introduction of biological inhibitors and measures to ensure a healthy environment for sustaining the coral reefs, thereby deterring the prolific growths of the dinoflagellate. As marine waters have great economic significance for people of the South Pacific islands in their search for food and income, the fish toxin is seen as a major problem which must be overcome. 8.4 Establishment and strengthening of environmental health services and institutions The objective is to collaborate in planning and developing environmental health services, policies and programmes associated with economic and area development, including staff training. Although there has been improvement in certain cases, some government environmental health agencies still lack the authority to shape national policies or the facilities, capacity and budget to deal with major problems. Some countries have created new institutions or separate pollution control commissions with functions overlapping those of the health authorities. Much effort will be needed to harmonize the work of these agencies to achieve common goals. Institutional development and sanitation programmes were implemented in Fiji, Lao People's Democratic Republic, Malaysia, Papua New Guinea, Samoa, Solomon Islands and Tonga. Cooperation in environ- mental sanitation services was provided in conjunction with projects for the development of basic health services in the New Hebrides, Philippines, Republic of Korea and Solomon Islands. A course for assistant health inspectors was conducted in the Solomon Islands with funds from UNDP; the course included a one-month study tour in Australia supported by the Australian Development Assistance Board. WHO cooperated with the Philippines Department of Health in planning basic sanitation measures for less privileged communities. 8.5 Food safety programme The objective is to collaborate in strengthening food protection and safety control programmes and in upgrading food hygiene standards. Progress in most developing countries or areas continued to be hampered by inadequate food hygiene programmes, poor sanitation facilities and practices, and prevalence of gastrointestinal infections. Adequate laboratory services to support food inspection as well as qualified staff in this field are also lacking. WHO cooperated with the Philippines, Republic of Korea and South Pacific governments in updating food control legislation, training staff, improving inspection techniques and upgrading food hygiene. WPR/RC28/3 page 51 A review carried out by the Regional Office indicated that priority should continue to be given to the upgrading of training in food hygiene. with opportunities for specialization in this field and inclusion of relevant components in the curriculum of the basic courses for health inspectors; a further priority should be the updating of food control legislation. 9. HEALTH STATISTICS To facilitate exchange of health information in the Region basic data on administration, demography, economy, education, health resources, manpower, health planning, sanitation. morbidity and mortality and other matters were collected through questionnaires and from relevant official publications, and compiled in the form of country health information profiles. Many governments have authorized distribution of the profiles within the Region. They are of considerable value not only in retrieval and dissemination of health information but also in formulation of the WHO regional programme. In pursuance of its objective of enabling the developing countries/ areas of the Region to utilize health statistical information for assessment of health conditions, evaluation of national health services and realistic formulation of health plans, WHO continued to support the governments in making optimum use of their limited resources to strengthen health statistical services at various levels and to improve health recording and reporting, particularly within primary health care systems. Specifically cooperation continued in strengthening central health statistics units, improving data processing capacity and introducing cross-sectional ad hoc surveys in Papua New Guinea and the Republic of Korea; developing-a simple data collection system for peripheral health services and introducing lay reporting of morbidity ./ data in the New Hebrides; and standardizing hospital records and training medical records personnel in the New Hebrides and the Philippines. At the end of 1976 WHO cooperation concluded in Malaysia; it had covered. among other aspects. the establishment of a monitoring system for the prompt detection of unusual occurrences of communicable diseases. A simple classification of morbidity and mortality data for the use of nonmedical health personnel being considered an essential tool for development of the primary health care system, one was proposed by the interregional working group on lay reporting of morbidity and mortality statistics, New Delhi, 22-27 November 1976. It is now under trial in some areas of the South Pacific. Statistical activities in support of other Regional Office health programmes increased significantly. ·Examples in this respect are the cooperation provided in preparing designs for the tuberculosis and leprosy survey in American Samoa and the Independent State of Western Samoa and the survey on the workload and activity of district health personnel in the Independent State of Western Samoa. WPR/RC28/3 page 52 10. WHO PUBLICATIONS In an attempt to disseminate information on WHO publications as widely as possible and, so far as is practicable, 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. Reductions in price, which vary in accordance with the country concerned, are also given if publications are ordered in bulk. Subscriptions covering all WHO publications are also available at concessional rates. All persons who have shown interest in a particular field are regularly advised about any forth- coming 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, WHO publications are now available in various languages, as follows (see also Annex 2): Japanese: Korean: Vietnamese: Portuguese: Bulletin of the World Health Organization Monograph Series Public Health Papers Offset Publications Technical Report Series Official Records Out of Series Publications Reports Out of Series Publications Monograph Series Technical Report Series Out of Series Publications 1 article 6 14 2 53 1 7 1 2 2 2 1 Rights have also been granted for the translation of further WHO publications, as follows: Japanese: Out of Series Publications 4 11. HEALTH INFORMATION OF THE PUBLIC Regional Committee The Regional Committee's twenty-seventh session received wide news coverage in the Region, including editorials on the topics of alcoholism, "barefoot doctors" and health care delivery systems. WPR/RC28/3 page 53 International news agencies also reported on the Committee's resolutions relating to medical research, the proposed regional centre for environmental health sciences and special assistance to Democratic Kampuchea, the Lao People's Democratic Republic and the Socialist Republic of Viet Nam in the health field. World Health Day The theme "Immunize and Protect Your Child" generated wide interest in national immunization activities. About one thousand coloured posters and the same number of wall sheets were distributed throughout the Region to celebrate the occasion. An article and photographs on Malaysia's immunization programme were included in the World Health Day envelopes distributed from WHO Headquarters throughout the world. The photographs also appeared in the February-March 1977 issue of World Health. The Tasmania Division of the Australian United Nations Association joined in the World Health Day promotional campaign with the participation of 350 schools in the State which received WHO leaflets, pamphlets and other materials on the theme. In Malaysia exhibitions on the World Health Day theme were held at the national, state and district levels for a period of nine months following 7 April 1977. A speech on the theme by the Minister of Health as well as the WHO film "Protect Them Now' were broadcast on the national television network. The WHO Regional Director's message was transmitted on Radio Malaysia. The New Zealand Department of Health was joined by the Plunket Society in commemorating the event. Posters were placed in all clinics. In Papua New Guinea the national radio network broadcast a message by the Minister for Health on the eve of World Health Day as well as the Regional Director's message and an interview with the WHO Representative. An editorial emphasizing the importance of immunization was published by a national newspaper. To promote local awareness, a competition for a World Health Day slogan was conducted throughout the country. Nearly 600 entries were received and three prizes were awarded. Women's committees participated in the celebration in Samoa. In Singapore maternal and child health clinics, hospitals and health centres teamed up in promoting immunization programmes. Media reporting on health Health news relating to WHO's work was widely disseminated in the Region including items on the new penicillin resistant strain of !• gonorrhoeae, the special programme for research and training in tropical diseases, immunization, smallpox eradication, safe use of pesticides and cancer. News cuttings received from Australia, Fiji, Japan, Malaysia, New Hebrides, New Zealand, Papua New Guinea, Philip- pines, Republic of Korea, Samoa, Singapore and Tonga totalled almost 15 000 column centimetres. WPR./RC28/3 page 54 News agency reports on the Papua New Guinea tuberculosis story which appeared in the October 1976 issue of World Health were published by newspapers in many parts of the Region and in Europe and the United States of America. Regional Office news features on fish poisoning in the South Pacific, oral rehydration in the Philippines, and water supply and malaria control in Sarawak, Malaysia, were published by major media of the Region. News cuttings from Kaala Lumpur, Manila, Seoul, Singapore and Wellington indicated extensive reporting of the regional seminar on the safe use of pesticides, Manila, 30 August-3 September 1976. In an opening address at the second south-east asian conference on rheumatic fever and rheumatic heart diseases, Philippine Heart Center for Asia, Quezon City, 27-30 September 1976, the Regional Director emphasized the important role that can be played by medical auxiliaries in the prevention and control of these diseases. His address was broadcast extensively and drew editorial support from Philippine newspapers. Thirty news releases, five special features and four press notes were issued. WHO information leaflets were supplied in response to lS~written requests. WHO Regional Office staff were guests on television programmes devoted to the Organization's work. Visitors Forty faculty members of Claremont College, Perth, Australia, and 44 senior students from the Centro Escolar University, Manila, Philippines, attended a lecture on WHO held at the Regional Office. Material on WHO was issued to 672 visitors to the Regional Office. Filma The Government of New Zealand agreed to finance a film on filariasis and scenes were filmed in Samoa and Tonga by a New Zealand photographer. WHO films were supplied in response to about 200 requests. 12. COOPERATION WITH OTHER ORGANIZATIONS 12.1 Cooperation with the United Nations and related agencies 12.1.1 Economic and Social Commission for Asia and the Pacific (ESCAP) Close liaison was maintained between the two organizations by the WHO Liaison Officer with ESCAP. WPR/RC28/3 page 55 WHO was represented at the following ESCAP-sponsored meetings: First session of the ESCAP Committee on Population, Bangkok, 29 June-S July 1976; ESCAP regional preparatory meeting for the United Nations water conference, Bangkok, 27 July-2 August 1976; Second session of the ESCAP Committee on Industry, Housing and Technology, Bangkok, 31 August-6 September 1976; Intergovernmental expert group meeting on integrated rural development, Tokyo, 1-7 February 1977; Thirty-third session of ESCAP, 5-14 April 1977. 12.1.2 United Nations Children's Fund (UNICEF) The Organization continued to maintain a close working relationship with UNICEF at all levels. UNICEF participated in the following WHO-sponsored meetings: twenty-seventh session of the Regional Committee for the Western Pacific, Manila, 6-11 September 1976; regional seminar on delivery of maternal and child health and family planning within primary health care, Manila, 14-20 September 1976; regional working group on basic health services, Manila, 21-29 September 1976; meetings of WHO Representatives, Manila, 17-23 November 1976 and 13-19 April 1977. WHO prepared technical comments on country recommendations concerning the Philippines, the Republic of Korea and countries/areas in the South Pacific for submission to the 1977 session of the UNICEF Executive Board, Manila, 17 May-3 June 1977. UNICEF is strongly supporting two recently introduced programmes: the promotion of primary health care, preparatory to the regional conference on primary health care which will be held in Manila in November 1977, by sponsoring national seminars; and the expanded programme on immunization by the provision of supplies and equipment. 12.1.3 United Nations Development Programme (UNDP) The financial problems affecting UNDP operations eased somewhat during the year, but difficulties continued in some projects because of shortage of funds. Emphasis has been given by the General Assembly to the strengthening of coordination, and special attention has been placed on the future role of UNDP in the overall context of technical development. The Regional Representative of UNDP in Bangkok visited the Regional Office to discuss items of common interest. Relations with the Resident Representatives in the Region continued to be good. WPR/RC28/3 page 56 In August 1976 a progress report on technical cooperation among developing countries (TCDC) was sent to WHO Headquarters using the standard format suggested by UNDP which indicated the extent to which there had been a response to the recommendations contained in the final report of the third session of the working group on technical cooperation among developing countries, New York, 1-10 May 1974. WHO is currently cooperating with UNDP in enabling governments to develop an information referral system for TCDC; suggestions were sent to ESCAP on bodies suitable for inclusion in its consolidated list of institutions due to participate in the system. At the January 1977 session of the UNDP Governing Council, the second country programme for the Philippines was approved. The second country prograDIIles for Malaysia and the Republic of Korea are scheduled for submission to the June 1977 session of the Governing Council. Tripartite reviews of the following UNDP-assisted projects were carried out with WHO participation: Regional Teacher Training Centre - 2 December 1976; Assistance for comprehensive water quality management of Laguna de Bay, Philippines - 15 December 1976; Health Services Development,- New Hebrides- 18 May 1977. WHO was represented at the regional seminar for UNDP Resident Representatives assigned to disaster-prone countries - disaster relief coordination, prevention and planning, Manila, 12-13 April 1977, at which reference was made to the assistance given by WHO to UNDRO. 12.1.4 United Nations Environment Programme (UNEP) In September 1976 the UNEP Regional Adviser, Regional Office for Asia and the Pacific, Bangkok, visited the Regional Office to discuss the scope of WHO's regional programme, particularly with regard to environmental aspects in the South Pacific, and then proceeded to Fiji and Papua New Guinea. 12.1.5 United Nations Fund for Population Activities (UNFPA) Active cooperation in UNFPA-supported activities vas maintained, at country level by WHO Representatives and field staff with UNFPA coordinators, and at regional office level. Regional Office staff participated in UNFPA tripartite project reviews in Malaysia and the Republic of Korea and in an evaluation of the family health project in Samoa conducted together with the UNFPA Associate Coordinator for the South Pacific. UNFPA continued its financial support to twelve family health projects in the Region. 12.1.6 World Food Programme (WFP) WPR/RC28/3 page 57 WHO cooperated with WFP in a number of activities as follows: Fiji and Samoa - nutrition improvement; Republic of Korea - food assistance to day-care centres; the Philippines - assistance to primary school children in Mindanao, feeding of preschool children and resettlement of people displaced by inundation of the Pantabangan Dam. 12.1.7 Food and Agriculture Organization of the United Nations (FAO) Cooperation with FAO included participation in the FAO thirteenth regional conference for Asia and the Far East, Manila, S-13 August 1976, and the consultation on improving nutrition of the rural poor in Asia and the Far East, Bangkok, 7-11 March 1977. 12.1.8 United Nations Educational, Scientific and Cultural Organization (UNESCO) WHO was represented at the following UNESCO-sponsored meetings: regional meeting on innovations in education and training of engineers and higher technicians, Seoul, 23-26 August 1976, and the preparatory meeting of experts for the next regional intergovernmental conference on communication policies and planning in Asia, Manila, 4-8 October 1976. 12.1.9 International Bank for Reconstruction and Development (IBRD or World Bank) WHO was represented at the Annual Meetings of the Boards of Governors of IBRD/IMF, Manila, 4-8 October 1976. Under the WHO/IBRD Cooperative Programme, a mission composed of staff of both organizations visited the Philippines in August/September 1976 and with the assistance of the GovernmeJ;lt conducted a sector study in water supply and sewerage/sanitation. The draft report of the mission containing an evaluation of the present situation and a pro- posed investment programme for 1977-81 was due to be presented to the Government in May 1977. The IBRD is supporting restructuring of the rural health services in the Philippines. Meetings have been held between WHO and represent- atives of IBRD but collaboration between the two agencies in implement- ing this programme needs to be strengthened. 12.1.10 International Labour Organisation (ILO) WHO was represented at the ILO/SPC subregional seminar on cooperatives and population, Suva, 13-15 December 1976. 12.2 Cooperation with intergovernmental organizations 12.2.1 Asian Development Bank (ASDB) An ASDB/WHO meeting was held in Manila on 6 August 1976. Among the topics discussed were country health programming, primary health WPR/RC28/3 page 58 care, environmental health, special assistance to the Socialist Republic of Viet Nam and the WHO research programme. A further meeting was hosted by ASDB in Manila on 28 March 1977 to discuss the progress made since the previous meeting and to consolidate the increased cooperation between the two organizations. It was interesting to note that the meeting held in August dealt with coordination between ASDB and WHO in general terms, while the March meeting dealt with specific items in which coordination would be welcomed. ASDB expressed its appreciation of the assistance already given by WHO staff and in the discussions on specific items pointed out new projects in which the help of WHO would be required. These related mainly to environmental health, and to the communicable disease aspects of water supply and irrigation projects (see also Section 8.2). ASDB was represented at the twenty-seventh session of the Regional Committee for the Western Pacific and representatives of WHO attended the Tenth Annual Meeting of the Board of Governors of the Asian Development Bank, Manila, 21-23 April 1977. WHO participated in the ASDB appraisal mission to the Mindanao irrigation project in Davao del Norte, Philippines, from 14 to 18 September 1976. 12.2.2 South Pacific Commission (SPC) The WHO Representative for the South Pacific, based in Suva, Fiji, continued to play an important role in maintaining close liaison with s~. Two meetings were held with the Secretary-General of SPC on the occasion of his attendance at the twenty-seventh session of the Regional Committee for the Western Pacific. The general question of relationships between the two organizations was discussed as well as possible arrangements for joint activities. The Secretary-General was assured that, as in the past, WHO would wherever possible cooperate fully with SPC in making staff available to assist in seminars, courses and related activities. The Secretary-General expressed the hope that perhaps by 1980 or 1981 SPC might be in a position to propose programmes for WHO collabo- ration and inclusion in its programme budget. WHO was represented at the following SPC meetings: Meeting of the Planning and Evaluation Committee, Noumea, 5-9 July 1976; Sixteenth South Pacific Conference, Noumea, 20-29 October 1976; Third Regional Conference of Statisticians, Vila, 15-19 November 1976; Comprehensive Environmental Management Programme Planning Meeting, Noumea, 23-25 February 1977; Meeting of the Planning and Evaluation Committee, Noumea, 23-27 May 1977. WPR/RC28/3 page 59 In August 1976 discussions were held with SPC on communicable diseases and epidemiological services. 12.3 Cooperation with other organizations and agencies 12.3.1 Southeast Asian Medical and Health Organization (SEAMHO) Southeast Asian Medical Information Centre (SEAMIC) WHO was represented at the seminar on health and industry, Manila, 23-27 November 1976, sponsored by the Southeast Asian Ministers of Education Organization (SEAMEO) under its tropical medicine and public health project (TROPMED). A paper was presented on "The role of WHO in occupational health in the Western Pacific Region". WHO was represented by its Regional Office for South-t;ast Asia at the fourth SEAMIC workshop on health statistics and health documentation, Bangkok, 11-17 January 1977. 12.3.2 United States Agency for International Development (USAID) The Regional Office was unable to participate in the WHO/USAID coordination meeting held in Geneva from 1 to 3 September 1976 but WHO Headquarters was informed that USAID was represented at the following meetings in the Region: Regional seminar on delivery of maternal and child health and family planning within primary health care, Manila, 14-20 September 1976 Regional working group on basic health services, Manila, 21-29 September 1976 It was also invited to send a representative to the regional seminar on new developments in fertility regulation, Manila, 12-16 September 1977 . WHO was represented at USAID-sponsored evaluation of the Medex approach, Honolulu, 16-18 February 1977. 12.4 Other joint work WHO was represented at the following meetings: South Pacific disaster preparedness and relief seminar, Suva, 20-24 September 1976 (organized by the League of Red Cross Societies and supported by the United Nations Disaster Relief Coordinator) Tenth eastern regional tuberculosis conference of the International Union Against Tuberculosis, Seoul, 11-15 October 1976 FAO/ILO/UNESCO interdisciplinary workshop on family planning/ better family living through communication and education for integrated rural development, Kunduz, Afghanistan, 2-13 October 1976 WPR/RC28/3 page 60 Western Pacific and South-East Asian regional conference on sexually transmitted diseases, Singapore, 6-9 January 1977 (organized by the International Union Against the Venereal Diseases and the Treponematoses) Thirty-fifth session of the International Committee of Military Medicine and Pharmacy, Seoul, 25-29 April 1977. 13. CONSTITUTIONAL AND LEGAL DEVELOPMENTS, FINANCIAL AND ADMINISTRATIVE DEVELOPMENTS 13.1 The Regional Committee The twenty-seventh session of the Regional Committee for the Western Pacific was held in Manila from 6 to 10 September 1976. The meeting was attended by representatives of 17 Member States, including Papua New Guinea (formerly an Associate Member) and the Socialist Republic of Viet Nam. Representatives of the United Nations Development Programme, the United Nations Children's Fund, the International Labour Organisation, the Asian Development Bank, the South Pacific Commission and 28 nongovernmental organizations in official relations with WHO were also present. Formalities on the last day of the session were overshadowed by the sad news of the death of Chairman Mao Tse-tung which had reached Manila the afternoon before. The Committee adopted unanimously a resolution conveying its deepest sympathy to the Government and people of the People's Republic of China. The Committee noted the progress made in promoting the concept of primary health care in the Region, and heard a report by the Regional Director on factors important for implementing expanded programmes of immunization. With regard to health manpower development, it noted that the Regional Teacher Training Centre in Sydney had been able to continue its programme through workshops and national courses, and now offered a Master's degree in health personnel education. It expressed its concern that the incidence of cancer, cardiovascular diseases and other chronic diseases was increasing in the Region, and welcomed the fact that the cardiovascular diseases was one of the five priority areas recommended for further study by the newly formed Regional Advisory Committee on Medical Research. In relation to this, the Committee stressed the need to make a closer study of diseases connected with old age and to make provision for the aged in the health services. The Committee reviewed the proposed programme budget estimates for the Region and requested that they be transmitted to the Director- General for inclusion in his proposed programme budget for 1978 and 1979. The Committee also welcomed as a wise innovation the new procedures and form of budget presentation proposed for introduction into the cycle of preparation of the 1980-1981 programme budget. Some representatives, The twenty-seventh session of the Regional Committee. Dr Tran Ngoc Dang, Rapporteur (French language); Mr E. Robin Safitoa, Vice-Chairman; the Honourable J.S. Singh, Chairman, Dr Francisco J. Dy. "' WPR/RC28/3 page 61 however, sought reassurance on questions such as the Organization's accountability; the need, despite the programme-oriented approach, to develop details of projects at a fairly early stage in order to guard against excessive expenditure and to permit evaluation; and the differing national budgetary cycles necessitating close collaboration between WHO and governments. Following the decision of the World Health Assembly to relate reporting by the Director-General to biennial programme budgeting and to the new concept of programming by objectives and budgeting by programmes, the Committee authorized the Regional Director to issue in even-numbered years, beginning in 1978, a short report covering significant matters and developments during the previous year from 1 July to 30 June; to issue in odd-numbered years, beginning in 1979, a comprehensive report on the previous biennium from 1 July to 30 June; and, beginning in 1977, to discontinue publishing a report on individual projects. In view of resolution WHA29.48 adopted by the Twenty-ninth World Health Assembly, which requested the Director-General to "reorient the working of the Organization with a view to ensuring that allocations of the regular programme budget reach the level of at least 60% in real tyrms towards technical cooperation and provision of services by 1980", and on the initiative of the representative of Australi8, the Committee agreed that it was particularly important to define the term "technical cooperation" in the WHO context, if misunderstanding and controversy were not to arise. It therefore made a first attempt to arrive at an acceptable definition. On the recommendation of a working group formed at the beginning of the session, the Committee decided that, with the adoption by the Health Assembly of the Sixth General Programme of Work covering a specific period, and the allocation of priorities for the regional programme under the principal and detailed objectives of the General Programme of Work, it was not necessary to prepare a separate regional programme of work as had been the practice hitherto, and that the Sixth General Programme of Work provided a sufficient guide for the delivery of the WHO programme in the Region,,, It established a subcommittee, consisting initially of the chief representatives of Australia, Fiji, Malaysia and the Philippines, but with membership to be rotated annually, to review, analyse and make recommendations on the development and implementation of the General Programme of Work as it affects the Western Pacific Region. Referring to operative para- graph 2(2) of resolution WHA29.20 adopted by the Twenty-ninth World Health Assembly, 2 the Committee also recommended for the consideration of the Executive Board three programme areas, of high priority within the Region, as being suitable for in-depth study: primary health care, prevention and control of communicable diseases, and nutrition. lwHo Handbook of Resolutions and Decisions, Vol. II (2nd ed.), 1977, p. 67. 2WHo Handbook of Resolutions and Decisions, Vol. II (2nd ed.), 1977' p. 2. WPR/RC28/3 page 62 The Regional Committee was presented with a review of the situation with regard to special assistance to Democratic Kampuchea, the Lao People's Democratic Republic and the Socialist Republic of VietNam as it existed in mid-1976. During the course of the session the representative of Australia announced his Government's intention to contribute A$ 500 000 for assistance to the Socialist Republic of Viet Nam. Word was also received that the Government of Canada would contribute US$ 250 000 for assistance to the Lao People's Democratic Republic. Several representatives made statements on the bilateral assistance that their governments were extending to these two countries, not only in the field of health. The Committee noted the considerable progress made since it authorized the Regional Director, at its twenty-sixth session, to take steps to strengthen and broaden the Region's role in research. Section 1.2 describes the steps taken to implement the recommendations of the first meeting of the Regional Advisory Committee on Medical Research which were endorsed by the Regional Committee. The Committee agreed that in many countries or areas of the Region alcoholism was considered to be a greater problem than drug dependence; lack of basic information on the extent and characteristics of the problem hindered the establishment of adequate preventive and remedial measures. It urged Member States to give priority to setting up data collection and monitoring systems which would be comparable on an intercountry basis. The Committee considered a proposal to establish a regional centre for environmental health sciences which would provide in one institute facilities for intensive training courses; for collecting basic data and data on progress in the field of environmental health; for estab- lishing criteria and standardized methods applicable to the Region; for carrying out research activities aimed at developing autochthonous technology where only limited resources are available; and for a free exchange of information. Bearing in mind resolution WHA29.48, the Committee advocated caution in undertaking an activity that might very well be carried out with existing mechanisms and accepted a proposal 1 that a study be made of the feasibility of establishing such a centre. The Committee stressed the great need for training in every aspect of child health, in all disciplines and at all levels, and the need to promote activities to improve the outcome of pregnancy and control the prevalence of diseases and factors bearing on the psychosocial develop- ment of children. It noted that malnutrition persists, even when national economic indicators improve, and that Member States need to develop simple 1 For report of the feasibility study, see document WPR/RC28/7 to be presented to the twenty-eighth session of the Regional Committee. I I WPR./RC28/3 page 63 nutritional surveillance systems which will provide data on deprived groups in order to facilitate long- and medium-term planning and to predict deterioration in nutritional status, so that rapid preventive action might be taken. The Committee accepted the invitation, confirmed by the Government of Japan, to hold its twenty-eighth session in Tokyo from 6 to 12 September 1977. It also accepted the offer of the Government of the Republic of the Philippines to act as host to its twenty-ninth session, which is to be held in Manila. The theme of the Technical Presentation was "Primary health care". "National drug policies and management" was selected as the topic for the Technical Presentation in 1977. 13.2 Regional Office 13.2.1 Organizational structure 13.2.1.1 Regional Office staff The posts of Director of Health Services, regional adviser (environmental health), regional environmental health officer, regional adviser (chronic and degenerative diseases) and administration and finance officer which became vacant were filled by reassignment. Selection has been made for the vacant post of regional adviser (health services development). The second post of regional adviser (communicable diseases), senior personnel officer and translator became vacant. Arrangements were made for performance of the duties attached to the post of senior personnel officer by recruitment of a consultant; a replacement was selected and was expected to take up duty within the reporting period. One post of Assistant Director of Health Services, the second post of regional adviser (health manpower development) and the posts of regional adviser (nursing education) and senior translator were abolished in implementation of resolution WHA29.48.1 However the second post of regional adviser (health manpower development) will have to be re-established because the workload is too heavy for only one staff member. One post of secretary and two posts of clerk- stenographer were also abolished. 13.2.1.2 WHO Representatives The posts of WHO Representative, Philippines, and a secretary for his office are still vacant. 1WHo Handbook of Resolutions and Decisions, Vol, II (2nd ed.), 1977 J p. 67. WPR/RC28/3 page 64 The post of WHO Representative for the South Pacific based in Suva, Fiji, which became vacant was filled by reassignment. The post of administrative officer in his office was abolished and in its place a post of administrative assistant in the general service category was established. One post of clerk-stenographer in the office of the WHO Representative, Lao People's Democratic Republic, was abolished. A post of WHO Representative, Papua New Guinea, was established and filled effective 1 August 1976. Posts of administrative assistant and clerk-stenographer for the office were established. The post of WHO Representative, Socialist Republic of Viet Nam, was transferred to Hanoi and was expected to be filled by July 1977. 13.2.1.3 Project staff A total of 105 selection committees were held between 1 July 1976 and 30 June 1977. During this period 13 project posts were filled either by recruitment or by reassignment. 74 consultants were recruited; the total period of their assignment was 111.1 manmonths. 13.2.2 Salaries and allowances A survey was made of the salaries and other conditions of service of staff in the general service category in February 1977; it was agreed by WHO Headquarters that changes in salary scale would be effective 1 March 1977. A new general service salary scale for Vientiane, Lao People's Democratic Republic, was established effective 1 July 1976. 13 .2.3 Regional Office premises 13.2.3.1 Construction 13.2.3.1.1 New Annex Contracts for the new annex were awarded on 27 January 1977 covering general construction, electrical work and airconditioning. The esti.ated cost of the new annex is Philippine pesos 3 560 874 (or US$ 481 199 at the rate of pesos 7.40 per US$1.00). The project cost may finally vary as 197. is for material to be purchased by the organization and 10% is for architect's and engineer's fees which will be based on the total cost. According to the agreement concluded with the contractors, the new construction should be completed by 27 January 1978. However it is possible that construction may be completed within a shorter period, depending on the rapidity of obtaining those materials which are to be purchased abroad. WPR/RC28/3 page 65 As there has been an escalation of costs of about 20% per year since the middle of 1975 when the plans were made, the third storey of the building had to be eliminated in order to avoid requesting additional funds to meet costs exceeding the allocation of US$ 480 000 from the WHO Real Estate Fund. As a result of elimination of one entire floor, the new annex will overall be reduced by 49%. The increase in the existing office space will be 25%. On the other hand the new annex will provide 19% less space for warehousing, the supply office, drivers' quarters, cafeteria stores and workshops, as compared to the previous structure which has been demolished. However the foundation of the new building is being constructed to carry four storeys so that third and fourth floors can be added at a later date if necessary. 13.2.3.2 Temporary quarters Temporary quarters were constructed at a cost of US$ 4300 for use of the electrician, carpenter and drivers and the cafeteria stores during the construction of the new annex. If the temporary quarters are retained in the Regional Office premises following construction of the new annex, the loss of non- office space due to elimination of the third storey will be reduced to 4%. 13.2.3.3 Flood protection Additional walls were built around the fish pools to prevent their flooding during the rainy season. 13.2.3.4 Car park Additional parking space of 20 bays was constructed at a cost of US$ 6440. 13.2.3.5 Repairs and maintenance The yearly maintenance of the central airconditioning system was carried out. Evaporative condensers were replaced after having been in service since the Regional Office buildings were erected in 1958. The roof deck of the main building underwent waterproofing repairs. The interior and exterior of the main building and the conference hall were repainted and revarnished. The lighting fixtures were secured for safety purposes. In conformity with a presidential decree, cots and bedding were purchased for use by staff in emergencies caused by floods and typhoons. The water pumps serving the building since their construction were replaced. WPR/RC28/3 page 66 13.2.3.6 Communications and records Workload statistics of the Registry are as follows: incoming communications and parcels, 68 400 incoming cables/telexes, 4275 incoming diplomatic pouches, 634 outgoing correspondence and parcels, 83 300 outgoing cables/telexes, 4408 outgoing diplomatic pouches, 791 The cost of postage for outgoing mail, cables, telexes and diplomatic bags amounted to approximately US$ 30 400. 13.2.3.7 Duplication and binding The total copy system helped in printing and collating documents rapidly and eliminating backlog. Most of the bookbinding work for the Office is now done internally. Documents comprising 2 517 286 impressions were produced, involv- ing the preparation of 26 280 offset masters. 13.2.3.8 Microform Microfilming of personnel records involving several thousand files was completed and the originals were destroyed. Files for projects completed in 1973, 1974 and 1975 were micro- filmed for the archives and the originals destroyed. 13.2.3.9 Word processing The two word-processing typewriters proved unsuitable for use in Manila. The machines are being replaced by the company's new and more efficient models and the unsatisfactory units returned. The amount deposited for the original machines has been credited to the purchase price of the new ones. 13.2.3.10 Project supplies and equipment Procurement action, including the issue of 388 purchase authoriza- tions, was taken for various medical supplies and equipment, medical literature, bulk drugs, etc., for projects in the Region, comprising 3166 line items amounting to US$ 3 622 000. -13.2.3.11 Conference hall WPR/RC28/3 page 67 In addition to the twenty-seventh session of the Regional Committee ten meetings were held on the Regional Office premises and two were arranged in Manila in locations outside the Office. 13.2.4 Regional obligations and expenditures 13.2.4.1 Regular budget Pages 68 and 69 of this Report contain a statement and a graphic presentation of the obligations incurred for the Region for the period 1967-76 (figures prior to 1967 were shown in the Annual Report of the Regional Director to the twenty-seventh session of the Regional Committee- WPR/RC27/3). However the amounts shown in US dollars cannot adequately reflect the volume of programme delivery from year to year because of the decreasing purchasing power of the funds over the 10-year period. A study of the rate of implementation of activities for which funds were available under the WHO regular budget, based on the allocations received from the Director-General for the fiscal years 1975 and 1976, shows 99.38% implementation in 1975 and 99.94% in 1976. In prior years the rate of implementation was based on the revised budget estimates for the year concerned. However, commencing with the 1976 report, the rate of implementation will be based on the final allocations received from the Director-General during the implementa- tion year, so as to give the Regional Committee a more precise state- ment of the rate of programme delivery. Revision of the basis of calculating the implementation rate resulted in a change from 98.77% to 99.38% in 1975. 13.2.4.2 UNDP-funded activities The obligations incurred in 1976 for UNDP-financed projects as shown in the table and graph on pages 68 and 69 decreased by approxi· mately 23% as compated with 1975. ·This resulted from the serious financial problem faced by·UNDP beginning in late 1975, causing expenditure of funds from that source to be curtailed, 13 .2 .• 4.3 UNFPA-funded activities It will be noted from the table and graph on pages 68 and 69 of this Report that there was a very slight decrease in expenditure on UNFPA-financed projects in 1976 as compa·red with 1975. tvPR/RC2S/3 page 68 YEAR 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 OBLIGATIONS INCURRED BY THE WHO WESTERN PACIFIC REGION!! 1967 •1976 (Expressed in millions of US dollars) 0 B L I G A T I 0 N S Regular budgetY UNDP UNFPA 4.05 0.75-y 4.39 1.13~/ 4.90 0. 79?.1 5.33 0.82§! 0.01 6.06 0 ~84?.:/ 0.30 6.68 0.71 0.58 7.52 0.96 1.07 8.50 0.95 1.24 10.47 1.26 0.97 11.14 0.97 0.96 Total 4.80 5.52 5.69 6.16 7.20. 7.97 9.55 10.69 12.70 13.07 !/Figures extracted from Official Records Nos 167, 175, 183, 191, 200, 208, 214, 222, 230 and 237 Financial Reports and Rep.orts of the External Auditor to the World Health Assembly. Figures prior to. 1967 are shown in the Twenty-sixth Annual Report of the Regional Director (WPR/RC27/3). y Includes the Voluntary Fund for Health Promotion, Funds-in-Tntst· and Reimbursable Funds, but excludes the United Nations Emergency Operation. 3/ Includes the UNDP/SF component obligation of $ 56 417 '!.! Includes the UNDP/SF component obligation of $ 287 073 ~I Includes the UNDP/SF component obligation of $ 429 632 §.I Includes the UNDP/SF component obligation of $ 319 764 u Includes the UNDP/SF component obligation of $ 196 811 --· 14.00 13.00 12.00 11.00 10.00 9.00 8.00 7.00 6.00 5.00 4.00 3.00 2.00 1.00 GRAPH OF OBLIGATIONS INCURRED BY THE WHO WESTERN PACIFIC REGION.!/1967-1976 (Expressed in millions of US dollars) I - Total oblig<= tion I - Regul ar bud get 'l/ ~ / --- UNO p 3/ L -- UNF PA J v I v v / v / L_ v v v """' v v L ,........ ~ ~ v ,..... ~ ,.. , ..... ---- ...... -- .... ~ .... -- --- --- --- y~-- ....,...,.- ..,...-- WPR/RC28/3 page 69/70 1 4.00 v 1 3.00 1 2.00 v 1 1. 00 1 0.00 9.00 8.00 7.00 6.00 5.00 4.00 3.00 2.00 -~ -- 1.00 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 !_/Figures extracted from Official Records Nos.167, 175, 183, 191,200, 208, 214, 222,230 and 237 Financial Reports and Reports of the External Auditor to the World Health Assembly, Figures prior to 1967 are shown in the Twenty-sixth Annual Report of the Regional Director (WPR/RC27 /3). ~/ Includes the Voluntary Fund for Health Promotion, Funds -in-Trust and Reimbursable Funds, but excludes the United Nations Emergency Operation, !1 Includes the UNDP/SF component obligations of $56 417 in 1967; $287 073 in 1968; $429 632 in 1969; $319 764 in 1970; and $196 811 in 1971. PART II EVALUATION SUMMARIES OF SELECTED PROJECTS WPR/RC28/3 page 72 EVALUATION SUMMARIES OF SELECTED PROJECTS The following selected projects are described. Environmental health advisory services, Malaysia (MAA/SES/001) Nursing education, Papua New Guinea (PNG/HHD/002) Education and training advisory services, Papua New Guinea (PNG/HMD/oo4) Regional working group on basic health services, Manila, 21-29 September 1976 (ICP/HSD/010) Oral health advisory services (ICP/ORH/001) 1. Title and number Source of funds Participating agencies Implementation dates 2. Background WPR/RC28/3 page 73 Environmental health advisory services MAA/SES/001 WHO regular budget Government, WHO January 1966 to present In Sabah and Sarawak rural development and the improvement of living conditions were major objectives. In particular the state health authorities wished to train personnel and develop water supply and sanitation. To cooperate in this endeavour a WHO sanitary engineer was assigned to Sarawak and later transferred to Sabah. In Peninsular Malaysia WHO had already provided technical cooperation through a project for the development of sanitary engineer- ing services within the framework of the Ministry of Health, Kuala Lumpur. In 1969 the plan of operation of the present project was modified to cover ongoing activities throughout Malaysia as well as further development of environmental health at the federal level. A second WHO engineer was assigned to the Ministry of Health for the latter purpose. 3. Objectives During the first phase of the project (1966-70) when operations were limited to Sabah and Sarawak, the objectives were to develop facilities suitable for villages and small rural communities, including latrines and water supplies, train health technicians and rural health supervisors in sanitation techniques and develop sanitation services generally. In May 1970, when planning of the operations commenced in Peninsular Malaysia, the following objectives were added: to collaborate with the Ministry of Health in further develop- ing an institutional framework for administration of environmental health programmes at federal level; to cooperate with the Ministry and other government agencies in various environmental health matters including water supply, sewerage, health aspects of land zoning and physical planning, solid wastes management, food sanitation, water and air pollution, factory environmental improvement, institutional sanitation, legislation and training; to coordinate the environmental health activities in Sarawak and Sabah with a view to their integration into the federal scheme. WPR/RC28/3 page 74 4. Activities 4.1 Water supply, sewerage and pollution control (a) Rural A rural water supply and sanitation programme was implemented throughout Malaysia with support from UNICEF in supplies and equipment for demonstration and training. By the end of 1976 water supplies had been provided to some 230 000 people in 922 rural communities in Sarawak and to some 32 000 people in 134 communities in Sabah. In Peninsular Malaysia field operations were initiated in 1976. Ten piped water supply systems and 775 wells were constructed, serving some 30 000 people; and 160 000 latrines were installed, serving an estimated population of 1 100 000. Total cost of the facilities was about M$ 417 million, exclusive of labour which was provided by the communities. UNICEF provided supplies and equipment worth about M$ 263 000, the balance of costs being met by the Government and communities. Details of the financing are as follows: GOVERNMENT ALLOCATIONS FOR SABAH, SARAWAK AND PENINSULAR MALAYSIA UNDER THE THIRD MALAYSIA PLAN, 1976-1980 (in Malaysian dollars) Averase annual Total allocation allocation Sa bah Federal funds 300000 State funds 800 000 220 000 Sarawak 1 500 000 300 000 Peninsular Malaysia 100 000 000 (Public works) 20 000 000 7 200000 (Health) 1 440 000 Total 109 800 000 21 960 000 1M$1 = US$0.40. _ _-;.- WPR/RC28/3 page 75 UNICEF CONTRIBUTIONS TO RURAL WATER SUPPLY AND TRAINING PROGRAMMES Total contribution Sa bah US$ 120 000 since 1973 Sarawak US$ 308 000 since 1967 Peninsular Malaysia US$ 50 000 since 1966 Sa bah Sarawak Peninsular Malays.ia TARGET POPULATION COVERAGE AND SCHEDULE FOR COMPLETION OF THE PROGRAMME No. of xears Highest rural reguired to PoEulation E02ulation com2lete the alreadx estimate Erograrmne served 660 000 16 (from 1976) 32 182 950 000 10 (from 1976) 229 673 4 000 000 15 (from 1976) 29 906 Average annual contribution US$ 30 000 US$ 28 000 US$ 25 000 Po2ulation s ti 11 in need of water facilities 627 818 (95%) 720 327 (76%) 3 970 094 (99%) To implement the prograrmne 133 rural environmental staff have been trained through annual courses in Sarawak since 1966, 70 in Sabah since 1975 and 121 in Peninsular Malaysia since 1976, at a total cost to the Government of M$ 1 006 000. (b) Urban - Planning The Federal Environmental Health and Engineering Unit, in conjunction with local authorities, the Ministry of Local Govern- ment and the Economic Planning Unit, Prime Minister's Department, carried out the following activities: collaboration with the authorities in the implementation and review of a large-scale feasibility study for Kuala Lumpur and environs and arrangements for project financing (M$ 134.5 million); completion of the Ipoh sewerage feasibility study and negotia- tions with the city to implement the project; completion of a preliminary sewerage study for six other towns and arrangements for several studies in Sarawak; WPR/RC28/3 page 76 elaboration of a sewerage plan for Peninsular Malaysia and preparation of the "National policy statement on sewerage planning" which was adopted by the Cabinet in 1975; preparation of a handbook "Guidelines for sewerage works design"; collaboration with IBRD and WHO in executing a sewerage sector study. Pollution control Water pollution surveys were conducted in beach areas of Penang, Straits of Johore and the Scudai River basin and an industrial wastes survey was started, Draft regulations for control of air and industrial wastes discharge were prepared in collaboration with other ministries. Guidance was given on a wide range of industrial wastes problems and specific requirements for water and air quality control and monitor- ing. Finally, advice was given on the use of water quality monitoring and testing equipment. Training In-service training was provided for newly recruited staff and, up to 1975, WHO fellowships totalling 6.6 man-years had been provided for ten government staff. 4.2 Institutional and programme development The Federal Environmental Health and Engineering Unit was established in the Ministry of Health in 1969. It was principally responsible for {i) development of the Environmental Quality Act (1974), (ii) amendment of the Water Enactment in 1971 to include water pollut- ion control, (iii) drafting of Sanitary Plumbing By-laws and other sanitary provisions of the Street Drainage and Building Act (1974). The Unit collaborated in drafting a Public Health Act and now administers the Radioactive Substances Act. Operative liaison was established between the Unit and the Public Works Department, the Ministry of Local Government, the Economic Planning Unit and all local authorities. It assisted in developing an Engineering Maintenance and Service Unit for medical institutions and is now the central agency for the national sewerage development programme. Needs were analysed and programmes established in (i) rural environmental sanitation, including operational plans, guidelines and training of staff, (ii) urban environmental planning, including provisions for sewerage, drainage, solid wastes management and food sanitation, and (iii) environmental quality control, including legislation, management plans and survey studies. Finally environmental health and engineering information resources were developed, including the establishment of a library. .. -. 4.3 Integration WPR/RC28/3 page 77 Programme planning and management of environmental health services for the States are now partially integrated. However there is still considerable autonomy in project implementation. 5. Problems The principal factors tending to retard project implementation have been: difficulties in ensuring that attention is paid to environmental health in projects and activities which are the responsibility of other government agencies; shortage of candidates for engineering posts and experienced environmental health staff; lack of clear legislation to support environmental health programmes. 6. Evaluation The rural water supply programme has been a marked success, generating strong public and government support; it has provided facilities for about 300 000 rural dwellers. There is, however, a need for further strengthening of rural environmental sanitation in Peninsular Malaysia and Sabah. Tl.e project has been instrumental in stimulating some government action in improving urban sewerage and acceptance of the need for sector development. Funding for initial projects amounts to M$ 153 million. However the demand for services in urban sewerage and environmental pollution control considerably exceeds the Unit's present capability. Development of the Federal Environmental Health and Engineering Unit has proceeded more slowly than planned but an effective organiza- tion has emerged with reasonable prospects of growth. The Unit's principal area of responsibility has been defined and an active programme of action developed to meet urgent national needs. The most important requirement is continued development of the Unit's capability so that it can fulfil its responsibilities in advising on all public health engineering aspects of environmental management. Some division of responsibilities in important environmental health sectors has occurred, with the establishment of separate units for food sanitation, vector control and occupational health within the Health Services Division, Ministry of Health, the assignment of responsibility for industrial hygiene to the Department of Factories and Machinery, and the delegation of major responsibility for environ- mental quality control to the Ministry of Science, Technology and Environment. However, if backed by efficient interagency cooperation, the evolving pattern should prove workable. WPR/R028/3 paae 78 Ultimately a problem that must be faced is that national development is proceeding at a pace that exceeds the growth of environmental health and engineering institutional capacity to provide adequate quality control. 1. Title and number Source of funds Participating agencies Implementation dates 2. Background Nursing education PNG/HMD/002 WHO regular budget Govermnent, WHO WPR/RC28/3 page 79 September 1970 to December 1979 When Papua New Guinea was still a Trust Territory administered by Australia, most of the posts of responsibility in nursing education and administration as well as public health nursing were held by expatriates. At the same time national nurses were sent overseas to study in these fields as postbasic programmes were not available locally. Then, as independence of the Territory approached, the Government of Australia requested WHO collaboration in providing such training in the country itself. It was agreed that three diploma courses would be developed, first in community health, then in nursing education and finally in nursing administration. 3. Objectives The plan of operation for the project was signed in 1970. It was concerned almost exclusively with the community health course for which it set the following objectives: to strengthen the public health nursing aspect of the basic nursing curriculum; to establish a postbasic course in public health to give nurses better preparation for meeting community health needs; to make better use and improve the performance of nursing personnel employed in public health, through inservice education. Subsequently two addenda extended the scope of the plan of operation. The first, signed in 1973, provided for WHO collaboration in preparing postbasic curricula in nursing education and also in nursing administration from 1974. The second addendum, signed in 1977, provided for continuation of the WHO support up to 1979, an evaluation of the three courses and the inclusion of new objectives as follows: in close coordination with national and international staff concerned with the development of health services, (i) to plan to meet current and foreseeable needs of qualified nurses for educational and administrative positions in the country and (ii) to collaborate with the College of Allied Health Sciences, Port Moresby, in improving the community health course; to prepare a cadre of nursing educators and administrators to meet the evolving needs of the health services; WPR/RC28/3 page 80 to plan, organize and implement a continuing education programme so as to improve the skills of nurse educators and administrators. 4. Activities The project is being implemented at the College of Allied Health Sciences, Port Moresby, directly under the auspices of the Department of Health. WHO provides the services of one nurse educator while all other services as well as facilities, supplies and equipment are furnished by the Government. The main activities of the project to date may be summarized as follows: (a) Diploma course in community health At the outset the committee set up to plan and design a curriculum for the course decided that it should be open to both registered nurses and health extension officers. The course was held four times, provid- ing training for a total of eight health extension officers, 39 national nurses and three nurses from neighbouring countries. However, establishment of the course on a sound basis proved difficult. It was therefore decided not to hold it in 1977 so as to allow for a complete revision of the curriculum, taking into account the new areas of community health to be covered and the changes which have taken place in the country's health manpower structure. (b) Diploma course in nursing education Since 1973 the course has been held three times, with a total of 29 graduates. (c) Diploma course in nursing administration The course became operational in 1975 and has been held twice with a total of 20 graduates. Two national counterparts of the WHO nurse educator of the project have been prepared as officers in charge respectively of the nursing education course and of the nursing administration course and will be able to take over complete responsibility for them in the near future. (d) Planning As mentioned, a committee was established for planning of the community health course. A similar committee was subsequently organized for planning, revision and evaluation of the nursing administration course. Planning of a new integrated "general nurse syllabus" to train nurses in hospital and community health work at state registration level was started in 1976. I~ 5. Problems The main problems encountered have been in the area of WPR/RC28/3 page 81 supportive facilities such as secretarial assistance, supplies, equipment and transportation. Relatively high turnover of nursing and other personnel within the central administration and the College itself also poses a problem. However this is to be expected in a newly independent country. The major constraint is the shortage of field practice areas of an appropriate standard where the graduates may be sent to obtain experience, Also there is an evident need for closer coordination of training activities with health service delivery. 6. Evaluation The qualitative evaluation of activities provided for in the second addendum to the plan of operation will be based on the current performance of all graduates of the three courses since their inception. At this stage, however, it can be said that project activities are not in conformity with those envisaged in the initial request and the plan of operation. Some project components, particularly the community health course, are still weak but on the other hand the training has been coordinated with that in other fields such as basic nursing education. WPR/RC28/3 page 82 1. Title and number Source of funds Participating agencies Implementation dates 2. Background Education and training advisory services PNG/HMD/004 WHO regular budget Government, WHO 1971-197 5 The project was established in 1971 because the Department of Health, in view of the accelerated expansion of health services taking place, was becoming particularly concerned about the training of health personnel. The Government planned to reassess the staffing needs of the health services, to determine the types of health workers required for the country in future years and to adjust the training programmes accordingly. 3. Objectives The overall objective was to produce health staff below the. level of a physician but having relevant skills to give efficient service as members of the health team. The specific objective was to support the Department of Health's Training Division and designated institutions in the planning, implementation and evaluation of various types of training for health personnel. Another specific objective developed after the launching of the project was to support the Training Division in conducting a health administration course for staff of the health services. 4. Activities As a first step WHO consultants visited the country in 1971 and 1972 to cooperate with the Government in reassessing the health manpower needs and planning appropriate training programmes. From their discussions with the authorities and their observations of training institutions and health facilities, the consultants concluded that the identified weaknesses of the health services could partly be ascribed to lack of adminatrative training and experience among lower-echelon staff. Following these consultant missions a WHO technical officer qualified in public health administration was assigned to Papua New Guinea in April 1972. He was given broad terms of reference, one of which was to advise the Department of Health on the organization of health administration training for various categories of personnel including hospital secretaries, district health extension officers and administrative officers. He submitted recommendations on the establish- ment of a suitable course for this purpose and participated in the teaching once it became operational. However, under the detailed plan of work which he drew up after his arrival, taking into account the provisions of the plan of operation and the local situation, the focus WPR/RC28/l page 83 of his activity shifted from planning of the course to actual training of the existing staff in administrative skills. He completed his assignment in April 1975. After the authorities had accepted the principle of setting up a course in health administration, which was to be of one year's duration and lead to the award of a diploma, active preparations commenced. A planning committee was formed with two subcommittees and three working groups, in all of which the WHO technical officer and his national counterparts were represented, A curriculum was approved by the planning committee in November 1972 and, after selection of 20 out of 83 applicants for the course, a first session commenced in February 1973. As regards organization, the course was held annually from 1973 to 1976 at the College of Allied Health Sciences, Port Moresby, under the auspices of the Department of Health. Initially it was run by the WHO technical officer but on completion of the assignment this , responsibility was assumed by his national counterpart, a graduate of the first session. A revised curriculum was introduced in 1975. Teachers were obtained from various sources at national level: apart from the resources of the College itself, those of the University of Papua New Guinea, the Papua New Guinea Administrative College, the College of Allied Health Sciences, Madang, and the Department of Health were utilized at different times. The WHO technical officer contributed 300 teaching hours during the first session of the course and continued to provide instruction until the end of his assignment. In the years 1973-76 a total of 52 students, including two from Nepal, completed the course. The national graduates are currently employed in various capacities in the health administration. Support of other training activities in the country included contributions by the WHO technical officer to the course for health extension officers at the College of Allied Health Sciences, Madang, to refresher courses for health extension and dental staff, and to the training of dispensers. Advice was also given on the coordination of all health-related diploma courses in the country. Finally, following discussions with the Department of Health and the Public Service Commission, the WHO technical officer submitted recommendations concerning the district health administration which were largely incorporated into the National Health Plan, 1974-78. 5. Problems (a) Training activities In this area a number of human problems were encountered: a generally low standard of basic education among the students, particularly in mathematics and English; problems of the students in personal relationships; and a lack of communication between students and teachers in the early stages of each session of the course. WPR/RC28/3 page 84 (b) National counterparts Initially two national counterparts had to be replaced in succession because they had other full-time jobs which made it difficult for them to attend to project work satisfactorily. But in January 1974 this problem was solved with the assignment of a capable national counterpart to the project on a full-time basis. 6. Evaluation It is not possible to evaluate the project in relation to the objectives in the plan of operation, as they are stated in broad and nonquantifiable terms. As mentioned, however, under the plan of work drawn up by the WHO technical officer, the main thrust of the project eventually became the training of staff of the health services in administr-ation. If this activity is accepted as a specific project objective it is correct to state that it has been met by establishing the one-year diploma course in health administration and conducting it successfully every year until 1976. OUt of the 50 national graduates of the course 41 (82%) are now in higher-echelon departmental administrative posts such as hospital secretary, accountant and administrative officer while the others are in senior technical posts such as principal health extension officer and training officer. The course is not being held in 1977 as the Department of Health has filled all its vacant administrative posts and the national course director has been transferred to the College of Allied Health Sciences, Madang. In view of this transfer it has also been decided not to conduct an evaluation of the course's relevance to national needs, scheduled for the current year. It is expected that in future the course will continue to be offered at the College of Allied Health Sciences, Port Moresby, using part-time lecturers from the Papua New Guinea Administrative College. 1. Title and number Source of funds Implementation dates 2. Background WPR/RC28/3 page 85 Regional working group on basic health services ICP/HSD/010 WHO regular budget International Epidemiological Association 21-29 September 1976 Strengthening the organization and delivery of health care has been a key activity of WHO for over 25 years and, from a modest beginn- ing in the 1950s, major programmes in this field have been established in many parts of the Region. In most developing countr'ies of the world it is apparent that, despite the efforts of governments and international organizations to provide relatively comprehensive health services run by qualified personnel, there has been failure to cover up to 80% of the population, namely those living in rural areas and urban slums. Nevertheless a number of successful or potentially successful programmes were set up, some of which WHO and UNICEF decided to examine for future guidance. Thus a study entitled "Alternative approaches to meeting basic health needs in developing countries" was commenced in December 1973 and the final report was presented to the twentieth session of the UNICEF/WHO Joint Committee on Health Policy in February 1975. 1 In May 1975 the study was endorsed by the UNICEF Executive Board and by the Twenty-eighth World Health Assembly, which considered that the document could serve as the basis for a worldwide programme of action in primary health care. At the regional level it was decided in 1974 that the delivery of health care at the periphery should be re-examined and provision was therefore made in the WHO programme budget for 1976 to hold a regional working group on basic health services. Subsequent discussions with the International Epidemiological Association (lEA) in 1975 led to the decision to convene the group under co-sponsorship of the two organizations. 3. Objectives The group was assigned the following objectives: to exchange views and information on the concepts, trends and present status of basic health services in the Region with particular reference to primary health care; 1ojukanovic, V. and Mach, E.P., ed.: Alternative approaches to meeting basic health needs in developing countries - a joint UNICEF/WHO study, Geneva, World Health Organization, 1975. WPR/RC28/3 page 86 to consider the application of results of operational research on basic health services conducted in the Region; to prepare guidelines for future development of basic health services with emphasis on primary health care; to consider the role of international agencies in the promotion and development of basic health services. 4. Organization It was decided that members of the group would be selected by WHO in view of their expertise at each level of health services, from central to peripheral, and as representatives of the major disciplines of medicine, nursing and environmental sanitation involved in the organization and delivery of health care. Sixteen members were eventually appointed including a "barefoot doctor" and a director of health services. The meeting was also attended by observers from UNICEF, USAID, UNDP and the University of the Philippines. The secretariat comprised four consultants from lEA and six from WHO, including physicians, a nurse, a sanitarian and a sociologist. A number of topics were presented to the group in plenary sessions, falling into five main areas: concepts and trends in basic health services with particular reference to primary health care; community involvement in primary health care; approaches in the planning, implementation and evaluation of basic health services; recommendations and guidelines for the future development of basic health services with emphasis on primary health care; role of WHO and other external agencies. Three discussion groups were set up to deal with the various points i~ a specified order of priority, ensuring equal coverage. 5. Conclusions 5.1 Concepts and trends The Group generally agreed with the concepts of primary health care embodied in the report of the UNICEF/WHO study previously mentioned. It identified the components of the primary health care approach as follows: prtmary health care consists of simple, efficacious and effective measures including preventive, promotive, curative and rehabilitative activities; '' -~ II , )!/ 1 '" WPR/RC28/3 page 87 it is carried out at the peripheral level of health services; it requires an intersectoral approach; community involvement is necessary for effective implementation; primary health care and community development are mutually supportive. Some members of the group felt it was inappropriate to refer to such care as "primary", preferring the term "basic" as the services are intended to reach the grassroots level. It was emphasized that maximum reliance should be placed on community resources in the provision of primary health care, while recognizing that there can also be a mix of resources from both the health agency and the community for this purpose, Whether such health workers in the community should be paid or not would depend on the local situation. 5.2 Community involvement The role of the community was seen as a collective effort to maintain a close relationship with the health agency, the community providing the link between the agency and individual families. The community must identify its own needs and problems and work out prio- rities for tackling them, furnishing the necessary information to the government agencies concerned. Another important factor in providing health care is political commitment since support by political leaders enhances community involvement, The community should also participate in the selection of primary health workers and support their training by the health agency. 5.3 Approaches in planning, implementation and evaluation Systems analysis It was generally agreed that systems analysis is closely linked with the other approaches used in the planning, implementation and evaluation of basic health services. Systems analysis is considered an effective tool in identifying and solving problems related to the services. Since several methods are available, it is important that the one selected be suitable for planning purposes in order to give the decision-makers the answers they require. Operational research The group concluded that planning is useful for overall strengthening of primary health care in developing countries while operational research is of value in improving the effectiveness of specific components of the care, Epidemiological approach The group agreed on the need for greater use of the epidemiological approach by health administrators, noting that there is often a gap between the academic studies carried out by universities and the minimal attention paid to epidemiology in health administrations and field services. WPR/RC28/3 page 88 5.4 Guidelines for the future development of services The countries/areas considered in this connexion were China, Fiji, Lao People's Democratic Republic, Malaysia, Papua New Guinea, Philippines, Republic of Korea, Samoa and the Solomon Islands. Two main patterns of development of primary health care services in the Region were noted, namely: (i) services where primary health care is seen as an extension of existing general health care to cover areas or communities previously underserved; (ii) services where primary health care evolves from a policy established within a country's overall political framework. An example of development according to the second pattern is that in the Lao People's Democratic Republic. Guidelines for the future development of basic health services with emphasis on primary health care were then laid down, taking into consideration the two patterns of development identified in the Region. 5.5 Role of WHO and other agencies The role of WHO, UNICEF, UNDP, USAID, lEA and other international agencies in the development of basic health services was discussed. The Group concluded that the different agencies should: coordinate their efforts through the government concerned; promote the multisectoral approach to health service develop- ment at all levels in a given country; cooperate with countries in developing basic health services which are suited to local needs rather than being based on a traditional or foreign pattern. 5.6 Report A full report of the group's discussions was issued on 25 October 1976 and will be published as Public Health Paper No. 1 of the Western Pacific Regional Office. 6. Evaluation A questionnaire for evaluation of the meeting was distributed to the 16 members of the working group and 13 submitted replies. With regard to the time allotted for the discussion groups and plenary sessions, field visit, reading of documents and other purposes, as well as the overall duration of the meeting, the comments were as I" WPR/RC28/3 page 89 follows: the times allowed should be lengthened (5.5%), kept as they are (60.4%), shortened (3.3%). No answer was received from 30.8% of respondents. Technical aspects of the meeting were found very satisfactory by 47.8% of respondents and satisfactory by 44.0%, with 8.2% not answer- ing the question. The technical aspects specified were rated as follows: Very Technical aspect satisfactory Satisfactory Objectives 48.3% 44.0% Consultants 48.1% 42.3% Documentation 46.2% 46.2% Grand total 47.8% 44.0% It can therefore be said that the working group was considered successful by the members. Finally the timing of the meeting was appropriate as it preceded the national workshops on primary health care scheduled by a number of governments in the Region in preparation for the regional conference on primary health care which will take place in Manila from 21 to 24 November 1977. WPR/RC28/3 page 90 1. Title and number Source of funds Participating agencies Implementation dates 2. Background Oral health advisory services ICP/ORH/001 WHO regular budget Governments World Health Organization 1961 to present The subject of dental health was first raised by WHO in the Western Pacific Region at the Technical Discussions during the twelfth session of the Regional Committee for the Western Pacific held in Wellington, New Zealand in 1961. It was concluded that this was a neglected field, that dental disease was a public health problem of some magnitude requiring immediate attention and that long-term overall planning was urgently needed. As a result an intercountry oral health advisory services project was established, to be implemented in three multiphased periods covering 20 years: the first (1961-72) concerned with fact-finding and general planning; the second (1973-77) with specific planning through country visits and implementation of recommendations on manpower development and effective delivery of oral health care; and the third (1978-82) with specialization in selected areas - it being anticipated that by then most countries/areas would have ongoing oral health services. 3. Objectives, strategy and approaches 3.1 Objectives The overall objective during the current second period is to initiate, expand and consolidate oral health programmes in the Region. The specific objectives are: (i) to strengthen the organization for delivery of oral health services; (ii) to collaborate in the development of programmes for prevention of dental diseases; (iii) to consolidate and develop programmes for training operating and nonoperating dental auxiliaries as well as group educational activities in public health dentistry; (iv) to stimulate community awareness and participation in respect of oral health; (v) to implement the recommendations of the WHO/SPC seminar held in Noumea in 1971 and those of the WHO workshop held in Singapore in 1972 (see Section 4.1). 3.2 Strategy and approaches In each country or area these are as follows: WPR/RC28/3 page 91 strengthening dental care delivery systems especially for captive groups such as schoolchildren; developing an appropriate organizational framework to facilitate dental care management; upgrading dental education in relation to the needs and in specific areas of professional competence; increasing the productivity of dentists by the greater use of auxiliary dental personnel (both operating and nonoperating) and improved dental equipment; emphasizing the team approach and developing training schemes, curricula and methods to meet the local requirements; training and utilizing dental auxiliaries, such as chairside assistants, dental therapists/hygienists and dental technicians, according to the local functional needs; promoting programmes for oral hygiene and other preventive measures including fluoridation; promoting dental health education activities pertinent to the socioeconomic and cultural needs. 4. Activities 4.1 First period, 1961-72 (Table 1) In the South Pacific a training programme on dental survey method- ology for nationals was held in Suva, Fiji, in 1965 with WHO cooperation. Subsequently oral health surveys coordinated by WHO were carried out in parts of the South Pacific. These operations culminated in a WHO/SPC seminar on dental health services of an educational and planning nature, held in Noumea in January/February 1971. There were 13 participants from the South Pacific as well as representatives from Australia and New Zealand. Elsewhere national dental epidemiology surveys were conducted, in some cases by former participants in the WHO course on dental survey methodology held in Singapore in 1964. To date such surveys have taken place in Hong Kong, Malaysia, Philippines, Republic of Korea and Singapore. During this period WHO consultant services and fellowships were provided to develop national expertise in establishing dental health services or strengthening them where they existed. Numerous school dental services were launched with support from WHO and UNICEF. WPR/RC28/3 page 92 The first regional workshop on dental health services, Singapore, 9-16 May 1972, ended this first period of the project. It was attended by 18 participants, four consultants, two temporary advisers and a representative group of observers. TABLE 1 FIRST PERIOD, 1961-72 PERIOD 1 FACT-FINDING AND GENERAL PLANNING Phase I • Questionnaire on dental health status and selection of countries or areas needing cooperation Phase II • Fact-finding and goodwill visits by consultants Phase Ill • Survey training project: training in dental survey techniques and calibration for selected officers from countries - Singapore: 1964 - Fiji : 1965 Phase IV • Initiation of national surveys Phase V Planning of general dental health programmes • - WHO/SPC seminar on dental health services, Noumea, 1971 • - First regional workshop on dental health services, Singapore, 1972 4.2 Second period, 1973-77 (Table 2) 1961-72 1961-62 1963-64 1964-65 1966-69 1970-72 0 Provision of consultant services In 1972 a full-time oral health officer was appointed to the project and made a number of field visits in response to government requests and expressions of interest. In each case he made specific recommendations in relation to the needs observed. He provided support in curriculum development for the training of dentists, dental hygienists, therapists and technicians and chairside assistants, in dental health education, in preventive dentistry and in dental care delivery. Attention was also paid to promotion of the dental health team concept and development of school dental services. Of signifi- cance was the contribution of WHO at national dental seminars and conferences held in Fiji with the participation of public health dentists from neighbouring islands and areas. The development of preventive programmes was the main theme of these national meetings. WPR/RC28/3 page 93 In 1976 consultants were utilized in specific fields such as the teaching of prosthodontics at the Fiji School of Medicine and of preventive dentistry at the Dental Faculty of the University of Malaya. The first WHO-sponsored regional course in public health dentistry was held in Singapore and Malaysia from 1 May to 30 June 1975 for 18 dental officers and 4 dental therapists from the Region. Successful projects and programmes were demonstrated in the two countries and participants were shown alternative dental care systems currently in operation in the Region and methods of using fluorides for the early prevention of dental caries. In May and June 1977 a second regional course in public health dentistry was held in Singapore and Malaysia with 18 participants. Current concepts in educational technology were introduced through the Regional Teacher Training Centre for Health Personnel, Sydney, Australia, where a workshop was held in February 1976 essentially for the teachers of dentists and dental auxiliaries. WHO provided consultant services in public health dentistry to the Institute of Public Health and the College of Dentistry of the University of the Philippines and the Dental Faculty of the University of Malaya. In the Republic of Korea the interest of dental educators from five dental schools in educational technology was encouraged at a national workshop on the development of the undergraduate dental curriculum held in Seoul in November 1976. The National Teacher Training Centre for Health Personnel played a major role at this workshop. A functional method of assessing orthodontic treatment require- ments, that could easily be adapted to varying conditions in the Region, was developed in Fiji in 1976 with consultant support. A working group on dental health education composed of-experts from the Region in the fields of dental public health and education was convened in Kuala Lumpur from 11 to 22 October 1976 to formulate guidelines on dental health education for use in the Region. On average about 15 countries/areas received fellowship awards annually for dentistry. WPR/RC28/3 page 94 TABLE 2. SECOND PERIOD, 1973-77 PERIOD 2 SPECIFIC PLANNING AND IMPLEMENTATION OF RECOMMENDATIONS FOR THE EFFECTIVE DELIVERY OF NATIONAL DENTAL CARE SERVICES 1973-77 O SL"rvicc' hy the oral health officer and Phase I • Advisory visits to: Democratic Kampuchea, Fiji, Hong Kong, Lao People's Democratic Republic, Philippines, Republic of Korea, Samoa, Socialist Republic of Viet Nam and Tonga 1972-73 Phase II • Continuation of advisory services • Implementation of recommendations of visits to: Fiji, Papua New Guinea, Philippines, Socialist Republic of Viet Nam • first regional course in public health dentistry • Projects under way 1974-75 r--· Phase III • Continuation of visits for: (a) dental health education (b) dental technology (c) orthodontics • working group on dental health education, Kuala Lumpur, 1976 • second regional course in public health dentistry, 1976•77 Singapore and Malaysia, 1977 5. Evaluation In evaluating the oral health programme two aspects must be considered: (a) the extent of reduction of the prevalence of dental diseases; (b) the status of implementation of national oral health services in relation to the strategies and approaches adopted. 5.1 Dental disease trends consultants. An analysis of the prevalence of the two main dental diseases in the Region indicates the followi.ng trends: Dental caries The prevalence of dental caries is increasing except in Hong Kong, New Zealand and Singapore. Differences in the prevalence of dental caries are greater among the ethnic groups within the countries or areas than between them. Periodontal disease Periodontal disease is the major cause of tooth loss in several countries in the Region and is not being effectively prevented or controlled. WPR/RC28/3 page 95 Remedial action It is recognized throughout the world that concerted action for prevention is necessary, otherwise tremendous increases in national effort will be required to develop and staff the necessary curative services. Cost/benefit analyses dramatically show that community water fluoridation can result in thirty-fold savings as compared with a curative service. Resolution WHA28.64 adopted by the Twenty-eighth World Health Assembly recommends that the Member States undertake a five-year programme proposed by the Director-Geyeral for promoting the use of fluoride in caries control programmes. 5.2 National oral health services Progress from the WHO fact-finding period to that of implementa- tion of national oral health services in selected fields is shown in Table 3. A comparison of figures for the period 1961-77 shows that there has been a general increase of dentists in the national services while operating dental auxiliaries are accepted by almost all the governments. Water fluoridation has commenced in Australia, Fiji, Hong Kong, Malaysia, New Zealand, Papua New Guinea and Singapore. Dental health education in conjunction with the development of school dental services is widespread. The intensity of activities for this purpose varies from place to place, being highest in Australia, Hong Kong, Malaysia, New Zealand and Singapore. Table 4 presents a pictograph of the progress of the different programmes in relation to the adopted strategies and approaches. This progress was achieved through national efforts, the WHO input generally serving as a catalyst in development of the services. 5.3 Summary The following general comments may be made concerning the impact of the project: the oral health programme has progressed in consonance with the objectives; the need for continuing education is evidenced by the interest shown in group educational activities by all categories of dental health personnel; requests from governments for fellowships, especially in current years, reflect a determination to improve the output and efficiency of their dental workforces within the framework of the national dental care systems; the requests to WHO for consultant services reflect a marked interest in improving not only basic undergraduate dental training but also the teaching of public health dentistry at institutes in the Region; it is expected that the programmes for prevention of dental diseases will be intensified in the Region. lWHO Handbook of Resolutions and Decisions, Vol. II (2nd ed.), 1977, p. 45. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 WPlt/ltC28/3 page 96 TABLE 3. IMPLEMENTATION OF NATIONAL ORAL HEALTH SERVICES IN SELECTED FIELDS, 1961-1977 Government Government operating Countries/areas Dental survey performed: dentists dental agency/researcher and employed auxiliaries year of survey (number) employed (number) 1961 1977 1961 1977 American Samoa Wong (1968) 1 7 0 0 Australia Barnard (1967) Davies (1969) ltodder (1974) Medcalf (1970) 18 710 0 148 Cook Islands Davies (1951) Hanaon (1974) 1 9 0 6 Fiji Masi-Wong (1965) 12 29 0 28 Gilbert Islands Wong-Malaki (1968) and Tuvalu Hollis ( 1972) 0 4 0 1 Guam Health Department (1972) 1 1 0 23 Hong Kong Wong (1968) 37 79 4 18 Malaysia Ministry of Health (1972) 45 229 15 560 New Zealand Hewat Eastcott (1967) 55 50 910 1319 Niue Talagi (1969) New Zealand Government 0 3 0 1 Papua New Guinea Barmes ( 1962) Hubble, Anderson (1969) 3 25 0 73 Philippines Health Department (1969) 400 1625 0 0 Republic of Korea KDHA* (1971) 9 405 0 56 Solomon Islands Wong (1969) Hollis (1971) 0 2 0 1 Singapore Ministry of Health (1970) 25 131 0 217 Tonga Tapealava (1969) 9 9 0 10 Trust Territory of the Pacific Islands Health Department (1968) 3 27 0 20 Symbols: + Implemented * Korean Dental Health Association Water f1uo- Dental health ridation education and commenced school dental or imple- services men ted established 1961 1977 1961 1977 0 0 0 + 0 + 0 + 0 0 0 + 0 + 0 + 0 0 0 + 0 0 0 + + + + + 0 + + + 1953 + + + 0 0 0 + 0 + 0 + 0 0 0 + 0 0 0 + 0 0 0 + 0 + + + 0 0 0 + 0 0 0 + (~: Information furnished by participants in dental workshops and obtained during field visits of the WHO oral health officer.). ·j ,..... (J) 0 !:; () ~ .... ..... .... .... ,... .... .... .... II>- 0 8 0 [> ~ ~ -'l C) Cl1 II>- c.:> t-0 .... 0 (0 00 -'l 0) Cl1 c.:> t-0 ..... CD '< .... 0 >-:l If g ~ (J) 5 '< 3 0 tr ... 0 "' - - "' g [> "' .... .... ::r "' 0 a ...... ~ ... >-:l >-:l en (J) ~ ;:3! "1::1 z z 3::: :r: C) I» C) "tl () :> :> ::r "' "' "' "' "' .... "' 0 "' ::r "' ::r.., 0 5' 0 "' .... CD 0 r::: ::l ... .... 0 r::: 3 .... (') ::l 0 ::l 0 ::l ~ (') .... '< "' ..... CD r::: ::l .... "' .... "' r::: =<: ::l "' 0. .... .... 0 (I) OQ .... o.. P . 0.. c. .... =<: .... OQ 3 "1::1~ OQ 0 r::: - r::: (t) .... tr l=t CD ::r :;:· (1> :;:· :;:· ::r OQ "' 3 tr ..;· "' "' OQ 3 >-jO ;.;- .... -<: -<: .... 5' tr r;>-:l "' ] N ~ r:::::. "' .... ...... t-o'• 0 .... 0 .... (1> .... .... .... .... "' ~ I;;' - 0 ::l .... ... .... ... .... "' .... .... ::l 0 0 .... .... z CD .... P'iiA' .... .-.'< ,._.'< ::l'< '"''< .... '< .... -'"''CD ::l (') 0 - II> (1> "' ~::I ~ CD "' "' "' "' ~ "' (1> CD I;;' 0 =<: - ::l -- ::l ::I 0 "' 0 "' 0" ::l ::l r::: 0 .... ...... (I) "' OQ r::: "' 0. {/) (1> tr =<: 0" .... 0" s:: ~. ~. "' .... ..... a ::l "' (I) "' (I) .... .... CD I;;'~ "' ~ Cl "' II> .... (1> 5' (1> g CD ::r'< .... 0. 0. lii''< ::l Q r::: "' s ::l g (1> ::l '< .... .... 0 .. 0. ... 0 .... CD ... .... ~...., 0 ao "' CD ~ II> 0" .... (1> ...., "''"" "' r::: CD "' "' "' .... .... .... STRATEGIES AND APPROACHES 0 D ~ tr "' '< OQ CD "' .5 ~· _.. [> ~ [> C> ~ [> [> ~ ~ [> ~ [> ~ ~ ~ ~ Public health dental care delivery: school dental service ~ ~ _.. [> [> _.. [> [> _.. _.. _.. ~ [> ~ ~ ~ _.. Dental service organizational framework: dentist in charge s. .... .... 0 '$ 0 r::: ij .... CD "' -"' ... CD "' "' [> D ~ 0 ~ ~ [> [> _.. ~ D [> 0 [> 0 ~ [> Upgrading of dentists' education: dental school established (1 or more) [> D _.. D D ~ D D ~ _.. _.. ~ ~ [> [> ~ [> Increasing of clinical productivity: use of monthly returns and other records C> D ~ [> [> [> [> [> ~ ~ _.. _.. [> _.. [> ~ 0 Use of dental therapists/hygienists: staff trained formally (incl. school dental nurses) ::r 0 =<: .... g .... e: OQ [> ~ ~ [> D D 0 0 [> _.. _.. 8 D [> 8 _.. ~ Use of trained chairside assistants ~ D ~ [> 0 D [> [> [> ~ ~ 0 _.. ~ [> [> 8 Use of dental technicians (mechanic in the dental public health service) CD .... e: CD _.. [> ~ D D D [> [> _.. _.. _.. _.. D _.. [> ~ [> Team approach: collaboration of dentist and supportive personnel with supervision "' 0' .... I> 0 _.. D [> [> 0 0 _.. I> [> 0 0 [> 0 ~ [> Local training facilities for dentists (postbasic inservice etc.) 2' ... .... ::r CD D D _.. D [> D [> 0 ~ _.. D 0 8 [> 0 ~ 0 Establishment of school for dental therapists or hygienists .... 0. CD <: CD ~ D _.. 0 _.. 0 ~ 0 ~ _.. ~ 0 8 [> 0 ~ 0 Establishment of school for dental technicians/mechanics .... 0 "' 3 CD ~ _.. [> D D D 0 0 [> [> [> 0 D C> D ~ D Establishment of school for chairside assistants ::l ..... -.. D ~ 0 [> [> [> ~ ~ _.. _.. I> I> _.. _.. ~ ~ Development of preventive programmes: fluoride mouthrinsing classroom toothbrushing [> [> ~ [> [> [> [> ~ ~ _.. _.. [> [> [> C> ~ [> National dental health education activities ANNEXES ... STRUCTURE OF THE WHO REGIONAL OFFICE FOR THE WESTERN PACIFIC ON 30 JUNE 1977 I Directcx- General L -------1 Regional Committee I I 1 I J I Regional Directcx I I Liaison and Public lnfarmation Re pcx ts Officer Officer . I Directcx of Health Services Chief, Administtation and Finance Administtative Officer Administtation and Finance Officer I I I I Assistant Director Assistant Director Assistant Director of Health Services of Health Services of Health Services ADHS(F) ADHS(H) ADHS(R) I I I I I Regional Advisers in: Regional Advisers in: Regional Advisers in: rWHO Re~esen- II Personnel I r Bud~et & Financ1 r Administtative ll Strengthening of Maternal and Child Communicable tatives ( ) Officers (2) fficers (2) Svs. Officers (2) Health Services (2) Health (1) Diseases ( 2) Health Statistics (l) Maternal and Child Chronic Diseases (l) Health/Family !I Nursing (Health Planning {1) Environmenta 1 r/ Countty Liaison I Services and Nutrition (1) Health (2) Manpower He;alth. Ed~tion (1) Malaria (2) Officer (1) Development) (1) Nursing Family Laboratory Health (1) Technology (1) Health Manpower De- Vector Biology and t I velopment including Library Services (2) Control (1) Field Staff Mental Health and DruR Abuse (1) : . • . ·---------·----------·---------· 1/ - Responsibility divided between ADHS(F) and ADHS(H). 2/ -Seven WHO Representatives, with offices located in: Fiji (Suva); Lao People's Democratic Republic (Vientiane); Malaysia {Kuala Lumpur); Papua New Guinea <Port Moresby); the Philippines (Manila); the Republic of Korea (Seoul); Socialist Republic of VietNam (Hanoi). The office in Suva coven American Samoa, Australia, Cook Islands, French Polynesia, Gilbert Islands, Guam, Nauru, New Caledonia, New Hebtldes, New Zealand, Niue, Samoa, Tokelau Islands, Tonga, Trust Territory of the Pacific Islands (llnited Nations Trust Territ<ry), Tuvalu and Wallis and Futuna Islands, That in Kuala Lumpur coven also Brunei and Singapore. ;!! - Pnc Country Liaison Officer with office located in Samoa !Apia) under the supervision of tne WHO Representative, Fiji (Suva). I Translation Officers 1 2) I II Editor II) I '0~ :;g (t-.. ,., ..... n ON .... co -- ..... w 0 N WPR/RC28/3 page 103 ANNEX 2 TRANSLATED WHO PUBLICATIONS ISSUED BY <Y.l'HER PUBLISHERS IN THE WESTERN PACIFIC REGION1 Bulletin of the World Health Organization Recommended Laboratory Methods for the Diagnosis of Plague. 1956. Volume 14, No. 3. pages 457-509 Monograph Series 2 7 21 39 40 41 42 56 Maternal Care and Mental Health, 1952 by J. Bowlby The Cost of Sickness and the Price of Health, 1951 by C.E.A. Winslow The Rural Hospital, 1955 by R.F. Bridgman Excreta Disposal in Rural Areas and Small Communities, 1958 (Extracts only) by E.G. Wagner and J.N. Lanoix Child Guidance Centres, 1960 by D. atckle and s. Lebovici Principles of Administration Applied to Nursing Service, 1958 by H .A. Goddard Water Supply for Rural Areas and Small Communities, 1959 by E.G. Wagner and J .N. Lanoix Cardiovascular Survey Methods, 1968 by G.A. Rose and H. Blackburn Language Japanese Japanese Japanese Japanese Vietnamese Japanese Japanese Vietnamese Japanese 1 Publications translated and issued by publishers to whom translation rights hav® been granted by WHO. The Organization does not accept responsi- bility for these translations or undertake their distribution. WPR/RC28/3 Annex 2 page 104 Public Health Papers 8 30 33 42 43 44 45 46 48 50 51 61 The Role of Im.unization in Communicable Disease Control, 1961 by R. Cruickshank, G. Edsall, J. de Moerloose and V.M. Zhdanov Noise: An Occupational Hazard and Public Nuisance, 1966 by A. Bell The Physiological Basis of Health Standard for Dwellings, 1968 by M.S. Goromosov The Principles and Practice of Screening for Disease, 1968 by J.M.G. Wilson and G. Jungner Problems in Community Wastes Management, 1969 by H.M. Ellis, W.E. Gilbertson, 0. Jaag, D.A. Okun, H.r. Shuval and J. Sumner The Prevention of Perinatal Morbidity and Mortality, 1972 Report on a seminar Principles of Health Planning in the USSR, 1971 by G.A. Popov Planning and Programming for Nursing Services, 1971 Mass Health Examinations, 1971 Approaches to National Health Planning, 1972 by Herman E. Hilleboe, Arne Barkhuus and William c. Thomas, Jr Evaluation of Coi'JIIlunity Health Centres, 1972 by Mil ton I. Roemer Hospital Legislation and Hospital Systems, 1973 by R.F. Bridgman and M.I. Roemer Health Practice Research and Formalized Managerial Methods, 1973 by F. Grundy and W .A. Reinke Educational Strategies for the Health Professions, 1974 Edited by George E. Miller and Tamas Ful"p Language Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Offset Publications 8 14 The Current and Future Use of Registers in Health Information Systems, 1974 Understanding Research in Nursing~ 1975 Technical Report Series 55 83 89 156 194 215 225 230 250 251 Public Health Administration First report of the Expe~t Committee~ 1952 Methodology of Planning and Integrated Health Programme for Rural Areas Second report of the Expert Committee on Public Health Administration, 1954 Health Education of the Public First report of the Expert Colllllittee, 1954 Training of Health Personnel in Health Education of the Public Report of the Expert Committee~ 1958 Local Health Service Third report of the Expert Committee on Public Health Administration, 1960 Planning of Public Health Services Fourth report of the Expert Committee on Public Health Administration1 1961 Public Health Aspects of Housing First report of the Expert Committee1 1961 Calcium Requirements Report of an FAO/WHO Expert Group, 1962 Urban Health Services Fifth report of the Expert Committee on Public Health Administration, 1963 Cancer Control First report of an Expert Committee 1 1963 Public Health Responsibilities in Radiation Protection Fourth report of the Expert Committee on Radiation, 1963 WPR/RC28/3 Annex 2 page 105 La.nguage Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese WPR/RC28/3 Annex 2 page 106 Technical Report Series (continued) 301 319 320 327 367 403 406 409 410 429 Protein Requirements Report of a Joint FAO/WHO Expert Group, 1965 WHO Expert Convnittee on Leprosy Third report, 1966 University Health Services Fourteenth report of the WHO Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel, 1966 The Use of Human Immunoglobulin Report of a WHO Expert Committee, 1966 Epidemiological Methods in the Study of Chronic Diseases Eleventh report of the WHO Expert Committee on Health Statistics, 1967 Treatment and Disposal of Wastes Report of a WHO Scientific Group, 1967 Moroidity Statistics Twelfth report of the WHO Expert Committee on Health Statistics, 1968 Principles for the Clinical Evaluation of Drugs Report of a WHO Scientific Group, 1968 Research into Environmental Pollution Report of Five WHO Scientific Groups, 1968 Planning and Evaluation of Health Education Services Report of a WHO Expert Committee, 1969 UrDan Air Pollution with Particular Reference to Motor Vehicles Report of a WHO Expert Committee, 1969 Statistics of Health Services and of Their Activities Thirteenth report of the WHO Expert Committee on Health Statistics, 1969 Language Japanese Vietnamese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese I•' Technical Report Series (continued) 432 Research in Health Education Report of a WHO Scientific Group. 1969 WPR/RC28/3 Annex 2 page 107 Language Japanese 439 National Environmental Health Programmes: Their Japanese Planning, Organizat~on and Administration Report of a WHO Expert Committee. 1970 440 Programmes of Analysis of Mortality Trends Japanese and Levels Report of a Joint United Nations/WHO Meeting, 1970 456 Training in National Health Planning Japanese Report of a WHO Expert Committee, 1970 459 WHO Expert Committee on Leprosy Vietnamese Fourth report, 1970 469 Cerebrovascular Diseases. Prevention, Treatment Japanese and Rehabilitation Re~ort of a WHO Meeting, 1971 472 Statistical Indicators for the Planning and Japanese Evaluation of Public Health Programmes 480 481 484 485 493 499 Fourteenth report of the WHO Expert Committee on Health Statistics, 1971 Personal Health Care and Social Security Report of a Joint Ito/WHO Committee, 1971 The Development of Studies in Health Manpower Report of a WHO Scientific Group, 1971 Solid Wastes Disposal and Control Report of a WHO EXpert Committee, 1971 Human Development and Public Health Report of a WHO Scientific Group. 1972 WHO Expert Committee on Smallpox Eradication Second report, 1972 Organization of Local and Intermediate Health Administrations Report 'or a WHO Expert Committee, 1972 Japanese Japanese Japanese Japanese Japanese Japanese WPR/RC28/3 Annex 2 page 108 Technical Report Series (continued) 506 507 510 511 517 519 522 533 535 536 546 548 552 Air Quality Criteria and Guides for Urban Air Pollutants Report of a WHO Expert Co11111i ttee, 1972 Psychogeriatrics Report of a WHO Scientific Group, 1972 Statistical Principles in Public Health Field Studies Fifteenth report of the WHO Expert co .. ittee on Health Statistics, 1972 Development of Environmental Health Criteria for Urban Planning Report of a WHO Scientific Group, 1972 Reuse of Effluents: Methods of Wastewater 'l'reatment and Health Safeguards Report of a WHO Meeting of Experts, 1973 Cell-Mediated Immunity and Resistance to Infection Report of a WHO Scientific Group, 1973 Energy and Protein Requirements Report of a Joint FAO/WHO Ad !:!2£ Expert Committee, 1973 Postgraduate Education and Training in Public Health Report of a WHO Expert Committee, 1973 Environmental and Health Monitoring in Occupational Health (Extracts) Report of a WHO Expert Committee, 1973 Bio-availabili ty of Drugs: Pharmacokinetic Aspects Report of a WHO Scientific Group, 1974 Assessment of the Carcinogenicity and Mutagenicity of Chemicals Report of a WHO Scientific Group, 1974 Planning and Organization of Geriatric Services Report of a WHO Expert Committee, 1974 WHO Expert Committee on Tuberculosis Ninth report, 1974 r. Language Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese ., Japanese Japanese Japanese Technical Report Series (continued) 554 558 559 563 568 571 Health Aspects of Environmental Pollution Control: Planning and Implementation of National Programmes Report of a WHO Expert Co11111ittee# 1974 Community Health Nursing Report of a WHO Expert Committee, 1974 New Approaches in Health Statistics Report of the Second International Conference of National Committees on Vital and Health Statistics, 1974 Guidelines for Evaluation of Drugs for Use in Man Report of a WHO Scientific Group# 1975 Smoking and Its Effects on Health Report of a WHO Expert Committee, 1975 Early Detection of Health Impairment in Occupational Exposure to Health Hazards Report of a WHO Study Group, 1975 Official Records 225 Fifth Report on the World Health Situation 1969-1972; 1975, Chapter 3# pages 19-22 Out of Series Publications Alternative Approaches to Meeting Basic Health Needs in Developing Countries A Joint UNICEF/WHO Study# 1975 *Child Care and the Growth of Love# 1953 Based by permission of the World Health Organization on the report Maternal Care and Mental Health by John Bowlby Abridged and Edited by Margery Fry Dictionary of Epilepsy, 1973 * In press. WPR/RC28/3 Annex 2 page 109 Language Japanese Japanese Japanese Japanese Japanese Japanese Japanese Korean Japanese Japanese WPR/RC28/3 Annex 2 page 110 Out of Series Publications European Standards for Drinking Water. 1970 Fundamentals of Exercise Testing. 1971 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 *Health by the People, 1975 Health Hazards of the Human Environment, 1972 * Hypertension and Stroke Control in the Community Proceedings of a WHO Meeting held in Tokyo. 11-13 March 1974, 1976 International Pharmacopoeia First edition, Volume I, 1951 Volume II, 1955 Supplement, 1959 International Standards for Drinking-Water Third edition, 1971 Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death Seventh revision, Volume I, 1955 Manual of the International Statistical Classification of Diseases. Injuries and Causes of Death Eighth revision, Volume I, 1967 *Methods Used in the USSR for Establishing Biologically Safe Levels of Toxic Substances, 1975 Oral Health Surveys. Basic Methods, 1971 Reports Report on the Seminar on the Training of Health Workers in Health Education. Manila. 23 July - 3 August 1973 * In press. - r- Language Japanese Japanese Japanese Japanese Japanese ... Japanese Portuguese Japanese Korean Japanese Japanese Japanese

.. , ., .,' IJ I, 1 - ORGANISATION MONDIALE , WORLD HEALTH ORGANIZATION DE LA SANTE REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU ReGIONAL DU PACIFIOUE OCCIDENTAL REGIONAL COMMITtEE Twenty-eighth session Tokyo 6-12 September 1977 Provisional agenda item 9 WPR/RC28/3 Corrol 13 July 1977 ENGLISH ONLY TWENTY-SEVENTH ANNUAL llEPORT OF THE REGIONAL DIRECTOR TO THE REGIONAL COMMITTEE FOR THE WESTERN PACIFIC Corrigendum Page 59, Section 12.3.2, second paragraph, second and third lines: delete "12-16 September 1977" and replace by "28 November- 3 December 1977" Page 101/102, Annex 1 - Structure of the WHO Regional Office for the Western Pacific on 30 June 1977: Footnote 2/, third line, insert "Solomon Islands" between Samoa and-Tokelau Islands.