SEA/RC33/2 Page 126 5.4 Bilateral and Other Agencies Frequent contacts were maintained both at the Regional Office level and in the countries of the Region with agencies such as the Swedish Inter- national Development Authority (SIDA), the Canadian International Development Agency (CIDA), the Danish International Development Agency (DANIDA) and the Norwegian Agency for International Development (NORAD) in respect of the assistance that is being provided by these agencies. Regular consultations were held with representatives of bilateral agencies such as US AID and the Overseas Development Ministry of the United Kingdom on their collaboration with the governments in the Region. 5.5 Non-governmental Organizations in Official Relations with WHO Close and cordial relations continued to be maintained with the national organizations in various countries of the Region affiliated to inter- national non-governmental organizations. Regional Office as well as field staff participated in a number of activities of these agencies,and WHO was represented at meetings sponsored by them. Representatives from 32 non-governmental organizations in official relations with WHO were present at the thirty-second session of the Regional Committee,andtheir presence was utilized for fruitful discussions and exchange of ideas. 6. PUBLIC INFORMATION During the year, activities aimed at dissemination of information on health coverage and on the work of WHO continued to be expanded in both urban and rural areas. Greater use was made of the satellite television facilities in India on an experimental basis by providing them with rele- vant information material and films. The thrust was on motivating and involving the people, through the mass media, to take up the challenge of achieving the goal of health for all by the year 2000. In this connexion, a monthly newsletter, HFA 2000, is being published regularly since December 1979. The response to this newsletter has been most encouraging. The signing of the Charter for Health Development by five countries in the Region also provided a good opportunity to highlight the conrmunity of interest in health and to underscore the importance of the subject to overall socio-economic development. This event, as well as the joint WHO/UNICEF inter-country meeting to formulate strategies for health for all, received wide coverage in the media. To ensure that information material gets to the most prominent leader- writers and media men in the Region, a media directory was compiled and the mailing lists suitably amended. Regional Cononittee: The thirty-second session of the Regional Committee was widely covered by the press, radio and television. The press releases were picked up by all the major publications in the Region and an end- of-the-session press conference addressed by the Regional Director, the Signing of the Charter for Health Development by Mr B. Shankaranand, India's Minister of Education, Health and Social Welfare (second from right), Dr Halfdan Mahler. Director-General, WHO (second from leit), and Dr V.T.H. Gunaratne, Regional Director, WHO (extreme left), in the presence of H.E. Mrs lndira Gandhi Prime Minister of India. On extreme right is Mr N.R. Laskar Minister of State for Health and Family Welfare. CHARTER FOR HEALTH DEVELOPMEN1 The Charter for Health Development wassigned in Jakarta in the presence of H.E. Dr Adam Malik. Vice-President of the Republic of Indonesia (centre). Picture shows Dr Suwardjono Surianingrat the Indonesian Minister of Health (right) and Dr V.T.H. Gunaratnesigning the document. CHARTER FOR HEALTH DEVELOPMENT Signing ceremony in Bangla. desh. H.E. Mr Justice Abdus Sattar. Vice-President of the People's Republic of Bangla- desh (right), and Dr Halfdan Mahler signing the Charter. It was also signed by the Minister of Health and Popu- lation Control. Dr M.A. Matin and Dr V.T.H. Gunaratne (not seen in the picture). Signing of the Charter for Health Development by H.E. Mr R. Prernadasa. Prime Minister of Sri Lanka (fourth from left). Mr Gamani Jaya- suriya. Minister of Health (second from left) Dr Halfdan Mahler and Dr V.T.H. Guna- ratne. The Minister for Public Health. Tha!land. Mr Boon- som Martin (right), slgning the Charter for Health Deve- lopment in Bangkok. Dr Halfdan Mahler and Dr V.T.H. Gunaratne signed on behalf of WHO. The Prime Minister of Thailand. H.E. General Kriangsak Chomanan, also signed the Charter. SEA/RC33/2 Page 127 Chairman and the Vice-Chairman of the Regional Committee, was very well attended. World Health Day: The theme for the 1980 World Health Day, "Smoking or Health: the choice is yours", evoked great interest. There was a large demand for information material and over 7000 sets were distributed in the Region. These included articles, posters, wall-charts and photo- graphs, and were sent to health education bureaux, social welfare organizations, educational institutions and the mass media. In India, on an experimental basis, information material was sent to all the zonal headquarters of the railways to be used as appropriate by the medical officers in their dispensaries and at railway stations. A broadcast by the Regional Director for All India Radio was translated into different languages and beamed to listeners in South-East Asia, Africa and West Asia. ~ndis's satellite television network also mounted a special programme on the occasion, which included a message by the Regional Director. Health education authorities in various countries of the Region organized special programmes, including seminars, workshops and exhibitions, to highlight the theme of World Health Day. The accent was on warning the younger generation and educating them about the dangers of smoking. Group Educational Activities: A number of group educational activities held in the Regional Office during the year were covered by the media. Facilities were provided to national and international media representa- tives to cover subjects of interest to them. The topics that were widely covered included malaria, pzevention of accidents, malnutrition, and "Health for All". The WHO Chronicle also published excerpts and write-ups based on reports or proceedings of various activities organized in the Regional Office. World Health carried a number of articles devoted to health development in the Region. A special contribution was prepared for the comemorative issue on smallpox eradication. The Information Unit continued to participate in various seminars and symposia devoted to health and socio-economic development aimed specifi- cally to involve and motivate the media. Cooperation with United Nations and other Agencies: The Regional Office continued to contribute material to the weekly newsletter published by the United Nations Information Centre in New Delhi. Efforts were also made to strengthen collaboration with the United Nations Information Centres in other countries of the Region. Photographs and Fihs: To meet the increasing demand for photographs, both by the media and by others interested in health informationand SEA/~c33/2 Page 128 education, arrangements were made to augment the Regional Office photo library. In collaboration with WHO Headquarters, the Regional Office was involved in producing a film on primary health care in Thailand. This is one of a series of six films depicting various aspects of PHC in different parts of the world. Visitors: More than 600 health educators, medical and nursing students and others visited the Regional Office and were briefed on the Organiza- tion's working, its aims and objectives.
SEA/RC33/2 Page 120 to provide additional accommodation, and a separate document giving detailed space requirements and a preliminary costing is under prepara- tion and will be presented for discussionat the thirty-third session of the Regional Committee, prior to being submitted to the Executive Board and the World Health Assembly for funding from the Organization's Real Estate Fund. 4. PROCUREMENT OF SUPPLIES AND EQUIPMENT During the period 1 July 1979 - 31 May 1980, procurement action was taken for supplies and equipment and medical literature amounting to $10 094 689. (a) Supplies and Equipment . . These consisted of laboratory items, hospital supplies, X-ray equipment, supplies for environ- mental programmes, material for teaching programmes, drugs, vaccines, biologicals, pesticides and spraying equipment, vehicles and administrative supplies. (b) Medical Literature . . $ 247 039 Where possible, having regard to prices and quality, purchases were made within the Region in accordance with the principle of technical coopera- tion among developing countries. The total amount spent on such purchases was $ 825 780 for supplies and equipment and $ 54 585 for literature. Plrchases on a Reimbursable Basis Purchases amounting to $26 961 were made as follows: For Bangladesh .. Yellow fever vaccine and anti-venom snake serum. For Nepal . . Anti-rabies vaccine and bleaching powder. Revolving Fund During the period under review purchase authorizations in respect of requests amounting to $ 133 786 were raised. Thirteen requests are being processed. 5. COLLABORATION WITH OTHER AGENCIES With the increasing demand for funds for activities in health and allied fields, and in view of the limited resources available to WHO under its SEA/RC33/2 Page 121 Regular Budget, it has become essential to explore extra-budgetary resources and reformulate proposals so as to attract potential donors. With this objective in view, a meeting on the Financing of Primary Health Care Programmes in Asia was convened in the Regional Office in July 1979 at which eight countries from this region and two countries from the Eastern Mediterranean Region were present. In addition, there were representatives from 15 countries and development agencies, UNICEF, UNDP, UNFPA, WFP, the Asian Development Bank, the Islamic Development Bank and three non-governmental organizations. The purpose of the meet- ing was to bring together the potential donors and the countries so that discussions between donor and recipient could result in the funding of projects. It is hoped that the countries will follow up the discussions with the agencies concerned and the efforts will bear fruit. 5.1 United Nations The United Nations High Commissioner for Refugees is seized of the refugee problem in Thailand and Indonesia. WHO has collaborated closely with the United Nations and the Government in the work of a relief medical officer to look after the health aspects of the relief opera- tions in Thailand. The United Nations Office of Technical Cooperation has provided two consultants to the UNDP-funded project "Tamil Nadu Water Supply and Sewerage Pre-investment Studies: Madras Metropolitan Area" in India. 5.1.1 United Nations Development Progrme (UNDP) UNDP, which continued to be the largest source of extra-budgetary resources, provided funds amounting to US $3.9 million during 1979. With increased inputs and greater absorbability on the part of the countries and with better implementation and management, it is expected that the programme delivery will increase further by the end of 1980. UNDP inputs to projects in the Region covered a variety of areas: water supply, drug production, health education, nutrition, epidemiology - almost the entire spectrum of WHO'S activities. A UNDP Mission on Least Developed Countries visited the Regional Office in May 1979 after visiting Bangladesh, Bhutan and Nepal. UNDP has agreed to fund two inter-country projects involving Bangladesh, Maldives and Nepal from this region and Afghanistan from the Eastern Mediterranean Region. The continuing interest of UNDP in the activities of WHO in this region was evidenced by the presence of its representatives not only at the Regional Committee session, but also at the Meeting on the Finanang of Primary Health Care Programmes in Asia and at the Regional Director's Meeting with the WHO Programme Coordinators. Steps were taken to fomu- late proposals for the third UNDP programme cycle (1982-1986) with regard to inter-country projects. SEA/RC33/2 Page 122 The Regional Office was represented in the joint UNDPIagency missions for the examination of country programming experiences. The missions visited Bangladesh, India and Nepal in this region during October 1979. The major purpose of these visits was to engage in a direct dialogue with the respective governments on the United Nations approach to the programming of UNDP resources and the effects of that approach on UNDP-funded development activities in the countries, aiming at the identification of specific, viable measures for improving the country programming process and the participation and contribution of the United Nations system. 5.1.2 United Nations ChiZdrenls Fund (UNICEF) The traditional close, cordial and fruitful relations between WHO and. UNICEF continued during the year. Contacts between the staff of the two organizations at different levels - regional, country and the field - have not only been maintained but further strengthened. The UNICEF Regional Director for South Central Asia in New Delhi and his staff took an active part in a number of meetings called by WHO, includ- ing the Regional Director's twenty-eighth meeting with the WHO Programme Coordinators. The presence of UNICEF country representatives at the Joint UNICEF/WHO Regional Meeting on the Formulation of Strategies for Health for all by the year 2000, held in the Regional Office in December 1979, enabled WHO and UNICEF representatives to exchange information on programme development, implementation and evaluation of their country programmes and ways and means to achieve more effective coordination and collaboration. 5.1.3 United Nations Fund for Population Activities (UNFPA) Consultations between the UNFPA coordinators in the countries concerned and the WHO Programme Coordinators and Regional Office staff have been frequent and fruitful. The UNFPA Coordinator in Sri Lanka visited the Regional Office to discuss projects relating to that country. The opportunity of a visit to New Delhi by the Assistant Executive Director and Chief of the Programme Division of UNFPA was utilized to discuss UNFPA-funded inter-country projects; she also addressed the WHO Programme Coordinators during their meeting with the Regional Director. Based on a visit by a Regional Office team to Bhutan, a project for assistance was formulated and submitted to UNFPA. Funds were approved for the implementation of an immediate programme and it is expected that the UNDP Governing Council will approve funds also for the remaining activities. At the end of June 1980, four UNFPA-funded projects were handed over to the Government of Bangladesh for execution. WHO will, however, continue to provide technical advice needed by the Government for the implementa- tion of these programmes. SEA/RC33/2 Page 123 WHO project staff participated in the Basic Needs Assessment Mission that visited India in 1979. The WHO Programme Coordinators in Nepal and Sri Lanka provided assistance to the Needs Assessment Missions that visited these countries in 1979 and 1980 respectively. A number of proposals for UNFPA assistance were reviewed in the Regional Office and sent to UNFPA for possible assistance. 5.1.4 Economic and SociaZ Conmission for Asia and the Pacific (ESCAPI The WHO Programme Coordinator in Thailand, who acts as the WHO Liaison Officer to ESCAP, assisted by a medical officer for liaison work, participated in a variety of activities of ESCAP, ranging from the traditional subjects such as nutrition, human environment and population to integrated rural development and environmental pollution. The WHO staff in Maldives participated in a project sponsored by ESCAP on integrated rural development in Alifu atoll. WHO is represented on inter-agency task forces and working groups set up by ESCAP. The inter-agency working group on TCDC is exploring ways to set up a coordinated information system. WHO also contributed a section on 'Health' for inclusion in the regional strategy paper prepared by ESCAP for presentation to the preparatory committee on the New Inter- national Development Strategy. 5.1.5 IntemtionuZ Atomic Energy Agency (IAEA) Collaboration with IAEA continued with a number of institutions in the Region participating in the IAEAIWHO Postal Dose Inter-comparison Studies for Cobalt-60 therapy and the comparative study of personnel film badge services to monitor radiation to which health personnel are exposed. 5.2 Specialized A~encies 5.2.1 United Nations Industria2 DeveZopment Organization (UNIDO) The Regional Office represented WHO at the Third General Assembly of UNIDO held in New Delhi in January 1980. Discussions were initiated with UNIDO for assistance to Nepal in the production of drugs under a UNDP-funded project on primary health care with WHO as the executing and WID0 as an associate agency. 5.2.2 Food and AgricuZture Organization of the United Nations (FAOI/WorZd Food Programme (WFPI WHO closely collaborated with FA0 in a number of activities. The Organization was represented at a number of group activities and meet- ings called by FAO, including the FA0 Regional Conference for Asia and -- SEA/RC33/2 Page 124 the Pacific, held in New Delhi in March 1980. A joint FAO/W~~O/UNICEF comprehensive programme on nutrition was developed in Burma. The Regional Adviser on Nutrition participated in a joint FAO/WHO/UNICEF team visit to Sri Lanka to review the nutrition surveillance programme and strengthen the Food and Nutrition Planning Unit. Funds were provided to Burma to enable a national staff member to participate in the PA01 UNDP Technical Consultation Among Developing Countries of Asia and the Pacific on Food Control Needs and Means, held in Manila in September 1979. The Director of the Food Policy and Nutrition Division of FA0 visited the Regional Office in October 1979 for discussions with the Regional Director. The schedules of forthcoming FAOlWorld Bank missions have been circulated to all WHO Programme Coordinators intheRegion to identify those in which WHO might be interested in participating. Cooperation with the World Food Programme continued to be good and fruit- ful, and close contacts were maintained. The Regional Office as well as field project staff participated in joint evaluation missions in Bangladesh and Sri Lanka; a similar mission to Indonesia is scheduled for September 1980. Proposals, as well as exten- sions to existing proposals, for WFP assistance to Bangladesh, India, Indonesia, Nepal, Sri tanka and Thailand were reviewed in the Regional Office and commented upon for eventual transmission to WFP through WHO Headquarters. 5.2.3 United Nations EducationaZ, Scientific and CuZturaZ Organization (UNESCO) WHO was represented at a number of meetings sponsored by UNESCO in different countries of the Region. WHO participated in the Regional Meeting of Experts from South and Central Asia on the Follow-up of UNCSTD (United Nations Conference on Science and Technology for Development) Recommendations for the Development of National and Regional Programmes and Projects in Science and Technology, held in Colombo in May. The WHO Programme Coordinator in Nepal and some of the field staff took part in the Philosophical Investigation of the Condi- tions for Endogenous Development of Science and Technology and the Sub-Regional Consultation for Identifying Training Needs in the Least Developed Asian Countries, held in Kathmandu in December 1979 and March 1980 respectively. The Organization was also represented in the Regional Meeting on the Development of Scientific and Technological Information Cooperative Programmes in South and Central Asia, held in New Delhi in September 1979. The Regional Adviser on Bealth Manpower Development attended the UNESCO Committee of Experts called in New Delhi in November to define SEA/RC33/2 Page 125 - the outline of a Preliminary Draft Convention on the Recognition of Studies, Diplomas and Degrees in Higher Education in Asia and Oceania. 5.2.4 InternutionaZ Ldour Organisation (ILO) Relations with ILO at different levels have continued to be close and cordial. ILO participates in two UNDP-funded projects - one in Burma (Strengthening of Health Services in the Newly Industrialized Areas, West Bank of Irrawaddy River) and the other in Indonesia (Development of Central and Regional Occupational Health and Industrial Hygiene Laboratories). In Augustfseptember 1979, the WHO Programme Coordinator in Dacca took part in a preparatory mission for UNDPfILO assistance on human resources development and employment planning to the Ministry of Planning of Bangladesh. 5.2.5 The Intemtionaz Bank for Reconstruction and Development (IBRD) The Regional Office continued its involvement in the WHOIIBRD Coopera- tive Programme through a Financial Analyst and a Sanitary Engineer. both stationed in Xew Delhi. The staff of the Cooperative Programme assisted the Bank in identifying and preparing water supply projects in Indonesia and Thailand, and in reviewing the billing and collection systems for the Bank-supported Water and Sewerage Authority project in Bangladesh. In India, the team helped in supervising the Bank-assisted water and sewerage project in Punjab, and in preparing Sector Memoranda for various states; this latter work was expected to be completed by mid-1980. A joint BankfWHO evaluation of the Cooperative Programe activities in this region was made in November 1979 and the review panel concluded that the Programme had effectively demonstrated the benefits of decentralized operations. 5.3 Asian Development Bank Relations with the Asian Development Bank improved further with frequent contacts during the year. The Regional Office fielded an assessmentfreview mission to Nepal for the Bank during January - April 1980 to review the existing organization for health care and plans for the future. The team consisted of a malariologist (team leader), a specialist in malaria research, an ecolo- gist and an architect. It is hoped that the findings of the team would help the Bank to determine its assistance to Nepal. A consultant on logistics recruited for the Bank by WHO is stationed in * the Regional Office. He made visits to Bangladesh, Burma, Indonesia and Nepal to study their pharmaceutical supply systems.
SEA/RC33/2 Page 120 to provide additional accommodation, and a separate document giving detailed space requirements and a preliminary costing is under prepara- tion and will be presented for discussionat the thirty-third session of the Regional Committee, prior to being submitted to the Executive Board and the World Health Assembly for funding from the Organization's Real Estate Fund. 4. PROCUREMENT OF SUPPLIES AND EQUIPMENT During the period 1 July 1979 - 31 May 1980, procurement action was taken for supplies and equipment and medical literature amounting to $10 094 689. (a) Supplies and Equipment . . These consisted of laboratory items, hospital supplies, X-ray equipment, supplies for environ- mental programmes, material for teaching programmes, drugs, vaccines, biologicals, pesticides and spraying equipment, vehicles and administrative supplies. (b) Medical Literature . . $ 247 039 Where possible, having regard to prices and quality, purchases were made within the Region in accordance with the principle of technical coopera- tion among developing countries. The total amount spent on such purchases was $ 825 780 for supplies and equipment and $ 54 585 for literature. Plrchases on a Reimbursable Basis Purchases amounting to $26 961 were made as follows: For Bangladesh .. Yellow fever vaccine and anti-venom snake serum. For Nepal . . Anti-rabies vaccine and bleaching powder. Revolving Fund During the period under review purchase authorizations in respect of requests amounting to $ 133 786 were raised. Thirteen requests are being processed. 5. COLLABORATION WITH OTHER AGENCIES With the increasing demand for funds for activities in health and allied fields, and in view of the limited resources available to WHO under its
SEA/RC33/2 Page 116 monitors the delivery of programmes periodically, and carries out technical and budgetary reviews in coordination with and guidance from the Headquarters Programme Committee (HPC) and the Global Programme Commit tee (GPC) . The programme budgeting procedure, as a flexible instrument to formulate country-based collaborative programmes, is now better established, having been used in the formulation of preliminary proposals for the 1982-1983 biennium. The Regional Office focal group for information systems development was reorganized. Earlier, the programme management information system was replaced by a simpler programme delivery status report, which has been kept under review in consultation with WPCs and necessary additional information was included to enable periodic monitoring of programme deli- very by Member States. The project milestone reporting system has been further reviewed and a simplified procedure introduced to enable techni- cal monitoring of programme implementation. A regional "guideline for programe evaluation" is being developed to enable a more effective evaluation of both inter-country and country programes. 3. ADMINISTRATION 3.1 General The Director-General visited the Regional Office in October 1979 for discussions with the Regional Director. In February 1980 he, along with the Regional Director, visited Bangladesh, India, Sri Lanka and Thailand to sign the Charter for Health Development. During the period under review, a number of important persons, including the Ministers of Health of the Republic of Maldives and of the Democratic Socialist Republic of Sri Lanka, the Ministers of Health of Gujarat and of Tamil Nadu States in India, as well as senior officials of health ministries of Member States and senior staff from United Nations agencies visited the Regional Officeandheld discussions withtheRegiona1 Director and other staff. In November 1979, Dr I.D. Ladnyi, Assistant Director-General, visited the Regional Office to attend the EPI Global Advisory Group meeting and in February and March 1980 he travelled to Indonesia, Thailand and India to observe EPI activities in the field. He again visited the Regional Office in April-May for a meeting of the Scientific Group on Vaccination against Tuberculosis. Mr W.W. Furth, Assistant Director-General, visited Bangladesh, Sri Lanka, Thailand and the Regional Office in March 1980 to study programme budget- ing at country level and discuss the aubject with the Regional Director and the Regional Programme Comittee. SEA/RC33/2 Page 117 Dr H. Nakajima, WHO Regional Director for the Western Pacific, visited the Regional Office in March 1980 and inaugurated an inter-regional meet- ing on Research in Viral Haemorrhagic Fevers. During the year, the Regional Director visited Indonesia to sign the Charter for Health Development and hold discussions with the national health authorities. He also went to Burma, Thailand and Sri Lanka and various parts of India where, in addition to conferring with government authorities, he inaugurated and attended a number of meetings. In March 1980, Banaras Hindu University, India, conferred upon the Regional Director the honorary Degree of Doctor of Science. Administrative arrangements were made for a large number of WHO-sponsored meetings, seminars, etc.,held in the Regional Office and in the countries of the Region (see Annex 4). Among the important activities heldinthe Regional Office werethemeeting on Financing of PHC Programmes in Asia (July 19791, the Joint UNICEF/WHO Regional Meetings on Strategies for Health for All by the Year 2000 (December 1979 and June 1980) and the sixth session of the Regional Advisory Committee on Medical Research (April 1980). In pursuance of the discussions at the thirty-second session of the Regional Committee and resolution SEA/RC32/R10, the Regional Director established a sub-committee to develop effective mechanisms for the formulation, monitoring and evaluation of inter-country projects and to review the criteria for the establishment of inter-regional programmes. The Committee, consisting of representatives from Bangladesh, India and Indonesia, met in February 1980 in the Regional Office. The report of the Sub-committee is being submitted to the thirty-third session of the Regional Committee. 3.2 Organizational Structure The organizational structure of the Regional Office as on 31 May 1980 is shown in Annex 1. Subsequent to the establishment of a discrete Environmental Health Unit in 1979, the post of Director, Planning and Coordination, whose functions had previously included the supervision of activities pertaining to environmental health, was replaced by that of Chief, Planning and Coordination. 3.3 Personnel 3.3.1 Staffing The distribution of professional staff in the Region by nationality as on 31 May 1980 is shown in Annex 2. A column giving the worldwide distribution of WHO staff by nationality has also been included. SEA/RC33/2 Page 118 The following table shows the number of posts in the professional category in the Region and the number actually filled as on 31 May 1980. Ten posts were inactivated because (i) 3 were to be filled by short-term consultants, (ii) 1 post was not to be filled and (iii) recruitment for 6 posts was held in abeyance. Organizational Location Regional Office Field Programmes Total Fourteen of the posts were actually filled by short-term consultants. During 1979,208 consultants were employedin field programmes for periods ranging from 2 weeks to 11 months. From 1 January to 31 May 1980, 70 consultants were employed. In accordance with resolution SEA/RC32/R14, the distribution of consultants recruited during the period 1 June1979 - 31 May 1980 by nationality is shown in Annex 3. 0 m m r1 r 0 w m o u 60 m m o rl a 71 m al z 54 dm 4 D w m 0 U m w wm 16 174 190 During the period 1 June 1979 - 31 May 1980, 36 professional and ten general service staff members left WHO service. Ten general service staff completed 30 years of service with WHO, one general service staff 25 years, and 12 general service staff 20 years. al 2 1 al u D PI m u m c $ 4 -4 uu 0 0 8 z rl u .r( m s u r m u 0 01 & r - 10 10 3.3.2 Staff Training A Management Workshop was held in New Delhi from 16 to 25 January 1980, attended by 18 participants. This workshop was designed specifically for a cross-section of WHO staff - from the Regional Office and the field and from both the technical and support services. The objectives of this m 4 c .r( a PI rl r1 d w QJ n 0 u m U m 0 & 16 164 180 u PI rl rl d w r1 rl 2 u U a m u m 0 & 15 136 151 m al u m m 3 h: -3- r m a o OOM u r a a .c PI 5 d al 3 rmal " $2 O mmg ualu muu Or1 01 &mr 1 24 25 . c 0 .d u u al PI rl m .. 2 r do 3 PI U PI ru m r1 ual m m au 0 PI - 4 4 Figure 2. OBLIGATIONS INCURRED ON FIELD ACTIVITIES IN THE SOUTH-EAST ASIA REGION (1975-1 979) US$ (Millions) Source: Off. Rec. 230, 237, doownents A31/29, A32/14 and A33/17 60.92 Regular Budget UNDP 0 other Sources Obligations US$ (millions) 22.0 SEA/RC33/2 Page 119 workshop were to help the participants develop and improve their own personal effectiveness in office management and in implementing collaborative programmes, the overall objective being to strengthen the regional capacity for programme delivery. The Director-General granted study leave for short periods to four staff members to receive training in their respective fields of work. 3.3.3 EmpZoyment Conditions The salary scales of the general service staff in Burma, India, Indonesia, Maldives, Nepal and Sri Lanka were revised. A consultant reviewed the General Service Post Classification Plan of the Regional Office. The representatives of the various agencies of the United Nations system in New Delhi held meetings from time to time to discuss matters of common concern. A regular dialogue also continued with staff representatives on matters of mutual interest. 3.4 Budget and Finance The total obligations incurred on field activities during 1979 were $28 650 522, an increase of 25.4 per cent as compared to 1978. The regular budget allocation for the South-East Asia Region in 1979 was increased during the year by $380 000 from funds originally budgeted under the Director-General's Development Programme. The obligations incurred on field activities in the last five financial years under different sources of funds are shown in Figure 2. Details of the financial implementation of the 1979 programmes under the regular budget are given in Annex 7. 3.5 Regional Office Building The purchase and installation of the new telephone exchange, as agreed to by the sixty-third session of the Executive Board, have been completed and the new system is functioning satisfactorily. Since the construction of the Regional Office building in 1962 and of an extension in 1972, there has been a considerable increase in programme activities, but the needs for additional space have been met through internal re-arrangements and by reducing the office space allotted to staff members. However, owing to the fact that a number of new posts have been established under programmes financed from voluntary contribu- tions, new programmes implemented at the regional level such as medical research, and a general extension of country activities for which support is provided from the Regional Office, the occupancy of the space avail- able has reached the ultimate limit. It has, therefore, become necessary SEA/RC33/2 Page 120 to provide additional accommodation, and a separate document giving detailed space requirements and a preliminary costing is under prepara- tion and will be presented for discussionat the thirty-third session of the Regional Committee, prior to being submitted to the Executive Board and the World Health Assembly for funding from the Organization's Real Estate Fund. 4. PROCUREMENT OF SUPPLIES AND EQUIPMENT During the period 1 July 1979 - 31 May 1980, procurement action was taken for supplies and equipment and medical literature amounting to $10 094 689. (a) Supplies and Equipment . . These consisted of laboratory items, hospital supplies, X-ray equipment, supplies for environ- mental programmes, material for teaching programmes, drugs, vaccines, biologicals, pesticides and spraying equipment, vehicles and administrative supplies. (b) Medical Literature . . $ 247 039 Where possible, having regard to prices and quality, purchases were made within the Region in accordance with the principle of technical coopera- tion among developing countries. The total amount spent on such purchases was $ 825 780 for supplies and equipment and $ 54 585 for literature. Plrchases on a Reimbursable Basis Purchases amounting to $26 961 were made as follows: For Bangladesh .. Yellow fever vaccine and anti-venom snake serum. For Nepal . . Anti-rabies vaccine and bleaching powder. Revolving Fund During the period under review purchase authorizations in respect of requests amounting to $ 133 786 were raised. Thirteen requests are being processed. 5. COLLABORATION WITH OTHER AGENCIES With the increasing demand for funds for activities in health and allied fields, and in view of the limited resources available to WHO under its
SEA/RC33/2 Page 115 as the topic for the technical discussions to be held during the thirty- third session in 1980. Among other items included in the agenda of the session and discussed by the Regional Committee were: (i) technical cooperation among developing countries (TCDC); (ii) strategies for achieving health for all by the year 2000; (iii) the contribution of health to the New International Economic Order; (iv) the Seventh General Programme of Work of WHO, and (v) study of WHO'S structures in the light of its functions. The Regional Committee, which adopted a total of 14 resolutions, decided to hold its thirty-third session in the Regional Office if no formal invitation was received." 2. REGIONAL PROGlWIME PLANNING AND DIRECTION The planning, direction and coordination of the regional programme have been under constant scrutiny with continued efforts to improve the development and delivery of programes in response to the dynamics of national health development efforts and the directives of the World Health Assembly, the Executive Board and the Regional Committee. Consultations with countries have continued on the nature and method of preparation of the Seventh General Programme of Work, which is poised to become an intermediate programme towards the long-term goal of HFA. Close consultation with the Regional Committee and Member countries will be maintained in further developing the regional contributions to the global programme. Medium-term programmes have been completed for all programme areas in consultation with the countries. The implementation of these programmes has been under continuous review to enable a flexible response to the changing national priorities and programmes thus lending strength and usefulness to the collaborative programme as a whole. The regional medium-term programme for health planning and management (country health programming) was evaluated and brought up to date at a consultative meeting held in January 1980. A guideline for action in TCDC in health planning and management in the Region was also developed. A Regional Office working group developed a strategy paper on support to the managerial process of national health development for the Global Prograpme Development Working Group. A detailed plan of action to implement the strategy is under preparation. The Regional Programme Committee supports and advises the Regional Director on programme matters, promotes policy and programme development, *At the invitation of the Government of Maldives, the thirty-third session is to be held in Male in September 1980. SEA/RC33/2 Page 116 monitors the delivery of programmes periodically, and carries out technical and budgetary reviews in coordination with and guidance from the Headquarters Programme Committee (HPC) and the Global Programme Commit tee (GPC) . The programme budgeting procedure, as a flexible instrument to formulate country-based collaborative programmes, is now better established, having been used in the formulation of preliminary proposals for the 1982-1983 biennium. The Regional Office focal group for information systems development was reorganized. Earlier, the programme management information system was replaced by a simpler programme delivery status report, which has been kept under review in consultation with WPCs and necessary additional information was included to enable periodic monitoring of programme deli- very by Member States. The project milestone reporting system has been further reviewed and a simplified procedure introduced to enable techni- cal monitoring of programme implementation. A regional "guideline for programe evaluation" is being developed to enable a more effective evaluation of both inter-country and country programes. 3. ADMINISTRATION 3.1 General The Director-General visited the Regional Office in October 1979 for discussions with the Regional Director. In February 1980 he, along with the Regional Director, visited Bangladesh, India, Sri Lanka and Thailand to sign the Charter for Health Development. During the period under review, a number of important persons, including the Ministers of Health of the Republic of Maldives and of the Democratic Socialist Republic of Sri Lanka, the Ministers of Health of Gujarat and of Tamil Nadu States in India, as well as senior officials of health ministries of Member States and senior staff from United Nations agencies visited the Regional Officeandheld discussions withtheRegiona1 Director and other staff. In November 1979, Dr I.D. Ladnyi, Assistant Director-General, visited the Regional Office to attend the EPI Global Advisory Group meeting and in February and March 1980 he travelled to Indonesia, Thailand and India to observe EPI activities in the field. He again visited the Regional Office in April-May for a meeting of the Scientific Group on Vaccination against Tuberculosis. Mr W.W. Furth, Assistant Director-General, visited Bangladesh, Sri Lanka, Thailand and the Regional Office in March 1980 to study programme budget- ing at country level and discuss the aubject with the Regional Director and the Regional Programme Comittee.
SEA/RC33/2 Page 111 1. REGIONAL COMMITTEE The thirty-second session of the Regional Committee for South-East Asia was held in the Regional Office in New Delhi from 18to 24September1979. The session was attended by delegates from Member States in the Region. Representa~ives of the United Nations and other agencies as well as from thirty-two non-governmental organizations in official relations with WHO and eight observers were also present. The session was opened by the outgoing Chairman, Professor Jambaa (Mongolia). Conveying the good wishes of his government for a success- ful session, he said that the Regional Committee session every.year provided an excellent forum at which to review the regional programme of work and to exchange views on common problems. In his inaugural address, Mr Charan Singh, Prime Minister of India, paid tribute to WHO for the "magnificent work it has been doing to promote health as a vital investment in man's development". He expressed concern for the uplift of those living in poverty, hunger and ill-health and said that more funds were being spent on technological advances than on the provision of basic needs to the rural areas. He added that those responsible for administering nations had to give greater and urgent recognition to the fact that economic development without simultaneous health development was an infructuous activity. Referring to the Alma Ata Declaration, he said that it would be hailed as the "Health Magna Carta" if the goal of "Health for All by the Year 2000" were implemented with sincerity by the countries of the world. Addressing the meeting, Mr Rabi Ray, India's Minister for Health and Family Welfare, praised WHO for the role it had been playing in "build- ing bridges, in healing wounds and in ameliorating the health of man". He called for collaboration at regional and international levels to tackle newly emerging problems through the sharing of experience, expertise and resources. Dr Prakorb Tuchinda, President of the Thirty-second World Health Assembly and leader of the delegation from Thailand, who also addressed the meet- ing, observed that while WHO stood for the promotion of collaborative efforts and acted as a catalyst in many areas, it was for the countries themselves to carry out appraisals of their policies and programmes and to reorient them to the changing situations and challenges. In his address, the Regional Director said that a survey of the health scene in many countries showed many encouraging trends and augured well for the launching of a major health offensive in the coming years. With the emergence of primary health care as a great conceptual advance and a key approach to better health, the universal social goal of "Health For All by the Year 2000" had become a feasible and logical objective. SEAIRC33/2 Page 112 To achieve this objective, political commitment at the highest level was necessary and considerable hard work was required to mobilize such political support and ensure adequate resources for health development. In his message, presented by the Regional Director, the Director-General of WHO emphasized that the struggle t:o attain an acceptable level of health for all by the year 2000 had become a political reality. He pointed out that only combined multi-sectoral national and international action could yield results. The Regional Committee elected Mr Rabi Ray (India) as Chairman and Mr M.K. Anwar (Bangladesh) as Vice-Chairman. In presenting his Annual Report, the Regional Director recalled that the most important development during the year had been the International Conference on Primary Health Care and the adoption of "Health for all by the year 2000" with primary health care as the key to its attainment as a universal social goal. The Committee was informed of the meeting which had been held to discuss the financing of primary health care programmes. This had provided an opportunity for the development of a closer understanding between the countries and the financing agencies. Countries were vigorously working towards strengthening their maternal and child health services, which were a vital component of the primary health care programme. Family planning programmes were also being implemented, mostly as part of comprehensive health Services, with the support of WHO and UNFPA. Among the communicable diseases, the Regional Director made special mention of malaria, particularly the programme to contain P. fakipanon resistance by strengthening the infrastructure of control programmes, training technical and managerial manpower, and through laboratory and field research. These measures had already produced encouraging results. The other priority areas mentioned included the provision of drinking water supply and basic sanitation, health manpower development and the regional research programe. WHO'S effort had mainly been to facilitate the transfer of technical information and the training of manpower in collaboration with the World Bank and UNDP. Research activities in all the priority areas identified by the South- East Asia ACMR had been promoted and supported. In addition to support- ing actual research programmes in the Region, efforts had been made to strengthen the research capabilities of the countries. Two comprehensive programmes of research - nutrition,and diarrhoea1 diseases of children - had been developed during the year. SEA/RC33/2 Page 113 The Regional Commirtee took up the discussion of the Annual Report of the Regional Director section by section. On the subject of strengthening of health services, attention was focused on the importance of health educa- tion as an integral part of health programmes. It was recognized that for primary health care the training of paramedical workers was at least as important as the training of health professionals, and the traditional practitioners of medicine should also be oriented in the principles of primary health care. Efforts were being made in many countries of the Region to increase the coverage of health services, especially in rural areas, through primary health care programes. It was accepted that for this, community participation was crucial and effective intrasectoral and intersectoral collaboration essential. One of the constraints in health care delivery to underserved populations was the paucity of doctors in rural areas. In regard to the prevention and control of communicable diseases, the Regional Committee concentrated its discussion on malaria, the expanded programme on immunization and leprosy. It was noted that, although malaria had shown a declining trend in the countries of the Region as a result of the strengthening of national anti-malaria activities, the problem of resistance of parasites to anti- malaria drugs, vector resistance to insecticides and the shortage of insecticides and anti-malaria drugs continued to pose difficulties. The establishment of multisectoral coordinating committees formalaria control was reported by some countries. Support to the national malaria programmes of some countries by bilateral agencies, principally CIDA, SIDA, US AID, and the governments of the Netherlands and the UK, was appreciated. While discussing the problem of leprosy, the Committee made a reference to resolution WHA32.39 and expressed concern that this region accounted for about 40% of the total number of leprosy cases in the world. The importance of early diagnosis and prompt and adequate treatment, especially of children, in order to achieve rapid cure and the prevention of deformities, was emphasized. The support to national leprosy control programmes by UNICEF and non-governmental and voluntary agencies such as the Sasakawa Foundation, the Danish Scouts Organization and the Order of Malta was recognized. While noting the progress made in establishing the expanded programme on immunization with WHO collaboration in most countries of the Region, the Committee expressed concern about the difficulties being experienced with regard to the cold chain facilities for the storage and transport of vaccines, and the monitoring and assessment of immunization activities, especially in remote rural areas. The Regional Committee emphasized the importance of stimulating and encouraging community involvement. It expressed the hope that adequate SEA/RC33/2 Page 114 priority would be given and resources at national and international level made available for the planning and implementation of community water supply and sanitation programmes in order to achieve national goals within the framework of the International Drinking Water Supply and Sanitation Decade. There was considerable discussion on health manpower development. The need to synchronize the development of both training and services so as to ensure proper health care delivery was emphasized. The Codttee also discussed the desirability of introducing degree qualifications and reducing diploma courses. WHO was requested to assist the countries in reviewing and revising existing curricula of various categories of health personnel to make these more need-based. With regard to research, the activities of the South-East Asia ACMR so far had been what could be considered as promotive or developmental in nature. Priority areas had been identified and links established between global, regional and national research activities, which had been progressively expanding. Two major efforts of the RACMR during the year had been the development of a diarrhoea1 diseases research programme and a comprehensive research-cum-action programme in nutrition. While appreciating the efforts in the field of research, the Regional Committee stressed the importance of making quicker progress towards enhancing national research capabilities and maximizing the utilization of national research centres in developing countries. Noting that 75% of the WHO collaborating centres were located in Europe and North America, while the South-East Asia Region had a mere 6%, the Committee requested that steps be taken to correct this serious imbalance. In considering organizational and administrative matters, the Committee raised the subject of the implementation of resolution WHA32.37 Rev.1 on the recruitment of international staff in WHO. It was pointed out that the new system of distribution of posts still reserved a high percentage of the posts to be allocated in relation to assessed contributions and did not sufficiently take into account the population and the capabili- ties of the Member States in this region to provide the Organization with skilled staff. In accordance with the usual practice, a Sub-committee on Programme Budget was established. The Sub-Committee reviewed the detailed elabora- tion of the 1980-1981 programme and noted the detailed project activities and agreed that the programme was in accordance with the General Programme of Work and policies of the Organization. The Regional Committee approved the Report of the Sub-committee. Technical discussions were held on "Drug policy, including traditional medicine, in the context of primary health care". "Health manpower plan- ning and community participation for primary health care" was selected SEA/RC33/2 Page 115 as the topic for the technical discussions to be held during the thirty- third session in 1980. Among other items included in the agenda of the session and discussed by the Regional Committee were: (i) technical cooperation among developing countries (TCDC); (ii) strategies for achieving health for all by the year 2000; (iii) the contribution of health to the New International Economic Order; (iv) the Seventh General Programme of Work of WHO, and (v) study of WHO'S structures in the light of its functions. The Regional Committee, which adopted a total of 14 resolutions, decided to hold its thirty-third session in the Regional Office if no formal invitation was received." 2. REGIONAL PROGlWIME PLANNING AND DIRECTION The planning, direction and coordination of the regional programme have been under constant scrutiny with continued efforts to improve the development and delivery of programes in response to the dynamics of national health development efforts and the directives of the World Health Assembly, the Executive Board and the Regional Committee. Consultations with countries have continued on the nature and method of preparation of the Seventh General Programme of Work, which is poised to become an intermediate programme towards the long-term goal of HFA. Close consultation with the Regional Committee and Member countries will be maintained in further developing the regional contributions to the global programme. Medium-term programmes have been completed for all programme areas in consultation with the countries. The implementation of these programmes has been under continuous review to enable a flexible response to the changing national priorities and programmes thus lending strength and usefulness to the collaborative programme as a whole. The regional medium-term programme for health planning and management (country health programming) was evaluated and brought up to date at a consultative meeting held in January 1980. A guideline for action in TCDC in health planning and management in the Region was also developed. A Regional Office working group developed a strategy paper on support to the managerial process of national health development for the Global Prograpme Development Working Group. A detailed plan of action to implement the strategy is under preparation. The Regional Programme Committee supports and advises the Regional Director on programme matters, promotes policy and programme development, *At the invitation of the Government of Maldives, the thirty-third session is to be held in Male in September 1980.
SEA/RC33/2 Page 109 Following the meeting of the research study group on filariasis held in 1979, specific research areas have been identified and protocols on these topics have been invited. The two WHO Special Programmes - Research, Development and Research Training in Human Reproduction and the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases - have continued to provide a major source of encouragement to research in this region. The Regional Office is actively collaborating with WHO Headquarters in promoting these, and two full-time staff members are engaged in the activities. Several centres of excellence in the Region are in the process of being designated as WHO collaborating centres for undertaking specific activi- ties of the regional research programe. It is envisaged that a network of institutions in each programme area would be set up which could function as a source of technical expertise to the Regional Office as well as collaborate among themselves in the spirit of technical coopera- tion among developing countries. In 1979 seven countries in the Region developed projects on research promotion and development utilizing WHO'S Regular Budget. The Regional allocation, together with these country allocations, forms nearly 10X of the overall Regular Budget of the Regional Office. WHO has been able to attract modest extrabudgetary funds so far, but considerable national and bilateral support has been generated in the Member countries through the limited catalytic resources provided by the Regional Office. Mobilization of further extrabudgetary resources will be pursued in collaboration with WHO Headquarters. The sixth session of the South-East Asia Regional Advisory Committee on Medical Research was held in the Regional Office in April 1980 to review .. the progress of research projects in the Region. The total number of research projects supported in the countries rose to 85 in 1979, includ- ing 45 projects financed during that year. Taking into consideration the inter-country and country allocations, the total amount available for research activities in the 1980-1981 biennium is $3 979 600 as against $2 357 100 in 1978-1979. 9. TECHNICAL INFORMATION AND REFERENCE SERVICES Two titles in the WHO Regional Publications, South-East Asia Series, were brought out during the year under review. These were: (1) The Eradica- tion of Smallpox from Bangladesh, and (2) A Manual on t!le Clinical Management of Acute Malaria. Two other publications, "A Guide to the Care of the Low Birth-Weight Infant" and "Appropriate Technology for Environmental Health in Villages" are under print. A total of 160 assignment reports of short-term consultants and long-term staff, final SEA/RC33/2 Page 110 reports on projects and those on meetings and seminars was edited, pro- cessed and issued. Reports brought out under special printed cover for wider distribution included those on (a) Establishment of a Regional Network of Health Literature,Library and Information Services; (b) Research-cum-action programme in nutrition for developing countries; (c) Technical information on Japanese encephalitis and guidelines for treatment; (d) Financing and management of water supply and sewerage; (e) Formulating strategies for health for all by the year 2000; (f) PZasmodiwn FaZcipanrm resistance to 4-aminoquinolines, and (g) the Eighth WHO Meeting of Directors or Representatives of Schools of Public Health. 4 publication entitled "Health Law of the Mongolian People's Republic" and a "Directory of Health Science Libraries in South-East Asia" were also brought out under special printed cover. In addition to the above, wide distribution was given to a large number of other documents. The report and minutes of the thirty-second session of the Regional Committee and the report of the technical discussions held during the session on "Drug policies, including traditional medicine, in the context of primary health care", were, as usual, edited and issued with a printed cover. A "Supplement to the Handbook of Resolutions and Decisions of the WHO Regional Committee for South-East Asia" was brought out, incorporating the resolutions adopted at the thirty-second session. Documentation and reference services were provided during meetings organized by WHO, including the Regional Cornittee, and requests for documents were complied with. Sa Zes The total sales during 1979 amounted to US$ 78 772, of which subscriptions accounted for US$ 42 572 and other sales US$ 36 200 (as compared with US$ 57 389 In 1978). The sales for the first five months of 1980 amounted to US$ 45 239. The Regional Office took part in the Fourth World Book Fair, held in New Delhi from 29 February to 11 March. In addition, regional publications were displayed at a number of national, international and WHO-sponsored meetings held in the Region. Also, groups visiting World Health House were briefed on WHO publications and their availability at concessional rates.
SEAlRC3312 Page 106 Library continued to supply reference material in connexion with various seminars and meetings held in the Regional Office and outside. Twenty-four student loan libraries were established in 1979 and 1980 in Bangladesh, Burma, India, Indonesia, Mongolia, Nepal, Sri Lanlca and Thailand. The Library actively participated in the planning and organization of an "Inter-country Consultative Meeting on Network of Health Literature, Library and Information Services", held in New Delhi in August 1979, and presented several papers. The Library, which is the MEDLINE Coordinating Station for South-East Asia, continued to provide, free of cost, MEDLINE searches requested by Member countries. It scrutinized the requests and obtained print-outs. for searchable requests from the National Library of Medicine, Betheeda, Md., USA, under a special agreement. A proposal to bring out an "Index to South-East Asia Health Literature" was submitted to Headquarters and is under consideration. The Regional Office Library took part in (1) an ESCAP Expert Group Meeting to Develop a Guide for Establishing a National Population Information Clearing House and Network System, held in Bangkok in September 1979, (2) a National Seminar on Health Science Librarier in India (Bangalore, February 1980) and (3) an ISIS User Seminar (Delhi, February 1980) organized by the Centre for Development of Instructional Technology (CENDIT) . The Regional Office Librarian visited Burma and Nepal in March 1980 in connexion with the organization of the libraries of the WHO Programme Coordinators' Offices. 8. RESEARCH PROMOTION AND DEVELOPMENT Under the regional research programme, which has entered its fifth year, action was taken to cover most of the priority research fields identified by the Regional Advisory Committee on Medical Research (SEA Am). In keeping with WHO'S efforts towards attaining the goal of health for all, steps have been taken to orient the research programme accordingly, with consideration being given not only to disease-related research but also to research on health services and health promotion. In addition, the programme is promoting technical cooperation among developing countries, including the transfer of technology not only among themselves but also from the developed nations. The activities to promote research have been aimed at collaboration in those critical areas which could stimulate national and bilateral action. In addition, the programme is now structured to facilitate closer SEA/RC33/2 Page 107 involvement of administrators and policy-makers together with research scientists to secure greater national codtment and also increase the utilization of the results of research. Recognizing the dearth of manpower and the need for better coordination of research among Member countries, the Regional Office has concentrated its efforts on strengthening research capabilities through the organi- zation of courses in research methods. Through such initiatives greater commitment has been generated at the national level. A limited number of research training and visiting scientist grants have also been provided for specific training. In view of the fact that medical research councils or similar bodies could play a vital role in promting research at the national level with WHO playing a promotive and coordinating role, a Meeting of Directors of Medical Research Councils or Analogous Bodies and Concerned Research Foci in the Relevant Ministries was held in December 1979 in Sri Lanka. This meeting drew up guidelines for overall research promotion and develop- ment at the country level on those vital issues which need further strengthening, such as ethical review mechanisms, a career structure for research scientists, organization of mission-oriented research on national priority problems, coordination, and utilization of the available manpower and institutional potential existing within the countries. Through national follow-up meetings the recommendations will be implemented which would, in addition to strengthening the national organizations, give WHO an opportunity to identify clearly its own actions pertaining to its catalytic and coordinating role for the development of the Organization's medium-term programme in research. In addition, through this mechanism of bringing together heads of research councils and other concerned national bodies further collaboration in the spirit of TCDC has been generated and will be pursued. The members of the SEA ACMR have willingly assisted the Regional Office in strengthening its role in the development, implementation and monitor- ing of the regional research programme. It is proposed to set up three ad hoc sub-committees, concerned, respectively, with research needs for health for all, diarrhoea1 diseases and nutrition. The sub-committee on research for health for all will review the research needs as per national strategies at its first meeting in July. It will suggest priorities for research for consideration at the seventh session of the SEA ACMR to be held in April 1981. Within the Regional Office the management mechanisms for implementing the inter-country research programme have been completed. The procedure of peer review of research proposals has been introduced and an "in-house" ethical review mechanism set up to complement the institutional and national review bodies as and when they are set up. Specific criteria for the award of research training and visiting scientist grants have also been laid down. Aa regards specific subjects, a compreheneive regional research progrme in dengue haemorrhagic fever is in operation which includes clinical, epidemiological, immunopathological and vector studies. A research programme for the development of a dengue vaccine has been initiated at the WHO Collaborating Centre on the Inrmunopathology of Dengue Haemor- rhagic Fever in Bangkok. It is proposed to strengthen further research activities in the field of epidemiology and vector biology. In regard to diarrhoea1 diseases, the research-cum-action progrm developed on the basis of national requirements through a series of meetings is progressing satisfactorily and several operational research activities are currently in progress. Further studies will be promoted. In nutrition, the research-cum-action programme developed in 1979 at two consultative meetings involving scientists and policy-makers has resulted in the development of 19 projects of importance to the Region. As an initial step, the Organization has actively promoted those projects falling within the field of nutrition and primary health care. Most of the countries are actively participating in these studies, which are currently in their initial phase. In order to generate further studies in health services research and recognizing that the approach to such research has to be country and culture specific and multidisciplinary in nature, the Regional Office organized a meeting of policy makers and research scientists to seek their guidance on the development of inter-country and national training courses. The aim is to help develop a multidisciplinary core group of scientists who could undertake research into problems at the country level and provide timely answers to policy makers and' administrators. Research study group meetings on leprosy and traditional medicine are scheduled to be held later in 1980 to develop research protocols on the specific priority topics identified. Research in these fields will be promoted in due course with the active collaboration and concurrence of governments. The studies on P. fa~c6pw.m. resistant to 4-aminoqufnolines are progres- sing satisfactorily and a meeting of the principal investigators was held to reviewthestatus of the studies and plan future work. me retrospective studies on liver diseases have been completed and a report is awaited. In the meantime, prospective studies proposed as per the medium-term research program on this subject are being actively pursued and the Regional Office is taking steps to identify centres of excellence in the Region which could be designated as collaborating centres to undertake the specific tasks spelt out in this WHO medium- term programme. Regarding research on the development of appropriate technology for improving environmental hulth at the village level, tw major studies are progressing in India. These concern the health benefits of water supply in rural areas and the field testing of integrated water supply and waste-water utilization systems for villages. SEA/RC33/2 Page 109 Following the meeting of the research study group on filariasis held in 1979, specific research areas have been identified and protocols on these topics have been invited. The two WHO Special Programmes - Research, Development and Research Training in Human Reproduction and the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases - have continued to provide a major source of encouragement to research in this region. The Regional Office is actively collaborating with WHO Headquarters in promoting these, and two full-time staff members are engaged in the activities. Several centres of excellence in the Region are in the process of being designated as WHO collaborating centres for undertaking specific activi- ties of the regional research programe. It is envisaged that a network of institutions in each programme area would be set up which could function as a source of technical expertise to the Regional Office as well as collaborate among themselves in the spirit of technical coopera- tion among developing countries. In 1979 seven countries in the Region developed projects on research promotion and development utilizing WHO'S Regular Budget. The Regional allocation, together with these country allocations, forms nearly 10X of the overall Regular Budget of the Regional Office. WHO has been able to attract modest extrabudgetary funds so far, but considerable national and bilateral support has been generated in the Member countries through the limited catalytic resources provided by the Regional Office. Mobilization of further extrabudgetary resources will be pursued in collaboration with WHO Headquarters. The sixth session of the South-East Asia Regional Advisory Committee on Medical Research was held in the Regional Office in April 1980 to review .. the progress of research projects in the Region. The total number of research projects supported in the countries rose to 85 in 1979, includ- ing 45 projects financed during that year. Taking into consideration the inter-country and country allocations, the total amount available for research activities in the 1980-1981 biennium is $3 979 600 as against $2 357 100 in 1978-1979. 9. TECHNICAL INFORMATION AND REFERENCE SERVICES Two titles in the WHO Regional Publications, South-East Asia Series, were brought out during the year under review. These were: (1) The Eradica- tion of Smallpox from Bangladesh, and (2) A Manual on t!le Clinical Management of Acute Malaria. Two other publications, "A Guide to the Care of the Low Birth-Weight Infant" and "Appropriate Technology for Environmental Health in Villages" are under print. A total of 160 assignment reports of short-term consultants and long-term staff, final
SEA/RC33/2 Page 92 As stated earlier, action was taken to develop the management informa- tion system on water supply. Water supply involves a wide range of activities undertaken by a number of different government departments and semi-government organizations. Pilot studies were undertaken on particular aspects of the problem in four countries of the Region. The inter-country project on National. Health Information Systems Development assisted in organizing group educational meetings at country level for executing more user-oriented statistical projects. It also helped in evaluating statistical techniques and the quality of informa- tion gathered within the Region, in designing special studies and surveys and in analysing the results. In addition, it provided statistical support and information to various health services and programmes. An effort has been made to establish a data repository service in the Regional Office. The information obtained from countries for the World Health Statistics Annual as well as from various reports and technical documents has been included in "A Bulletin of Health Statistical Information, 19809', which will be distributed to Member countries. It is hoped that this will initiate a continuous process of information exchange between the countries and the Regional Office leading to improvements in future issues. National training courses on the application of ICD/9 were organized by Burma, India, Indonesia and Thailand in which WHO assisted by providing consultant services or background material or both. The team leader of the project attended a meeting on the International Classification of Diseases in Taromina, Sicily, in November 1979. Since the holding of the consultative meeting on the development of NHIS in the Regional Office in December 1978, collaborative assistance has been provided in the development of national health information systems or subsystems (hospital information sub-system, environmental health sub-system) through visitsto countries. Such assistance was provided to Indonesia, Nepal, Sri Lanka and Thailand. An inter-country working groupon information systems development is being planned for 1981 to initiate collaborative action for promoting the development of NHIS. 7. DEVELOPMENT OF HEALTH MANPOWER The focus of the health manpower development (HMD) programme is on: fostering coordination among the training programmes for all types of health workers and the way in which those personnel are used in primary health care; ensuring that the training is oriented towards the needs of PHC within the framework of health for all; assisting the countries of the Region in collaborating with and helping each other in all areas of health manpower development, and on promoting regional acceptance of SEA/RC33/2 Page 93 the need for newly-emerging priorities such as "team training", "continuing education" and "research in health manpower development". The Organization has, therefore, attempted to assist Member countries in: developing effective mechanisms to coordinate health services' and health manpower planning; reorienting the content of basic training programmes towards community needs; developing curricula for various categories of health workers which are competency-based and learner- centred; fostering the development of centres of educational excellence in the Region, and carrying out and reporting on relevant research in health services and manpower development. The Medium-Ten Progrme in Health Manpower Development 'I The Medium-Term Programne (MTP) constitutes the basis for all the activities in health manpower development. In the past year a great deal of effort has been made in reviewing the MTP and relating it to specific contributions to the achievement of health for all. Health Manpower Planning A Consultation on Coordinated Health Services and Manpower Development was held in the Regional Office in August 1979. The Consultation reviewed the experiences of the countries in the linkage between the educational and health sectors, discussed the obstacles and constraints to coordination and developed general and country-specific strategies to bring about closer collaboration between the health service and manpower development sectors. A workshop on health manpower planning was conducted in Nepal and was followed by a project formulation exercise. In Bangtodesh, preparations have been made to conduct a health manpower planning exercise. Tmining in Health Services Management Contractual agreements were signed between &urncr, Sri Lanka and India to develop training programmes to improve the management of primary health care personnel. Under this agreement, &uma has undertaken a systems analysis of the management problems of primary health care programmes and, based on this analysis, is now developing a training programme for all levels of managers of PHC programmes. In Sri Lanka, models for the delivery of primary health care are being developed and are expected to provide the training ground for promoting those administrative and management skills most lacking among all categories of primary health care workers. Discussions are being held with the authorities in India to develop a management training programme for primary health care personnel in the country. SEA/RC33/2 Page 94 fesearch in Health Manpower Deuelopient Following the Research Study Group meeting on Health Manpower Develop- ment and the recommendations of the Regional Advisory Committee on Medical Research on the proposals to be developed and implemented in selected institutes in the Region, a consultant visited several countries during 1980 to stimulate the development of the research protocols. The reactions of the governments of Bangladesh, Burma, Indonesia, Sri Lanka and Thailand have been obtained and action is being initiated to promote studies in priority areas. 7.1 Medical Education Undergraduate Medical Eduoation The Organization continued to assist medical colleges in the Region in reorienting the medical curriculum and making it more relevant to the needs of the community. In BangZadesh, a consultant assisted the medical colleges in the teaching of physiology. The Government has reconstituted the National Committee for Medical Education, which will be responsible for assessing the existing curricula, syllabi, laboratory facilities and teaching staff required for the medical schools. A Teacher Training Cell has been formed and sub-connnittees on undergraduate and post-graduate medical education have been set up. In Ma, the UNDP-assisted project on medical education was completed during the year. A short-term consultant was assigned to Institute of Medicine I to help with basic and advanced training courses in immunofluorescence. In DPR Korea, WHO continues to collaborate in the programme for pre- paring medical and health professional~ for the international health community by improving their linguistic skills. In India, fellowships were awarded to teachers in medical colleges to enable them to keep abreast of the latest knowledge in their respective specialties and also to prepare them for planning and improving the educational processes so as to meet national needs. During the period under review, the National Teacher Training Centre at the Jawaharlal Institute of Post-graduate Medical Education and Research, Pondicherry, held two national courses on educational sciences for teachers of health personnel from a number of medical colleges. A consultant assisted the Centre in one of these courses. SEAIRC3312 Page 95 In Indonesia, a WHO staff member assisted the Consortium of Medical Sciences until March 1980 in training in curriculum development at government and private medical schools. An evaluation of the programme indicated that all the thirteen government medical schools now have mechanisms for self-sustaining educational development; that nearly three-quarters of them have developed all their training programmes so that these are competency-based and their objectives are stated in measurable terms; that the teachers in those medical schools are equally responsive to changes in the methods of teaching that they use, and that all these developments are geared to the production of a curriculum which is community-oriented. A short-term consultant on internal medicine was assigned to the State Medical Institute, Mongo~ia, during the year. In Nepat, assistance was continued to the Institute of Medicine, Tribhwan University, in conducting the Diploma Course in General and Community Medicine. Short-term consultants in anatomy, physiology, clinical pharmacology and surgery were assigned during the period under review. Sri Lanka has been provided with a number of fellowships for the teaching staff of training prograuanes in undergraduate medical schools. Assistance has also been given in upgrading the teaching programmes in medical microbiology for both undergraduate and post-graduate medical students. A similar, specific programme has also been implemented concerning the teaching of hlrman reproduction. In Thaitand, a national seminar was held to review the status of medical education and the need to reorient it towards achieving the goal of health for all. A short-term consultant assisted in developing a programme to train health personnel, including physicians, in primary health care and to assess the possibility of utilizing peripheral health care institutions for teaching medical students. Post-pduate Medical Eduaatwn The Organization has continued to provide overall support to the development of post-graduate medical education in the Region. In Bangtadesh, a consultant, assigned to the National Institute of Preventive and Social Medicine, assisted in developing the curricula for its training programmes and reviewed the organizational arrangements. Consultants in health education, audio-visual aids and biostatistics were also assigned to the Institute. In Burma, a consultant assigned to the Post-graduate School of Radiology studied the feasibility of starting a Master's Degree Course in Radiology. SEA/RC33/2 Page 96 The long-term staff member attached to the Faculty of Public Health in Indonesia until December 1979 assisted in developing the curricula based on the needs of the community and in replanning its approaches to the teaching-learning process. A short-term consultant was also assigned to the Consortium of Medical Sciences to review the post-graduate training programmes in other fields and to advise on the establishment of such programmes, particularly for the basic sciences. The document for a new UNDP project has been signed in Mo?qoZia to develop a program of post-graduate education for health personnel in the country, as a follow-up of the previous project on assistance to the State Medical Institute. It is expected that under this project post- graduate training institutes will be established in several aimaks, apart from those at Ulan Bator. The programme of post-graduate medical education in Sri Lmka gathered momentum during the year, and a consultant was assigned to review the situation and make recommendations. WHO also provided consultants to assist in the M.D. examinations in surgery, obstetrics and gynaecology, internal medicine and community medicine, with a view to identifying the needs. A further consultant assisted the Post-graduate Institute of Medicine in the formulation of plans to develop a diploma course in occupational health. Fellowships have also been provided for the candidates of M.D. in community medicine to undergo training for one year after their examina tion. Continuing Education Member countries realize the importance of continuing education not only to enable health personnel trained long ago to catch up on new kaowledge or to bring them up to date, but also as a necessary mechanism for maintaining and increasing those skills which become necessary because of changing circumstances. The importance of providing continuing education for all categories of health workers was underscored at the thirty-second session of the Regional Committee held in 1979. During the year an inter-country project on continuing education has assisted the countries through the organization of workshops and consultations, the distribution of curricula guidelines, and the development of appropriate learning materials, particularly for nurses. In India, the National Academy of Medical Sciences has started a pro- gramme of continuing education for doctors which will later be expanded to include other categories of health workers. WHO has assisted in this programme. In Sri Lanka, a pilot project on continuing education for primary health workers has already been initiated. SEA/RC33/2 Page 97 Teacher Training Programmes The development of teacher training at local, national and regional level continues to be an essential ingredient of many of the Organization's support programmes. These training progranunes have many functions of which the more significant are: to help teachers of health personnel to plan, implement and evaluate their training programmes in a systematic way; to assist the teachers in making informed educational decisions for themselves; to promote mechanisms at the level of the individual institution or for the country as a whole so that they can take over the responsibility for developing their own programmes, and to create a regional network of training centres to foster technical cooperation among developing countries. " The two Regional Teacher Training Centres - in Peradeniya, Sri Lunka, and in Bangkok, ThuiZand - have continued to provide basic two-week courses in educational science, and have also accepted teachers from medical colleges on short-term fellowships. In Bangladesh, late in 1979 a two-week workshop on teaching methodology was held for teachers of medical assistants. The National Committee for Medical Education has formed a teacher training cell to organize workshops. In Sm, a short-term consultant assisted in the development of a national-level workshop on "Educational Science for Teachers of Health Personnel for Primary Health Care". The Medical Education Unit at Institute of Medicine I, Rangoon, has been conducting workshops to train teachers from this institute as well as those from other health institu- tions in educational science. In India, the National Teacher Training Centre in Pondicherry has held workshops in educational science for teachers from other medical colleges. A second teacher training centre is being developed in Chandigarh which will primarily cater to the needs of the medical colleges in the northern part of the country. In Indonesia, a network of national-level centres is being developed and a short-term consultant was assigned to assist in making the final plans and programmes. 7.2 Education and Training in Maternal and Child Health The activities in this area were directed towards responding to the needs of the Region for training in maternal and child health care in the context of PHC. The preparation of paediatricians, obstetricians and maternal and child health managers for their new roles in the light of the primary health care strategy, and in the context of overall development, is considered important. SEA/RC33/2 Page 98 As a training strategy for maternal and child health care, a regional teacher education programme was developed at a consultative meeting attended by senior teachers of child health, obstetrics and gynaecology, preventive and social medicine, medical educationists and maternal and chFld health planners. This programme is to be implemented during 1980. As a follow-up of the UNICEF/WHO Course for Senior Teachers of Child Health, technical support by way of educational materials was provided to strengthen teaching progranmes, especially in the social aspects of paediatrics. In Bm, the training program in maternal and child health was geared primarily to orient health personnel in basic health services in the context of primary health care and to train community-level auxiliary midwives and personnel of health-related sectors such as township education officers and headmasters of schools. In India, the demonstration and dissemination of the remodelled under- graduate paediatric curriculum continued with the provision of intra- country fellowships. At the request of the Government, this progrw was evaluated by a temporary adviser. The review found that the programme had been successful and that there was a need to accelerate its implementation by setting up a third demonstration centre. The draft of a Handbook on Child Health to be used as a teaching/training tool for this curriculum, which was completed by a panel of authors, was reviewed by the Ad hoc Cormnittee on Paediatric Education. Many useful recommendations were made for its improvement both in content and presentation. The second draft is under preparation. The implementation of the education programme in the teaching of maternal and child health including family planning to undergraduates and interns proceeded according to plan. District-level paediatricians were trained in the care of the newborn through national seminars supported by grants-in-aid. Under an inter-regional project the educational programme for senior obstetricians and senior health administrators on the medical termination of pregnancy and advanced techniques of maternal care was continued through support for one study tour and one national seminar. In Maldives, a consultant assisted in giving training in maternal and child health to community health assistants at the Allied Health Services Training Centre. Training programes in maternal and child health in Mongotia were directed towards developing health manpower at the aim& level. especially in the ten model aimaks where integrated family health services have been set up. SEA/RC33/2 Page 99 In Nepal, health manpower training in maternal and child health including family planning was supported mainly through national and regional training programs, especially for health personnel at district level. In %itand, support was given to selected personnel for advanced training outside the country to prepare them for the increased responsi- bilities inherent in the expansion of the service outlets in famfly health and improvement in the quality and comprehensiveness of the services. Technical support was also provided for training in maternal and child health, including family planning, to peripheral and primary health care workers. Continuing education in maternal and child health for all levels of health workers through national seminars and workshops was supported . 7.3 Education and Training in Sanitary Engineering An attempt has been made to orient the practical training of sanitary engineers to the objectives of the United Nations International Drinking Water Supply and Sanitation Decade. Action is being taken to recast the fellowships programme in such a way that practising engineers can study field experience in other developing countries. An example of this reorientation is the plan to study solid wastes management in Asian cities such as Bangkok, Hong Kong, Singapore and Kuala Lumpur. A study programme of piped water supply to small communities with appropriate technology and involving the communities themselves is being organized. Courses in practical management concepts and principles for senior engineers are planned at regional level. With the collaboration of the World Bank, proposals are being developed for giving practical in-service training to senior engineering staff in project formulation, feasibility reports, project appraisal and evaluation. In the field of environmental pollution, the Regional Office is studying the development of special courses for groups of trainees on specific environmental pollution problems prevalent in the Region. Simultaneouely, there will be less emphasis on fellowships for fulltime post-graduate studies in sanitary engineering in the industrialized countries. Assistance is also being offered to universities in the Region to attune their sanitary engineering courses to the needs of the countries. With support from GTZ (Federal Republic of Germany) and UNICEF, workshops are also being arranged for orienting both key national staff as well as staff from the multilateral agencies working with them, in the concepts and strategies to be adopted for attaining the goal of the Decade. SEAlRC3312 Page 100 7.4 Training in Epidemiology Further efforts have been made to strengthen facilities for the training of epidemiologists in the countries of the Region. A regional training programme in epidemiology has been formulated to strengthen the existing national training institutions and improve training strategy and methods. Following discussions that the Regional Director and the Director of the Division of Communicable Diseases from WHO Headquarters had with the national health authorities in Thailand regarding the establishment of a training programme in epidemiology with the assistance of WHO and CDC, Atlanta, such a programme has been launched in that country, and a WHO epidemiologist has been in position since April/May 1980. 7.5 Training of Auxiliaries and Community Health Workers To overcome the shortage of health manpower, especially in the rural areas, the recruitment of community health workers who have undergone a brief period of training to work for their own comunity voluntarily or with minimum incentives, is being ancouraged in most countries of the Region. Such a programme is gaining momentum and the activities which have been undertaken include the training of trainers, the preparation of learning materials relevant to the needs and priorities of the workers, the developwant and use of audio-visual aids in training, the organization of in-service training programmes for supervisors and the conduct of research to support development at the peripheral level. In Bangladesh, domiciliary visiting services at the village level are undertaken by the multi-purpose family welfare worker (FWW) and the family welfare assistant (FWA), whose activities are mainly in the field of family planning and maternal and child health. The village health workers, who will be community-based, will be guided and supervised by the FWWs and the FWAs. The village health workers are being trained in the six thanas in the pilot project areas for primary health care. Under the patti ohikitshak scheme, which was launched in September 1978, one p~lli chikitehak, or village healer, will be made available in each of the 65 000 villages in the country; 2 400 such workers have already been trained. The village health worker and the palti ohikitshak will be the grass-roots workers 'located in the village. The medical assistant training programme, which was started more than two years ago, is now firmly established and so far 478 medical assistants have completed their training from the four schools. The Government plans to open four additional schools, and the course for medical assistants has been lengthened from 2-112 years to 3 years. Primary health care was initiated in Burvia in 17 townships and has gradually expanded to 75 townships; the aim is to cover 50% of the total of 65 320 villages by 1982. Community health workers are being trained for both rural and urban areas, the aim being to have 26 000 such workers for the rural and 6 600 for the urban areas. So far, more than SEA/RC33/2 Page 101 10 000 of them have been trained and posted. A national workshop in educational sciences was held in 1978 for the trainers of connnunity health workers and in 1979 a follow-up evaluation workshop was organized in addition to a second national worbhop on educational sciences for the trainers. A WHO consultant assisted the national personnel in conducting tests and assessing the readability, comprehensibility and relevance of the community health workers' manual. In Indk, the community health workers scheme continued to train more such workers. The Government has changed the name of the scheme to "community health volunteers' scheme". WHO provides assistance in the educational aspects and in the production of manuals. Already 130 000 volunteers have been trained and are in position. Apart from this category of community health volunteers, 250 000 dais (traditional u birth attendants) have been trained, with special orientation in family planning and maternal and child health. The Bureau of Health Planning in Indonesia is intensifying its efforts to formulate a long-term health manpower plan to support primary health care. WHO has continued to collaborate in the training of the health nurse or perawt kesehatun (the PK) nurse by assigning three long-term staff members. Revision of the curricula and the development of learning materials have been undertaken. In ~Yuldives, a long-term WHO staff member has been assigned to the Allied Health Services Training Centre in Mal6. The training of community health workers has continued and their job description has been revised. Training programmes for nurse aides, community health aides, dispensers and footwnas have been undertaken as well as programmes of continuing education for the trainers of these workers. A new category of primary health worker, known as the family health worker, is being developed in the country. In Nepal, training is given to village health workers, who are an . important link between the integrated health posts and the people in the delivery of basic health services. These village health workers are selected by and are under the direct administrative supervision of the village panchayats. A pilot scheme for the training of community leaders to develop ward health volunteers who in turn will assist and support the village health workers has been undertaken, and plans are being made for its expansion. So far 1 400 village health workers have been trained, and a mid-term review has reported that these workers have had a significant impact, especially in raising the community's awareness about family planning, oral rehydration and nutrition. In Sri Lanka, a consultant was assigned to the National Institute of Health Sciences, Kalutara, to assist in its further development. In Thailand, the training programme for nurse practitioners at the Faculty of Public Health has continued. ., SEA/RC33/2 Page 102 Two types of health volunteers at the village level have been trained: village health communicators and village health volunteers. The Government aims to have 448 000 village health communicators and 44 800 village health volunteers. So far more than 100 000 village health communicators and more than 15 000 village health volunteers have received training. 7.6 Group Educational Activities During the period under review, 128 group educational activities were organized, of which 79 were at the national level, 37 inter-country, 10 inter-regional and 2 of a general nature. Emphasis was laid on increasing the activities at the national level to cater to the needs and requirements of individual countries. The subjects covered in these meetings were primary health care, expanded programme on immunization, malaria, nursing, diarrhoea1 diseases, mental health, maternal and child health, environmental health, traditional medicine and health manpower development. There has been an increase in the nwnber of research study group meetings, in which priority areas such as malaria, diarrhoea1 diseases, chronic liver diseases, health services research, traditional medicine and health manpower development were dealt with. The first meeting on Regional Cooperation in the Implementation of the WHO Fellowships Programme was held in September 1979 in the Regional Office (see under 7.7 "Fellowships"). 7.7 Fellowships During the twelve-month period 1 May 1979 - 30 April 1980, a total of 846 fellowships was awarded using various sources of funds: 681 (80%) from the Regular Budget, 64 (8%) from UNDP, 82 (10%) from UNFPA and 19 (2%) under inter-regional and other projects funded by WHO Head- quarters. The fellowships awarded consisted of: 144 (17%) against the 1978 budget, 624 (74%) against the 1979 budget, and 78 (9%) against the 1980 budget. Under the Regular Budget for 1979, a sum of US$ 3 371 610 waa provided for fellowships, constituting 17% of the total budget and involving a total of 813 fellowships. Up to the end of 1979, 566 had been awarded (70%). Of the remaining fellowships, 117 (14%) have been awarded so far during 1980, and the balance of 130 (16%) is expected to be awarded before the end of June. UNDP provided US$ 519 994 for fellowships during 1979. Of the 190 fellowships planned during 1979, 138 (73%) have been awarded, 14 (7%) are being processed and applications are awaited in reapect of 38 (20%). SEA/RC33/2 Page 103 Under UNFPA funds, a sum of US$ 259 575 was provided for fellowships during 1979, constituting 7% of the total UNFPA budget for the Region. The number of fellowships planned during 1979 was 123, of which 92 (75%) have been awarded; applications have not yet been received in respect of 31 (25%). During 1979, fellowships awarded totalled 940, of which 222 (24%) were against the 1978 budget. The table below shows that 43% of all fellowships were awarded for study within South-East Asia; of the other Regions, the European Region took most, and 9% of fellowships involved travel to the USA. It also shows that about 50% of the fellows were professional health workers such as doctors, nurses and environmental health engineers and that 76% of the DISTRIBUTION OF FELLOWSHIPS (a) By Budget and By Region 'Three fellows visited Egypt (EMRO) as part of the Czechoslovakia/ USSR/Egypt training course in epidemiology. (b) By Type, Sex, Age and Duration HQ and others - - 13 6 19 SEAR0 PRO EURO USA TOTAL n. TYPe Professional 421 (50%) Others 425 (50%) UNDP 31 7 20 6 64 Total 367 (43%) 75 (9%) 327 (39%) 77 ( 9%) 846 . 275 68 273 6 5 681 UNFPA 61 - 21 - 82 Sex Male 644 (76%) Female 202 (24%) Age Under 25 24 ( 3%) 26-34 150 (18%) 35-44 379 (45%) 45-54 274 (32%) 55+ 19 ( 2%) Duration Under 1 month 135 (16%) Upto 3 months 297 (35%) Upto 6 months 214 (25%) Upto 12 months 162 (19%) Above 12 months 38 ( 5%) SEA/RC33/2 Page 104 awards were for males and 24% for females. The table also shows the distribution of the fellowships among age groups: 45% were awarded to candidates between the ages of 35 and 44 years. Of the fellowships awarded, 135 (16%) were for a duration of one month and less, 297 (35%) for up to 3 months, 214 (25%) for up to 6 months, 162 (19%) for up to 12 months and 38 (5%) for durations beyond 12 months; 439 (52%) of the fellows were placed for study in one country, 145 (17%) in two countries, 151 (18%) visited three countries, 75 (9%) four countries and 36 (4x1, five countries. Of the difficulties experienced in the speedy implementation of the fellowships programme, special mention should be made, with one or two exceptions, of the poor response to furnishing the terms of reference and the long delay in receiving applications. The position in respect of the 1980 programme is, out of 979 fellowships planned, terms of reference for 211 (22%) and applications for 441 (45%) are still awaited, though half of the programe year is nearly over. This gives insuffi- cient time for processing placements during the programme year itself. It is noted that utilization reports on returned fellows' employment and contribution and government evaluation are received only for a small proportion, e.g., about 20%, which makes any meaningful attempt at evaluation of the fellowships programme difficult. An analysis of 244 utilization reports received during the reporting period demonstrated that 100% were suitably employed, 82% introduced new activities and 84% imparted lcnowledge to others. A Conference on Regional Cooperation in the Implementation of the WHO Fellowships Programe was held in the Regional Office from 26 to 29 September 1979 and was attended by representatives of the countries of the Region and one representative each from EMRO, EURO, WPRO, the Department of Health and Social Security, UK, and the British Council, London. The aims and objectives of the Conference were to review the planning and administrative mechanisms to improve the implementation of the fellowships programe. The recommendations of the Conference have been brought to the notice of the governments with a view to their full implementation. There is an increasing trend towards regionalization of the fellowships programme, as seen from the table below: Numberof regional fellowshius awarded 145 (29%) 196 (34%) 299 (44%) 280 (47%) Calendar year 1976 1977 1978 1979 Number of fellowships awarded 500 578 676 591 SEA/RC33/2 Page 105 Subjects of Fellowships The following table shows distribution of the fellowships awarded, by country and by subject. Fellowships Awarded (Under all Budgets) by Subject of Study and Country of Origin of the Fellow (1 May 1979 - 30 April 1980) Fellows from other Regwns 0 Z a Y 0 h w 1. 2. 3. 4. 5. 6. 7. 8. . During the period under review, 68 fellows from the following countries and territories outside South-East Asia visited this region: Afghanistan, Benin, Canada, Egypt, Fiji, Iraq, Japan, Republic of Korea, Malaysia, Mauritius, Philippines, Somalia, Sudan, Syria, USA, Western Samoa and Yemen. + 5 0) 1 m 3 a a0 m dm* m a muJ-4 g $ U Subject a2-1 C m U u !4 0) Public Health 14 9 3 8 23 6 7 13 5 18 106 13 Environmental Health Nursing Maternal and Child Health Communicable Diseases Clinical Basic Medical Sciences Others Total I 1 7.8 Regional Office Library During the period 1 July 1979 - 31 May 1980, the Regional Office Library received 8023 books, pamphlets, WHO publications, current periodicals and reports; 2798 persons (2327 WHO staff and 471 others) visited the Library and 1354 books and periodicals were issued on loan to Regional Office and field staff as well as on inter-library loans. Photocopies of 9420 pages were supplied. For references needed by the Regional Office, field staff and Headquarters, 82 loan requests were sent to local libraries. The SEAlRC3312 Page 106 Library continued to supply reference material in connexion with various seminars and meetings held in the Regional Office and outside. Twenty-four student loan libraries were established in 1979 and 1980 in Bangladesh, Burma, India, Indonesia, Mongolia, Nepal, Sri Lanlca and Thailand. The Library actively participated in the planning and organization of an "Inter-country Consultative Meeting on Network of Health Literature, Library and Information Services", held in New Delhi in August 1979, and presented several papers. The Library, which is the MEDLINE Coordinating Station for South-East Asia, continued to provide, free of cost, MEDLINE searches requested by Member countries. It scrutinized the requests and obtained print-outs. for searchable requests from the National Library of Medicine, Betheeda, Md., USA, under a special agreement. A proposal to bring out an "Index to South-East Asia Health Literature" was submitted to Headquarters and is under consideration. The Regional Office Library took part in (1) an ESCAP Expert Group Meeting to Develop a Guide for Establishing a National Population Information Clearing House and Network System, held in Bangkok in September 1979, (2) a National Seminar on Health Science Librarier in India (Bangalore, February 1980) and (3) an ISIS User Seminar (Delhi, February 1980) organized by the Centre for Development of Instructional Technology (CENDIT) . The Regional Office Librarian visited Burma and Nepal in March 1980 in connexion with the organization of the libraries of the WHO Programme Coordinators' Offices. 8. RESEARCH PROMOTION AND DEVELOPMENT Under the regional research programme, which has entered its fifth year, action was taken to cover most of the priority research fields identified by the Regional Advisory Committee on Medical Research (SEA Am). In keeping with WHO'S efforts towards attaining the goal of health for all, steps have been taken to orient the research programme accordingly, with consideration being given not only to disease-related research but also to research on health services and health promotion. In addition, the programme is promoting technical cooperation among developing countries, including the transfer of technology not only among themselves but also from the developed nations. The activities to promote research have been aimed at collaboration in those critical areas which could stimulate national and bilateral action. In addition, the programme is now structured to facilitate closer
responsibility among different directorates, such as Food and Drug, CDC and Fisheries; for developing simple codes of practice for itinerant vendors; for drafting regulations governing the sale of food in markets, and on operational matters concerning routine inspections, record keeping, monitoring and enforcement as well as health education. Recommendations have also been made in regard to training, management and staffing. 6. HEALTH INFORMATION AND STATISTICS The development of national health information systems (NHIS) in the countries of the Region was continued through the inter-country project "National Health Information Systems Development", with health statistics largely incorporated as a component. The Consultative Meeting on National Health Information Systems Development organized in December 1978 provided most of the basic guidelines and stimulated the interest of countries in the development of NHIS, recognizing it as an essential requisite for the planning, management and evaluation of health programmes. As a result, projects on NHIS or its component sub-systems were initiated or strengthened in Bangladesh, Burma, India, Indonesia, Mongolia, Nepal, Sri Lanka and Thailand. In Bangladesh, assistance in the development of health statistics and medical record keeping was provided from time to time. A long-term systems analyst is under recruitment to assist in the development of a functional health information system to provide support to health services management. In addition, national training courses in health statistics and medical records science will be organized, in collabora- tion with WHO. A long-term systems analyst has been provided to &uma to assist in evaluating health programmes and the use of computers for the develop- ment of the national health information system. The training of national staff in health information systems, computer science, demography and biostatistics and medical record science was supported. The statistician assigned to the Mycobacterial Disease Project (Rifampicin Trial) continued to assist with the trial in selected areas of the country where leprosy is still highly prevalent. In India, WHO collaborated in strenghening the information/statistical systems at both the state and national levels and in providing training in medical records through two projects, "Strengthening of Health Statistical Services" and "Development of Medical Health Records in Hospitals". Further attempts are being made by the national authorities to explore the feasibility of adopting a lay reporting system for the collection of information on morbidity and mortality. Field trials were organized in this connexion in several states. The offices of the Registrar- General and the Central Bureau of Health Intelligence, in collaboration SEA/RC33/2 Page 90 with WHO, held a three-day national meeting on Medical Certification of Cause of Death. The bi-annual training courses for medical record technicians and the annual course for medical record officers continued to be held. In Indonesia, a detailed study was made of the organization and infra- structure of the information sub-systems of various health programmes with a view to promoting the coordination and integration of information at national and sub-national levels. Also, a review was made of the country's hospital recording and reporting system to provide technical collaboration for the new project, "Strengthening of Hospital Statistics as a sub-system of the NHIS". The development of a country progrme profile for Indonesia was initiated. Direct assistance was provided in the computer processing and statis- tical analysis of the data collected in a perinatal mortality survey conducted in hospitals within Bandung and a rural area outside the city. The survey, which also includes a component, "hypertensive disorders of pregnancy", is a collaborative study being conducted in five countries of the Region and coordinated by the Regional Office. Two WHO temporary advisers assisted in the organization and conduct of three training courses on the application of the International Classi- f ication of Diseases, Ninth Revision (ICD/9). Necessary training material was also provided for this purpose. In MongoZia, a consultant assisted the project on epidemiological studies of population growth in regard to the statistical aspects. Among these were the design of a study on maternal mortality and another on nutritional feeding patterns. He also helped in developing programmes for data processing and visited maternal and child health institutions in a number of aimaks to evaluate their performance. The national health survey using the sample method is continuing and the statistical analysis of the data on population, morbidity and mortality and the health service activities in 1978 has been completed. A ten-day work- shop on health information system was organized for 30 participants. A short-term consultant (statistician) was assigned to Nepal to help with a project on health planning and programming. He also assisted in the statistical aspects of the project's activities such as a mid-term review of the Fifth Five-Year Plan, formulation of the Sixth Plan, and the procedures and methodology of the health planning process at district level. The activities also included a field study of reporting and recording procedures at the peripheral and district levels and their standardization, identification of information needs of project/programme chiefs, and modification of existing information sub-systems to meet the needs of development planning and the management process. Assistance was also provided in the statistical analysis of a leprosy study. WHO collaborated in a review of the proposed project on NHIS development as well as a study of the existing situation in respect of information SEA/Rc33/2 Page 91 systems development for all health programmes. The data bank system and the inventory for information at the Planning Unit of the Ministry of Health were also studied and recomnendations were made for the commence- ment of NHIS. Assistance was provided in the development of a curriculum for the training of statistical assistants by the integrated community health project. In Sri Lanka, a preliminary study was made and work programmed for the establishment of a new project "National Health Information Systems Development". A long-term health information specialist is being recruited for this project. A review was undertaken of the development work on medical records in teaching hospitals with a follow-up on the evaluation on medical record procedures, made by a WHO Headquarters consultant earlier in the year. + A team from the Regional Office visited Sri Lanka in connexion with the development of a management information system on water supply. Discussions were held with senior officials of the Ministry of Local Government and the National Wacer Supply and Sanitation Board and, as a result, two pilot studies were initiated to develop management infor- mation systems on piped water and tube-well water supplies. Statistical assistance was also provided to the Food and Nutrition Policy Planning Division of the Ministry of Plan Implementation, which undertook a number of surveys to obtain baseline data for evaluating the Integrated Rural Development Programme. The surveys covered nutritional status, socio-economic indicators and agricultural data. The assistance mainly consisted of detailed advice on data processing and arrangements for analysing the data. In Thailand, a study was made of the newly reoriented health information services and the health planning and management information system at the Ministry of Public Health, and also the development of central and provincial health information centres, for further collaboration. . A consultant from WHO Headquarters was assigned to assist and supervise the coding of data according to ICD/9. Appropriate training material was also provided. Another team of two WHO consultants assisted in the development of NHIS. especially in the context of developing an appropriate technology for this purpose. A further two-man team visited Thailand to brief national programme managers and their staff on the preparation of country programme profiles. Profiles covering a wide range of programme areas have been completed and are in use. Thailand was another country visited by the joint enviromnental health and health statistics mission, which assisted the Provincial Water Authority and the National Economic and Social Development Board in arranging a pilot study for the development of the management informa- *7 tion system on water supply. SEA/RC33/2 Page 92 As stated earlier, action was taken to develop the management informa- tion system on water supply. Water supply involves a wide range of activities undertaken by a number of different government departments and semi-government organizations. Pilot studies were undertaken on particular aspects of the problem in four countries of the Region. The inter-country project on National. Health Information Systems Development assisted in organizing group educational meetings at country level for executing more user-oriented statistical projects. It also helped in evaluating statistical techniques and the quality of informa- tion gathered within the Region, in designing special studies and surveys and in analysing the results. In addition, it provided statistical support and information to various health services and programmes. An effort has been made to establish a data repository service in the Regional Office. The information obtained from countries for the World Health Statistics Annual as well as from various reports and technical documents has been included in "A Bulletin of Health Statistical Information, 19809', which will be distributed to Member countries. It is hoped that this will initiate a continuous process of information exchange between the countries and the Regional Office leading to improvements in future issues. National training courses on the application of ICD/9 were organized by Burma, India, Indonesia and Thailand in which WHO assisted by providing consultant services or background material or both. The team leader of the project attended a meeting on the International Classification of Diseases in Taromina, Sicily, in November 1979. Since the holding of the consultative meeting on the development of NHIS in the Regional Office in December 1978, collaborative assistance has been provided in the development of national health information systems or subsystems (hospital information sub-system, environmental health sub-system) through visitsto countries. Such assistance was provided to Indonesia, Nepal, Sri Lanka and Thailand. An inter-country working groupon information systems development is being planned for 1981 to initiate collaborative action for promoting the development of NHIS. 7. DEVELOPMENT OF HEALTH MANPOWER The focus of the health manpower development (HMD) programme is on: fostering coordination among the training programmes for all types of health workers and the way in which those personnel are used in primary health care; ensuring that the training is oriented towards the needs of PHC within the framework of health for all; assisting the countries of the Region in collaborating with and helping each other in all areas of health manpower development, and on promoting regional acceptance of
SEA/RC33/2 Page 81 In Indonesia and ThaiZand, quality control programmes in pharmaceuticals and biologicals were strengthened with WHO assistance. WHO, with UNDP support, assisted in the training of national staff in the quality control of bacterial and viral vaccines. Batches of DPT and BCG vaccines produced by BIOPHARMA, Indonesia, were tested in WHO reference laboratories. In order to develop and strengthen national quality assurance programmes in vaccines, particularly used in EPI, two inter-country workshops were conducted by WHO. A workshop on DPT vaccines was organized in Jakarta in September 1979 to provide on-the-bench training to participants from Bangladesh, India, Indonesia, Nepal, Sri Lanka and Thailand. The participants were trained in the techniques of quality control of diphtheria, pertussis and tetanus vaccines as per WHO protocols and also in the preparation of reference standards. Since most of the countries in the Region are introducing polio and measles vaccination in the EPI programme, a Workshop on Quality Control of Polio and Measles Vaccines was held at the Central Research Institute, Kasauli (India). The Workshop provided an opportunity to participants from Bangladesh, Burma, India, Indonesia, Mongolia, Nigeria, Sri Lanka and Thailand to learn the techniques of virus titration and potency testing, neutralization tests, and antibody titration. 4.4 Vaccine Production WHO has continued to strengthen the national laboratories involved in the production of vaccines, particularly those required for EPI. Assistance was provided to BangZadesh in strengthening further its programe for the production of vaccines at the Institute of Public Health, Dacca. Trial batches of BPL inactivated vaccine have met the minimum WHO requirements. National personnel received training in the production of DPT vaccine. In India, facilities for the production of DPT vaccine at the Central Research Institute, Kasauli, were further strengthened through the provision of supplies and equipment. A WHO consultant advised on improving the facilities for the production of freeze-dried vaccine at the King Institute, Guindy, Madras. The Haffkine Institute now produces working seeds and vaccines of Types I, I1 and 111. In !7'kaihnd, a WHO consultant assisted the Government Pharmaceutical Organization in improving the technology of tetanus, diphtheria and pertussis vaccine production. 5. PROMOTION OF ENVIRONMENTAL HEALTH ~r With the development of the medium-term programme for the promotion of environmental health in 1978-79, the stage has been set for attempting SEA/RC33/2 Page 82 a greater degree of rationalization of external inputs in support of national programmes. This process has been started first in the sub-programme of basic sanitary measures and, in particular, community water supply and sanitation, as countries are developing master plans for the Inter- national Drinking Water Supply and Sanitation Decade (1981-1990) and reorienting their sector plans, yearly programmes and annual imple- mentation priorities. The external cooperation sought by countries for such reprogramming has provided the opportunity also to reprogramme the external inputs required. Although such a rationalization is at the moment restricted to WHO inputs for the sector, it is expected that the inputs of the whole United Nations system will supplement and complement country plans through UNDP as the focal point, eventually leading to joint programing. The coordination of bilateral inputs by governments would thus be facilitated. As examples of this initial attempt at rationalization, the reprogram- ming of consultant and fellowship inputs for India and Sri Lanka for the 1980-1981 biennium can be cited. 5.1 Environmental Health Most countries of the Region have established national mechanisms to coordinate policy and action for the International Drinking Water Supply and Sanitation Decade, and have forwarded their reports on the state of preparedness for the Decade to the Secretary-General of the United Nations. These will be reviewed at the one-day Special Session of the General Assembly in November 1980 to inaugurate the Decade. A consultation was held in November 1979 at the Regional Office to review the regional targets, strategies and actions in the preparatory phase of the Decade. Senior national officials responsible for overall socio-economic and sector planning, administrativelengineering heads of national water and sanitation departments and health officials participated, in addition to representatives of United Nations agencies Following this consultation, national workshops are being organized by the countries to review and reorient their programmes. Under the UNDP/WHO inter-regional cooperation project, technical support has been given to Bangladesh, India and Nepal for programme development and project identification. In the second phase of the WHO/GTZ (Federal Republic of Germany) inter-regional project, similar action has been initiated in Burma, Indonesia and Thailand. In Sri Lanka, the programme plan for the Decade being developed by the Government with assistance from US AID is also supported by WHO. With DANIDA support, an inter-country project was initiated to develop, in the Region, information services in enviroamental health, especially in relation to community water supply and sanitation. WATER AND SANITATION The supply of safe drinking water and the provision of facilities for proper excreta disposal constitute the corner- stone of health development, particularly , rural areas. The first consequence of lhe lack of these vital needs is disease. Safe and plentiful water will be a major step towards health for all. Deep wells with raised parapet walls help prevent water-borne infections. which are a major cause of ill-health in the Region. Regular chlorination ensures the safety of well water for drinking. For uninte er supply. main- 3 is as imDortant WATER AND SANITATION Pit latrines for rural populations will prevent infection and solve the problem of excreta disposal. - ,. . , The expenditure on providing safe drinking water is always a good in- vestment. Piped water supply needs to be pro- vided to more and more rural areas in the Region. SEA/RC33/2 Page 83 The pre-investment studies on water supply and sewerage for Madras City in India with UNDP assistance continued as planned. Similar studies for a rural water supply project in East Java in Indonesia maintained progress. A new pre-investment project for rural water supply and sanitation in the province of Nusa Tenggara Timur with UNDP assistance was approved and arrangements were under way to start it in mid-1980. In the sub-progrannne of recognition and control of environmental pollution, a regional seminar was organized to assess the environmental impact of developments, including health impacts. A UNEP-funded pilot project on biological monitoring was started with India's participation. Assistance was continued to several countries in the development of more systematic and continuous monitoring programmes for water and air . pollution through participation in the UNEP/WHO/UNESCO/WMO Global Environmental Monitoring System (GEMS). Efforts were continued to collect information from the countries on major potential pollution sources for a regional inventory and for the formulation of a regional pro gramme. Under the food safety sub-programme, within the framework of the regional medium-term programme for the promotion of environmental health, some countries in the Region have formulated strategies for the implementation and management of activities in this field (see also Section 5.4 "Food Safety Programmes"). An evaluation was made in November 1979 by World Bank and WHO staff of the regionalized WHOIIBRD Cooperative Programme in South-East Asia. The assessment revealed that regionalization had led to considerable improvement in the operational cost effectiveness of the Programme. It also showed that the Programme needed to be strengthened in its inputs for national sector planning and programming for the Water and Sanitation Decade in the countries of the Region. This activity has since been strengthened and the staff have been assisting national planning activities through sector memoranda in India, in reviewing plans for national projects in Nepal and Sri Lanka, and specific projects in Indonesia and Thailand. The staff of the Programe assisted the Bank in identifying and prepar- ing water supply projects in Indonesia and Thailand; in reviewing the billing and collection systems for the Water and Sewerage Authority project in Bangladesh, and in supervising the water and sewerage project in Punjab, India, both supported by the Bank. The Regional Office continued to collaborate actively in the UNDPIWorld Bank Global Project on Low-cost Water and Sanitation Techniques - Develop- ment of Demonstration Projects, and participated in the International Seminar on Low-cost Techniques for the Disposal of Human Wastes in Urban Communities, held in Calcutta in January. -, The major developments in the countries of the Region during the period under review are summarized below. SEA/RC33/2 Page 84 In BangZadesh, with the tubewell water supply programme registering record coverage of population, the Government, in close collaboration with WHO and UNICEF, finalized the various steps to improve operation and maintenance with substantial community involvement. Inputs into project support communication were considerably increased to ensure higher utilization of safe tubewell water for domestic use. A sub- sidiary plan of operations, exclusively directed to provide sanitary pour-flush latrines in rural homes, came into effect with the participation of both the Health and Local Government ministries in this venture. The UNDP-assisted project for the DaccafChittagong Water and Sewerage Authorities brought better revenues for them through substantial reforms by way of reducing wastage of treated water, better systems of, tariff, metering and collection of water charges as well as improved techniques of stores management, quality control, etc. Technical support was also extended to the country's Water Pollution Control Board to develop further its capabilities in the detection and assessment of environmental impacts. In Burma, technical support was extended through a sanitary engineer and two short-term consultants to recast and develop the proposed UNDP-funded project for water supply to ten towns covering an estimated population of 384 100 by 1990. A project for improving the conditions of the existing piped water supply in the 34 villages of Taung Zin, including their extension to 7 villages in the first phase and 49 more villages in the second phase, was also drawn up to meet the needs of 102 400 people by 1990; this project will receive assistance from the Australian Development Assistance Bureau. The tempo of activities in India was accelerated to prepare a country sector master plan for the Decade by October 1980. Three meetings of state chief public health engineers have been held; two UNDPIWHO consultants are assisting in the sector master plan, and sector memoranda have been completed for all states and union territories. A special feature in this UNDP/WHO Cooperation Project with World Bank assistance is the use of local consultancy services. A guide to the preparation of project feasibility reports is also being developed in India with WHO, UNDP and World Bank collaboration. Technical advice was provided, through short-term consultants, on specific problem in water and air pollution control identified by the Government. In Indonesia, activities for the promotion of environmental health were carried out mainly through enhancing drinking water supply and sani- tation of premises, the control of environmental pollution affecting health, and other sanitation measures. The UNDP-funded project on pre-investment studies for the East Java Province rural water supply development completed its work plan as scheduled. Final designs, construction drawings and material take-offs for different piped water supply systems were completed and implementation started. A new UNDP- SEA/RC33/2 Page 85 funded project - rural water supply in Nusa Tenggara Timur - was signed and was scheduled to begin in June. It will assist in the preparation of an implementation plan for rural water supply and sanitation in the Province, based on an appropriate institutional organization and the resources available. Another similar project for Central Java, to be funded by the Government of the Federal Republic of Germany and executed by WHO, made a good headway and is likely to begin in AugustlSepternber 1980. A further two projects to be executed with UNDP support - rural water supply in South Sulawesi and the training of consultant firms for pre-investment studies - are under review and are expected to connnence during the latter part of 1980 or early in 1981. In Matdives, the WHO sanitary engineer has assisted the Government in finalizing the UN Capital Development Fund-f inanced project, wldch provides for a grant of US$ 1 238 000 for the construction of 15 health centres, 64 rainwater storage tanks and 83 community latrines in selected islands benefiting about 100 000 people. A plan of action for providing basic sanitary measures was also finalized and signed by the Government and WHO. In MongoZia, a plan of operations for strengthening and improving the environmental health services was signed in March 1980. In addition, a proposal was drawn up for possible UNEP assistance in establishing a National Environmental Health Centre. In NepuZ, where the second post of WHO sanitary engineer was filled during the year, the WHO staff are assisting the launching of the first small-scale project on school sanitation. Activities funded by WHO have included the provision of consultants to prepare the "Ten-Year Plan for Water Supplies and Sanitation", "The Large-Scale Shallow Tubewell/Handpump Scheme for the Terai", and a "Field Manual for Handpumps in Nepal", and a tour for senior government personnel to study tubewells, handpumps and related matters in Bangladesh and India. In Sri Lanka, a program plan for the Decade is being developed following a discussion of the first draft plan at a national workshop organized by the Government. The programme plan should enable the Government to identify and formulate priority projects for investment. A major constraint in achieving the Decade targets will be the critical manpower situation at the professional and artisan levels. Resulting from the tripartite review of the UNDPfWHO project - Institutional support to the National Water Supply and Drainage Board - the scope of its activities is to be enlarged. In ThaiZand, technical support to the Government was continued, under the ongoing UNDP-funded project on environmental health and the WHO/ IBRD Cooperative Programme, in the expansion of basic sanitary facilities in urban and rural areas, in the development of environmental health policies, programmes, services and institutions, and in the abatement and control of environmental pollution. The Government agreed SEA/RC33/2 Page 86 to participate in the DANIDA-funded inter-country project on building up information systems/services in environmental health in South-East Asia, and a mission visited the country to review the existing systems/ services and to prepare a work-plan for their further development. On the basis of the report of the preparatory mission in early 1979 under the WHO/GTZ inter-regional cooperation project for the Decade, the Government of the Federal Republic of Germany has agreed to provide technical support under the second phase. 5.2 Occupational Health With the growth of industrial development and the greater use of toxic substances in agriculture, problems related to workers' health are increasing both in number and seriousness. The situation is further aggravated by the fact that the health services available to workers are very limited. Also, there is an acute shortage of trained personnel in occupational health. While the number of institutions in this field is limited, there is a great need to provide all possible assistance for their development. It is against this background that WHO continued to provide assistance to the countries of the Region in carrying out appropriate studies of occupational health problems. BangLadesh received assistance in the further development of the industrial hygiene laboratory at the National Institute of Preventive and Social Medicine, Dacca, and in the training of national staff. The UNDP-assisted project on the "Strengthening of Health Services in the newly Industrialized Areas (West Bank of Irrawaddy River)'' in Burnm is making good progress. Steps were taken to assign specialists to demonstrate, collaborate and train national personnel in the maintenance of field and laboratory equipment; to advise on the recognition, assessment and control of occupational health hazards, and on the methodology of assessing the environmental sanitation situation, sample checking and laboratory testing. During the year, a number of national courses dealing with various aspects of occupational health were organized with the active participation of the national project manager. Tvo school health teams and five dental units were established in the project area. WHO'S assistance to India during the year was in the form of fellowships for advanced training abroad to strengthen occupational health services. The services of a consultant in agricultural hygiene chemistry were provided to Indonesia. He advised the national authorities on air sampling and analysis of agricultural chemicals and their metabolites and on the designing of experimental toxicology. SEA/RC33/2 Page 87 A specialist in education and training helped Sri Lunka in the organization and conduct of several short courses on subjects such as "Policy Development for Occupational Health and Safety Programmes", "Planning and Implementation of Occupational Health and Safety Services in Industry", and "Occupational Health and Safety Practice £orIndustrial Medical officers". These courses were attended by a large number of top management executives from many organizations and establishments. A consultant visited Thrriknd in January 1980 to advise the Government on laboratory techniques related to occupational health. A staff member from WHO Headquarters visited Bangkok in March to discuss with the Director of the Division of Occupational Health in the Ministry of Public Health WHO'S collaboration in the field of occupational health. - Occupational health activities in the countries of the Region are being further strengthened through fellowships for advanced training abroad and the provision of supplies and equipment. 5.3 Radiation Medicine Technical collaboration continued for strengthening radiation health services and for standardizing radiotherapy dosimetry through a joint WHO/IAEA programme. In this context, one of the secondary standard dosimetric laboratories in the Region initiated an independent regional postal dose-intercomparison programme. An inter-country workshop on the quality control of nuclear medicine imaging devices was conducted in collaboration with the United States Bureau of Radiological Health and the Radiation Medicine Centre, Bombay. WHO was represented at the General Assembly of ZAEA which was held in New Delhi in December. The peaceful uses of nuclear energy for irradiation was among the subjects discussed. During the year, documentation on non-ionizing radiation was made available to Member States. The radiation protection services in BangZadesh and Burma were provided with regular supplies of films. In India, two consultants were assigned to the Radiation Medicine Centre, Bombay, to conduct an inter-country workshop on the quality control of nuclear medicine imaging devices. Participants from Bangladesh, Burma, India, Indonesia and Thailand attended this workshop, for which the Radiation Medicine Centre was supplied with phantoms, isotopes and chemicals. An evaluation of the workshop indicated the need for further workshops on quality assurance, radiopharmaceuticals and instrumentation every year or every alternate year at the regional and national levels. A publication on the layout and equipment for a radiopharmacy laboratory in different types of hospitals was considered necessary. The Radiation Medicine Centre published a report on a WHO- sponsored national seminar on radioimmunoassays held earlier, which was widely distributed. A consultant was assigned to Indonesia to assess the existing facilities and standard of radiotherapy for cancer control. He recommended the SEA/RC33/2 Page 88 training of radiological physicists, extension of radiotherapy facilities to provincial hospitals by providing conventional X-ray units, cobalt therapy units and an after-loading unit for the treatment of gynaecological cancer, as well as the establishment of national radiation protection services. In Mongolia, a consultant assisted in training health personnel in radiation dosimetry and radiation health protection. He advised on the construction of radiology, radiotherapy and nuclear medicine labora- tories and the training of radiological physicists. He also evaluated the availability of instrumentation for dosimetric purposes and made suggestions for improvement. In Sri Lanka, a consultant advised on the organization of radiotherapy services in the Government Cancer Institute, Maharagama, and the training of personnel for this institute and other zonal centres being developed. The Radiotherapy Department at the National Cancer Institute in Bangkok, FhaiZrmd,was assisted by a consultant in the organization of treatment procedures. A second consultant is to be assigned to assist in treat- ment, planning and the training of radiotherapists. The Secondary Standard Dosimetric Laboratory in Bangkok continued to provide and expand calibration and personnel dosimetric services in the country. 5.4 Food Safety Programme The development of rational food safety programmes suited to the situation in the Region is still in its infancy. The low standards of environmental sanitation in most countries and the acute shortage of manpower, as well as fragmented institutional responsibilities in some, have been serious constraints in this regard. The Organization has continued to assist countries in reviewing food laws and regulations and in initiating training activities. WHO fellowships have been instrumental in enabling key national staff to acquire the latest knowledge in the sphere of food safety and control. Country reports on the food control situation and needs in respect of seven countries of this region - Bangladesh, Burma, India, Indonesia, Nepal, Sri Lanka and Thailand - as well as Bhutan were prepared and submitted to a technical consultation organized under the auspices of the Food and Agriculture Organization and UNDP and held in Manila in September 1979. The Consultation recommended priority areas for the provision of training in food inspection, analysis, development of laws with regulations and standards, exchange of information, monitoring of contaminants, etc. Action programmes recommended at national level call for measures in ten priority areas. Simultaneously, regional-level support activities, both medium-term and long-term, have been identified. Arising from a consultant mission to Indonesia, recommendations have been made to the Government for coordinating the work and assigning responsibility among different directorates, such as Food and Drug, CDC and Fisheries; for developing simple codes of practice for itinerant vendors; for drafting regulations governing the sale of food in markets, and on operational matters concerning routine inspections, record keeping, monitoring and enforcement as well as health education. Recommendations have also been made in regard to training, management and staffing. 6. HEALTH INFORMATION AND STATISTICS The development of national health information systems (NHIS) in the countries of the Region was continued through the inter-country project "National Health Information Systems Development", with health statistics largely incorporated as a component. The Consultative Meeting on National Health Information Systems Development organized in December 1978 provided most of the basic guidelines and stimulated the interest of countries in the development of NHIS, recognizing it as an essential requisite for the planning, management and evaluation of health programmes. As a result, projects on NHIS or its component sub-systems were initiated or strengthened in Bangladesh, Burma, India, Indonesia, Mongolia, Nepal, Sri Lanka and Thailand. In Bangladesh, assistance in the development of health statistics and medical record keeping was provided from time to time. A long-term systems analyst is under recruitment to assist in the development of a functional health information system to provide support to health services management. In addition, national training courses in health statistics and medical records science will be organized, in collabora- tion with WHO. A long-term systems analyst has been provided to &uma to assist in evaluating health programmes and the use of computers for the develop- ment of the national health information system. The training of national staff in health information systems, computer science, demography and biostatistics and medical record science was supported. The statistician assigned to the Mycobacterial Disease Project (Rifampicin Trial) continued to assist with the trial in selected areas of the country where leprosy is still highly prevalent. In India, WHO collaborated in strenghening the information/statistical systems at both the state and national levels and in providing training in medical records through two projects, "Strengthening of Health Statistical Services" and "Development of Medical Health Records in Hospitals". Further attempts are being made by the national authorities to explore the feasibility of adopting a lay reporting system for the collection of information on morbidity and mortality. Field trials were organized in this connexion in several states. The offices of the Registrar- General and the Central Bureau of Health Intelligence, in collaboration
SEA/RC33/2 Page 78 A workshop on immuno-diagnosis of parasitic infections was held at the Post-graduate Institute of Medical Education and Research, Chandigarh. 4. HEBLTH LABORATORY SERVICES Il.1 Organization of Laboratory Services Laboratory services have now developed a pyramidal structure, with the peripheral, intermediate and regional laboratories giving support to the diagnosis and epidemiology of most diseases. The apex laboratories function as referral centres for training, for the preparation of manuals and the supply of reagents and media. WHO collaborated with the countries of the Region in strengthening the structure and functions of these laboratories at different levels of the health care system to improve their capabilities to play a more effective role in comprehen- sive health care development. The Organization's support was mainly to develop expertise in advanced laboratory techniques, help train technologists and promote training in laboratory management, and the production of manuals on standardized laboratory procedures. In Bangladesh, a WHO microbiologist assisted in organizing training courses, particularly in microbiology and serology, to strengthen intermediate laboratories. Sero-surveillance studies of brucellosis, typhoid, diphtheria and tetanus were undertaken. A training course in microbiology was organized with the assistance of DANIDA. In Bumta, following the assignment of a WHO consultant to assist the Virology Unit in regard to methods of isolation and the characterization of arboviruses, further assistance was provided to strengthen the programme of surveillance of entero-viruses. A consultant trained national staff in virus isolation and identification techniques. Laboratory services were reorganized; twenty 'C' type laboratories were established, and training programmes completed as planned. There are plans by WHO Headquarters to undertake operational studies on health laboratories in support of primary health care. WHO continued to assist India in strengthening state public health laboratories and reference laboratories. The WHO microbiologist assinned to the countrv trained the staff of the central and district - - publyc health laboratokies in Rajasthan, Uttar Pradesh and Andhra Pradesh in the microbiology of water and enteropathogens, as well as in laboratory management and quality control. Attempts were made to bring about coordination and collaboration between public health and peri- pheral laboratories. WIIO assisted with two workshops - one on histocompatible antigens system (HLA), held at the All-India Institute of Medical Sciences, New Delhi, and the other, on the standardization of procedures and quality control in blood banking, which took place in Chandigarh. A workshop on hospital infections with special reference to gram-negative bacilli was held at the National Pseudomonas Centre, All-India Institute of Medical Sciences, New Delhi. Further, SEA/RC33/2 Page 79 a Seminar on Transferable Antibiotic Resistance in Bacteria and its Control was organized at the WHO Collaborating Centre at the Sucheta Kripalani Medical College, New Delhi. In Indonesia, laboratories at the provincial and district levels were assisted by WHO staff, who conducted on-the-bench training in micro- biology to improve the quality of work. Short training courses for laboratory workers of health centres were held in support of the PHC programme. A WHO consultant assisted provincial and regional laboratories in developing expertise in entero-microbiology, particu- larly in the techniques of phage and sero-typing of organisms. A training course was held at the Centre for Biomedical Research, Jakarta. A WHO consultant was assigned to Matdives to assist in improving laboratory facilities, particularly in microbiology. In MagoZia, a WHO consultant assisted in further strengthening diagnostic and public health laboratories through training; supplies and equipment were also provided. The laboratory services programme in Nepal received further WHO support for strengthening district and regional laboratories. The Central Regional Laboratory has become operational. In Sri hka, a WHO consultant assisted in the evaluation of laboratory support to primary health care and in the strengthening of laboratory services at the higher levels of health care. In ThaiZamI, where the project is aimed at increasing laboratory support to the primary health care programme, more district and health-centre laboratories are being developed and regional laboratories upgraded. 4.2 Quality Assurance The countries in the Region have over the last decade developed an infrastructure for health laboratories, with WHO assistance. In order to improve the quality of work, particularly in clinical chemistry, the programme of internal and external quality control, initiated in 1977, was further strengthened. In Burma, a lyophilized serum for use in the external quality control programme has been prepared and is being evaluated. In India, a conference of directors of laboratories participating in the clinical chemistry quality assurance scheme was convened with WHO technical support. The meeting reviewed the performance of the participating laboratories and suggested steps to strengthen the programme further. It recommended that the national programme should create facilities for the production of control sera for distribution. The director of the national control laboratory was awarded a WHO fellowship in clinical chemistry to study the preparation of control sera and quality control techniques. SEA/RC33/2 Page 80 A WHO consultant assisted Indonesia in evaluating the performance of quality control laboratories. He recommended several measures to improve the status of clinical chemistry in diagnostic and public health laboratories. In !lkikind, quality control continues to be strengthened at various levels. Participants from Burma, Indonesia, Nepal and Thailand attended a WHO-supported Workshop in Clinical Chemistry Quality Control, held at Kuala Lumpur and Singapore. Following the training course in haematology held in Bangkok earlier, external quality control in haematology has been initiated in labora- tories in India, Indonesia and Thailand. 4.3 Quality Control of Pharmaceuticals and Biologicals Most countries in the Region have developed strategies for improving the supply of essential drugs and vaccines for their national health programmes. WHO has assisted in this activity and has especially strengthened the laboratory facilities and training programes in the field of quality assurance. In &mgtadesh, assistance was provided to the Government Pharmaceutical Laboratory and WHO long-term staff helped with the training of personnel of the Pharmaceutical Production Unit. Training was also given in quality control. In Burma, the quality control laboratory was further strengthened with UNDP support. National personnel received training in quality control techniques, pharmacology, food and water microbiology and also in drug control administration, quality assurance in foods and drugs and in the drafting of legislation. WHOIFAO consultants were assigned to assist in the development of a food safety programme. In India, the Drug Control Laboratory was provided supplies and equip- ment for further improving procedures for drug analysis. The Laboratory participates in the WHO programme of evaluation of basic tests developed by the Organization for drug quality assurance. A consultant was provided to assist in developing a national control laboratory for the testing of oral polio vaccines prepared at the Haffkine Institute, Bombay. He visited the &££kine Institute and the Central Research Institute, Kasauli, and tested two batches of vaccine for neurovirulence in monkeys. National personnel were trained in the testing procedures and in neurovirulence testing. Five batches of vaccine will be tested and the programme will continue until consistency in the quality of vaccine is established. Another consultant was assigned to the BCG Vaccine Laboratory, Guindy (Madras) and to the National Institute of Communicable Diseases, Delhi, to give further assistance in improving quality assurance facilities and procedures and to evaluate the performance of these laboratories in the production and testing of freeze-dried vaccine. SEA/RC33/2 Page 81 In Indonesia and ThaiZand, quality control programmes in pharmaceuticals and biologicals were strengthened with WHO assistance. WHO, with UNDP support, assisted in the training of national staff in the quality control of bacterial and viral vaccines. Batches of DPT and BCG vaccines produced by BIOPHARMA, Indonesia, were tested in WHO reference laboratories. In order to develop and strengthen national quality assurance programmes in vaccines, particularly used in EPI, two inter-country workshops were conducted by WHO. A workshop on DPT vaccines was organized in Jakarta in September 1979 to provide on-the-bench training to participants from Bangladesh, India, Indonesia, Nepal, Sri Lanka and Thailand. The participants were trained in the techniques of quality control of diphtheria, pertussis and tetanus vaccines as per WHO protocols and also in the preparation of reference standards. Since most of the countries in the Region are introducing polio and measles vaccination in the EPI programme, a Workshop on Quality Control of Polio and Measles Vaccines was held at the Central Research Institute, Kasauli (India). The Workshop provided an opportunity to participants from Bangladesh, Burma, India, Indonesia, Mongolia, Nigeria, Sri Lanka and Thailand to learn the techniques of virus titration and potency testing, neutralization tests, and antibody titration. 4.4 Vaccine Production WHO has continued to strengthen the national laboratories involved in the production of vaccines, particularly those required for EPI. Assistance was provided to BangZadesh in strengthening further its programe for the production of vaccines at the Institute of Public Health, Dacca. Trial batches of BPL inactivated vaccine have met the minimum WHO requirements. National personnel received training in the production of DPT vaccine. In India, facilities for the production of DPT vaccine at the Central Research Institute, Kasauli, were further strengthened through the provision of supplies and equipment. A WHO consultant advised on improving the facilities for the production of freeze-dried vaccine at the King Institute, Guindy, Madras. The Haffkine Institute now produces working seeds and vaccines of Types I, I1 and 111. In !7'kaihnd, a WHO consultant assisted the Government Pharmaceutical Organization in improving the technology of tetanus, diphtheria and pertussis vaccine production. 5. PROMOTION OF ENVIRONMENTAL HEALTH ~r With the development of the medium-term programme for the promotion of environmental health in 1978-79, the stage has been set for attempting
SEA/RC33/2 Page 71 long-lasting larvicide are being planned under local conditions where conservation of potable water is a major priority. Re-stocking of wells with larvivorous fish is again being attempted, despite the adverse effects on the fish due to the chlorination measures taken to combat cholera transmission. A set-back occurred in 1979 to the anti- malaria programe when one of the two traditional vectors, Anopheles tesselatus, was detected on three atolls after an apparent absence (following a single round of DDT spraying) of seven years or more. Both A. tesselatus and the principal vector, A. subpictus, fortunately continue to be susceptible to DDT. In Nepal, WHO is providing a consultant in entomology to assist the anti-malaria programe in the planning and implementation of its activities, with emphasis on identifying problems requiring applied field research. Studies are also being planned on the cytogenetics of DDT-resistant Anopheles annularis, the principal vector in the development areas of the Terai. In Sri Lunka, UNDP has agreed to continue its assistance to Phase I1 of the vector control project until the end of 1981. This project, which coordinates the activities of the Anti-Filariasis Campaign (Ministry of Health), the programe of Colombo Municipality and that of the Medical Research Institute, is primarily concerned with the transmission and control of filariasis and dengue. Mapping and surveillance of permanent and temporary mosquito breeding sites in the Colombo municipal area is continuing. In rural areas, trials are planned with slow-release abate chips in coconut husk soak pits, which are the main source of CuZa quinquefasciatus (C. fatigans). A consultant is under recruitment to examine this problem and others connected with the control of Aedes aegypti. Following visits in 1979 and 1980 by a consultant in the transmission and cultivation of viruses, particularly dengue, the virology laboratory at the Medical Research Institute became fully operational. In Thailand, mappingofmalarious areas according to their degree of receptivity has been completed. A trial is being undertaken of surveillance activities based on different levels of malariogenic potential. In the five malaria control regions, monitoring of vector susceptibility to pesticides has been pursued systematically. In south-east Thailand, trials were undertaken on slow and controlled release larvicide formulations against Anopheles balabacensis in gem- mining pits. A trial of methods to control dengue haemorrhagic fever in four provinces of south-east Thailand is proceeding, with emphasis on community participation and health education of school children. The Organization sent a consultant to Thailand early in 1980 to examine research capabilities in the identification and cultivation of bacterial pathogens of mosquito larvae. 3. DISEASE PREVENTION AND CONTROL - NON-COMMUNICABLE DISEASES With the continuing rise in the average life expectancy at birth, there has been a change in the pattern of mortality and morbidity registered SEA/RC33/2 Page 72 in the Region. To deal with such emerging health problems, technical collaboration with Member countries needs to lay emphasis on the strengthening of facilities for training, services and research for the prevention and control of non-connnunicable diseases as an integral part of primary health care. Formulation of national plans for prevention and control, preparation of medium-term programmes and mobilization of extrabudgetary resources received priority attention. During the year, inter-countrylinter-regional group educational activities were organized on: (1) the prevention and control of accidents; (2) the prevention and control of pulmonary hypertension; (3) community control of rheumatic fever and rheumatic heart diseases; (4) histopathological diagnosis of tumours, and (5) the quality control of nuclear medicine imaging devices. Technical collaboration was planned for stimulating national activities in health care problems of the elderly, the prevention and management of deafness, including rehabilitation of the deaf, and the epidemiological investigation of diabetes mellitus amongst the poor in rural and urban areas. Promotion of appropriate technology in low-vision and auditory aids also received attention. 3.1 Cancer The inter-country seminar on histopathological diagnosis of tumoura, mentioned above, was held in Bangladesh and attended by 32 participants from 7 countries. The participants agreed on closer regional colla- boration, exchange of interesting and difficult material for diagnosis, development of a regionallnational information system for the exchange of scientific knowledge and skill relating to cancer, and the publica- tion of the WHO standardized nomenclature of tumours in local medical journals. The inter-country collaborative research on prospective and retrospective studies on chronic liver diseases, including liver cancer, progressed satisfactorily in Bangladesh, Burma, India, Indonesia, Mongolia, Nepal, Sri Lanka and Thailand. A consultant visited Burma, Indonesia, Sri Lanka and Thailand to review the progress and advise on further technical collaboration. In Bangkdesh, a consultant visited a number of medical colleges and some selected hospitals, organized group meetings of faculty members and doctors, assessed the magnitude of the cancer problem, evaluated existing facilities, and advised on the formulation of a national plan for the prevention and control of cancer. He recommended strengthening of facilities for early detection and diagnosis, establishment of stationary and mobile cancer detection units, development of cancer health education, setting up of registration and treatment facilities, organization of training courses in oncology, and eventual establishment of a national cancer institute for research. In Burma, preparations were made for developing a cancer control plan as part of the country health programing exercise. Technical collaboration was maintained with DPR Koma in training ontological specialists, strengthening cancer research and in planning SEA/RC33/2 Page 73 and implementing the national cancer control programme. Action was initiated for a team to visit the country and assist further in plan- ning prevention and control measures. A preparatory mission visited selected cancer centres in Idia and drew up a project document which was forwarded to the Government for UNDP assistance. The Indian Council of Medical Research established a standing committee under the Director-General of Health Services to prepare a national plan for cancer research. This committee has recommended the organization of epidemiological, operational, applied and basic research on oropharyngeal, cervical, oesophageal and liver cancer. Regional and state cancer centres are being strengthened and a referral system for the management of cancer patients is being developed in a phased manner. Audio-visual material based on epidemiological studies has been developed at the Dental Research Unit of the Tata Institute of Fundamental Research, Bombay. An educational film on the carcinogenic hazards of chewing tobacco has been produced in local/ regional languages. The services of a short-term consultant were made available for conducting a course on pulmonary cytology at the Cytology Research Centre, Maulana Azad Medical College, New Delhi. The magnitude of the cancer problem in Indonesia was reviewed by a consultant, who also assessed facilities for prevention, earlydiagnosis, treatment, training of health manpower and research. He formulated plans and recommendations for the phased implementation of a national cancer control programme which were forwarded to the Government for action along with suggestions for medium-term and long-term plans for prevention and control. Another consultant assessed the available radiotherapy facilities for cancer treatment and advised on initiating extension of radiotherapy treatment to more provincial hospitals. He also indicated the type of treatment units to be installed. In MongoZia, the programme for cancer screening in the aimaks was completed and the construction of the cancer hospital in Ulan Bator made further progress. A WHO/IARC/UICC team visited Sri kmka and assisted in the development of a national cancer policy and plan. Technical collaboration was extended for the implementation of the national plan with preliminary emphasis on training in oncology, strengthening facilities for early detection and organization of referral services for treatment. Assistance was also provided for epidemiological research, cancer registration and standardization of treatment procedures. Training of primaryhealth workers in the early detection of oral pre-cancerous and cancerous lesions was undertaken to enable them to refer patient$ to the intermediate levels of health care. In Thailand, a consultant advised and assisted in the organization of radiotherapy treatment at the National Cancer Institute in Bangkok. A meeting of health professionals from the provincial hospitals discussed the details of implementation of the cancer control plan. The National SEA/RC33/2 Page 74 Cancer Institute continued its training activities in cancer registra- tion and exfoliative cytology. Research on liver cancer and anti-cancer drugs is under way. 3.2 Cardiovascular Diseases During the year under review, group educational activities were organized for discussing the prevention and control of cardiovascular diseases. An inter-country seminar on the prevention and control of pulmonary hypertension was held in the Regional Office in October. Eighteen participants from nine countries reviewed the magnitude of the problem of chronic obstructive pulmonary disorders in the countries of the Region, developed protocols for epidemiological investigations, prepared guidelines for management, including rehabilitation, at different levels of health care and formulated plans for collaborative research at regional and national levels. An inter-regional meeting on the connnunity control of rheumatic fever and rheumatic heart diseases, also organized in the Regional Office, reviewed the results of ongoing collaborative studies and discussed strategies for prevention and control. The importance of detection of streptococcal carriers, identification of risk groups amongst school children, prophylactic measures to be adopted, and community-oriented prevention and control activities received detailed consideration at this meeting, which was attended by 24 participants from all over the world. As for activities in individual countries, a consultant visited Bangladesh and assisted a national meeting in developing a plan for the prevention and control of cardiovascular diseases. The training and research activities at the National Institute of Cardiovascular Diseases continued to develop with bilateral assistance. Strengthening of educational and training facilities in the medical colleges and the establishment of services for cardiac resuscitation and rehabilitation in district hospitals and thana health complexes, and epidemiological investigations on hypertension are making progress at the Post-graduate Institute of Medicine and Research. A consultant was assigned to DPR Korea to assist in organizing a streptococcal microbiology laboratory and planning a national programme for the study of streptococcal infections, the carrier problem and prophylactic measures to protect school children. Technical collabora- tion continued to be extended for training specialists in cardiology and cardiac surgery and for strengthening facilities for research in cardiovascular disease prevention and control. In India, a meeting was held at the Post-graduate Institute of Medical Education and Research in Chandigarh to formulate a national plan for the prevention and control of cardiovascular diseases. The Indian Council of Medical Research continued to support national collaborative studies on rheumatic fever and rheumatic heart diseases, hypertension SEA/RC33/2 Page 75 and risk factors relating to ischaemic heart disease. A consultant was assigned to assist with training in streptococcal microbiology at the Sree Chitra Tirunal Centre, Trivandrum, and in conducting an ICMR/WHO- sponsored workshop at the Sucheta Kripalani Medical College, New Delhi. In MongoZia, a course in cardiology for aimak physicians was conducted and a registry of sudden deaths due to myocardial infarction was established. Screening to identify risk groups with high blood pressure and rheumatism was also introduced. Epidemiological studies on chronic pulmonary obstructive disorders and cor pulmonale, and community- oriented preventive measures including demonstration of building smokeless fire-places in village houses continued to be undertaken. Negotiations were continued with bilateral agencies for implementing a cmunity-oriented epidemiological survey and a cardiovascular diseases prevention and control programme in Sri Lanka. The Cardiology Unit in the Colombo Group of Hospitals has plans for expansion to provide paediatric cardiology and cardiac surgery. Departments of cardiology are being established in other medical faculty centres for improving the training of undergraduates in the management of cardiovascular diseases. Technical collaboration was provided to Thailand for analysing epidemiological data already collected on cardiovascular diseases in the country. A subsidy was providedfor conducting a national seminar on the prevention and control of cardiovascular diseases. A consultant was under recruitment to assist the Government in finalizing the national plan for the promotion of cardiovascular health. 3.3 Prevention of Blindness The development of national activities for the prevention and control of blindness gained further momentum with increasing interest from donor agencies in developed countries. The International Agency for the Prevention of Blindness, the Royal Commonwealth Society for the Welfare of the Blind, the Christoffel Blindenmission, the Operation Eyesight Universal, the Japan Shipbuilding Industry Foundation, DANIDA and the National Eye Institute of USA collaborated with the Regional Office and provided resources for the implementation of eye health programmes in many countries of the Region. A team of two consultants (an epidemiologist and an ophthalmic pathologist) visited Burma, India, Indonesia, Nepal and Thailand and assessed the existing facilities and pattern of eye health problems, and recommended a plan of action for promoting epidemiological investigations and the training of ophthalmic pathologists. A consultant was assigned to Bungtadesh to evaluate existing facilities for training, services and research in eye health and formulate a national plan of action for the prevention and control of blindness. An ophthalmic training and services complex is under construction in Chittagong with bilateral assistance from the Australian Government. SEA/RC33/2 Page 76 A National Institute of Ophthalmology is in the early phases of develop- ment in Dacca. The International Agency for the Prevention of Blindness provided financial assistance and organized a training programme for ten doctors in Singapore. During the second phase of this programme, these doctors had their clinical and practical training in Chittagong. This agency also supported the practical training of 15 doctors and 30 para- medical workers in eye camps conducted in Bangladesh. Continuing education activities were also organized. The Royal Commonwealth Society for the Welfare of the Blind continued to support eye camp activities. In Burmu, the strengthening of training facilities for ophthalmologists and other health personnel, and the expansion of community-oriented ophthalmic services received further technical support through resouroes made available by the Sasakawa Health Foundation and the British National Committee for the Prevention of Blindness. Two consultants were assigned to Burma during the year: an ophthalmic pathologist assisted in the teaching and development of ophthalmic pathology services. The second consultant advised on the development of training facilities and the organization of comprehensive eye health services, and also discussed the details of collaborative research on glaucoma and corneal injuries. The national plan for the prevention of visual impairment and control of blindness in India continued to receive technical assistance from DANIDA. A consultant studied the implementation of the programme at different levels of the delivery of ophthalmic services and made recommendations on the development of a system of monitoring progress in collaboration with the National Informatics Centre in New Delhi. Another consultant visited selected centres, institutes and departments of ophthalmology to review research activities and evaluate the potential for further research. His findings indicated the need for rapid development of the scientific base for the implementation of the national programme and identified priority areas and opportunities for research in ophthalmic problems. Recommendations were made for continuing training and coordination of research at the national level. The Regional Office sponsored national meetings/workshops on topics such as ophthalmic research, community-oriented eye health services, rehabilitation of the blind, the role of voluntary organizations in the implementation of the national plan, eye health education and mobile eye camps. The national coordination committee decided to publicize the national plan in local languages to promote community awareness and participation. "The Operation Cataract" project in Medak District of Andhra Pradesh progressed well with the implementation of its objectives. Health education material for training in eye health was prepared by the Indian Registry of Pathology and distributed to training institutions. A consultant visited Indonesia to study the pattern of eye diseases and assess the potential for epidemiological investigations. He also had discussions with ophthalmologists and epidemiologists on the research methodology for the investigation of glaucoma. Supplies and equipment SEA/RC33/2 Page 77 were made available for strengthening eye health services at provincial hospitals. In Nepal, based on a sample survey, a project proposal for a national programme for the prevention and control of blindness was prepared and submitted for funding from the Netherlands, and action taken for the implementation of the first phase. The Operation Eyesight Universal continued to provide assistance to the Nepal Eye Hospital. Supplies and equipment and fellowships for specialization in ophthalmology were made available from contributions from the Japan Shipbuilding Industry Foundation and the Sasakawa Health Foundation. A consultant partici- pated in the meeting which formulated a national plan for the prevention and control of blindness. A team of two consultants - an epidemiologist and an ophthalmic pathologist - reviewed the pattern of ocular.morbidity and recommended epidemiological investigations of fungal keratitis resulting from ocular injuries. In Sri Lunka, a consultant assessed the status of eye health services and advised on the training of ophthalmologists and the organization of comprehensive services at different levels of the public health system. Another consultant was assigned to formulate a plan of action for the establishment of a school for the training of ophthalmic auxiliaries, and later to participate in a national seminar convened to elaborate the details of the training curriculum, job responsibilities, employment potential and the resources for the project. A mobile ophthalmic unit was presented by the Regional Director to the Colombo Eye Hospital for providing ophthalmic services, including eye health education, to the people living in rural areas. A consultant was assigned to advise on the organization and demonstration of services through mass eye camps. Similar services will be provided to assist in organizing a school for ophthalmic auxiliaries. In ThaiZund, comprehensive ophthalmic services in five provincial hospitals staffed by doctors and nurses trained in Bangkok and the hospital in Buriram commenced operation. Five doctors and five nurses working in these provincial hospitals were awarded fellowships to visit selected ophthalmic institutions in India and acquire knowledge on the conduct of community-oriented eye camps. Supplies and equipment and additional fellowships for training were provided from contributions made available through the Sasakawa Health Trust Fund. Two consultants were also assigned to help promote epidemiological research and develop facilities for ophthalmic pathology services. 3.4 Immunology The WHO Collaborating Centre for Research and Training in Innnunology established in 1970 at the Department of Clinical Chemistry, All-India Institute of Medical Sciences, New Delhi, received further assistance during the year. Support was given to a national Workshop on HLA Antigens held at the Institute in 1979. A similar workshop was also organized by the ICMR at the Blood Group Reference Centre in Bombay. SEA/RC33/2 Page 78 A workshop on immuno-diagnosis of parasitic infections was held at the Post-graduate Institute of Medical Education and Research, Chandigarh. 4. HEBLTH LABORATORY SERVICES Il.1 Organization of Laboratory Services Laboratory services have now developed a pyramidal structure, with the peripheral, intermediate and regional laboratories giving support to the diagnosis and epidemiology of most diseases. The apex laboratories function as referral centres for training, for the preparation of manuals and the supply of reagents and media. WHO collaborated with the countries of the Region in strengthening the structure and functions of these laboratories at different levels of the health care system to improve their capabilities to play a more effective role in comprehen- sive health care development. The Organization's support was mainly to develop expertise in advanced laboratory techniques, help train technologists and promote training in laboratory management, and the production of manuals on standardized laboratory procedures. In Bangladesh, a WHO microbiologist assisted in organizing training courses, particularly in microbiology and serology, to strengthen intermediate laboratories. Sero-surveillance studies of brucellosis, typhoid, diphtheria and tetanus were undertaken. A training course in microbiology was organized with the assistance of DANIDA. In Bumta, following the assignment of a WHO consultant to assist the Virology Unit in regard to methods of isolation and the characterization of arboviruses, further assistance was provided to strengthen the programme of surveillance of entero-viruses. A consultant trained national staff in virus isolation and identification techniques. Laboratory services were reorganized; twenty 'C' type laboratories were established, and training programmes completed as planned. There are plans by WHO Headquarters to undertake operational studies on health laboratories in support of primary health care. WHO continued to assist India in strengthening state public health laboratories and reference laboratories. The WHO microbiologist assinned to the countrv trained the staff of the central and district - - publyc health laboratokies in Rajasthan, Uttar Pradesh and Andhra Pradesh in the microbiology of water and enteropathogens, as well as in laboratory management and quality control. Attempts were made to bring about coordination and collaboration between public health and peri- pheral laboratories. WIIO assisted with two workshops - one on histocompatible antigens system (HLA), held at the All-India Institute of Medical Sciences, New Delhi, and the other, on the standardization of procedures and quality control in blood banking, which took place in Chandigarh. A workshop on hospital infections with special reference to gram-negative bacilli was held at the National Pseudomonas Centre, All-India Institute of Medical Sciences, New Delhi. Further,
SEA/RC33/2 Page 37 1.12 Drug Policies and Management WHO has been assisting the countries of the Regioninevolving pharmaceu- tical supply systems to provide essential drugs of assured quality for the primary health care programme. Most countries have identified the essential drugs required for PHC and for higher levels of health care. In Bangladesh, a WHO consultant advised the Central Medical Stores on the manufacture of seven essential drugs. Further assistance is being planned through donor agenciesto increase the capacityof the country to manufacture all the31essential drugs requiredfor primary health care. In Burma, a master plan was prepared to provide assistance to the Burma Pharmaceutical Industry in producing the essential drugs required. WHO and UNDP collaborated with Indonesia in the development of a compre- hensive programme covering various aspects of the pharmaceutical supply system. Pre-feasibility reports were prepared for starting a new unit for the production of essential drugs, improvement in quality assurance, updating of drug legislation, improvement in the storage and distribu- tion system, and the expansion of BIOPHARMA. In addition, WHO provided assistance in improving and expanding the production facilities at the government manufacturing units at Manggarrai Factory. A meeting of ASEAN countries organized in Jakarta with support from WHO highlighted the problems regarding legislation, evaluation and quality assurance. A task force has been formed to implement some of the recommendations of the meeting. In MongoZia, plans are being made to develop a manufacturing unit for the production of biologicals such as vaccines and blood products. WHO will provide consultants to assist in preparing a techno-economic feasibility report. Assistance from UNDP and UNIDO is being provided to Nepal for improving the capacity for the production of essential drugs by the Royal DrugsCo. and for strengthening quality control, storage, distribution and drug utilization under the umbrella of the primary health care programme. In Sri Lanka, based on the pre-feasibility study of the State Pharmaceu- tical Corporation, Colombo, made by WHO, plans are under way to set up a unit for the manufacture of essential drugs. The supply of essential drugs,including vaccines, is of great importance to the PHC programme. A global meeting to define the role of WHO in pharmaceuticals is scheduled to take place in the Regional Office in the last quarter of 1980. 2. DISEASE PREVENTION AND CONTROL - COMMUNICABLE DISEASES Despite the efforts being made to control them, connnunicable diseases persist as the Region's number one public health concern. One of the SEA/RC33/2 Page 38 difficulties faced in the area of epidemiological surveillance is the dearth of trained epidemiologists and an inadequate infrastructure. The Organization has, therefore, initiated action to establish a regional training programe which will be task based and field oriented. The programme was scheduled to become fully operative in the first half of 1980 in Thailand as a joint effort of WHO, the Royal Thai Government and the Centre for Disease Control, Atlanta, Georgia, USA. Malaria continued to be a major problem in eight of the ten countries in the Region. The problem of resistance of vectors to insecticides and of parasites to anti-malaria drugs is yet to be solved. Nevertheless, the shift in the strategy from eradication to control has shown encouraging results, and the number of cases, when considered in the Region as a whole, has shown a marked reduction as compared to that in the previous year. This decline is, however, not uniform in all the malaria-affected countries, and there is therefore an urgent need to strengthen the programme in some of them. During the year, WHO supported research activities both in the field and in the laboratory. SIDA and US AID continued to give substantial assistance to some of the national control programmes. Leprosy and tubercutosis control activities are progressing either as independent or as combined programmes of the general health services in most countries. The problems of incomplete case-finding and unsatis- factory case-holding and treatment are being tackled with vigour. Research on the epidemiological aspects and the development of a more effective treatment regimen for leprosy has been continuing in India and Burma with WHO support. Acute diarrhoea2 diseases, especially in infants and children, continued to be a major cause of death among this group. Following the acceptance of oral rehydration therapy as a major tool in bringing down the death rate, countries of the Region have launched phased programmes for the control of diarrhoea1 diseases. A medium-term plan has been drawn up by WHO for collaboration with the countries in programe development, delivery, monitoring and evaluation of services. The production of sufficient quantities of oral rehydration fluids and the development of a supply and logistics system have been major constraints, and UNICEF has been assisting substantially in solving these problems. WHO provided funds to a number of research projects concerned with the technical and operational problems relevant to the delivery of oral rehydration services in field situations. In the case of. the Expanded Programne on Imnization, the Organization has assisted governments in developing national programmes and organiz- ing intensive training in both the technical and management aspects at country as well as inter-country levels. It has, in addition, provided technical support in developing cold chains and logistic systems, which are vital for the programme. UNICEF plays a significant role by supporting training, providing vaccines, and developing the cold chain. SEA/RC33/2 Page 39 In regard to dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS), the Organization has supported governments in the technical aspects of their programmes and organized research activities at the WHO Collaborating Centre on DHF in Bangkok and other institutions. Steps have been taken for starting work on developing a vaccine against DHF. An inter-regional seminar was held in the Regional Office in March this year to discuss the whole spectrum of haemorrhagic fevers due to various etiologic agents and to take stock of the situation in respect of DHF/DSS vis-a-vis other haemorrhagic fevers. The importance of DHF has been increasing due to the fact that sporadic cases have been appearing in countries other than Burma, Indonesia and Thailand, where the disease is endemic, and the number of cases has been rising steadily. In 1979, WHO provided a team consisting of epidemiologists, an entomologist, a virologist and clinicians to Maldives to investigate a suspected outbreak of DW and recommend measures for prevention. SexuaZZy transmitted diseases have been recognized as a public health problem in a number of countries, but because of social reasons, case finding and prompt treatment have posed difficulties. The problem of drug resistance in gonococcus is yet to be solved. The Organization has been assisting in the control of these diseases by conducting workshops and seminars for the dissemination of the latest knowledge to the medical profession and by providing technical support in developing national programmes. Countries in the Region have shown growing interest in the control of zoonotic diseases, especially brucellosis and rabies. Most of the countries are facing problems in the control of rabies. WHO has supported Mongolia in developing self-sufficiency in the production of brucella vaccine. The problem of zoonotic diseases was discussed at an inter-country consultation held in Delhi in November 1979. The participants from seven countries exchanged views on the technical and managerial aspects of these diseases and emphasized the need for strengthening WHO'S support in this area. 2.1 Epidemiolo~ical Surveillance During the year under review, the strengthening of epidemiological surveillance services in the Region continued to be supported by WHO. Emphasis was laid on manpower development, improvement of data collection procedures, and the utilization of epidemiological informa- tion for decision making, planning, implementation and evaluation of health services. Field-oriented training programmes at the national level received strong support. In BangZadesh, the epidemiological surveillance system has been expanded from the central level to the district and thana health complex levels. The Institute of Epidemiology, Disease Control and Research continued its activities pertaining to the development and consolidation of the surveillance of communicable diseases; the provision of diagnostic laboratory facilities for virology and supportive and referrallaboratory SEA/RC33/2 Page 40 facilities for entomology and parasitology; the provision of laboratory and surveillance training for health personnel, and the conduct of research relevant to the core programmes of communicable-disease surveillance and laboratory work. The services of a consultant were provided to demonstrate and teach the mosquito inoculatton technique for tt8.e isolation of arboviruses; to advise on arbovirus serological techniques, and to train national staff in the use of the fluorescent microscope in rapid diagnostic techniques. In &crma, a WHO consultant assigned from May to August 1979 assisted in further developing laboratory techniques for enterwirus isolation and serology as well as in introducing methods for the laboratory sunreil- lance of poliomyelitis. An epidemiological assessment of poliomyelitfs was carried out in August 1979 in Rangoon, which was followed by the visit of a WHO consultant in November to review the epidemiology of poliomyelitis in the country and give further advice. In India, WHO collaborated with the National Institute of Communicable Diseases, Delhi, in organizing workshops in such areas as epidemiology, medical mycology, imunochemistry and filariasis. A WHO consultant was assigned to the Institute from February to May 1980 to assist and advise on plague surveillance and the production of plague antigen. He also visited the Plague Surveillance Unit, Bangalore, and the Plague Laboratory of the Haffkine Institute, Bombay, for discussions. Another consultant assessed the epidemiological situation relating to DHF and advised on prevention and control measures. In Indonesia, a WHO entomologist assisted in the organization, develop- ment, implementation and evaluation of the entomological aspects of vector-borne diseases. A WHO consultant was assigned to the Special Hospital for Communicable Diseases in Tanjung Priok, Jakarta, to review the development of its various departments, assist in the organization and management of the Hospital and to advise on clinical and epidemio- logical studies on enteric diseases. Another consultant assisted in conducting a short in-service training course in epidemiology at the Directorate General, CDC, Jakarta. He also helped with the preparation of a plan to deal with the health aspects of natural disasters. In addition, he held discussions on the development of an M.Sc. course in epidemiology. A third consultant visited the country in December 1979 to review the epidemiological situation of arbovirus infections, dengue haemorrhagic fever and Japanese encephalitis and to advise on preventive and control measures and on planning for arbovirus research. At the Disease Ecology Centre of the National Institute of Health Research and Development, Jakarta, the WHO team consisting of an epidemiologist and a statistician assisted a number of research activities. Outbreaks of a dengue-like disease were reported in bkzZdives, and one of the Regional Advisers on Comunicable Diseases and other WHO staff assisted the national authorities in investigating the outbreaks. SEA/RC33/2 Page 41 In MongoZia, assistance continued to be given in the further development of epidemiological surveillance of diseases representing major public health problems such as meningococcal meningitis and viral hepatitis. The WHO epidemiologist assigned to the project from July 1978 to December 1979 assisted in the developmentof epidemiological surveillance and the control of communicable diseases; in health laboratory micro- biology and virology; in the planning and implementation of research on communicable diseases of public health importance,and in the training of epidemiologists and health laboratory personnel. Technical cooperation was provided to Sri Lanka through a consultant who assisted in analysing and interpreting epidemiological data on pyrexia of unknown origin and other unidentified fevers. Another consultant advised on the clinical diagnosis of dengue fever and the management of DHF patients. In ThaiZmzd, the epidemiological surveillance network at the district level was strengthened. Assistance was provided for improving facilities for the training of epidemiologists in the Region (see also section 7.4, "Training in Epidemiology"). A medium-term programme on epidemiological surveillance has been pre- pared for the Region. 2.2 Diseases Subject to the International Health Regulations For the fourth consecutive year no case of smallpox was reported in any country of the Region. Cases of cholera, however, continued to be reported from eight countries. Plague was reported from Burma, but the number of cases and deaths has come down significantly. 2.2.1 Smallpox Eradication As stated above, countries of the Region continued to be free from smallpox during the period under review. Nevertheless, surveillance continued to be carried out in all countries. Rumours of suspected smallpox were checked by national health staff on a number of occasions and found to be without basis. 2.2.2 Diarrhoea2 Diseases Including Cholera Diarrhoea1 diseases continued to be major public health problems, particularly among children, who constitute the most vulnerable group. The incidence of these diseases according to hospital statistics, which provide the only available reliable data, has been estimated to range from 9 to 32 cases per thousand population. In addition, diarrhoea1 diseases cause high mortality and morbidity and contribute to malnutri- tion in at least 30% of those under five years of age. The diagnostic techniques have been vastly improved and simplified. Knowledge about the etiology of most diarrhoeal-disease cases enables the choice of adequate preventive measures to be applied in different epidemiological SEA/RC~~/~ Page 42 Diseases Subject to the International Health Regulations Notified by Countries of the Region, 1977-1979 (Information compiZed from data made avaiZabZe to WHO Headquarters by Govements) *including one imported case 1 country Bangladesh Burma India Indonesia Maldives Nepal Sri Lanka Thailand 1 Year 1977 1978 1979 1977 1978 1979 1977 1978 1979 1977 1978 1979 1977 1978 1979 1977 1978 1979 1977 1978 1979 1977 1978 1979 Cases - - - - - - - - - - - - - - - - - - - - - - - - Cholera Cases 10 403 5 576 2 154 2 723 3 351 874 13 850 10 585 2 912 17 112 10 693 18 603 - 11 336 - 428 1 662 22 5 48* 46 383 4 183 1 788 Smallpox Deaths - - - - - - - - - - - - - - - - - - - - - - - - Deaths 354 81 21 210 372 75 739 246 165 780 507 728 - 220 - 4 10 - - 2 - 5 123 44 Cases - - - 591 171 7 3 - - - - - - - - - - - - - - - - - - Plague - Deaths - - - 26 6 2 - - - - - - - - - - - - - - - - - - SEA/RC33/2 Page 43 conditions. The most significant therapeutic measure is the rapid development of oral rehydration therapy which can prevent and treat dehydration, in most acute cases, at home. Stress continues to be laid on breastfeeding infants during and after diarrhoeal diseases, in addition to oral rehydration. The education of mothers, family and community members, and peripheral health workers is also emphasized. The objective of the diarrhoeal-disease programme is to reduce mortality xnd morbidity through appropriate treatment and preventive services at the primary health care level, the training of workers at all levels and support to research in designing new and better measures for control. During 1979, Indonesia reported the highest number of cholera cases, followed by India, Bangladesh, Thailand, Burma, Sri Lanka and Nepal. The total number of cases reported in 1979 in the Region was 26 399, with a case-fatality rate of 3.9196, as compared to 47 431 cases with a case-fatality rate of 3.29% in 1978. WHO has developed a meaningful collaboration with the International Centre for Diarrhoeal Diseases Research, Bangladesh, which is being designated as a WHO Collaborating Centre for Research and Training in the Control of Diarrhoea1 Diseases. It will train research scientists in selected fields as required by the regional research programme on diarrhoeal diseases; train health workers who will be responsible for training other workers concerned with the implementation of national diarrhoeal-disease surveillance and control programmes, and provide advisory services. WHO also cooperates in reviews of research protocols and training programmes. In India, technical cooperation was provided to the study on the health benefits of water supply in a rural area in Uttar Pradesh. A WHO consultant was assigned to the National Institute of Cholera and Enteric Diseases, Calcutta, in November-December 1979 to advise and cooperate in vibro-phage research and related cholera research activities. A consultant from WHO Headquarters visited the Institute in November 1979 and developed practical guidelines for training in the use of oral rehydration solution at treatment facilities, He also reviewed clinical research activities. In Indonesia, a WHO consultant assisted in reviewing the surveillance and descriptive epidemiology of cholera in different parts of Java and in conducting epidemiological studies to determine the important mode(s) of its transmission during epidemic and non-epidemic periods. He also cooperated with communicable disease control personnel in regard to methods of investigation, analysis and control of diarrhoeal disease epidemics. A WHO consultant was assigned to Nepal during February-March 1980 to study the protocol and the work plan for operational research in diarrhoeal diseases and to assist in the organization and conduct of a national workshop. Assistance was also given in finalizing the SEA/RC33/2 Page 44 required forms and cards for gathering information, in setting up laboratories, and in drawing up a list of laboratory equipment. In Sri Lanka, WHO staff, together with a consultant, assistedinreviewing the progress and plans of the national diarrhoeal-disease services and research programme and advised on setting up a research project to study the etiology of acute diarrhoea, revi.ew other diarrhoeal disease research activities, and perform laboratory demonstration of methods for the diagnosis of rotavirus and enterotoxigenic E. cot< diarrhoea. As a follow-up of this visit, plans are under way to recruit two WHO consultants. One of them will review project documents on diarrhoeal- disease control and research, devise curricula for senior health staff and other health workers, prepare teaching and educational aids and set up an evaluation mechanism. The other consultant will assist in con- ducting a feasibility study to determine how the country can best meet its annual requirement of 4 million packets of oral rehydration solution. The plan for a regional programme of services and research in diarrhoeal diseases, developed at an inter-country consultative meeting held in June 1979, was circulated to Member countries. A work plan has been prepared to support national programes. A WHO medical officer in diarrhoeal diseases has been in position in the Regional Office since November 1979 to promote and coordinate a services-cum-research programme in diarrhoeal diseases in the countries of the Region. Together with a consultant from WHO Headquarters he visited Bangladesh, India, Indonesia and Sri Lanka during January 1980 to carry out a feasibility study of the training centres and their needs for producing manpower for the control of diarrhoeal diseases. In order to cater to the need for regional training in services, research and related activities in diarrhoeal diseases control, it is planned to establish regional training centres as follows: (1) at the International Centre for Diarrhoea1 Diseases Research, Dacca, (2) the Faculty of Medicine, University of Indonesia, and the Communicable Diseases Control Division, Ministry of Health, Jakarta, and (3) the National Institute of Cholera and Enteric Diseases, Calcutta, as well as at the Institute of Preventive Medicine and the National Institute of Nutrition, Hyderabad. A consultant in diarrhoeal diseases visited Thailand in April 1980 to explore the feasibility of holding training courses for country programme managers in Bangkok in October 1980 and to review the activities of the national diarrhoeal disease control programme. WHO is collaborating with UNICEF in the production and delivery of oral rehydration packages to the comnunity. A consultant jointly assigned by UNICEF and WHO visited Bangladesh, India and Indonesia in September 1979 to study the supply and local production of oral rehydration solution packages to speed up the development of national diarrhoeal- disease control programmes. WHO has assisted with the organization and conduct of national workshops and seminars on oral rehydration therapy and other aspects of diarrhoeal diseases in the countries of the Region. At the national level, most of the countries have established co- ordination committees. Specialists from the countries have participated SEA/RC33/2 Page 45 in meetings of the Technical Advisory Group and of scientific working groupslsub-groups on various aspects of diarrhoea1 diseases organized by WHO Headquarters in Geneva. Through extra-budgetary resources the programme has received further impetus. UNDP input, which is being negotiated, will help stimulate the programme activities in the Region. WHO is supporting diarrhoeal-disease research in Burma, India,Indonesia, Nepal and Sri Lanka. Currently, five research studies are being conducted in these countries and more are being developed with WHO support. Plans are under way to hold an inter-country group educational'activity in the Regional Office in November 1980 to review the current national diarrhoeal-disease control programmes with reference to oral rehydration therapy and other aspects concerned with the delivery of this component. 2.2.3 Plague Em reported 73 cases with two deaths during 1979 as compared to 171 cases and six deaths in the previous year. The Rodent Control Demonstration Unit (a WHO inter-regional project) continued to under- take studies and surveys on plague serology and epidemiology. The Unit has developed a protocol for a comprehensive study of the ecology of plague. It has been able to establish clearly that all species of small mammals collected by it in Rangoon were involved in some degree in the epidemiological picture of plague and that the appropriate flea vector species are present and abundant. In India, a WHO consultant, assigned from February to May 1980, assisted and advised the National Institute of Communicable Diseases on the production of plague antigen. A grant was given in support of a WHO cooperative study on tests for the detection of plague antibodies. At the request of the Government, arrangements are being made to train a group of scientists in Burma, where human cases are occurring,in human and rodent plague and also study actual cases - typical or atypical - and the epidemiological situation. 2.3 Malaria and Other Parasitic Diseases Malaria continues to be a major public health problem in eight countries of the Region, namely Bangladesh, Burma, India, Indonesia, Maldives, Nepal, Sri Lanka and Thailand. 2.3.1 Malaria An overall improvement was reported in the epidemiological situation in the Region but, as stated above, malaria remains a major health concern. Significant reductions in incidence occurred in India, Indonesia and SEA/RC33/2 Page 46 Sri Lanka, and lesser decreases were noted in Maldives, Nepal and Thailand. Bangladesh and Bum, however, showed marginal increases. The reduction in the microscopically diagnosed malaria positive cases in 1979, compared with the previous year, was about 25X, the annual parasite incidence being 3.35 per thousand in 1979 (4.60 in 1978). In this connexion, however, there appears (on the basis of incomplete data) co have been a reduction of 4% in the annual number of blood slides examined, films being collected from 6.8% of the population in 1979 (7.3% in 1978). The slide positivity rate fell to 4.9% (6.3% in 1978), but the slide falciparum rate increased slightly to 0.99% (0.95% in 1978), there being a marginal increase in the absolute number of P. falcipanrm infections, the proportion vis-a-vis other species being 20.2% (14.8% in 1978). Vector resistance to pesticides in general use continues to be a serious problem in India, Indonesia, Nepal and Sri Lanka. Susceptibility testing for such resistance has been intensified to detect and delineate its development and distribution. Testing materials are supplied by WHO to the malaria control programmes on a regular basis, and assistance and training in the use of the test kits are provided where necessary by WHO entomologists. The Organization directed its efforts in technical cooperation towards the development of medium-term programmes, the evaluation of programmes, the development and implementation of applied field research, and the organization of and participation in training activities. Attention was also paid to the promotion of inter-sectoral coordination and coopera- tion in border areas, to the provision of assistance in developing national self-sufficiency in the production of insecticides and anti- malarial drugs, and to support in the procurement of supplies and equipment. WHO provided consultants for the annual assessments of the programmes in Burma, India, Nepal, Sri Lanka and Thailand. These assessments were undertaken jointly with representatives of the governments and the bilateral agencies assisting each programme. The role of WHO in respect of malaria border coordination meetings was maintained, the Regional Office acting as a focal point for the exchange of information arising from the meetings. Applied field research in malaria was undertaken vigorously throughout the Region during the year under review. A principal aspect of the research was the study on sensitivity of P. faL&pan~n to 4-amino- quinolines. Important regional studies are in progress on AnopheZes species complexes and on resistance to insecticides by vectors. Studies were additionally undertaken into the operational, epidemiological and ecological aspects of malaria control work. The Regional Collaborative Studies on Drug Resistant Malaria, with special emphasis on P. fak?+lm7n resistance to 4-aminoquinolines, which were started in 1977 in Thailand and extended during 1978 to Bangladesh, Figure 1. SOUTH-EAST ASIA REGION INCIDENCE OF MALARIA AND F.FALCIPARUh! INFECTIONS ......... :.:...:.:.. ............. ..:,:.::.,::i ..... ".-l ......... ..." .......... - Slide Positivity Rate % - Slide fazcipamun Rate % BANGLADESH BURMA NEPAL MALDIVES Mill. Z 6-- 12 % 4-- 8 - 3--6 2 -- 4 200 20 1 -- 2 100 10 75 76 77 78 79 75 76 77 78 79 75 76 77 78 79 75 76 77 78 79 INDIA INDONESIA (Java and Bali) SRI LANU THAILAND SEA/RC33/2 , Page 47 Burma, India, Nepal and Sri Lanka, were further extended to Indonesia in 1979. The progress made by all these countries was reported at a seminar attended by the principal investigators in Chiang Mai, Thailand, in October 1979. Data produced have made it possible to commence mapping the sensitivity levels of strains of the parasite throughout the Region. National follow-up refresher courses in the in vitro technique on the response of P. fa2cipanrm to chloroquine were organized with WHO technical support in India, Indonesia and Sri Lanka. During these courses the opportunity was taken to demonstrate the micro in vitro technique to the monitoring teams. During the year a manual on the clinical management of severe falciparum malaria was prepared and published in the WHO South-East Asia Regional Publications Series. A regional workshop on field research methodology was conducted in Bangkok in December which reviewed the programme of applied research and explored avenues for future studies. In addition, the participants were instructed in practical methods of preparing research study designs, protocols and proposals relating to chemotherapy, insecticide resistance, and the role of the community and the primary health care system in anti-malaria operations. Progress has been made by the countries in developing research cells within their anti-malaria organizations. External assistance required for some of the resultant activities is being met partly from regional funds and partly from the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR). Regional support with assistance fromTDRwas also extended to strengthen research capabilities within malaria programnes, institutions and universities. One of the more important results has been the establishment in institutions in Burma, India and Thailand of continuous in vitro cultivation of P. faZcipanrm, essential to further advances in the immunology and chemotherapy of malaria, and particularly in vaccine development. Of equal importance in the context of HFA/2000 is applied field research into anti-malarial delivery systems at the community and primary health care levels. Proper utilization of these systems is increasingly essential for the delivery of drugs, and studies are being initiated to find ways by which the systems may be strengthened and enabled to deliver mosquito control methods and eventually vaccines. Training continues to be a fundamental aspect of the malaria control programmes in the Region, and is strongly supported at various levels by WHO. Fellowships were awarded to anti-malaria personnel, wherever possible within the Region, and subsidies made available for national training programmes. An inter-regional project, "Coordination of the Malaria Training Programmes in Asian Countries", based in Kuala Lumpur, SEA/RC33/2 Page 48 has become operational. Member countries have been informed of the activities of the project and requested to indicate their requirements for assistance under this programme. The overall state of anti-malaria programmes in the Region is as follows : Millions (mid-1980) Population in the Region 1044.1 Population in originally malarious areas 964.9 Population in areas under anti-malaria operations 906.5 In areas under control programme 872.4 In areas under eradication progrannne 34.1 Population in areas with no specific anti-malaria operations 58.4 Highlights of anti-malaria activities in different countries are given below: In Bangladesh, the expansion of the areas requiring insecticide spraying reflects the deteriorating malaria situation. There was hardly any change in the annual blood examination rate, which continues to be low, but the slide positivity rate of 3.3% in 1979 was the highest recorded for the decade. Another disturbing feature in the epidemiological situation was that 66% of the cases recorded in 1979 were from the low malaria risk areas. The proportion of P. faZcipmwn incidence, however, continues to decline. Studies on P. falciprma sensitivity to chloro- quine continued to be conducted at the Institute of Epidemiology, Disease Control and Research. These studies have shown the presence of resistant strains in the high malaria risk areas along the entire eastern border. The degree of resistance recorded ranges from the RI to the RIII level. Results of susceptibility tests for vector resistance carried out do not indicate any evidence of resistance among the known vectors. Some of the recommendations contained in the 1978 assessment report have been implemented. A national Malaria Coordination Committee with representation from other sectors has been established and similar committees are being formed at divisional and district levels. It is hoped that this would lead to improved intersectoral coordination and cooperation with the Malaria Control Programme. The pace of imple- mentation of the recommendations has, however, been tardy; this has hampered operations and not been conducive to attract external assistance which is urgently needed for antimalaria supplies and transport. WHO has been closely associated with the Government's efforts to secure Case detection and treatment can help in pre- venting the spread of malaria. Insecticide spraying against the mosquito vector still remains the first line of attack to control malaria. FIGHTING MALARIA ~idemiologicar surveluance ana proper record deping help in taking effective control measures. , THE ANCENT SCOURGE i Leprosy has tew equals as a cause 01 numan suffering and social degradation. Sutveys reud a far higher prevalence of the disease in the Reuion than is apparent. Leprosy victims, who are usually looked u,,., as outcasts. need help with rehabilitation and to engage in produ~live vocations. Treatment for leprosy requires regular intake of drugs over a long period. SEA/RC33/2 Page 49 external resources. The Government of the Netherlands will provide 1000 tons of DDT and 700 tons of benzene for the DDT factory, while the response of potential donors is awaited. The supplies from the Swiss Government donation of US$ 26 882 were received. WHO provided anti- malarials costing US$ 140 000 as an emergency measure. Training has received a boost with the implementation of an extensive programme for personnel at the district and thana levels involved in the antimalaria programme. A total of 85 personnel at the district level received one week's training between June and September 1979. A five-day training course for 356 thana health administrators was undertaken by two teams from January to April 1980. These courses were supported by WHO through local cost subsidy. In Bma, out of a population of 33.1 million, 30.7 million lived in malarious areas, in 73% of which control activities were in progress. Drug distribution continued to be the mainstay of the programme, intra- domiciliary spraying with DDT covering only 6.9 million people although resistance to this insecticide occurred in A. mnukris and A. bala- bacemis. The estimated morbidity due to malaria was 45 per thousand population. Consistent with the pattern of epidemiological dynamics in past years, the malaria situation showed no significant change during the period under review. The projected annual blood examination rate remained at a low level of 1.2%, resulting in an unrealistically low annual parasite incidence of 0.56 per thousand (0.57 in 1978), and the slide positivity rate was 4.8% (4.9 in 1978). The proportion of P. fatcipamrm increased from 69.6% to 73.9%, and the slide falciparum rate from 3.4% to 4.8%. Strains of this species resistant to chloro- quine at RI and RII levels were widely distributed, in vivo and in vitro testing conducted by the programme and by the Department of Medical Research in Rangoon, Phaungyi, Akyab and Sandaway confirming their presence. Assistance extended to the programme by WHO was used largely for fellowships and supplies. Support was also given by UNICEF and Canada (CIDA) for the supply of DDT, drugs and equipment, and by theNetherlands in respect of two WHO specialists in vector-borne disease control. In India, 640 million people, out of an estimated total population of 675 million, lived in malarious areas, all of which were under surveil- lance. A population of 405 million was protected by anti-vector measures. In 1977, in order to counteract a deteriorating malaria situation, the Government introduced a modified plan of operations aimed at the prevention of mortality due to malaria, reduction of morbidity, and elimination of the adverse effects of the disease on development projects. Presently 70% of the central health budget is spent on these activities, with Rs 750 million budgeted for the National Malaria Eradication Programme during the current financial year. The modified plan has resulted in an overall decline of malaria incidence in the SEA/RC33/2 Page 50 country. Increased reliance is placed on community participation. liberal distribution of anti-malarial drugs through community health workers and volunteer drug distributors being responsible for much of the reduction of morbidity and mortality in rural and inaccessible areas. Available data indicate a total of 2.7 million cases during 1979 (morbidity 4.0 per thousand population) - a reduction of nearly 30% over the figures for 1978. A major technical problem of growing significance is pesticide resist- ance. The principal vector in the rural areas, A. culidfacies, has in many districts developed double resistance to DDT and HCH and in others, in western India, shows multiple resistance to DDT, HCH and malathion; A. stephemi, in urban areas, shows double resistance to DDT and HCB. In response to the increasing need for a variety of insecticides, national production of DDT, RCH and malathion is being expanded. Strengthening of the National Malaria Eradication Programme in areas where falciparum malaria is prominent has been organized through the P. faZdpomrm Contailnnent Programe (PfCP), supported by the Swedish Government (SIDA) and WIIO. During the year, a third zone was added to the area covered, the work already in progress in north-eastem India and in Bihar, Orissa and West Bengal being extended to Andhra Pradesh, Madhya Pradesh and Maharashtra. Despite this intensified programme of intradomiciliary spraying with DDT, chemotherapy and surveillance, there has been a slight increase in the absolute number of P. faZdpanrm cases, while the proportion of this species in relation to other species has increased from 10% to more than 15%. Five international staff have been assigned to the Programme during the year, and are involved in its epidemiological and applied research components. In many parts of north-east India resistance of P.faZdpm to 4-aminoquinolines is suspected on clinical grounds; in vivo and in vitro tests carried out by the monitoring teams of the Indian Council of Medical Research attached to the NMEP regional offices confirm that resistance is present in Nagaland, Assam, Meghalaya, Arunachal Pradesh and Mizoram, and during 1979 it was also confirmed in Orissa, indicating an ominous spread westwards. WHO support was extended to the Programme in a number of areas. Fellowships were provided and grants and subsidies arranged for insti- tutional and field training, including a workshop on malaria serology, held in October 1979 at the National Institute of Communicable Diseases. At the NICD, regular courses on malariology and entomology were held for medical officers and biologists from NMEP (including PfCP) and from the Defence ~e~arbent and the Railways, while the regional coordinating organizations of NMEP also trained malaria and other health workers (primary health centre personnel). The Progrlunae also received from WHO supplies and equipment, and personnel who provided advice in respect of research, training, and pesticide toxicity and etorage. The N~EP and PfCP were separately SEAfRC3312 Page 51 subjected to independent assessment by joint Government, SIDA and WHO teams during the period January-March 1980, and the recommendations are being considered by the Government. Periodic review meetings of the PfCP were also held. The malaria control programme in Indonesia covers the entire population in Java and Bali but in the other islands coverage provided is for priority areas of socio-economic importance and transmigration projects. Extensive training needs and development of the health infrastructure have been identified in the preliminary data collection for expansion of population coverage in the other islands. The US AID loan agreement terminated in February and negotiations are under way for the revival of assistance and also for support from other sources for the programme. Strengthening of the central organization with technical staff needs urgent consideration. The establishment of a National Malaria Coordi- nation Committee with representation from other sectors and similar committees at the provincial level would promote support from and cooperation of other sectors in anti-malaria activities. There has been a dramatic reduction in the number of malaria cases recorded in Java and Bali - 56% less than in 1978. Although there has been a 27% decrease in the annual blood examination rate, the lowering of the slide positivity rate by 40% is an indication of an improving malaria situation in these two highly populated islands. Despite an increase in the proportion of P. faZcipamrm, the number of infections has been less than in 1978. Monitoring teams established in East Kalimantan and Irian Jaya have confirmed, by applying both in uiuo and in vitro methods, that chloroquine-resistant P. faZcipanrm is widespread in the two provinces at RI and RII levels. Suspected foci of resistance have been reported from the provinces of Lampung and E. Nusa Tenggara. Recent findings in Java point to a rise in the level and extent of DDT resistance in A. aconitus. Assistance was provided in carrying out trials with other insecticides, methods of insecticide application and other vector control measures. In Kabupatan Banjannegara, a high case incidence area, fenitrothion thermal fogging with intensive case detection has been instituted to reduce transmission. Two seminars for provincial staff in Java/Bali and the other islands were held in September and November 1979 respectively. A 12-day training course for medical staff of health centres in Java/Bali was organized in October. A three-week training course on in vitro testing of P. falci- panrm sensitivity to chloroquine was conducted by the WHO laboratory specialist in May. WHO also provided funds for printing an illustrated key to 'Anopheline Mosquitoes in Indonesia' in Bhasa Indonesia, prepared by the WHO entomologist. In Maldives, 56% of a population of 150 000 was screened during the year for malaria by blood examination. The case incidence was 3.3 per thousand population, all attributable to P. viva, a decrease by 16% SEA/RC33/2 Page 52 since the previous year. Of the 329 confirmed cases, 19 had been imported. Nearly 90% of the cases occurred in four northern atolls and Laam atoll, the remainder being found in the other islands inhabited by 74% of the population. The slide positivity rate registered a slight decrease,Erom 0.42% in 1978 to 0.39% in 1979. Since June 1975 no falciparum infections have been detected. Control measures employed continued to be intradomiciliary spraying of DDT, to which the vectors A. subpictus and A. tessetatus remained susceptible. The latter mosquito, after an apparent absence of from 7 to 13 years following a single-spray cycle, was found in 1979 on three atolls. Anti-larval measures, including attempts to restock fish in wells, drug distribution, and surveillance, were also undertaken. Community participation in these measures, led by the island chiefs and health volunteers, continued to be indispensable. Timely execution of the work, particularly the spraying, was, however, hampered by transport problems between the atolls. WHO support for the programme continued during the year, in terms of personnel, training fellowships, and supplies and equipment. In Nepal, malaria is still regarded as a major health problem. The annual number of cases has since 1974 fluctuated between 12 000 and 13 000, and during 1979 a total of 12 131 were detected. In the foot- hills and hilly areas of the country, where the main vector, A. fluvia- ti& is susceptible to DDT, the incidence of malaria has gradually declined. In the nine Terai districts, cultivated areas in the plains, there has, however, been some deterioration due to ecological changes brought about through the implementation of development projects, extensive population movement,and the presence of DDT resistance in the principal vector there, A. annutaris, which in 1979 continued to extend its range. During 1980 a population of 880 000 is scheduled to be protected by malathion spraying in these areas. A large proportion of the P. faZcipancn cases continued to be imported from the north-eastern parts of India, and many of the parasites were found to be resistant at RI and RII levels to chloroquine upon in vivo and in vitro testing by the programme monitoring teams. The incidence of falciparum malaria acquired within Nepal, however, showed a decline. Following a situational analysis by an internal assessment team, an independent assessment was carried out during January and February 1980. At a seminar conducted in March 1980, detailed proposals for applied field research were formulated. An Asian Development Bank/WHO mission is currently involved in preparing a project proposal for malaria training and research, to be considered by the Asian Development Bank for support. To ensure an inter-sectoral approach to anti-malaria operations, a co- ordination committee has been established. A task force has been formed by the Malaria Eradication Board to study the present organizational structure in relation to the management aspects of the programme. SEA/RC33/2 Page 53 WHO continued to assist the programme with advisory personnel. Support was extended also in respect of fellowships and supplies and equipment, and a large quantity of malathion was provided to augment the amounts supplied through bilateral aid by the Netherlands, United Kingdom and USA. The last named Government, together with UNDP, supplied DDT. In Sri kka, 9.8 million people of a population of 14.7 million lived in malarious areas. The number of detected cases was 47 855, indicating a decrease in incidence of 31% over the previous year. The annual parasite incidence decreased from 6.4 per thousand to 4.9, and the slide positivity rate from 7.1% to 4.8%. In respect of P. falcipurwn, which remained sensitive to 4-aminoquinolines, the number of infections diminished by 30% and their proportion remained stable at 2.7%. Control measures included intradomiciliary spraying using malathion in selected areas, the vector A. cuZicifacie8 continuing to be susceptible to this insecticide but not to DDT. A main storage building for malathion is under construction in Colombo district and a chain of district stores would also be built. Anti-larval measures, including intermittent flushing of rivers and elimination of breeding places by filling abandoned gem pits, space spraying at pilgrimage centres, drug distribution and surveillance, were undertaken. Community participation in the form of volunteer treatment centres proved valuable in this regard. Useful information was provided by the island-wide network of indicator institutions containing activated passive case detection agents. The principal problem areas continued to be those where illicit gem mining and chena (slash and burn) cultivation occurred. The programme was supported by WHO through advisory staff, fellowships, and supplies and equipment. Bilateral aid was extended for the supply of malathion and other commodities by the Netherlands, United Kingdom, and USA, and representatives of these countries and of WHO joined the Government in undertaking the second annual evaluation of the programme in February-March 1980. The recommendations arising from this evaluation included the establishment of an epidemiological unit within the programme, intensification of existing control measures, including malathion spray coverage, enhancement of surveillance and evaluation procedures, particularly monitoring for the development of vector resistance to malathion, and the promotion of community participation and political support. In Thailand, though the rate of increase in malaria cases has slowed down from 1977, it was only in 1979, for the first time in seven years, that there was a decrease in the number of cases detected. The decrease in case incidence was nearly 10% and was more marked for P. vivare than P. fazciparwn. The improving situation may be the outcome of the revised strategy implemented in 1977178. In recent years there has been a steady flow of immigrants from the riparian countries who uponinvitro testing show malaria parasites 100% resistant to chloroquine and pyrimethamine. This emphasizes the need for prompt and appropriate anti-malaria measures to be carried out in and around refugee camps to prevent the occurrence of outbreaks in neighbouring villages. SEA/RC~~/~ Page 54 A $4.5 million loan-and-grant agreement was entered into between the Government and US AID commencing October 1979 for three years. This assistance would be directed for training, applied field research activities, health education and the establishment of malaria clinics at strategic points. With the resumption of US AID assistance the anti- malaria budget in 1980 would be operating at the required level, in contrast to the previous years when it was considerably less than the amount required. The Regional Collaborative Studies on in vitro testing for P. faZcipanrm resistant to 4-aminoquinolines have progressed satisfactorily with 14 provinces covered. It is hoped to complete these by the end of 1980. It is now evident that there are few areas where chloroquine-sensitive strains of P. faZcipamrm exist, all areas tested having highly resistant strains. Assistance has been provided for the planning and monitoring of vector resistance to insecticides. In 1979, a total of 117 susceptibility tests were carried out in index villages specifically selected for this purpose. These tests have revealed that in some parts of the north there is a decrease in susceptibility to DDT in A. minimus and A. baMacewis. An independent assessment of the prograrmne was carried out jointly by the Government and WHO in August/September 1979. The team was impressed with the determined efforts of the Government to cope with the malaria situationin spite of administrative, operational and technical problems. The team was also satisfied with the progress made since the launching of the new strategy in some regions, but was concerned over the critical situation in others. Its recommendations stressed the management and operational evaluation system,budgetary requirements, training, research and the role of the rural health services in anti-malaria activities. A national seminar on malaria sponsored by US AID and a meeting of regional epidemiologists to plan epidemiological activities at the regional level and to discuss the implementation of the assessment team's recommendations were held in February 1980. A training course for malaria workers was held in March, supported by WHO. In a small area in the Central Sulawesi region of Indonesia, where the disease continues to persist, control measures are being taken, based on epidemiological studies carried out earlier. Filariasis is a major problem in this region, with an estimated 236 million people exposed to the infection in India alone. Other affected countries include Bangladesh, Burma, Indonesia, Sri Lanka and Thailand. Following a meeting of the Joint Western Pacific/South-East Asia Working Group on Brugian Filariasis in Kuala Lumpur in June 1979, a meeting of SEA/RC33/2 Page 55 the Bi-Regional Research Study Group on Culex-borne Bancroftian Filariasis was held in the Regional Office in November to review the situation of Bancroftian filariasis in the various countries of the Region and discuss chemotherapeutic and vector control problems. A number of research protocols were developed, to explore more effective ways of controlling the disease. In India, a national workshop on filariasis was supported by WHO. ., In :ndia, the surveillance and control of this disease continued to be carried out by the Government following the outbreak of Kala-Azar in 1977 in Bihar. An international symposium on leishmaniasis was held at the National Institute of Communicable Diseases, Delhi, in January 1980, in which the Regional Office was represented. 2.4 Bacterial Diseases 2.4.1 TubercuZosis Tuberculosis continues to be a major public health problem in the Region. In Bangladesh, where the national control activities continued as planned, it is estimated that there are 350 000 sputum-positive and 3 million radiologically positive cases of tuberculosis. An assessment of the BCG vaccination campaign done in June 1979 through a scar survey indicated that it covered 26.75% of the child population. It is estimated that about 37% of the child population of the country has received BCG vaccination. Training activities consisted of the training of medical officers from the referral institutions, of epidemiological surveillance teams in scar surveys, and the retraining of family welfare workers. The main operational task, namely, organization and implementation of the BCG campaign to cover the child population through family welfarelprimary health workers, has been a success. A WHO consultant is under recruitment to advise on programme formulation for the maintenance phase of BCG vaccination, to assist in the preparation of a manual for maternal and child health workers engaged in BCG vaccination during the maintenance phase, and to advise on case-finding and treatment for mycobacterial diseases in thana health complexes. The aim of the national tuberculosis control programme in &ma continues to be reduction in the annual risk of infection from 1.6% to 1% by 1982, i.e., 5% annually. The strategies employed to achieve this consist of direct BCG vaccination of children up to 14 years of age with emphasis on new-borns and pre-school children, and ambulatory chemotherapy for all detected cases. Under the Expanded Programme on Immunization, the programme envisages tackling childhood diseases of public health importance, including tuberculosis. SEA/RC33/2 Page 56 In India, assistance continued to be provided to the Tuberculosis Chemotherapy Centre and the Tuberculosis Prevention Trial, Madras. New areas in the field of immunology and biochemistry have been taken up at the former and further research is going on in short-course chemotherapy. A WHO consultant reviewed the progress of the studies at the Centre and discussed the current activities during a visit in January 1980. Particular attention was also paid to the organizational and administrative activities of the Centre's clinical studies, especially in regard to coordination and interim assessment of thera- peutic results and of toxicity. The consultant also visited the National Tuberculosis Institute at Bangalore to review its progress. This institute has the responsibility of monitoring the national programme by collecting, compiling and analysing data on the work of district tuberculosis centres and suggesting remedial action for further improvement. The Tuberculosis Prevention Trial in Madras, which has been going on since 1971, has already completed its third examination round, i.e., the observation time of 7% years. A WHO temporary adviser essisted in the analysis of the data of the Trial during January 1980. The first scientific report of the findings of this trial has been brought out and shows that BCG vaccination affords no protection against lung tuberculosis in the southern part of India. In order to consider the findings of the Trial, a Joint ICMRIWHO Scientific Group Meeting on Vaccination Against Tuberculosis was convened in the Regional Office in May, which recognized the high scientific quality of the Trial. The evidence available indicated that BCG did not protect against bacillary pulmonary tuberculosis but that this result should not be regarded as applying automatically to other parts of the world. The lack of protective effect of BCG vaccine might be related to the interaction between a variety of epidemiological, environmental and immunological characteristics of the population of Chingleput (near Madras). The meeting therefore recommended various investigations to test hypotheses relevant to these possibilities and a full and detailed analysis of the follow-up results in various vaccination groups when the ten-year follow up would be complete, so that the maximum scientific information on BCG vaccine could be obtained. The Group felt that the report on the Trial provided insufficient information on the effect of BCG vaccine in infants and young children, and that further studies on this topic were needed. In Mazdives, a case-finding survey for tuberculosis has been completed in all islands except Kaafu (Male atoll) and Male. In addition, immunization of the eligible population was undertaken in the islands surveyed. As of 31 December 1979, there were 598 tuberculosis cases under treatment. BCG vaccination was carried out in Nepal, as planned. Assessment, follow-up, case-detection and scar surveys were also undertaken according to schedule and training given to various categories of staff The progrannne delivery was effective and community participation SEA/RC33/2 Page 57 encouraging. A WHO consultant, assigned to the country from December 1979 to April 1980, reviewed the project activities as detailed in the project formulation for tuberculosis control in general and the technical quality of each activity in particular,and also the work of the Tuberculosis Association and other voluntary agencies. He also assisted the integrated and cmunity health services and EPI in imp1ementir.g a comprehensive tuberculosis control programme as an integral part of basic health services, including the maintenance of BCG vaccination as a part of EPI. Advice was also given on the training of all categories of health workers in tuberculosis control. Plans are under way to organize the second national seminar on tuber- culosis in November 1980. 2.4.2 Leprosy The problem of leprosy is big in terns of numbers, accounting for over five million cases in this region. It is a matter of great concern that despite scientific advances in its management, millions should still be afflicted by this mutilating disease. It is estimated that in BrmgZadesh, there are 200 000 cases of leprosy, mainly in Rangpur, Mymensingh, Rajshahi, Sylhet and Dacca districts. Both active case-finding and the clinical approach for case-detection continued. As of August 1979, there were 30 446 registered leprosy patients, of whom 10 051 (33%) were of the lepromatous type. Efforts have been made gradually to introduce passive case-finding activities in 150 thana health complexes. Assistance continued to be given to the training of all categories of staff. A protocol was prepared for "an epidemiological study of dapsone-resistant leprosy" in Nilphamari area of Rangpur district. A WHO operations officer was assigned in February to assist, among other things, in the development of leprosy control activities and the BCG vaccination programme at all levels, in relevant training programmes, and inthe regular evaluation of the operational and epidemiological aspects of the mycobacterial disease control programme. m &uma, under the rifampicin trial, the administration of rifampicin was well planned and executed. The activities include rifampicin treatment of open cases in the field and the collection of random urine samples; DADDS injections to rifampicin-treated open cases; urine dapsone tests, mouse-foot pad tests and mass survey. Follow-up treatment and clinical reviews indicate that the patients are benefiting from more regular dapsone treatment. Reactions have not become markedly more frequent or severe and have been successfully treated in the field. Treated patients are being regularly followed up. The WHO statistician in the project also continued to assist with the BCG cohort study and the coding of data. In July 1979, a WHO temporary adviser assisted with the planning of a dapsone resistance survey in relation to the Chemotherapy of Leprosy (THELEP) trials. A consultant assigned from August to November 1979 participated in the rifampicin mass survey, to - diagnose and classify newly detected cases, and to conduct a complete ~EAlRC3312 Page 58 reassessment of all patients listed for the BCG cohort evaluation study (multibacillary cases). Another consultant visited Mandalay in September 1979 to observe the activities of the mouse-foot pad laboratory in connexion with the dapsone resistance survey. A statis- tician from WHO Headquarters visited Burma during January-February 1980 to investigate the statistical and data handling facilities that could be made available for the BCG cohort study and the rifampicin trial (both WHO-assisted leprosy projects) and to suggest a procedure for the smooth and orderly transfer of the data handling responsibility from Geneva to Rangoon. m India, the national leprosy control programme, which is implemented as a special programme, is steadily gaining momentum with the aim of controlling leprosy by detecting and treating all cases so as to prevent the spread of the disease. Through consultants WHO has been collaborating in the evaluation of the problem and in exploring the possibility of opening reconstructive surgery units for the correction of deformities among leprosy patients. Vehicles, equipment, including microscopes, and publications and drugs (as an emergency measure) have been made available to different leprosy control units, centres and institutions. A number of workshops covering various aspects of leprosy such as health education, statistics, epidemiology control, reconstruc- tive surgery, trophic ulcers, prosthetics, management of insensitive hands and feet and claw hands deformity have been supported. Several institutes and individuals received funds for research on different aspects of the disease. The Swedish International Development Authority has agreed to provide rifampicin and lamprene capsules for intensifying the treatment programe in India. A large part of the SIDA support to the national leprosy control programme is channelled through WHO. A new SIDA-funded pilot project for multi-drug trials (an intensified programme involving a closed, supervised treatment with more effective drugs such as rifampicin and clofazimine) is being started in Purulia and Wardha. The Damien Leprosy Foundation of Belgium has agreed to help in carrying out limited epidemiological surveillance, in establishing some model leprosy control units and to the supply of drugs through WHO. A consultant from WHO Headquarters visited the All-India Institute of Medical Sciences, New Delhi, and the Schieffelin Leprosy Research and Training Centre, Karigiri, in September 1979, in accordance with the direction of THELEP (Chemotherapy of Leprosy Programme) thatsite visits be made to these institutions to assist them in their work. The Central Leprosy Teaching and Research Institute, Chingleput, has been under- taking THELEP multicentre drug trials for quite some time. In November- December 1979, a THELEP-sponsored Workshop on Mouse-Foot Pad Standardization and Application was held at Chingleput to train the participants in mouse-foot pad methods for the cultivation of M. Lepme and in the application of the technique for research in leprosy. In Indonesia, where the Danish "Save the Children" Organization is providing assistance, the WHO leprologist continued to assist in the SEA/RC33/2 Page 59 training of leprosy supervisors and leprosy workers as trainers, at the National Leprosy Training Centre at Ujung Pandang. Random surveys were undertaken in Maluku and South Sulawesi. A trial is being planned in two regencies for a WHO-sponsored project on a "Recording and reporting information system for leprosy control activities". A WHO temporary adviser visited Indonesia in September-October 1979 to assist in the development of the protocol for a dapsone resistance survey in South Sulawesi, and to assess the potential for developing an institution- strengthening proposal from the Department of Microbiology, University of Indonesia, Jakarta. The possibilities were further explored during a visit in May 1980 of the Secretary, Immunology of Leprosy and THELEP Steering Committees from WHO Headquarters, and the Medical Research Officer (Tropical Diseases) from the Regional Office, to conduct a dapsone resistance survey as well as clinical trials in the chemotherapy of leprosy under the TDR. In Maldives, the case-finding survey for leprosy has been completed for every island except Kaafu (Male atoll) and Male. As of 31 December 1979, there were 1500 leprosy cases under treatment. A representative of the Danish "Scouts Aid" (which is assisting the project) visited Maldives in November 1979 for discussions with the national health officials and WHO staff concerned. In Nepal, work on leprosy case-detection, health education and the setting up of treatment clinics has been completed in Mohattari (Central Region) and Jhapa (Eastern Region) districts. In the Western and Far- Eastern Regions, control activities have been completed in Tanahu, Lamjung, Bardia and Banke districts. The completion of these leprosy surveys brings the number of districts where control activities have been established to twenty-one. A mid-term review has shown that the leprosy special programme in two districts has had a significant impact on community behaviour and knowledge about the disease. The activities have also included training of all grades of medical workers. A WHO consultant is to be assigned to Nepal in mid-1980 to collaborate in planning the strategy for community involvement in leprosy control measures and to advise the Government on defining the role of national and international voluntary organizations. The Second International Workshop on Leprosy Control in Asia, sponsored jointly by the Government, the Sasakawa Memorial Health Foundation and WHO, was held in Kathmandu in October to review the status of comunity involvement and participation, to identify the social, cultural and other factors inhibiting or fostering the participation of the patients, the family and the community in leprosy control activities, and to suggest approaches to secure greater participation. In addition to countries from this region, some countries from the Western Pacific were also represented. This provided a good opportunity to lay adequate emphasis on the rather neglected area of comunity participation in leprosy control. In %iZand, support was provided for an Evaluation Project of Inte- grated Leprosy Control Services in Uthai Thani Province. AWHO consultant SEA/RC33/2 Page 60 was assigned during March-April 1980 to assist in the planning stage. assess and evaluate the operations of the epidemiological survey, and to design parameters for further analysis of epidemiological and operational surveys. A medical officer has been assigned to an inter-country project and based at the Regional Office since January 1980 to promote leprosy control and research activities in the Region and to stimulate programme proposals in leprosy control projects funded by voluntary contributions. The Japan Shipbuilding Industry Foundation has provided support to various leprosy control activities in the Region. Leprosy research is expanding rapidly both under the regional research programme and under the UNDP/World Bank/WHO Special Programme for Research and Training in' Tropical Diseases. Pressing problems have been recognized which require urgent consideration. The foremost among these are inadequacies in case- finding, case-holding and release from control of inactive cases. Equally important is the problem of persistence of infection and resist- ance to DDS. An inter-country consultative meeting was held in the Regional Office in June 1980 to consider these problems and to assist in formulating a coordinated regional approach to their solution. 2.4.3 sexually-TMnsmitted Diseases Sexually-transmitted diseases, particularly syphilis and gonorrhoea. continue to pose serious public health problems. Though reliable data on their prevalence are not available, permissiveness, promiscuity and tourism tend to spread these diseases. Health education, community awareness, social motivation, professional cooperation in notification and case-finding and, above all, enlightenment and active participation of the people in promoting personal hygiene, can result in effective prevention of these diseases. In India, grants were provided for workahops for paramedical and medical personnel to exchange vim and to focus attention on various lacunae in the control of sexually-transmitted diseases. Also, supplies and equipment were given for strengthening appropriate institutions. 2.4.4 Diphtheria, Pertussis and Tetunue These diseases. which are covered under the activities of the Expanded -~ .--- ~~-- ~~ ~. Programme on Immunization, continue to be public health probleme of considerable importance in the countries of this region. 2.5 Viral, Chlamydial, Rickettsia1 and Related Diseases 2.5.1 Trachoma Trachoma is still a public health problem in this region. WHO assist- ance consists essentially of advisory services, fellowships, the provision of supplies and the processing of records. SEA/RC33/2 Page 61 Poliomyelitis is endemic in most countries of the Region. Polio vacci- nation is administered in some countries under the Expanded Programme on Immunization. On the basis of the results of a seroanalysis of limited numbers of blood samples in Rangoon in early 1979, it was decided to hold a statistically acceptable random sampling sero-survey of antibodies of all three types of polio viruses in Rangoon city to elucidate the current epidemiological picture of the disease. One of the Regional Advisers on Communicable Diseases visited Rangoon in August 1979 to assistthenational authorities in organizing the sero-survey. Following this a WHO short-term consultant was sent to Rangoon in November 1979 to review the epidemiological situation regarding poliomyelitis in Rangoon based on the data obtained through the sero-survey and other available information. From the results, it can be concluded that the status of poliomyelitis in Rangoon in 1979 was the same as in 1966. A phased programme of polio immunization in Rangoon is to be launched in the second halfof1980 under the national programme on immunization. 2.5.3 Dengue Haemorrhagic Fever Dengue haemorrhagic fever continued to be endemic in Burma, Indonesia and Thailand, where the available data in respect of the calendar year 1979 were as follows: Sporadic cases of dengue fever with haemorrhagic manifestations were also reported from Maldives and Sri Lanka. Country Burma Indonesia Thailand In Em, dengue haemorrhagic fever was reported from Rangoon as well as other states and divisions. Clinical manifestations including encephalopathy were reported which need further in-depth studies. A clinical trial on corticosteroid for the treatment of dengue shock syndrome has been completed. In Indaeeia, research on clinical trials was completed. Cases 4 684 3 203 11 276 Deaths 158 153 102 Case fatality rate 3.6% 4.8% 0.9% SEA/RC33/2 Page 62 Outbreaks of a dengue-like disease were reported in Maldives in May-June 1979. One of the Regional Advisers on Conmunicable Diseases and the WHO staff stationed in Male assisted the national authorities in investi- gating the outbreaks at Male and Edhyafushi island. Serological studies revealed that the disease had been caused by dengue viruses. Advisory services were provided through four h'H0 consultants to (1) study the epidemiology of dengue fever in Male and other atolls and assist in a serological survey of the dengue antibody level in the population in Male; (2) assess the overall epidemiological situation of dengue infection and advise on long-term preventive and control measures; (3) assist with clinical diagnosis and management of patients of dengue fever and DHF, and (4) assess the situation of Aedes mosquitoes in the country for arboviruses and other vector-borne diseases. In Sri Tanka, a WHO consultant-paediatrician carried out a follow-up survey of the clinical aspects of the dengue haemorrhagic fever situation in January 1980. A WHO consultant (virologist/epidemiologist) visited India and Sri Lanka during January 1980 to follow up on the recommendations of the Research Study Group Meeting on the Epidemiology of Dengue Haemorrhagic Fever held in March 1979. Collaboration with the Medical Research Institute, Colombo, to test the blood specimens of DHF cases collected from Maldives has been arranged by WHO. Epidemiological studies, including clinical-virological, prospective-serological and entomological studies in Male, have been planned for 1980-1981, with laboratory support from within the Region. The WHO Collaborating Centre for Research in the Imunopathology of Dengue Haemorrhagic Fever, Bangkok, Thaitand, continued its studies on morphology, the morphogenesis of dengue antigen and virus, immuno- pathology and immunochemistry. The Centre was redesignated as a WHO Collaborating Centre for three more years, with modified terms of reference to include the development of a dengue vaccine. A WHO consultant was assigned in November-December 1979 to assist in preparing the protocol for the development of the vaccine. He also assisted the National Virus Research Institute in strengthening its arbovirus laboratory and in preparing the research protocol for epidemiological studies on dengue haemorrhagic fever in a DHF endemic area in the country. A meeting on research in viral haemorrhagic fevers (dengue and chikungunya haemorrhagic fevers, Crimean-Congo haemorrhagic fever, Rift Valley fever, yellow fever, Korean haemorrhagic fever, lassa fever, Marburg and Ebola haemorrhagic fevers) in the Eastern Mediterranean, South-East Asia and Western Pacific Regions was organized in the Regional Office in March 1980. This meeting reviewed the state of knowledge regarding those viral haemorrhagic fevers of relevance to these regions and identified the areas in which research could be carried out within the framework of technical cooperation among countries and Regions. TRADITIONAL MEDICINE Reliance on the traditional forms of medicine has increased and countries are taking advantage ot the rich heritage available thrnughout the Region. DHF The unmistakable marks of dengue haemorrhagic fever. DHF is among the ten leading causes of hospitalira- tion as well as of deaths in children in at least three countries of the Region. EPI The expanded programme on im- munization has been established in most countries and is making progress as an integral part of the health services (right, top). BCG Extensive BCG vaccination is being continued as part of anti-TB pro- grammes in most countries of the Region. The Regional Director. Dr V.T.H. Gunarat Health Day 1980. which highlighted the ha; yours". sting a talk from All India Radio on the occaslon ot WOI kinq under the theme "Smoking or Health: The choice Mr Gamani Jayasuriya. Minister of Health. Sri Lanka. inaugurating the meeting of D~rectors of Medical Re- search Councils and Analogous Bodies and Concerned Research Foci in the Relevant Ministries. which took place ~n Colombo in December 1979. Sitting to his left on the dais are: Mr B.C. Perera. Secretary. Ministry of Health. Sri Lanka. Dr V.T.H. Gunaratne. Dr Prakorb Tuchinda. Under Secretary of Statefor Public Health Thailand,and Dr K.H. Notaney. WHO Programme Coard~nator in Sri Lanka. SEA/RC33/2 Page 63 2.5.4 Viral Hepatitis The disease has been reported from Burma, Mongolia and Sri Lanka as a major public health problem. WHO staff from Headquarters and theRegiona1 Office, together with a consultant, visited Burma in August 1979 for discussions with the national health authorities on a research project on viral hepatitis B. The prevalence of the hepatitis B surface antigen in normal population in Burma is about 10% and the vertical transmission from mothers to newborn babies is relatively high. A project document has been prepared for joint support from WHO and CDC, Atlanta, for a study in Burma to define the incidence and transmission of hepatitis B virus infection to offspring and to determine the efficacy of trans- mission intervention with immunoglobulins in infancy. A future study to determine the efficacy of hepatitis B vaccine in reducing the carrier state in infancy and early childhood is also planned. The establishment ofanetwork of national centres for viral hepatitis in the Region is under way to facilitate the surveillance ofthedisease and the standardization of methods and reagents at the international level. 2.5.5 Japanese Encephalitis Technical guidelines to deal with Japanese encephalitis were given wide distribution in the Region. In India,an epidemic of Japanese encephalitis was reported in the States of Karnataka, Andhra Pradesh, Maharashtra and West Bengal during 1979, with a high number of cases and deaths. At the request oftheGoverment, WHO arranged for the supply of 30 000 doses of freeze-dried vaccine. Training in the use of specialized spraying equipment was given to a national worker in Nepal. 2.6 Expanded Programme on Immunization Recognizing that the Expanded Programme on Imunization (EPI) is one of WHO'S priority efforts to foster the development of primary health care, and that the programme's success is an essential element in achieving health for all, governmentsand WHO continued to pay particular attention to the implementation of the programme in all countries of the Region. During the period under review, special efforts were made to train national programme managers and health workers responsible for vaccine logistics. With WHO'S support an inter-country course on the planning and management of EPI was held in Bangkok for 39 participants. Also, three inter-country courses on vaccine logistics and cold chain were organized - 2 in India and 1 in Thailand - in which training was given to 51 national personnel. Training of mid-level EPI managers started with an inter-country course in Bangalore, India, in November 1979. A similar inter-country course was held in Bangkok in March 1980, and 14 trainers from 3 countries completed it; one more course was held in Calcutta in April 1980. Following these activities, national EPI . SEA/RC33/2 Page 64 training courses for health staff at all levels were held in 7 countries, with WHO'S support and participation. Operational manuals on EPI were prepared in three countries. Twenty- three WHO fellows from four countries went on EPI training and orientation tours during the year. Staff from the Regional Office visited 9 countries to take part in programme planning, review and evaluation, training activities, research meetings, and the collection of epidemiological data on EPI target diseases. They also assisted in finding solutions to managerial and technical problems. For the same purpose, 12 consultants (including three staff members from WHO Headquarters) visited nine countries of the Region during the year. Cold chain equipment, locally produced in the countries of the Region. was tested for its "cold life". In two countries, plans were finalized to install solar-powered refrigerators to test them for storing vaccines. Assistance was given in installing regional cold stores for vaccines in two countries. Vaccines were supplied to one country through WHO in 1980, utilizing voluntary contributions. In November 1979, a regional meeting on EPI management was held in New Delhi with the participation of national EPI managers and other senior health workers involved in the programme in all ten countries of the Region. The national programmes were reviewed and discussed, especially community participation in EPI implementation. Also in November 1979, a meeting of the EPI Global Advisory Group was held in the Regional Office. Plans were made for conducting EPI operational research in the Region, with WHO support. In one country, an EPI research and training area is to be established which will also serve other countries. As a result of all the above-mentioned activities, the programme in the Region was further expanded during the year, and it covered a greater number of children and women. The following is a summary of activities in individual countries: In Bangladesh, a five-year plan of operations for EPI has been prepared by the National Advisory Committee. Implementation of the programme started in seven immunization centres in mid-1979, and it is planned to have a total of 3000 health centres by the end of 1984, to provide immunization to children and women. In addition to BCG, DPT and TT vaccines, polio and measles vaccines will also be available for urban populations. While vaccines and cold chain equipment were supplied by UNICEF, national staff were trained for EPI with WHO assistance. A review of progress of implementation was undertaken in March 1980 with WHO participation. SEA/RC33/2 Page 65 The EPI plan of operations for Bhutan was finalized in 1979. In selected areas of the country, children have been immunized against tuberculosis, diphtheria, tetanus, whooping cough and poliomyelitis. A feasibility study on measles immunization is to start during 1980. Vaccines, supplies and equipment for the programme have been procured with WHO and UNDP cooperation. The national EPI managers, who have been assigned, and other health staff involved in EPI have undergone training abroad. A consultant visited the country during the year and assisted in collecting epidemiological data on neonatal tetanus. In Bma, the programme has been extended from Greater Rangoon to Phase I1 areas in 22 townships all over the country. An assessment of immunization coverage based on area reports was conducted by the national authorities in Phase I areas. The best coverage was for BCG vaccination (68.5% of newborns and over 99% of children aged 5-6 years). Lower figures were obtained for DPT immunization of children and tetanus toxoid vaccination of pregnant women. Areas for improvement were identified and recommendations made regarding the managerial and technical aspects of the programme. A serological survey was conducted in the Greater Rangoon area during which sera were collected from 1000 children aged 0-5 years who had not been immunized previously; 15% of these sera were found to be negative to all three types of polio virus. The remaining 85% of sera contained antibodies to one, two, or three types of the virus. The results of this survey indicated the "natural" immunity level among children in the urban areas of the country and provided epidemiological information necessary for setting priorities for the further expansion of the programme. In India, training in EPI continued to be carried out during the year - two courses each on vaccine logistics and mid-level management. The progress of EPI implementation was reviewed with WHO participation in 7 States (Orissa, West Bengal, Karnataka, Gujarat, Haryana, Tamil Nadu and Rajasthan) and recommendations made for further improvement and expansion of the programme. Immunization coverage was evaluated by the cluster sampling method in six states and union territories. In the urban areas of Bangalore, 38% of pregnant women surveyed had received two or three doses of tetanus toxoid; DPT coverage of children was found to be: 62% one dose and 52% three doses of the triple vaccine. Medium-term EPI plans of operations were prepared at state level. To study the problem of measles, a WHO consultant visited several states, collected epidemiological data and evaluated the public health importance of the disease, which seemed to contribute heavily to the high mortality among infants and young children. A study on the operational feasibility of measles immunization was also launched in cooperation with UNICEF. This study indicated that before immunization could be introduced on a large scale, it was necessary, among other things, to expand the cold chain and ensure its smooth functioning. SEAIRC3312 Page 66 Cold chain equipment was supplied during the year. Refrigerators specially designed for use in areas with irregular supply of electricity and voltage fluctuations, were supplied for testing. Plans were made to establish EPI demonstration and training areas in several states and personnel sent abroad for orientation. UNICEF and SIDA continued to extend full cooperation in the implementation of the programme. In Indonesia, the programme further expanded during the reporting period. By the end of 1979, EPI had covered 1195 kecamatans - 37% of the total. The target is to cover 51% of all kecamatans by 1981 and 80% by 1984. A survey of immunization coverage was conducted in the last quarter of 1979 in randomly selected areas. The survey indicated that 55% of children received two doses of DPT, as well as BCG and smallpox vaccinations. A strong and well staffed central EPS Unit was established in Jakarta. The national EPI manual was printed and distributed. A draft booklet on immunization for use by students and the medical profession was also prepared. Training of national staff in EPI continued during the year. Eleven participants from Indonesia completed WHO courses on EPI management and vaccine logistics. EPI management training courses of two weeks' duration were organized at the provincial level for 200 health workers. Also, a course on vaccine logistics was conducted for the staff responsible for vaccine handling in most of the provinces. The central vaccine cold-room and three provincial cold rooms became operational at the end of 1979; three more rooms are under construction. With assistance from a consultant, the cold chain for vaccine distri- bution was improved further, with equipment produced locally and also received from abroad. An agreement was finalized with a bilateral agency for assistance amounting to US$ 13.2 million to be made available during 1980-1984. Data on EPI are also included in the national health information system and plans made for establishing a supplementary surveillance system through "sentinel areas" in 26 kecamatans. A symposium on immunization was held in Jakarta in November, in collaboration with WHO, UNICEF and the International Children's Centre. Senior health staff from the provinces and scientists from a number of other countries participated. In Maldives, BCG and DPT imunizations were given to children in atolls by the mobile unit team of the leprosy and tuberculosie control SEA/RC33/2 Page 67 programme, which has reported satisfactory coverage in the islands visited. In Male, children were also immunized against poliomyelitis. The EPI programme in Mongolia was expanded further during the year. Cold chain and sterilization equipment was supplied. A trial was conducted on the use of disposable syringes for the immunization of children in selected urban areas. Two workers went abroad on WHO fellowships to study problems related to the implementation of EPI. A seminar was held in Ulan Bator for EPI managers from the aimaks and an instruction booklet on EPI printed and distributed to the health staff. A WHO consultant assisted in studying the epidemiological situation of viral hepatitis and reviewed the present practice of sterilizing syringes and needles. The reported immunization coverage in 1978 was: 100% for BCG, measles and smallpox, and 98% for DPT, DT and polio. No cases of tetanus, diphtheria or poliomyelitis were reported in Mongolia during the year. In Nepal, immunization continued to be provided by the staff of the smallpox eradication programme, the integrated community health services, family planning personnel, staff of the tuberculosis control programme and by voluntary organizations. A WHO consultant visited the country and assisted in the further development of the cold chain for vaccine storage and distribution. Another consultant assisted in conducting an epidemiological survey of neonatal tetanus, which revealed that the mortality caused by the disease was 15 per 1000 live births in the southern part of the country (Terai) . During the first quarter of 1980, the programme was independently evaluated with WHO and UNICEF participation. Nine districts were visited by a group of senior national health workers, UNICEF workers, a WHO consultant, and two staff members from WHO Headquarters. The results of the evaluation indicated that the major problems were managerial and organizational. Recommendations were made in regard to coordination, management, reporting, epidemiological studies, community participation, training, and the operational aspects of EPI. In Sri &ka, all health divisions in Phase I and 11 areas had been covered by EPI activities by the end of 1979. Healthstaff from Phase I11 divisions received training in EPI. Cold chain equipment and vehicles for the programme have been supplied and distributed to all health divisions in the country. A National Advisory Committee on EPI has been appointed and met several times to review the progress of implementation. Immunization coverage reported in Phase I areas in 1978 was: BCG 67%, DPT (3 doses) 34%, polio (3 doses) 32%, and TT (2 doses) for pregnant women 32%. WHO .. participated in a review of the programme in 1979. SEA/RC33/2 Page 68 Training was given to staff in the cluster sampling technique for assessing immunization coverage and plans made for extending the programme to plantations. The national EPI manual was printed and distributed to health staff. In cooperation with UNICEF, plans were made to establish a mobile unit for the maintenance and repair of the cold chain. In Thailand, polio vaccine supplied by UNICEF was given to children in selected urban areas in 23 provinces in 1979. In 197811979, the reported immunization coverage was as follows: BCG-54% of all infants; smallpox-48%; DPT (2 doses)-43%; oral polio vaccine (3 doses)-78% (only in selected areas) and TT (2 doses) for pregnant women-15%. The cluster sampling method was used for the assessment of coverage in Bangkok and in two provinces. Refrigerators and other cold chain equipment were supplied to all district hospitals, health centres and midwifery clinics all over the country. The local production of BCG, DPT and TT vaccines was gradually expanded in 1978-1979 and vaccine samples tested for potency. Twenty-six senior health workers completed WHO-sponsored EPI courses conducted in the country. Following this, over 1600 health workers received EPI training, which is continuing. Sixteen thousand copies of the national EPI manual were printed and distributed to health staff. 2.7 Veterinary Public Health The countries in the Region are interested in strengthening veterinary public health programmes, particularly the control of priority zoonoses (rabies, brucellosis, echinococcosis, etc.) and food hygiene. An inter-country seminar for the planning of national and regional programmes for the surveillance, prevention and control of zoonoses and related food-borne diseases was held at the National Institute of Communicable Diseases,Delhi, in November 1979. The seminar identified rabies, brucellosis, echinococcosis, leptospirosis, plague and food- borne infections and intoxications as priority diseases. It reviewed the strategies and methods for surveillance, prevention and control and recommended the most suitable ones for inclusion in national control programmes. The meeting also approved a medium-term programme covering the period 1980-1983 and recommended the establishment of a zoonoses control centre. This centre will be the focal point for the coordination of national and inter-country projects and programmes and will take into full consideration the principles of technical cooperation among developing countries. A new post of veterinary public health officer is being established in the Regional Office, with resources made available by the Federal Republic of Germany. Zoonoses and food-borne diseases are assuming public health importance in the countries of the Region, the major zoonotic problem being rabies. WHO has been providing assistance in the control of canine rabies and the production of anti-rabies vaccine. SEA/RC33/2 Page 69 India received assistance from a consultant in strengthening the programme of plague surveillance and the preparation of plague antigens required for surveillance. Nepal received assistance in rabies control. A WHO consultant advised the rabies control programme in Sri Lmka on the strategies for control- ling the population of stray dogs and on the preparation of veterinary anti-rabic vaccine. 2.8 Vector Biology and Control Vector biology and control activities were pursued in countries of the Region, in respect of the mosquito carriers of malaria, filariasis, dengue and Japanese encephalitis, and in certain areas also of the vectors of plague and typhus. The principal problems encountered during the year were the changing habitats of vectors caused by human inter- ference with the environment, as in areas of widespread deforestation and agricultural and water developments, expansion in areas of vector resistance to insecticides, and the uncertain role played by species complexes in the transmission of malaria. Increasing stress was laid on the multi-sectoral approach to vector-borne disease control through bio-environmental methods built into hydroelectric, irrigation and water supply projects. A particularly important contribution of the Regional Office to the control of epidemics or threat of epidemics of mosquito-borne virus diseases was the setting up of a Regional Emergency Unit for Vector Abatement (REWA), capable of providing space spraying anywhere in the Region at short notice. To make use of this unit in the countries of the Region, a training course in the methodology of such spraying in particular, and also in vector control measures in general, was organized by WHO in June 1980 in Delhi and Bombay. Participants from Bangladesh, Burma, Indonesia, Nepal, Sri Lanka and Thailand attended this course. Earlier, a national worker from Nepal received this specialized training in USA during 1979. Activities in individual countries are smarized as follows: In Bagtadesh, colonies of mosquitoes were established and maintained in the insectary of the Institute of Epidemiology, Disease Control and Research, Dacca, for research activities. The integration of vector- borne disease control with basic health services has necessitated the establishment of a multi-purpose entomological task force. In Bwma, 1.5 million kyats have been allocated for the construction of a building in Rangoon to serve as the headquarters of the Vector-borne Disease Control Programme. With financial assistance amounting to US$ 452 000 over a three-year period from the Government of the Netherlands, two long-term WHO staff members - an entomologist and a technical officer (sanitarian) - were assigned to the programme and a team leader (under the WHO regular budget) is being recruited. The SEA/RC33/2 Page 70 programme has also received supplies and equipment from UNICEF, and 5.65 million Canadian dollars over a five-year period from the Canadian Government (CIDA). In April 1980, an external assessment team consist- ing of representatives of the Governments of Canada and the Netherlands, together with WHO, reviewed the programme, which deals with malaria, filariasis, dengue haemorrhagic fever and Japanese encephalitis. To cope with the problem of DDT resistance in Anopheles annutaris and the breeding of A. swrdaicus in the coastal areas, larvicidal trials are being carried out using Fenitrothion, Pirimiphos methyl and Temeph0sE.C. The work of the WHO Rodent Control Demonstration Unit (RCDU) continued during the year, and several important scientific publications were produced. In India, the increasing use of malathion for vector control made it necessary in April 1980 for a team of national and WHO staff members to visit the spray areas in western India to assess the safety precautions being taken in the storage and utilization of this potentially hazardous insecticide. The steady progression of Anopheles cuZicifacies doubly resistant to HCH and DDT,andtrebly resistant to HCH, DDT and malathion, and of A. stephensi resistant to HCH and DDT, is causing increasing concern, and appropriate studies were undertaken in Gujarat by the Indian Council of Medical Research with support from the WHOITDR programme. In regard to the biological aspects of vector control, WHO is assigning a consultant to assist in establishing a colony of the larvivorous fish Nothobranchius guentheri, in identifying local fish with similar habits, and in drawing up protocols for field trials. With financial assistance from the Swedish International Development Authority (SIDA), a WHO entomologist has been assigned to the P. falcipam Containment Programme to study the distribution, bionomics and control of Anopheles in eastern India. The filariasis control activities continue to be an integral part of the national malaria eradication programme. The Government of Indonesia is strengthening the M.Sc. course in medical entomology at the Bogor Agriculture University to provide personnel required for the vector control programme; this course may receive financial support from the WHOITDR programme. Several research studies were undertaken, notably to identify methods for preventing the further spread of DDT-resistant AnopheZes aconitus and to determine the effectiveness of larvivorous fish against anophelines. The work of the Vector Biology and Control Research Unit (VBCRU-11) and its sub-unit in Semarang continued during the year. The activities included a number of research projects dealing with malaria vectors, rodents and ectoparasites, vectors of filariasis, insecticide trials and methods of insecticide application. In addition to these activities, the Unit and its sub-unit are providing the national staff with opportunities in training. A WHO consultant visited Maldives to review anti-mosquito measures with particular reference to Aedes. Trials of Ecopro 1700 chips as a SEA/RC33/2 Page 71 long-lasting larvicide are being planned under local conditions where conservation of potable water is a major priority. Re-stocking of wells with larvivorous fish is again being attempted, despite the adverse effects on the fish due to the chlorination measures taken to combat cholera transmission. A set-back occurred in 1979 to the anti- malaria programe when one of the two traditional vectors, Anopheles tesselatus, was detected on three atolls after an apparent absence (following a single round of DDT spraying) of seven years or more. Both A. tesselatus and the principal vector, A. subpictus, fortunately continue to be susceptible to DDT. In Nepal, WHO is providing a consultant in entomology to assist the anti-malaria programe in the planning and implementation of its activities, with emphasis on identifying problems requiring applied field research. Studies are also being planned on the cytogenetics of DDT-resistant Anopheles annularis, the principal vector in the development areas of the Terai. In Sri Lunka, UNDP has agreed to continue its assistance to Phase I1 of the vector control project until the end of 1981. This project, which coordinates the activities of the Anti-Filariasis Campaign (Ministry of Health), the programe of Colombo Municipality and that of the Medical Research Institute, is primarily concerned with the transmission and control of filariasis and dengue. Mapping and surveillance of permanent and temporary mosquito breeding sites in the Colombo municipal area is continuing. In rural areas, trials are planned with slow-release abate chips in coconut husk soak pits, which are the main source of CuZa quinquefasciatus (C. fatigans). A consultant is under recruitment to examine this problem and others connected with the control of Aedes aegypti. Following visits in 1979 and 1980 by a consultant in the transmission and cultivation of viruses, particularly dengue, the virology laboratory at the Medical Research Institute became fully operational. In Thailand, mappingofmalarious areas according to their degree of receptivity has been completed. A trial is being undertaken of surveillance activities based on different levels of malariogenic potential. In the five malaria control regions, monitoring of vector susceptibility to pesticides has been pursued systematically. In south-east Thailand, trials were undertaken on slow and controlled release larvicide formulations against Anopheles balabacensis in gem- mining pits. A trial of methods to control dengue haemorrhagic fever in four provinces of south-east Thailand is proceeding, with emphasis on community participation and health education of school children. The Organization sent a consultant to Thailand early in 1980 to examine research capabilities in the identification and cultivation of bacterial pathogens of mosquito larvae. 3. DISEASE PREVENTION AND CONTROL - NON-COMMUNICABLE DISEASES With the continuing rise in the average life expectancy at birth, there has been a change in the pattern of mortality and morbidity registered
1. STRENGTHENING OF HEALTH SERVICES 1.1 Planning and Development of Health Services During the period under review, several countries have successfully undertaken mid-term evaluations of country health programming (CHP). Medium-term health plans have been formulated or are in the process of being formulated. Governments are now endeavouring to extend the health planning process to the provincial and district levels so as to make it more relevant, and also to improve the managerial process for better implementation and operation. The monitoring and evaluation of priority health programmes using practical and useful indicatorsarenow receiving greater attention. The acceptance of primary health care as the key approach to the extension of health services implies, for most countries, the promotion of health and the provision of health care to all communities through the use of community health workers and the stimulation of community participation in health development. There is a clear understanding that primary health care is the key approach and not just an alternative. The extension of primary health care to the whole population entails inescapable implications for the entire health system. All levels of the government health services must be geared to provide the support needed at the village level, where the majority of the population lives. Training, supervision and the provision of supplies and referral facilities become essential activities of the basic health services. Primary health care in many of the countries includes the use of traditional medical practitioners, calling for a reorientation of thinking throughout the health system. 1.1.1 Health Phing, Progrme Fomlation and Evaluation The health planning and management activities which began in the countries of the Region in the early seventies continued during 1979- 1980. More countries joined those which had already applied country health programming for sound programme planning and management. The translation of the objectives of national health planning into broad programmes continues to help in clarifying the linkages needed between the planning, management and evaluation of major priority health programmes in a medium-term perspective. Early in 1980, an inter-country consultative meeting was held to review the medium-term programme in health planning and management and to revise it for the remaining years of WHO'S Sixth General Programme of Work. This meeting confirmed that several common areas of planning and management development warrant collaboration with external agencies and among the countries themselves. These include health programme SEA/RC33/2 Page 2 evaluation, the design and implementation of information systems, the analysis and formulation of current and future health policies, the creation of national foci of policy and technical support to health development (such as national health development centres or networks), the conduct of health services research, the provision of management training, the design and strengthening of support systems such as budget and finance, supply and logistics, personnel administration, and the planning and management of health services manpower. Three inter-country projects dealing, respectively, with research and development, training in planning, and information systems development, have continued to provide technical support to the countries in health planning and management and to provide back-up support to country projects. National training courses were organized and consultant services were provided in the field of information systems. Support was given to the conduct of studies on costs of health care and the financing of primary health care. A number of countries participated in a regional assessment of country health programing aimed at identifying the strengths and weaknesses of the process. As part of this review, national case studies were prepared and presented at an inter-regional seminar on country health programming held at Dubrovnik (Yugoslavia) in November 1979. Although it was evident that the countries of the South-East Asia Region were in the forefront of applying systematic health planning, much more remained to be done in extending this process to the areas of programme imple- mentation, management and evaluation. BangZadesh completed a review of its First Five-Year Plan and formulated the Second Five-Year Plan with emphasis on primary health care. A national training workshop for district-level health administrators was conducted in May 1979 in active collaboration with the Dacca university Faculty of Business Administration. National health policies have been formulated and a national committee for the implementation and coordi- nation of primary health care is being constituted. Preparations are under wayto develop a health manpower plan. These efforts are supported by a country project in planning and management to which a WHO public health administrator has been assigned. Buma continued its efforts to develop a system for the monitoring and evaluation of the CHP programmes under the Third People's Health Plan. In addition, a special analysis was undertaken to identify management problems within primary health care and the basic health services. The results of this analysis are being used as a basis for a management training programme for staff at all levels of the health services. Preparations are now under way for conducting the second cycle of CHP, taking into account the policy review carried out during the national seminar on health for all held in April 1980 and the mid-term evaluation of the People's Health Plan. SEA/RC33/2 Page 3 The focus of support to health planning and management in India was on training. A workshop on health planning organized for state-level officials stimulated further interest in training and planning activities at this level. A workshop on health economics and management was also held at the National Institute of Health and Family Welfare. This is to be followed by a series of state-level case studies in health economics which will form the basis of subsequent workshops. Steps have also been initiated to develop programme profiles. Indonesia is in the midst of its Third Development Plan, which was formulated by using the CHP approach. Extensive participation of health managers at the provincial level was achieved during the formulation of this plan and has set the tone for the future. The services of a WHO public health administrator, an economist and a statistician were provided to support the Bureau of Health Planning. The activities of the Bureau included preparation of plans and budgets, review of budgetary guidelines, evaluation of selected projects, analysis of the health financing system, collection of data for long-term policy formulation, and manpcwer planning. Formulation of the policy for health for all and designing the health services system constitute the major activities in 1980. Early in 1980 Maldives joined the ranks of those countries which have carried out the CHP exercise. A streamlined version of that planning process was used to formulate the policy for health for all and the operational strategies for the medium-term. For the first time, the community,and ministries other than health were also intimately involved in the planning process. A conrmunity survey was conducted and a seminar on health development was organized in a northern atoll. The resultant short-term strategies and programmes are lending support to primary health care. In Mongolia, activities during the year included the preparation of background material for the national health plan, organization of a seminar on health information, and the completion of programme formulation in maternal and child health. The national health information system also continued to receive priority attention. Nepal carried out a series of planning and management activities leading to a thorough mid-term plan review and the formulation of its Sixth Five-Year Plan. In addition, work on a national health manpower plan has begun, as has planning for the related teaching hospital. A WHO public health administrator assists in the development of the health information system and the design and implementation of health planning procedures at the district level. Sri kmka followed up the CHP exercise held earlier with the detailed formulation of the health service system for the Mahaweli development area. Subsequently, a WHO management officer was assigned and steps taken to review and revise the health manpower system and strengthen planning and management capabilities at the divisional and district sEA/RC33/2 Page 4 levels. Two workshops in health management were held during 1979 for district-level health administrators with WHO support, and a guideline for district health plans was formulated. ThaiZmzd continues to strengthen its health planning and management capability through the conduct of workshops and training courses. Nanagement data in six selected areas were collected preparatory to an expanded programme in health management training. A mid-plan evaluation of the Fourth Five-Year Plan was undertaken in preparation for the Fifth Plan, commencing in 1980. The Planning Division continued to evolve, in coordination with other ministries, a process of integrated provin- cial-level planning. The National Health Development Institute, set up with WHO assistance, has already carried out a number of activities such as policy analysis and formulation, evaluation and problem-solving in' management. It is establishing a mechanism to improve the national planning process through CHP and promote maximum inter-sectoral collaboration. A national health coordination commission has been proposed for monitoring health development. 1.1.2 Organization of Basic Health Services With efforts continuing for the strengthening of the health services infrastructure, the major emphasis has now shifted to the reorientation and reorganization of the health services system to subsente the identified needs of health for all. Activities have been aimed at bringing about improvements in the planning, management and evaluation of health services through appropriate training courses. Integrated multi-sectoral programmes such as the Mahaweli project in Sri Lanka and integrated rural development projects in Bangladesh and India have continued to make steady progress. Technical assistance in the form of expertise, fellowships and supplies and equipment in support of these efforts of the governments continued to be provided. In Bangladesh, the imbalance in the health services as between rural and urban areas is being gradually rectified with the expansion of health manpower, the health infrastructure and facilities, and the procurement and production of essential drugs. Since the rural areas account for more than 80% of the country's population, the Government has taken steps to strengthen the rural health services and support ongoing primary health care programmes. By the end of 1979, 244 thana health complexes had been established and another 46 complexes are expected to start operating by mid-1980. The referral system for the thana health centre, involving the sub-divisional or district hospital, is being strengthened. Thana health centres will also provide continuing education for primary health care workers to keep them abreast of new medical skills. WHO collaborated in the planning as well as the preparation of the curriculum and training material for the PalZi Chikitshuks (village doctors) scheme. This category of health worker will be drawn from candidates of either sex who have passed secondary school, and also from practitioners without formal medical qualifications. The training of the second group of 10 000 PaZli Chikitshake has started SEA/RC33/2 Page 5 in 100 thanas; 65 000 such workers are proposed to be trained. A draft manual for training this category of workers is being prepared. In Bhutan, through the basic health sciences project, the conversion of dispensaries into integrated basic health units has continued. The Health School continued to train health assistants, basic health workers and auxiliary nurse-midwives for the 31 basic health units established so far. A WHO consultant was assigned to review the structure of the national health services and to recommend its strengthening in order to improve and expand the delivery of health care. Through this project various components of health care also received attention. Another consultant was provided to review the water supply and sanitation situation and to make recommendations for further development. A third consultant collaborated in a study of the technologies used by traditional practitioners, advised on the possibilities of their practising modern techniques through orientation and training, and suggested measures for the integration of traditional medicine with the system of medical care. Assistance was provided in conducting a seminar on the expanded programme on immunization, which was launched during the year. In Bunna, the People's Health Plan, since its launching in April 1978 starting with 15 townships, had covered another 25 townships by April 1979, and preparations are under way to extend this plan to 35 townships in 1980. At the end of the planned period (1981-82), comprehensive health care delivery is expected to cover 147 townships, or 50% of the total in Burma. At the village level, there are 195 station hospitals, 1107 rural health centres and 3335 sub-centres. In addition, 4000 midwives serve the rural areas. The township medical officers and township health officers, who will function as managers at the township level, have been given orientation in the management and evaluation process. In the first year of the Plan, 666 community health workers and 300 auxiliary midwives were trained and, in the second year, 800 CHWs and 300 ANMs are undergoing training. For purposes of evaluation, collection of baseline data in villages was undertaken by basic health service and voluntary workers under the supervision of township medical officers and township health officers. As a built-in process, evaluation is carried out quarterly, annually and after each plan period, with a view to assessing the impact of the programme. In India, in line with the ~overnment's health policy, considerable stress is being laid on the preventive and promotive aspects of health, with a change in the resource-allocation pattern from curative to preventive programmes. Each of the 106 medical colleges in the country has taken up one to three primary health centres as their rural field practice area where medical students are exposed to primary health care. To maximize the delivery of health care to the rural population, a separate division - Rural Health Division - has been established in the Central Ministry of Health and Family Welfare with the primary SEA/RC33/2 Page 6 responsibility of coordinating the efforts of the Centre and the states, drawing up plans and programmes, and undertaking regular reviews and evaluation. At present, primary health centres form the nucleus for the provision of health services in rural areas. There are about 5380 primary health centres functioning in the country, each covering between 50 000 and 100 000 people. It has been decided to upgrade one out of every four primary health centres into a rural hospital for providing proper referral services to the rural population. The community health workers scheme has been extended to 1689 primary health centres, and 114 213 persons have been trained as community health workers. Attempts have been made to link the community health workers programme with the multipurpose workers' scheme to ensure integrated supervision of and effective support to community health workers in health care delivery. WHO continues to collaborate in the training programmes, in the production of manuals and in the planning and implementation of this programme. Village communities have been involved in the supervision of the activities of community health workers to ensure their better functioning. The programme aims to have 600 000 such volunteers, broadly on the basis of one volunteer per village, by 1983. Another complementary scheme in the field of rural health involves traditional birth attendants or dais. These workers, at the rate of one per village, are being given appropriate training to enhance their useful- ness to the community. Already, more than 250 000 such persons have been trained, with special orientation in family planning and welfare objectives. Further, with a view to making the best use of all locally available resources, more than 200 000 practitioners of traditional medicine will be brought within the programme for the delivery of health care in the rural areas. Towards this end, it is intended to provide special short-term peripatetic training at local centres, to equip them to deliver services within the overall objective of the national primary health care programme. WHO is collaborating with the Government in establishing and strengthening the rural health administration at state and district levels by organizing group educational activities. In Indonesia, steady progress continued to be made in strengthening the infrastructureof ruralhealth services. There are now 4353 health centres covering all kecamatans (districts). The existing 7397 unipurpose health units (polyclinics and maternal and child health centres) are being integrated to become multipurpose sub-centres. More than 80% of the Puskesmas (primary health centres) are now headed by doctors and 91% of the target for the placement of para-professional staff has been achieved. The primary health care programme has been expanded to cover a total of 12 provinces. Several kecamatans and villages not formerly included in the programme have initiated programmes on their own. The programme for the training of trainers for village health workers has gone through the national, provincial and kabupatan levels. Kecamatan training teams will train village health workers during the first two years of Repelita 111 (Third Five-Year Plan). Under the primary health care programme self-learning materials for teachers at the kecamatan and village levels are being prepared with UNICEF support. A WHO consultant assisted in the assessment of the operation of the programme S~A/Rc33/2 Page 7 during the last two years of Repelita 11. Manuals for village health workers and their teachers have been developed and are to be field- tested soon. US AID has provided $ 5 million, representing part of its assistance programme for EPI, to the Directorate General of Community Health for strengthening basic health services. Assistance was provided in developing the "Country Needs Assessment Document" and the project proposals which were presented at the July 1979 Meeting on the Financing of Primary Health Care Programmes in Asia. Training courses were conducted for 540 health centre personnel in the team approach so as to increase the utilization of the Health Centre Reference Manual. Two hundred and ninety-six mobile health centres have been established. Two workshops were organized to review the family health care prograrmne in 11 out of the 16 provinces where it is operating. A national work- shop on public health nursing and supervision is to be organized for nursing personnel at various administrative levels. Areas of WHO collaboration with the Government include analysis of existing health and health-related policies, demographic projections, and the public sector financing of health services at national and provincial levels. Plans to develop health centre reporting and surveill.?~ce systems have been prepared. Two consultants assisted the Sub-Directorate of Community Health Services in examining the content and utilization of the Health Centre Reference Manual. In Maldives, the emphasis continued to be on the integrated health care approach. The Ministry of Health has drawn up a plan to open four regional hospitals through external assistance; out of these one is nearing completion. WHO has been collaborating in the training of community health workers and providing consultants in clinical specialties. The Government has carried out a national exercise involving all health and health-related sectors to prepare for country health programming, which will focus on strategies for health for all. MongoZia, which has made steady progress in improving the state of health of its population, now lays stress on providing a better quality of health care, in particular, maternal and child health. A long-term WHO hospital architect was assigned to assist the Government in developing functional designs of hospitals or remodelling the existing ones, as well as to train local designers. A consultant developed a draft project document for a pilot primary health care centre covering Khubsugal Aimak. In Nepal, where 96% of the population lives in rural areas in difficult terrain, successive development plans have given priority to the provision of health care to the maximum number of people. The health services, which in the past were mainly in urban areas and the terai region, delivered mostly curative medical care through hospitals and other institutions. During the last few years, there have been considerable improvements in rural health facilities, mostly directed at the un-served rural population. A further significant expansion of the health services is under way, as the Fifth Five-Year Development Plan envisages strengthening of the infrastructure of the health services SEA/RC33/2 Page 8 in rural areas by the establishment of 810 health posts to be supervised by 48 district health offices, with a referral system to hospitals (one in each of the country's 75 districts). These will be administered by the four regional health offices. A wide range of activities were accomplished, including the construction or conversion of more health posts; the in-service training of personnel in health posts and district health officers; the training of community leaders; the assessment of the nutritional state of children under five, and the expansion of the innnunization programme. A WHO team, in collaboration with other agencies, continued to provide active support to these efforts. Bearing in mind the constraints posed by shortages of capital and manpower resources, the Government conducted a mid-term situational analysis within the framework of the Fifth Five-Year Development Plan in collaboration with WHO, UNICEF, UNFPA and US AID. This exercise was timely, as it coincided with preparations for implementing a village-volunteer, primary health care scheme with the support of the basic health services. Basic training of village health workers and community leaders has been initiated. A major survey of the total health system and facilities, from the central level through the district and health post levels to the recipients of health care, was conducted. This study, in which WHO as well as UNICEF and US AID collaborated, is expected to facilitate reforms in the health system under Nepal's Sixth Five-Year Plan. The survey has provided particularly valuable information in the areas of family planning and integrated health services. In Sri Lanka, in order to achieve the balanced development of health services, the Ministry of Health is placing emphasis on preventive services and organizational changes which will result in the implementation of a strong primary health care programme throughout the country. The Institute of Hygiene, Kalutara, is being developed as the National Institute of Health Sciences, with a wider role and responsibility for training and health development. A pilot project for the training of community health workers was initiated in two districts under the charge of the medical officers of health. The village health volunteer programe, initiated in 1976, is being further developed. So far, 6000 village volunteers have been trained and are working. The Mahaweli Project - a major national development project with multisectoral inputs - continues to be developed in a coordinated way. The experience of this project will be particularly useful for ensuring intersectoral collaboration in health development towards attaining the objectives of health for all on a national scale. The expansion of the integrated rural health service infrastructure in Thailand in support of primary health care continued to make steady progress. The training of village health volunteers and village health communicators in collaboration with WHO has made considerable headway throughout the country. All 60 training modules for these workers have been printed and used in all the provinces involved. As of September Primary health care means reaching out to the people. HEALTH FOR ALL Health for the people and by the people. Health staff keep in close touch with the community to secure their participation. primary health coverage necessarily ~lves health care when people are invc ill. The traditional rural society in th€ Region likes its health worker to be from the community. accessible at all times and responsive to its needs TH FOR AL The popularity of health r pends largely on the exter they can meet the immedia those they serve. Norkers de- 11 to which te needs of AS some 401;/, of the Reg~on's nnnllla tion is under 15 vears of aaa. ---- - children need sp ion. Pro1 heal HEALTH FOR ALL per care of thl, ",".",th infants WI ."A . nrn ill ensure a ..., ,." ..... -,,- I w...ductive life. Malnutrition is not the result of an , inadequate diet alone, but also of poorly prepared food. Therefore 'A* ' mothers need to be guided in the #- - preparation of a healthy and balanced '--C diet far thefamily. - Traditional healers form a large res voir of health manpower in the rural areas of the Region. Their support is vital in providing health care to all. HEALTH FOR ALL .-..;hing by doing Health and nutrition education, parti- . - rrPPI cularly of mothers, can be of immense value in achieving health for all. HEALTH FOR ALL Prever 2ation from ltive measures such as immuni- of children ensure protection childhood diseases-still the maior killers in the Region. 1 I education ling programmes far medical stuoents need to be made more relevant to changing requirements of the ct munity. A student of medicine visits a home as part of her practical training. Health workers should identify them- selves with the needs. problems and aspirations of the rural masses to be able to serve them better. SEA/RC33/2 Page 9 1979, a total of 96 932 village health communicators and 3992 tambon trainers have been trained. A training programme in urban administra- tion and planning for personnel from 118 municipalities was completed. As part of this programme, two senior health administrators of Bangkok Metropolis were sent to Austria to attend a course on health planning development with special reference to urban areas. The Lampang Health Development Project was extended for two years with US AID assistance for the purpose of evaluation. It is proposed to prepare a series of monographs on the experiences of the Lampang Project. WHO collaborated closely in this project in various aspects, including evaluation, education and training. 1.1.3 Operational Studies " In pursuance of the objective of health for all by the year 2000 and in consonance with the guidelines evolved at the Alma Ata Conference on Primary Health Care, Member countries are making concerted efforts to develop result-oriented health services research in order to seek urgent answers to priority problems. Since 1976, when the South-East Asia Regional Advisory Committee on Medical Research identified health services research as a priority area, three research study group meetings have been held and have delineated several specific research areas relevant to the promotion of primary health care. WHO assistance was provided to a number of research projects in the Region. It was recognized that there was a need to enhance the research capability of the investigators to help bring the benefits of research to the people. Towards this end, a Regional Meeting on the Development of Health Services Research was held in November 1979 to give orientation in health services research to key persons in the health and other development sectors and in academic institutions so that they could function as a nucleus in their respective countries for the promotion of such research. The participants, who were high-level policy makers and research scientists, unequivocally expressed the need for the development of local cadres with capability in health services research. They also drew up a broad outline for a regional multidisciplinary course. In Bangladesh, assistance was given to the Bangladesh Institute of Development Studies in conducting a study on the financial aspects of health care delivery. This study provided an overview of the range of financing methods used presently, including innovative and experi- mental schemes. In Bma, as a follow up of the recently-completed Study on the Outcome of Pregnancy, including Perinatal Mortality and Morbidity and Low Birth Weight, a Study on the Application of Risk Strategies in Maternal and Child Care in Primary Health Care was initiated. Two studies, one on the role of health workers in the lay reporting of vital statistics and the other on the role of midwives in epidemiological surveillance, were completed. Assistance was given for a detailed study of the management SEA/RC33/2 Page 10 problem in the implementation of primary health care under the People's Health Plan. The findings of this study provided useful inputs for the formulation of a management training programme and the development of a training protocol. Assistance continued to be provided to India in studies of the factors influencing the adoption of practices related to the health aspects of family planning and in the development of courses in health education. The data from the Study of the Outcome of Pregnancy, including Perinatal Mortality and Morbidity and Low Birth Weight, are being anaIysed for the preparation of the protocol for the study on the Application of Risk Strategies in Maternal and Child Care in Primary Health Care. In collaboration with the National Institute of Health and Family Weflare, a five-day national workshop on health economics and management was organized in New Delhi in September 1979. The aims of the workshop were, among other things, to orient health planners and administrators in basic economic concepts and their application in the field of health; to identify cost centres and ways and means of effecting economies in health expenditure in the identified cost centres; and to identify areas of study in the field of health economics. A course in health planning and management for state-level officials was conducted at Shillong, also in collaboration with the National Institute of Health and Family Welfare, to expose the participants to the principles, practices and methodologies of health planning and to strengthen and improve health planning at the state level. In Indonesia, assistance continued to be provided to the study for the development of the disability prevention and rehabilitation component of public health care. The Study on the Outcome of Pregnancy, including Perinatal Morbidity and Mortality and Low Birth Weight, was completed. In Sri Lanka, the study to determine the effectiveness of health education by volunteers in the family health education programme continued to make progress. Field work for the Study on the Outcome of Pregnancy, including Perinatal Mortality and Morbidity and Low Birth Weight, has been completed and the data are being processed. A study on Sri Lanka Health Sector Commodity Requirement and Expenditure Flows was initiated in November 1979. A draft of the study on the role of indigenous medical practitioners has been prepared and one on the manpower and health personnel management system is being conducted. A number of studies are being undertaken in ThaiZand. The study on the Outcome of Pregnancy, including Perinatal Mortality and Morbidity and Low Birth Weight was, as in other countries, completed and the data are being analysed. An experimental Study of the Impact of the Age and Sex of Leaders on the Implementation of Health Programmes continued to make progress and an interim report is being prepared. Studies recently started include: Application of Risk Strategies in Maternal and Child Care in Primary Health Care; pilot study of a simplified maternal and child health data collection card; factors affecting Rural Low Birth Weight, and the strengthening of basic immunization programmes in urban SEA/RC33/2 Page 11 communities. The following studies are under consideration: comparison of the effectiveness and impact of corresponding supervision between qualified and non-qualified health educators at the provincial level; survey of community and government expectations of health delivery system, and a pilot study on village and neighbourhood cooperatives. Assistance was given in the mid-term assessment of the Fourth Five-Year Health Plan. The results and conclusions of the analysis and evaluation would serve as a valuable input for policy formulation and planning activities leading to the development of national strategies and plans of action for health for all. 1.2 Primary Health Care All the countries of the Region have unequivocally accepted the global * commitment of health for all by the year 2000 as their social goal with primary health care as the key approach. The thirty-second session of the Regional Conmittee, held in September 1979, reviewed the situation and evolved guidelines for the development of national and regional strategies to achieve the objectives of health for all through action programmes. To assist Member countries in this important task, a Regional Meeting on the "Formulation of Strategies for Health for All by the Year 2000 with Primary Health Care as the Key Approach" was held in the Regional Office from 1 to 6 December 1979, jointly sponsored by UNICEF and WHO. Twenty-five high-level national participants from the health and related sectors from nine countries attended the meeting, which was preceded by national-level preparatory activities in most countries, supported by WHO. The regional meeting focused on the clarification of the concepts and connotations of "Health for All by the Year 2000" in national terms, and reviewed the existing and proposed national mechanisms for developing appropriate national KFA policies, strategies and plans of action with particular emphasis on inter- sectoral collaboration and community participation. It also considered issues for drawing up broad plans for the period 1980-2000 for health development as a part of overall national development. The participants also discussed specific critical issues related to the planning, implementation and evaluation of primary health care as the key approach to HFA and identified areas for active WHOIUNICEF support. The deliberations of this meeting led to intensive activities at national level which consisted of critical reviews of national health systems for the purpose of reorientation, perspective planning, implementation and evaluation of primary health care programmes, resource-need analysis, and the use of appropriate indicators for setting targets and for monitoring performance. As a logical sequence to the December meeting, yet another Regional Meeting on Strategies for Health for All by the Year 2000, again jointly sponsored by UNICEF and WHO, was held in the Regional Office from 24 to 30 June 1980 to review the national strategies for HFA/2000 as well as to formulate the regional strategy. Political commitment and national resolve are indeed the primary factors in making the universal goal of health for all by the year 2000 a SEA/RC~~/~ Page 12 reality. A significant milestone in this regard is the Charter for Health Development, which was finalized and endorsed at the thirty-first session of the Regional Committee and which has so far been ratified by five countries in the Region. For the South-East Asia Region, the Charter is indeed a milestone as it not only denotes a firm commitment to the cause of health but also provides a powerful mechanism to trans- late such commitment into reality. In BangZadesh, a National Health Council has been established to help ensure the implementation of national policies and guide the Ministry of Health in developing services, keeping health for all as the ultimate goal. The implementation of primary health care programmes will be guided by a central body which will be responsible for the planning, management and evaluation of health services in general and primary health care in particular. The Second Five-Year Plan (1980-1985) envisages the operation of thana health complexes, one in each of the 356 rural thanas, as well as 4500 union health centres and family welfare centres. These will chiefly give support to the primary health care activities at the village level, in terms of training,supply of drugs as well as the provision of guidelines and supervision along with the domiciliary health services of the government health institutions. In Bunna, a task force for HFAl2000 headed by the Minister of Health is being established to draw up a tentative national strategy with the participation of other ministries concerned, such as the Ministry of Planning and Finance, the Ministry of Agriculture and Forests, the Ministry of Education and the Ministry of Social Welfare. A meeting jointly sponsored by the Ministry of Planning and Finance, the Ministry of Health, WHO and UNICEF was organized for formulating national policies, strategies and plans of action for the future medium-term programmes and a long-term perspective programme for HFA/2000. The highlights of the primary health care programe in Burma include: (1) the deployment of two categories of voluntary health workers - the community health worker and the auxiliary midwife - and (2) community participation. The community is involved from the very beginning of the planning process and in the implementation and evaluation of various activities at the local level. The programme envisages provision of primary health care services through the recruitment of voluntary community health workers supported by the local community, and their training by the township health department. Supervision of the community health workers will be carried out by the basic health services. Guidelines, materials and manuals for teaching are being developed by the Health Department to support the training and field activities of community health workers. India places great emphasis on primary health care with increased allocation for rural health and the strengthening of the infrastructure at the peripheral level. WHO and UNICEF are collaborating in the development of the primary health care programme. Assistance from WHO has been in the form of fellowships, equipment and grants. The grants have been used for the printing of manuals for multipurpose workers and SEA/RC33/2 Page 13 the payment of stipends to district medical officers and the trainers of health and family welfare training centres. Support was also given for the conduct of a national meeting for the formulation of strategies for health for all hich, among other things, recommended the establishment of central coordinating mechanisms between the existing centres of expertise in the health and health-related fields with a view to linking them in a functional network to facilitate their contribution to HFA activities. Steps have been initiated for establishing a coordinating mechanism between the various ministries and departments concerned at the central, state and district levels. Indonesia is formulating an appropriate national health system, as part of the essential steps for the achievement of the objectives of health for all. Similarly, the formulation of long-term health plans in relation to HFA is also receiving special attention. Since the begin- ning of 1979, the Ministry of Health has undertaken reorganization of the health services to improve intrasectoral coordination and strengthen the provincial and regency health offices to ensure programme imple- mentation. It has been decided to establish a national committee to review and reformulate the basic health policies, to formulate the long-term plan and to design the basic pattern of the Indonesian health system. In addition, a steering committee headed by the Minister of Health and consisting of all first-echelon officers in the Ministry of Health, and a planning team with the Secretary-General of the Ministry of Health as General Chairman, are being established. Working groups have been formed, to which national experts in the health and other sectors will be invited as necessary. Assistance was provided in the organization of a national seminar to formulate plans of action and national strategies for HFA/2000. In Maldives, a national conference with the participation of represen- tatives of different sectors discussed priorities in health as an integral part of national development. Using this national dialogue as a base, a country health programing exercise was carried out, in collaboration with WHO, to formulate strategies and plans for achieving the objectives of health for all. The Allied Health Services Training Centre continues to train community health workers. In order to strengthen the delivery of health care, the Government plans to increase the number of community health workers from one to two at each health centre. Another category of health personnel - the family health worker - is being trained for service in those islands where there is no health centre. In addition, the "foolumas", the traditional birth attendants, are being reoriented for maternal and child health as well as general health services. Mongolia considers the approach of health for all as relevant to the country's health situation. The priority programmes enunciated in the national health policy cover the main elements of primary health care, and efforts are being made to draw up a detailed and comprehensive PHC package. A task force has been established to define strategies for realizing the goals and targets of health for all. A national committee SEA/RC33/2 Page 14 is to be constitutedto coordinate and prepare detailed and concrete policy guidelines, reformulating in more explicit terms the goals and approaches in the field of health development to serve as a basis for a national inter-sectoral plan of action. The English version of a booklet, "Health Law of the Mongolian People's Republic", which deals comprehensively with all health aspects, was published in 1979. The most significant activities in Nepal were the preparatory steps taken by the Government for the elaboration of policies, strategies and plans of action in relation to health for all. Action was taken to set up a joint Government/WHO Management Group to support and guide the Department of Health and the Health Planning Unit in planning, imple- mentation, evaluation and intra and inter-sectoral coordination, including the coordination of all extra sources of support. In addition, a National Health Development Council, a top-level, policy-making body, has been set up to evaluate the progress made by primary health care programmes and take corrective measures to ensure balanced development. In Sri Lanka, concerted efforts are afoot to strengthen the health infrastructure in order to ensure that primary health care reaches the unserved and under-selved rural population. A multi-sectoral commitment has been made towards the achievement of health for all and primary health care has been accepted as the vehicle through which this will be realized. A National Health Council chaired by the Prime Minister and with the Minister of Health as the secretary has been established to ensure combined and collaborative action on the part of different ministries and departments. Under this council, a National Health Development Committee has been set up to coordinate and implement health programmes. In Thailand, the activities of the nation-wide primary health care project have been extended to cover approximately 15 000 villages in 69 provinces. The primary health care administrative unit in the Office of the Under-Secretary of State for Public Health has been designated as the focal point for the national inter-sectoral coordi- nating mechanism. The Government has approved the establishment of a formal mechanism for the coordination of collaborative efforts between the Ministry of Public Health and the Office of State Universities. Joint ventures in regional, provincial and local development planning are also being carried out under the auspices of the National Social and Economic Development Board and the Ministry of the Interior, in which the Ministry of Public Health is closely collaborating. In addition, a National Health Development Institute with financial assist- ance from WHO Headquarters has been constituted. The board of the Institute will have on it representatives from other ministries, departments and agencies, and will have functional linkages with them. A number of national seminars and workshops for various categories of officials from relevant divisions in the Ministry of Public Health as well as from other sectors, were held. An inter-regional committee on primary health care under the Chairmanship of the Deputy Minister of Public Health was established with a full-fledged secretariat. The SEA/RC33/2 Page 15 Government of Thailand constituted an ad hoc committee to undertake preparatory activities for national conferences on policies and strategies to achieve health for all. The first in the series of such meetings was held in November 1979 in which about 100 persons from all relevant sectors participated. With support from WHO and UNICEF, the Ministry of Public Health organized a bi-regional (South-East Asia and Western Pacific) workshop on primary health care in June 1980 in order to share experiences among developing countries. Case studies in four countries of the two Regions were used as inputs. 1.3 Traditional Medicine Most of the countries of the Region have recognized the importance of traditional medicine, particularly its potential usefulness in primary health care. Considering that the vast majority of the population, at least in this part of the world, depend largely on traditional practitioners for their medical care, it is heartening to note that traditional medicine has attained its rightful place. WHO has continued to develop and strengthen programmes of traditional medicine in the countries of the Region. This has been done through visits of specialists, the participation of educationists and research workers in international meetings and conferences and tours in the People's Republic of China (with UNDP support) and elsewhere. Research is also being stimulated in priority areas identified by the study group on traditional medicine of the Regional Advisory Committee on Medical Research. In addition, fellowships have been awarded and supplies made available in order to give further impetus to traditional medicine. A consultant who visited Indonesia and Thailand in June-July 1979 held detailed discussions with the national authorities and carried out surveys to find out the place of traditional medicine in ongoing or planned programmes related to primary health care. In Indonesia, he participated in the Second South-East AsiaIWestem Pacific Regional Meeting of Pharmacologists, held in Yogyakarta in June 1979. It is very encouraging that the Government of Thailand has made traditional medicine an integral part of primary health care. A very significant development during the year was the designation of the Gujarat Ayurved University, Jamnagar (India), as a WllO Collaborating Centre for Traditional Medicine (Ayurved), initially for a period of three years, in order to make the maximum use of the expertise available in the Region. This is the first such collaborating centre in South- East Asia. Action is under way to designate a similar centre at Varanasi. India. The project. "Research on the Efficacy of Ayurvedic Treatment of Rheumatoid Arthritis",continues to make progress at the Ayurvedic Trust and Research Institute in Coimbatore, India. WHO arranged for visits of some research workers from Sri Lanka to this institute. Some important group educational activities held outside the Region with participants from South-East Asia were: a training course on SEA/RC33/2 Page 16 acupuncture treatment, China, 1 September - 30 November 1979; a study tour on traditional medicine with emphasis on medicinal plants, hosted by the People's Republic of China to exchange experience on the role of traditional medicine in the organization of community health care delivery systems, June 1980; an International Conference on Traditional Asian Medicine, held in Canberra (Australia) from 2-8 September 1979, and a Consultation on Potential for Use of Plants Indicated in Tradi- tional Medicine in Diabetes Mellitus and Cardiovascular Diseases,Geneva, 30 October - 2 November 1979. In India, the indigenous systems of medicine have been accepted as integral parts of the country's health services. The authorities are very keen to develop these systems rapidly so that health care is delivered to the millions living in the rural and far-flung areas. The Government has launched many schemes to improve the quality of graduate and post-graduate education, promote research activities and the planned production of iierbalmedicines. Two important group educational acti- vities took place in India during the year - a national seminar on Ayurvedic Research, organized by the Gujarat University in November 1979, and the First Conference on "the Role of Ayurveda and Traditional Medicine in Primary Health Care", inaugurated by the Regional Director at the Institute of Medical Sciences, Banaras Hindu University,Varanasi, in March 1980. 1.4 Family Health In the regional programme in maternal and child health including family planning, the emphasis is on promoting national efforts to reorient this programme towards the social objective of health for all. Technical support was provided to ensure continuation of the emphasis on child welfare initiated during the International Year of the Child. Towards this end, national and regional programmes for the care of the pre- school child in the context of primary health care were formulated at a consultative meeting held in November 1979. Based on WHO'S long-term programme in maternal and child health as adopted by the World Health Assembly in May 1979, stress was laid on stimulating countries to include concrete plans for maternal and child health care as essential elements of primary health care. Care during pregnancy and child health, family planning, infant and child care with added emphasis on nutrition, prevention of infections, promotion of the physical and psychosocial development of the child and education for family life were also suggested as important components. In the field of training in maternal and child health and family plan- ning, the main objective was to promote self-reliance through the strengthening of national capabilities for training all levels of workers. Special attention was given to the training of front-line workers and their supervisors as well as workers of other related sectors. A programme that received particular attention was the development of a regional teacher education programme in maternal and child health, which has as its aim the strengthening of the capabilities SEA/RC33/2 Page 17 of national institutions and the promotion of technical cooperation among developing countries. Continued support was also provided for the revision of curricula for the teaching of paediatrics and maternal and child health to medical undergraduates and interns. In addition, research in some priority areas of maternal and child health relevant to future studies of health services research continued to receive assistance. Various group educational activities in maternal and child health carried out during the year are described elsewhere in the report (see Section 7.2 Education and Training in Maternal and Child Health, Section 7.7 "Group Educational Activities" and Annex 4). Activities carried out in the different countries during the period under review are briefly described below with special reference to project targets and evaluation. In Bangladesh, as a follow-up of an inter-regional course in fertility management and maternal and child health care held earlier, a national workshop was organized and two curricula - one for peripheral workers in family planning and maternal and child health and the other for intermediate personnel (district and supervisory officers) - were developed with the support of a WHO consultant. To strengthen the maternal and child health services in Bhutrm, two projects to be funded by UNFPA have been formulated. One of the projects is designed to develop and strengthen training in maternal and child health and family health, since the major constraint has been the lack of trained manpower. In Burma, assistance was given to the family health component of the People's Health Programme for the further extension of coverage and improvement of the quality of maternal and child health services and of school health and nutrition services. Programmes of orientation and training for basic health workers, community workers, township education officers and headmasters of schools also received support. Fellowships were awarded for training outside the country to develop health manpower in maternal and child health to provide referral services for primary health care. Detailed analysis of the data on the perinatal study continued, and preliminary steps were taken to carry out a study on the Application of Risk Strategies in Maternal and Child Care in PHC. A WHO consultant was assigned during the year to advise on the managerial and training aspects of the family health programme and to review the organization of maternity services. The programme targets were achieved. In India, through technical cooperation extended to maternal and child health activities, support was given to national efforts to strengthen the family planning programme. SEA/RC33/2 Page 18 The care of the newborn at the district level was supported through national educational programmes for paediatricians at this level. WHO continued to collaborate in disseminating further the re-modelled curriculum in paediatrics and in demonstrating the integrated teaching of maternal and child health, including family planning, to medical undergraduates and interns. A WHO temporary adviser carried out an evaluation of the programme on undergraduate paediatric education which revealed that the programme has been satisfactory and the fellows have benefited and have become reoriented, but that less than one-fifth of the medical colleges in the country have availed of the programme so a. It has, therefore, been recommended that the programme should continue and be strengthened by the addition of another demonstration centre, in order to benefit as many paediatriciana as possible from the "prototype" or "average" medical colleges in the country. The evaluation results have been communicated to the Government. The Organization continued its collaboration in the family welfare programme. A study tour for senior health administrators and obstetricians was arranged through an inter-regional project. Two other activities supported through the inter-regional programme were a Seminar on Social Distribution of Conventional Contraceptives, and a Workshop on Medical Termination of Pregnancy and Advanced Techniques of Maternal Care. The second year's data on the collaborative study on perinatal mortality and morbidity are being processed. Assistance was given to preliminary activities for formulating a research protocol for the second phase of the study. In Indonesia, through the project "Medical Services in Family Health", the development of an integrated approach to the delivery of family health services is being strengthened; observation tours to countries in the Region having successful programmes are being organized. Under the "Health of Family" project, fellowships are provided in maternal and child health and school health. A new component, "Community Health Nursing", has been added to this project in order to strengthen community health services further. The perinatal study which was started two years ago has been completed and a detailed analysis of the data is under way. In Maldives, a consultant assisted with the strengthening of the child health programme as well as the teaching of maternal and child health to community health assistants. The country health programming exercise carried out in February-March 1980 has set targets for improving the situation concerning complications of delivery and for reducing maternal and infant mortality rates. Accordingly, within two years, 50 per cent of the pregnant women are to receive antenatal care in the second and third trimesters of pregnancy and 50 per cent of all deliveries will be attended by trained women. The infant mortality rate is to be reduced from 120 to 90 by 1990. SEA/RC33/2 Page 19 WHO'scooperationwith MongoZiawas directed towards further expanding and improving the integrated family health programme,especially at the aimak level. Together with UNICEF, support was also given to pre-school care, the nutritionof mothers and children,and the rehabilitation of handicap- ped children. All activities were carriedouton schedule,exceptfor the tripartite evaluation of the programme by the Government,UNICEF and WHO. The first phase of the UNFPA-funded project, "Epidemiological Studies of Population Growth", was completed in December 1979. A review of the preliminary phase of the programme, carried out in August 1979, revealed satisfactory implementation of planned activities with an obligation of 78 per cent of the approved budget. Activities related to health educa- tion that could not be completed in time have been carried over to the new project. During the preliminary phase of the project comprehensive maternal and child health services were established in ten districts with emphasis on the preventive and promotive aspects and on improvement in the quality of specialist care for mothers and children. Advice was given on developing a study protocol on the nutrition of infants and young children. A consultant in statistics assisted in the analysis of data from research studies completed earlier. WHO collaborated in the preparation of a new project proposal for UNFPA assistance which was reviewed by the UNFPA Needs Assessment Mission to Mongolia. Pre-project funding has been approved by UNFPA. In Nepal, based on the findings and recommendations of the UNFPA Needs Assessment Mission, technical support was provided in the formulation of projects, especially those related to the strengthening of the inte- grated community health project in the Ministry of Health, the service delivery system, the family planninglmaternal and child health project, and the use of traditional medical practitioners in family health. These projects were planned to start operations from July 1980. Assistance was also given in the further development of the health A manpower requirements in maternal and child health, mainly at the district level, through national and regional training programmes. A consultant collaborated in the formulation of a training programme in tubectomy (minilap technique), and assisted with the training. WHO also helped in the procurement of some equipment required for the programme. Another WHO consultant was assigned to the country to help review and assess the child health component of the national family health programme, to make recommendations for strengthening the child health programme, especially at the primary care level, and to identify areas for further technical cooperation. A research study on the growth and development of children, using the WHO Growth Chart, is being initiated as a follow-up activity. In Sri Lunka, the UNFPA-funded projects, "Strengthening of the Hospital- based Family Health Services" and "Family Healthl',were revised in August 1979 for further extension. A WHO consultant was assigned to assist with the execution of these projects. SEA/RC33/2 Page 20 As planned in the first project, 32 district hospitals have been upgraded through additional inputs, including equipment and supplies, and a further 55 hospitals and peripheral units are being upgraded in 1980 to provide sterilization facilities and maternal and child health services. Further, a programme to train district medical officers in performing sterilization operations has already started. To promote family health in rural areas, a manual for family health workers has been published in English and Sinhala and the Tamil version is under production. To introduce this manual, supervisors and peripheral health workers are being given on-the-job training. Orientation and training in maternal and child health and family planning for groups of medical officers and paramedical staff in municipal areas is under way. In order to evolve optimal strategies for the delivery of family health services in the rural areas, field research and management studies have been undertaken in selected places. WHO'S technical cooperation in Thailand was extended, mainly through the execution of UNFPA-funded projects, for the further strengthening of the national family planning programme, which continued to make good progress. A consultant was assigned under the Regional Team on Family Health to provide support to the national family planning programe. The project targets were achieved on schedule. In the field of maternal and child health, support was given to develop a simple, effective information system for maternal and child health, including family planning. A pilot study of a simplified maternal and child health data collection card was initiated for this purpose. Support was also given to a study on perinatal mortality and morbidity. including low birth weight, in one of the provinces. Work on the WHO collaborative perinatal study was continued with the analysis of research data. Assistance was provided in developing a research protocol for the Study on the Application of the Risk Strategies in Maternal and Child Care in PHC. 1.5 Nursing In the year under review, emphasis has been laid on the development of nursing manpower planning at the national level. Special efforts are being made to enable the integration of nursing with the total health manpower development. Despite all attempts to increase the number of nurses/midwives in the Region, there is still a shortage of these categories of health workers. To ease this problem, special attention has been given to the utilization and management of nursing manpower. Nursing activities in the context of primary health care are carried out by various categories of nursing personnel at different levels. Since there is still a great need for the training and utilization of different categories of nursing personnel, their role and responsibility, as well as their contribution to primary health care,should therefore be clearly defined. With the support of WHO nursing field staff, task analyses and the preparation of job descriptions have been undertaken. SEA/RC33/2 Page 21 Nursing Education In nursing education, continuous support is given to the countries in reviewing and improving curricula with a community orientation. A plan is to be developed for implementing a "conanunity health-oriented nursing education planning and teaching guideline" in one country. The prepara- tion of nurses in special clinical areas as a back-up service for primary health care has received greater attention. The development of innovative training programmes for community health workers has been undertaken by national and WHO staff. Nursing Research The need for nursing research is recognized in this region. The major constraint, however, is the inadequate number of qualified nursing research personnel. Technical cooperation among developing countries, therefore, plays an important role in this area. Special efforts have been made to assist in the development of research protocols which can be used to identify problems affecting nursing education and nursing service or to modify nursing education programmes to prepare nurses for their role in primary health care. Lists of nursing resource persons for primary health care in this region are being compiled by WHO. Nursing Service Administration In the field of organization and management of nursing services some progress has been made in setting standards of care and relating the achievement of these standards to the most economical and efficient ways. Activities have focused on strategies for the improvement and refinement of existing programmes keeping in mind community orientation. When required, radical changes and programme substitutions were made to produce a category of nursing personnel for utilization outside the institutional framework. d. Assistance was provided to clinical specialties in improving nursing practice. Examples are: neurological nursing; mental health/ psychiatric nursing; orthopaediclrehabilitation nursing, and community health nursing. Continuing education programmes were organized and national plans formulated for continuing education for existing staff. There is need to strengthen further the participation of nursing administrators in country health programmes and to develop skills in the planning and management of the nursing component of the health care delivery system. Country Activities The Organization has been collaborating closely with the countries in the development of nursing. The following is a summary of activities in each country, reflecting the needs, problems and progress during the period under review. SEA/RC33/2 Page 22 In Bangladesh, basic nursing education through 18 government training centres continues to show improvement. The preparation of teaching personnel for the training of nurses for primary health care was undertaken. A plan for developing a division of continuing education is in the initial stages and further details are being worked out. In Burma, an assessment of the pilot project on the training of traditional birth attendants was completed in December 1979. The project proved to be very successful as a model for training, and the Government has extended it to other areas of the country. During the year WHO consultants have worked with the national staff in India to develop specialists in clinical nursing in different areas. Special efforts are needed to strengthen mental health and psychiatric nursing in the RAK College of Nursing in New Delhi and the College of Nursing in Bangalore. The need to revise national curricula with emphasis on community orientation has been recognized. In Indonesia, a plan for converting more nursingfmidwifery programmes to the PK (health nurse) programme has been finalized. WHO staff have been giving assistance in planning the details of the course content. In order to prepare teaching staff for those schools which are planning to convert soon to the new training programme, some assistance is needed in the form of orientation to the concept of PK curricula, planning and implementation. The progress made by the nursing component of the family health care programme has been very satisfactory. The WHO public health nurse educator has developed the functions and activities of the nurse in primary health care, which can serve as a very useful guideline. A WHO consultant collaborated in the successful development of an in- service training programme for health centre staff to introduce and encourage the utilization of the Health Centre Reference Manual. The new project on nursing manpower development in Irian Jaya commenced in March 1980. The Government of MaZdives has decided to increase the student intake for various training programmes at the Allied Health Services Training Centre to meet the health manpower needs of the country. Emphasis is therefore placed on designing appropriate teaching strategies. The revision of curricula for various auxiliary health workers based on task and competency is under way. A task analysis of all categories of health personnel was undertaken and job descriptions for communityhealth workers and health aides were developed. In Mongolia, the translation of three nursing text-books from English into Russian was completed. A group of authors has been identified who will write text-books for middle-grade health workers. Seven workshops for 102 teaching staff were conducted at Ulan Bator, Darkhan, Gob-Altai, and Sanshand. The architectural design and location of a nursing school SEA/RC33/2 Page 23 in Ulan Bator were approved. Approximately 35 nursing graduates from the post-basic courses in teaching and administration became available to assume the teaching responsibilities in basic nursing programmes as well as nursing administration in various institutions. Much progress in the field of nursing has been made by the national staff with the assistance of the WHO nurse educator, but there is a need for further strengthening of many aspects of the programme. In Nepal, the training programme in community health nursing is being formulated for implementation in 1980. This will be the second major effort in the post-basic school. The post-basic course for the preparation of midwifery tutors is progressing satisfactorily and the first group is expected to graduate this year. A short-term consultant assisted in the assessment of existing auxiliary nursing programmes and the development of a community-oriented basic nursing curriculum. The Post-Basic School of Nursing in Sri mka has a one-year diploma course in teaching and supervision in schools of nursing and a course in management and supervision. In addition, the National Institute of Health Sciences in Kalutara offers a post-basic diploma course in public health nursing. Much attention is given to basic nursing and midwifery education. The programme to train an increased number of public health midwives was implemented with the assistance of a WHO consultant. In ThaiZand, the nursing practitioner programme is being evaluated to strengthen the basic nursing programme in primary health care. Initial steps were taken to formulate and carry out nursing research. Training in research methodology has been undertaken by the national staff in selected nursing faculties. 1.6 Health Education a, Health education efforts in the countries of the Region have steadily been intensified towards the attainment of the social goal of HFA 2000. The following is a sumnary of activities in individual countries. In BmtgZadesh, two WHO long-term health education specialists provided assistance during the period under review. One of them, who completed his assignment at the end of 1979, was concerned with the further development of health education at the central, regional, district and sub-divisional levels. To meet the manpower requirements resulting from this development, 114 sub-divisional health education officers were recruited and trained within the country, partly with WHO support, and assigned to the sub-divisions. Since the country needs a much more expandedand strengthened health education service, a plan was prepared for possible assistance from the World Bank. The other health education specialist, who left at the end of March I I 1980, mainly assisted in the development of health education in primary '+ health care and in the planning, initiation and development of the SEA/RC33/2 Page 24 post-graduate programme in health education at the National Institute of Preventive and Social Medicine. A short-term consultant in educational technology also assisted the Institute in developing curricula in the field of audio-visual aids for health education. In Burma, health education officers assigned to the divisions and townships as well as to the Health Education Bureau provide support to primary health care and other major health programnes. There are, however, constraints on account of limited manpower, equipment, supplies and training. A major programme to extend the present health education services in support of health care is required. In India, the expanding programme of community health workers with heavy responsibilities for health education has made greater demands on health education specialists assigned to the central, state and district health education bureaux. This, in turn, led to the organization of a national workshop on the current status of health education services in India, held in New Delhi in February 1980. This workshop was followed by a National Workshop on Teaching Aids for Health Education and on Health Education in the Undergraduate Medical Curriculum. The Central Health Education Bureau is also engaged in training the trainers in health and family welfare, and in assisting state and district health education units, medical schools and the National Council of Educational Research and Training in their health education responsibilities. WHO continues to collaborate in all these activities. The Provincial Health Department of Irian Jaya in Indonesia is develop- ing health education as an integral part of health services, and to facilitate this, health education units in the Province and the districts are being established. Workshops on health management and health education were held during February-March 1980. In addition, short orientation courses were organized in the provincial capital and in the districts and sub-districts. The WHO health education specialist supported all these activities. Following the country health programming exercise conducted early in 1980, Maldives identified the educational aspect of its primary health care programme. A short-term consultant has been assigned under the inter-country project "Health Education in Family Health" (ICP HED 003) to provide technical support. The Government of Mongolia is engaged in the development of health education curricula for primary and secondary schools and teachers' colleges. In addition, it is proposed to prepare textbooks and other learning resource materials and also train teachers for school health education. The plan, which will come into operation later in 1980, will start as a pilot project and, based on the experience gained, will be extended to other areas. A WHO health education specialist has been assigned to assist the Government in this regard. SEA/RC33/2 Page 25 In Nepal, the acting Chief of Health Education as well as his colleagues are back in position after completing post-graduate training abroad in health education. With the augmentation of its limited health education manpower, Nepal is now expanding health education services in support of primary health care, environmental health, school health and other programes. During the year, Sri Lanka made significant progress in the field of health education. The Health Education Bureau in the Department of Health Services now has units dealing with school, hospital, dental and community health education, training, research and evaluation, field studies and demonstration. Professionally qualified health educators are in charge of these units and have also been assigned to each of the superintendents of health services to support the educational activities in the field. To augment the existing number of health education specialists, 35 graduate health educators have been recruited and are being given a three-month training within the country. Training in health education is a major activity. In addition to in- service training, the Government is now engaged in the basic health education training of health workers such as physicians, nurses and sanitarians. Textbooks and other learning resource materials are being provided. WHO collaborates in these efforts and has provided two short- term consultants, equipment and supplies as well as fellowships for the training of health educators. The main thrust of the health education progrannne in Thailand is in support of primary health care activities in the provinces. The Government is now engaged in establishing regional and provincial health education units to provide such support. In addition, facilities for training, planning and the production of audio-visual and communi- cation aids have been established. Together with support to school health education, efforts are being made to utilize mass communication media. WHO is collaborating in all these efforts and is proposing to assign a short-term consultant to review the progress. The Organization also recognizes the important educational role played by health workers, community leaders and village health volunteers, especially in primary health care programmes. Efforts were therefore intensified for collaboration with the countries in the training of these workers. Since primary health care involves health education utilizing minimally trained health workers and community health volunteers, preparation of new strategies and new material for the training of these workers was encouraged. In addition, the pre-service preparation of health personnel such as physicians, nurses and sani- tarians in health education was supported, The Organization concen- trated on the reorientation of health education specialists to meet the needs of primary health care. At the same time, WHO also took steps to review the curricula for preparing health education specialists in the Region. SEA/RC33/2 Page 26 Efforts for community participation and involvement in various health programmes supported by WHO emphasized the need for greater research into health behaviour. Successive working groups constituted under the Regional Advisory Committee on Medical Research also identified several aspects for such research. Two consultants in social sciences were recruited to survey the current status, appropriate institutions in the countries, as well as available manpower. Research projects on different aspects of health education funded by WHO Headquarters continued to make progress in India, Sri Lanka and Thailand. Programmes of health education research on community participation, nutrition and environmental health, supported by the Regional Office, are also going on in some countries. 1.7 Nutrition Following significant advances made in the past and the profound change that has taken place in the overall approaches to health as a result of the commitment to achieve the goal of health for all, it became necessary during the year to assess the general directions in the field of nutrition. Nutrition activities must take into account the factors determining the growth of children and be in line with the pace of health development and other related areas. In this way nutrition is seen not as a vertical programme but as a technical input for operational units. One of the basic constraints in this regard at present is the lack of appropriate information, although in individual countries sufficient data were available to define the magnitude of the problem. By means of published information, reports of consultants and visits to some of the countries, it is evident that the magnitude of the problem, the national structures, the causative factors and national commitments differ not only from country to country but also within countries. Against this background, discussions were held with specialists in nutrition in different countries and, in line with the objectives and strategies for the development of health services, a tentative frame- work for a regional programme on nutrition was developed during the year. A study of the composition and role of nutrition units in all countries of the Region was made by a WHO consultant. The Regional Office is actively supporting these units. The definition of nutritional inputs into the primary health care services is being pursued through the inter-country project, "Nutrition in Primary Health Care". National seminars are being supported in different countries of the Region, and the outcome of these activities is to be discussed in depth at an inter-country meeting scheduled for 1981. The Regional Office also collaborated in the development of the nutrition component of family and primary health care programmes. SEA/RC33/2 Page 27 The utilization of data sources in the development of appropriate surveillance systems is a priority for most of the countries of the Region, and the Regional Office has supported this effort by means of distribution of pertinent bibliographies, technical collaboration and through the regional research programme. Preparations are being made for an inter-country meeting to evolve general guidelines and discuss new approaches. In the area of specific nutritional deficiencies, WHO has lent support to the world campaign against goitre in collaboration with the World Food Council and UNICEF. All countries have prepared detailed programmes for the solution of this problem and have expressed their needs for external support. What is now necessary is to enlist the support of external agencies. During the year a consultant visited most of the countries in the Region and had discussions with research groups to delineate the priority problems and seek solutions at the country level. Based on his findings, the Regional Office developed a research-cum-action programme in nutrition. A workshop held in June 1979 identified five areas, includ- ing 19 projects. Nutrition in primary health care was selected as the priority area for short-term development, as its components would support the overall nutrition programme. Background material on similar projects developed both within the Region and outside was prepared for a study group meeting held in October. This group drew up protocols to serve as a basis for projects to be implemented in the different countries, suitably adapted to meet local conditions and requirements. Funds were provided to six countries, and in some with limited research facilities, technical support was given for developing expertise. Assistance was provided to strengthen the nutrition units in the countries of the Region. A consultant assisted the governments of Bhutan and Maldives in ascertaining the need for setting up nutrition units. In Burma and Indonesia, a consultant reviewed the involvement of the nutrition unit in the design and evaluation of nutritional activities within the primary health care system. The Government of Bangladesh has requested the services of short-term consultants to help in reviewing nutrition activities, in developing the curriculum and syllabus for a diploma course in public health nutrition, in drawing up proposals for research in nutrition, and in establishing close liaison among all the institutions working in the field of nutrition throughout the country. Financial assistance was provided for the organization of a national seminar on "The Role of the Health Sector in Nutrition Activities", held in Dacca in November. In Bhutan, a consultant assisted in the training programme for the trainers of school teachers who later carried out an assessment of the nutritional and health status of school children through the measurement SEA/RC33/2 Page 28 of heights and weights and the examination for anaemia, goitre and angular stomatitis. In India, WHO continued to collaborate in the two nutrition courses organized annually by the National Institute of Nutrition, Hyderabad. TWO consultants cooperated with the Government of In&ne&a in planning a nutrition surveillance unit and its organizational structure and in devising a system of recording, reporting and processing of data on nutrition surveillance. In MaZdives, where a country health programming exercise was carried out during the year, priority was accorded to the implementation of nutrition programmes within the primary health care system. A consultant assisted the Government of Mongolia in the preparation of a design of an epidemiological study on infant nutrition. In NepaZ, a nutrition cell was established in the Ministry of Health. A national nutrition coordination committee was formed to suggest steps for the integration of nutrition in all relevant activities of the health services. A consultant assisted the Government in formulating a research protocol on weaning and other foods using village resources. Assistance was given to Sri Lunka in formulating a comprehensive health project for pre-school children, in reviewing the nutrition surveillance programme and in guiding the national staff in the preparation of the protocols for nutrition research projects. In Thaitend, assistance was provided for various training progrannnes. A national seminar was held in Kanjanaburi Province from 25 to 27 July 1979 in which 50 nutritionists, scientists and physicians participated. 1.8 Medical Care It is heartening to note that governments are seized of the problem of extending medical care to the vast unserved and underserved populations living in rural areas by providing medical care through hospitals and health centres. In Bangkdesh, a WHO staff member continued to assist in strengthening the Central Medical Stores Workshop to make it more effective and efficient to meet the needs of the country. He also helped to train manpower for other workshops. Medical care services are being strengthened in Bunna through the award of fellowships and the provision of supplies and equipment. A number of fellowships for advanced training were arranged for the Democratic PeopZels RepubZic of Korea to strengthen further the services SEA/RC33/2 Page 29 related to medical care, hospital administration and other important specialties. Supplies and equipment were also made available. In India, which has a considerable medical care infrastructure, the stress is on the development of interlinked referral services and logistic support to primary health care. Efforts continued for the strengthening of the different systems of indigenous medicine which form an integral part of the country's health care services. The Government is very keen to develop these systems so that health care becomes available to the millions living in the rural and far-flung areas The Government of Indonesia aims, under Repelita 111, which covers the period 1979-1984, to create better opportunities for every citizen to attain the highest level of health through efforts to deliver expanded, more equitable and more accessible health services, with priority to the low income rural and urban population. The main objectives of developing the health care system are to reduce mortality and morbidity, improve the nutritional status of the community, and ensure equal distribution and utilization of health care services. Although Maldives has qualified and trained doctors for the treatment of routine cases, assistance is required from outside the country in certain specialties. Towards this end, WHO assigned specialists in different fields - a surgical team, an ENT team and a bacteriologist - to Maldives during the period under review. The main aim of the teams was to treat patients with special problems and, at the same time, train national health personnel. Steps were taken to assign an electro-medical engineer to Sri Lanka to assist the national authorities in planning and conducting training courses for technicians and also to advise on the installation, maintenance and repair of health equipment. Some fellowships were provided in medical stores management, in addition to supplies and equipment. 1.9 Care of the Aged, Disability Prevention and Medical Rehabilitation Bearing in mind that 1981 has been designated as the International Year for Disabled Persons (IMP), the Organization provided consultancy services to Member countries to evaluate developments and to formulate programmes for implementing the objectives and goals of IYDP. In August 1979, an inter-country Seminar on the Prevention and Control of Accidents was organized with 23 participants from 8 countries of the Region, to assess the magnitude of the problem and the existing facilities and to plan regional and national strategies for the prevention and control of domestic, occupational, traffic and other accidents. A medium-term programme was formulated for the health care of the elderly. Two participants (one each from India and Thailand) attended the Preparatory Meeting for the WHO Conference on Road Traffic Accidents in Developing Countries held in Paris in December 1979. SEA/RC33/2 Page 30 As for activities during the year in the various countries, the Institute for Disability, Prevention and Rehabilitation in Bangladesh continued to make satisfactory progress. A WHO-sponsored National Seminar on Community Programme for Disability Prevention and Rehabilitation, held in Rangoon, Bm (3-7 December 1979), reviewed the existing situation,assessed the facilities and drew up a detailed national plan, including recommendations on legislation for disability prevention and rehabilitation. A specialist from India participated in an Informal Consultation on Community Training for the Disabled, held in Mexico in November 1979 to discuss the practical possibilities of implementing rehabilitation programmes in developing countries and to draft a manual on "Training the Disabled in the Community". This field manual is being tested in Trivandrum. Preliminary preparations were made for conducting a national meeting on the prevention of traffic accidents. The training of orthotic and prosthetic technicians at the National Institute of Prosthetic and Orthotic Training in Orissa and the development of the satellite centres affiliated to the orthotic and prosthetic manufactur- ing corporation, ALIMCO, Kanpur, progressed satisfactorily. At St. Martha's Hospital in Bangalore, the World Rehabilitation Fund conducted the annual prosthetic training course. Physical facilities at the Institute of Rehabilitation and the Hemiplegia Centre in Lucknow were organized and training courses were being planned. A national meeting for planning disability and rehabilitation facilities was organized in Indones'b in which more than 300 health personnel participated. The Regional Office provided documentation and background material for this meeting. The World Rehabilitation Fund awarded fellowships for training and collaborated in the development of rehabi- litation activities in hospitals in Jakarta, Bandung, Surabaya, Manado and Solo. In MongoZia, the training of health personnel and the organization of services for accidents, disability prevention and medical rehabilitation continued to make progress. In Nepal, a multisectoral and multidisciplinary group prepared a draft national plan for disability prevention and medical rehabilitation. Action was initiated for exploring the availability of extrabudgetary resources for the implementation of this plan. Community-oriented disability prevention and rehabilitation services at Ragama Hospital in Sri Mka were developing satisfactorily. A staff member of the School of Physiotherapy and Occupational Therapy, Colombo, assisted in the preparation of a manual on "Training the Disabled in the Community". In Thailand, a national meeting was organized to review the problem of traffic accidents and formulate a plan of action for the prevention and SEA/RC33/2 Page 31 management of emergencies. The training of health and allied personnel and the expansion of rehabilitation facilities at the intermediate and central levels of health care continued to record progress. Member States were requested to organize national meetings to review developments and prepare national plans for the health care of the aged, disability prevention and rehabilitation as an integral part of primary health care in the overall context of health for all. A consultant is under recruitment to assist in the planning and development of these programes. 1.10 Oral Health The problems connected with oral health are receiving increasing P attention in the countries of the Region. Although the dental health care of the people in many of the countries continues to be unsatis- factory, with growing awareness of the importance of public health dentistry and of oral health, governments are promoting programmes in this area with particular emphasis on the community aspects. Under the oral health project in Bangladesh, the curriculum for the bachelor's course in dental medicine has been reviewed with the accent on preventive dentistry. This project will also help improve the facilities at the Dacca Dental College. A national path-finder survey of oral health was conducted and a number of students were examined. Further assistance is planned, amongst other things, in organizing and conducting the training of dental health workers and also for a nation- wide programme of oral health education. In India, WHO collaborated in conducting a national Workshop on Dental Diseases and Orofacila Anomalies in Children, in November 1979 in New Delhi. ..~. To mark the 20th anniversary of the Faculty of Dentistry, University of Padjadjaran, Bandung, Indonesia, a symposium on the comprehensive management of paediatric patients was organized in September 1979. Several specialists from other countries also participated in this important activity, the subject of which was specially chosen to commemorate the International Year of the Child (1979). It is proposed to provide assistance in setting standards needed for epidemiological studies of oral diseases and for the integration of dental health in primary health care. In Sri knka,anisland-wide field training programme for school dental nurses in dental health education and prevention was completed. Workshops were held in various parts of the country, with field practice forming the core of the programme. As a result of these activities, emphasis is now placed on a prevention-oriented, community-based oral health care delivery system. The Government has developed a new project, "Preventive Oral Health Care in the Delivery of Primary Health Care in Sri Lanka". Steps were taken to implement progrannnes promoting SEA/RC33/2 Page 32 dental hygiene in the primary schools of Colombo. Further assistance is proposed for developing a national plan in preventive dental health and for strengthening dental health education. In ThaiZand, the oral disease programmes on the effect of chlorhexidine and fluoridated chewing gum are proceeding according to plan. In addition to financial assistance, the services of a specialist were provided to collaborate with the Government in the preparation and conduct of a national workshop on educational materials for dental health education, which was held in Bangkok in December 1979. The project document for the establishment of a Regional Training and Demonstration Centre in Oral Health in Chiang Mai was finalized and signed by the Government. The Division of Dental Health has developed., in collaboration with WHO, a plan of activities for the Centre for 1980, 1981 and 1982. A national conference on primary health care, held in Bangkok in November 1979, identified four more essential elements of primary health care that need strengthening, dental health being one of them. 1.11 Mental Health, Drug Dependence and Alcohol-related Problems Evidence increasingly continues to project the importance of this major programme area, not only in terms of the Organization's new programme classification structure but also as reflected by the greater attention and growing commitment that it commands in many Member countries. This area, which includes the prevention, treatment and rehabilitation of mental and neurological disorders, drug dependence and alcohol-related problems, is concerned also with the mental health implications of social, economic and environmental development, so much in evidence in this region. WHO, through its coordinating mechanisms at global and regional levels, has actively promoted and supported national policy formulation. In a number of countries this has led to commitments to include mental health as a component of primary health care and to take it into consideration in the development of strategies towards health for all. Collaboration within the Region in the important area of drug dependence, treatment and rehabilitation has continued and has extended to inter- regional activities with particular reference to narcotic drugs. It is, however, not without concern that attention is shifting to the emerging problems of other drug abuses and problems related to the increasing consumption of alcohol. Developing countries are by no means immune from these known hazards of industrialized societies. Important contributions have been made by countries in the Region to global and regional collaborative activities in all these fields, while some national programmes, too, have been developing satisfactorily. The commitment of Member countries to the integration of mental health activities is being pursued at different levels of the determination and SEA/RC33/2 Page 33 implementation of national policy. The Organization's medium-term programme in mental health has taken these developments into account. The Regional Office, under an inter-country project on mental health, supported the attendance of national representatives at a joint study meeting on child mental health convened by UNICEF, WHO and non-govern- mental organizations in Salzburg, Austria, in July 1979. The outcome of this meeting, leading to activities in child mental health and psychosocial development, is important for countries with relatively high percentages of children and young people among their population. In Bangtadesh, the second and third in the annual series of national workshops on mental health were held late in 1979. A consultant assisted these workshops, which help in the implementation of the national plan to integrate mental health in the general health services and in primary health care. A mental health service and training centre has been opened in Dacca with WHO support to provide training to all categories of health workers and those in other disciplines in community mental health. It will also be a focal point for specialist training in the country. A vehicle has been provided to this centre by the Yugoslav voluntary organization, "Hungry Child". Key national personnel have attended appropriate regional and global training programmes in community and social psychiatry on WHO fellowships. The mental health programme in Bm continues to receive WHO support through the United Nations/Burma Programme on Drug Abuse Control. Psychiatric centres in Rangoon and Mandalay play an important role in the provision of services and the training of staff. -. The extension of mental health services beyond these psychiatric centres to general hospitals and to other townships continues. The post- graduate training programme is now well established and there has been a perceptible increase in specialist manpower now available. In India, a series of national workshops on various aspects of mental health were held, with WHO support. At the National Institute of Mental Health and Neurosciences, Bangalore, which during the year celebrated its 25th anniversary, national meetings were held on post-graduate psychiatric education, and training given in clinical psychology. A meeting was convened by the Ministry of Health with WHO support to prepare a national plan for mental retardation services in the country. This meeting brought together representatives from not only the health sector, but also education and welfare and the national non-governmental organizations concerned with mentally retarded adults and children. SEA/RC33/2 Page 34 International collaboration in WHO activities within the medium-term programme in mental health continued to be strongly supported by a number of centres in India. Collaborative work includes the development of community mental health services and of manpower for mental health, as well as biomedical and pharmacological research. Two national centres for collaborative research and training in the neurosciences have been designated and recognized by WHO at TN Medical College and BYL Nair Charitable Hospital, Bombay, and the Institute of Neurology, Madras Medical College and Government General Hospital, Madras. These centres will provide the necessary linkages for the global programme on neurosciences being developed with emphasis on the needs of developing countries and the neurological problems of tropical diseases. 7 With WHO support, the Directorate of Mental Health in Indonesia held a national mental health teaching seminar on traditional healing with specific reference to psycho-socio-cultural mechanisms. Three consultants assisted in the conduct of the seminar, which was attended by partici- pants from the health and related disciplines. Observers from other ASEAN countries also attended this seminar. As the implementation of the national mental health plan proceeds, the rate of integration of mental health in the general health services is increasing. Together with the programme of integration in primary health care centres (PUSKeSMAS), there is now a programme for integrating mental health into district general hospitals. The framework for the collection of data on mental health is being established gradually to cover the new facilities and services. In Jakarta, an ambitious and innovative project on community mental health is being developed jointly by the Jakarta Metropolitan Health Department, the Directorate of Mental Health of the Ministry of Public Health, the Department of Psychiatry and the Faculty of Public Health of the University of Indonesia. This project is being developed through multisectoral coordination among all government, public, metropolitan, private and voluntary agencies in the city. A multidisciplinary team is being developed to which WHO is providing technical support and assistance. The Directorate of Mental Health of the Department of Medical Care in the Ministry of Health is being designated as a WHO Collaborating Centre for Research and Training in Mental Health. This centre will provide an additional base in the Region for training in community mental health and for international collaborative activities within the WHO medium- term programme. In Mongolia, following the pattern of implementation of the national mental health plan, WHO continues to provide support mainly through the fellowships programme for specialist manpower. This year a national staff member is to receive training in forensic psychiatric preparatory to the establishment of services and training in this discipline. SEA/RC33/2 Page 35 A WHO grant was provided in 1979 to assist the national activities undertaken to mark the twentieth year of the commencement of neuro- psychiatric services in the country. The national advisory body on mental health established in Sri Lanka during 1979 has been the focus for the development and implementation of national policy. Most of the major provincial. general hospitals now have functioning psychiatric units and at least one of the base hospitals has a psychiatrist attached to it. WHO support to the development of these services is being increased. Two consultants have been advising on the general administration of the two mental hospitals at Angoda and Mulleriyawa and have made recommendations for using these hospitals in the countrywide mental health service. The Post-graduate Institute of Medicine has introduced higher examina- tions in psychiatry, and the first part of these examinations was conducted in June 1980. WHO has, for many years, been assisting in the establishment of country-based specialty training. With this aim now realized, support will be increasingly directed at strengthening the necessary services. WHO support has continued to the University Department of Psychiatry in Colombo and useful epidemiological data on the use and needs for mental health services are now available for evaluation and the planning of appropriate services. In Thailand, the first national seminar on mental health was held in March 1980 with WHO support. Participants from many sectors and disciplines, including health education, justice, religion, administra- tion and planning, and voluntary and private mental health agencies made recommendations for a national mental health policy to improve and promote a comprehensive community-based mental health programme. The Division of Mental Health of the Ministry of Public Health is collaborating in two global projects. The monitoring of mental health needs, a project designed to establish the basic recording of mental health data for the evaluation and planning of mental health services, is being extended to two additional districts. The second project concerns the assessment of danger in forensic and administrative psychiatry. Case studies and assessment procedures are being reviewed in a number of countries including Thailand, which is the only country in this region with a functional and designated forensic psychiatry service. Drug Dependence and AZcohoZ-related ProbZems With assistance from the United Nations/Burma Programme for Drug Abuse Control, the renovation and construction of the Drug Treatment Centre at Mandalay has been completed and the Centre has been functioning since 1 January 1980. Since the beginning of this programme, the Health Department has continued to make substantial improvements in treatment SEA/RC33/2 Page 36 facilities at centres located in major drug-affected areas, with UNFDAC support. Six doctors responsible for drug addiction treatment in provincial hospitals attended a WHO training course on "Treatment and Rehabili- tation of Drug Dependent Persons" held in Hong Kong in November 1979. The Department of Health organized in Rangoon a national Seminar on Drug Dependency in September 1979. This meeting brought together health personnel from the 14 states and divisions to review major aspects of the drug abuse problems in the country. The participants recornended the strategy for the utilization of all resources made available nationally and from the United Nations and other agencies. In Thailand, the health sector of the United Nations Programme on Drug Abuse Control has continued to support the drug treatment centre in Chiang Mai and the seven major research projects being undertaken by the Drug Dependence Research Centre of the Institute of Health Research, Chulalongkorn University, Bangkok. During the year, the Institute of Health Research was designated as a WHO Collaborating Centre for Research and Training in Drug Dependence. Funds from the WHO regular budget supported national participation in a study tour of neighbouring countries having activities in drug control dependence and in the WHO Training Course held in Hong Kong on the Treatment and Rehabilitation of Drug Dependent Persons. The second in a series of national workshops on Drug Dependence, Treatment and Rehabilitation was also supported by WHO. This meeting developed a medium-term national training plan for physicians and other workers concerned with the detection, control and treatment of drug abuse. Thailand agreed to be one of those countries to be studied by WHO to provide a detailed evaluation of the national response to the United Nations Convention on Psychotropic Substances. Finland and Madagascar also participated in this study,and the information, after it is analysed, will provide a substantial basis for WHO'S submissions to the United Nations Commission on Narcotic Drugs. From this region, India, Sri Lanka and Thailand were contributors to the WHO International Review of Preventive Measures, Policies and Programmes on the Prevention of Alcohol-related Problems. This detailed compilation of country experiences was referred to in the report of the Director- General to the Thirty-second World Health Assembly, which urged Member States to deal with the prevention and control of these problems. Although no individual country projects or inter-country initiatives have resulted so far, the Regional Advisory Group on Mental Health and some national bodies and voluntary agencies are already seeking WO's technical assistance in the collection of information and the develop- ment of appropriate collaborative programmes, mainly of a preventive and educational nature. SEA/RC33/2 Page 37 1.12 Drug Policies and Management WHO has been assisting the countries of the Regioninevolving pharmaceu- tical supply systems to provide essential drugs of assured quality for the primary health care programme. Most countries have identified the essential drugs required for PHC and for higher levels of health care. In Bangladesh, a WHO consultant advised the Central Medical Stores on the manufacture of seven essential drugs. Further assistance is being planned through donor agenciesto increase the capacityof the country to manufacture all the31essential drugs requiredfor primary health care. In Burma, a master plan was prepared to provide assistance to the Burma Pharmaceutical Industry in producing the essential drugs required. WHO and UNDP collaborated with Indonesia in the development of a compre- hensive programme covering various aspects of the pharmaceutical supply system. Pre-feasibility reports were prepared for starting a new unit for the production of essential drugs, improvement in quality assurance, updating of drug legislation, improvement in the storage and distribu- tion system, and the expansion of BIOPHARMA. In addition, WHO provided assistance in improving and expanding the production facilities at the government manufacturing units at Manggarrai Factory. A meeting of ASEAN countries organized in Jakarta with support from WHO highlighted the problems regarding legislation, evaluation and quality assurance. A task force has been formed to implement some of the recommendations of the meeting. In MongoZia, plans are being made to develop a manufacturing unit for the production of biologicals such as vaccines and blood products. WHO will provide consultants to assist in preparing a techno-economic feasibility report. Assistance from UNDP and UNIDO is being provided to Nepal for improving the capacity for the production of essential drugs by the Royal DrugsCo. and for strengthening quality control, storage, distribution and drug utilization under the umbrella of the primary health care programme. In Sri Lanka, based on the pre-feasibility study of the State Pharmaceu- tical Corporation, Colombo, made by WHO, plans are under way to set up a unit for the manufacture of essential drugs. The supply of essential drugs,including vaccines, is of great importance to the PHC programme. A global meeting to define the role of WHO in pharmaceuticals is scheduled to take place in the Regional Office in the last quarter of 1980. 2. DISEASE PREVENTION AND CONTROL - COMMUNICABLE DISEASES Despite the efforts being made to control them, connnunicable diseases persist as the Region's number one public health concern. One of the
ANNUAL REPORT OF THE REGIONAL DIRECTOR WORLD HEALTH ORGANlZATlON REGIONAL OFFICE FOR SOUTH-EAST ASIA WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR SOUTH-EAST ASIA THIR I'Y-SECOND ANNUAL REPORT OF THE REGIONAL DIRECTOR 'I'O THE REGIONAL COMMITTEE FOR SOUTH-EAST ASIA 1 JULY 1079-30 JUNE 1980 The march t towards Health for All. . . SEA/RC33/2 Page iii CONTENTS INTRODUCTION vii PART I - GENERAL REVIEW OF ACTIVITIES 1 STRENGTHENING OF HEALTH SERVICES Planning and Development of Health Services Health planning, programme formulation and evaluation Organization of basic health services Operational studies Primary Health Care Traditional Medicine Family Health Nursing Health Education Nutrition Nedical Care Care of the Aged, Disability Prevention and Medical Rehabilitation Oral Health Mental Health, Drug Dependence and Alcohol-related Problems Drug Policies and Management 2 DISEASE PREVENTION AND CONTROL - COMMUNICABLE DISEASES Epidemiological Surveillance Diseases Subject to the International Health Regulations Smallpox eradication Diarrhoea1 diseases including cholera Plague Malaria and Other Parasitic Diseases Malaria Schistosomiasis Filariasis Leishmaniasis Bacterial Diseases Tuberculosis Leprosy Sexually-transmitted diseases Diphtheria, pertussis and tetanus Viral, Chlamydial, Rickettsia1 and Related Diseases Trachoma Poliomyelitis Dengue haemorrhagic fever SEA/RC33/2 Page iv 2.5.4 Viral hepatitis 2.5.5 Japanese encephalitis 2.6 Expanded Programme on Immunization 2.7 Veterinary Public Health 2.8 Vector Biology and Control 3 DISEASE PREVENTION AND CONTROL - NON-COMMUNICABLE DISEASES 3.1 Cancer 3.2 Cardiovascular Diseases 3.3 Prevention of Blindness 3.4 Imunology 4 HEALTH LABORATORY SERVICES 4.1 Organization of Laboratory Services 4.2 Quality Assurance 4.3 Quality Control of Pharmaceuticals and Biologicals 4.4 Vaccine Production 5 PROMOTION OF ENVIRONMENTAL HEALTH 5.1 Environmental Health 5.2 Occupational Health 5.3 Radiation Medicine 5.4 Food Safety Programme 6 HEALTH INFORMATION AND STATISTICS 7 DEVELOPMENT OF HEALTH MANPOWER 7.1 Medical Education 7.2 Education and Training in Maternal and Child Health 7.3 Education and Training in Sanitary Engineering 7.4 Training in Epidemiology 7.5 Training of Auxiliaries and Community Health Workers 7.6 Group Educational Activities 7.7 Fellowships 7.8 Regional Office Library 8 RESEARCH PROMOTION AND DEVELOPMENT 9 TECHNICAL INFORMATION AND REFERENCE SERVICES SEA/RC33/2 Page v PART I1 - ORGANIZATIONAL AND ADMINISTRATIVE MATTERS 1 REGIONAL COMMITTEE 111 2 REGIONAL PROGRAMME PLANNING AND DIRECTION 115 3 ADMINISTRATION 116 General Organizational Structure Personnel Staffing Staff training Employment conditions Budget and Finance Regional Office Building 4 PROCUREMENT OF SUPPLIES AND EQUIPMENT 120 5 COLLABORATION WITH OTHER AGENCIES 120 United Nations United Nations Development Programme (UNDP) United Nations Children's Fund (UNICEF) United Nations Fund for Population Activities (UNFPA) Economic and Social Commission for Asia and the Pacific (ESCAP) International Atomic Energy Agency (IAEA) Specialized Agencies United Nations Industrial Development Organization (UNIDO) Food and Agriculture Organization of the United Nations (FAO)/ World Food Progranrme (WFP) United Nations Educational, Scientific and Cultural Organization (UNESCO) International Labour Organisation (ILO) The International Bank for Reconstruction and Development (IBRD) Asian Development Bank Bilateral and Other Agencies Non-governmental Organizations in Official Relations with WHO 6 PUBLIC INFORMATION 126 PART I11 - ACTIVITIES UNDERTAKEN BY GOVERNMENTS WITH THE HELP OF WHO PROJECT LIST 129 SEA/RC33/2 Page vi Bangladesh Bhutan Burma Democratic People's Republic of Korea India Indonesia Maldives Mongolia Nepal Sri Lanka Thailand Inter-Country Inter-Regional Activities Outside the Region with Participants from the South-East Asia Region ANNEXES 1 Organizational Structure 189 2 Geographical Distribution of International Staff Assigned to the South-East Asia Region as of 31 May 1980 190 3 Distribution of Short-Term Consultants By Nationality 191 4 Meetings and Courses Organized or Assisted By WHO and Held in the South-East Asia Region 192 5 Conferences and Meetings in the South-East Asia Region Called By Governments/Other Organizations at Which WHO was Represented 199 6 List of Technical Reports Issued by the Regional Office 203 7 Statement Showing the Implementation of 1979 Programmes Under the Regular Budget in the South-East Asia Region 220 FIGURES 1 Incidence of Malaria and P. falcipurwn Infections 2 Obligations Incurred on Field Activities in the South-East Asia Region SEA/RC33/2 Page vii INTRODUCTION The Repoht Zhd I am pesenthg ihh yeah ih 06 bpUid sigignidicance ,to me pmonalhj, because .it wLee be my hi hepoht .to Me Regional Cornhittee. I have Mthetredohe faken Me eibetl*y 06 devidhg 6mm Me pmdice 06 pesent- hg a keviw 06 pughub in Me Intrcoduction .to Me Repoht. 06 cowe, Paht I, as ad, contad a twiw 06 .the aotivities and poghesb made duhuzg Me yeah. In the InCwduotion, I pmpobe, inbtead, to bcurvey bhie6Ly Me wv5.m heaeth scene in .tw 06 maj0h developnentb in Me but 12 yam - a pehiod duhing wkich I, as Me Regional Dheotoh, have had Me pivilege 06 saving Me Memben. SMes in in kegion. One 06 Me m0s.t bigni6icant developnentb 06 .tkib decade, as .hie& 06 aU times, ih the &ation 06 bmW!@oX huqhocLt the wohed. The Tkihty- M Wohed Heaeth hsembly in Mag .i9d yeah 6om~ deda.ted Me gLobd enadication 06 in disease, 6.inaeey bhingk down the whin on .i9d ancient enemy 06 mankind - a &Md disease thai had Wed and maimed tnL.LLionb since Lime hemohiae. Tkid 6.Lgm.L viotohq eva be chdhed as a majok miees.tone in man's jowtneg .to- bettthetr h&. It ih 06 paaCi& bigigni~ic~?.!~Ce .to m0b.t co&U 06 owt Region whae sm&pox was one 06 Me majoh pubfie hdh phobLenu. In viewing tkid hemahkabLe ackievement in hhethobpeLt, one cannot but m0Lvd at .the bdkpendo~~b ed60ht X%d a Ulh&d - d%2 bllptteme Uade 06 && wiee and po&&i& buppoht, Me spontaneoud h6Low 06 intehnational coop&on, Me uemphy mob&aL&n 06 intW and &emd hesomces, .the Luztchcng e66ohts 06 Mou&m& 06 heaeth loahhem and, above &, Me bud&zined intthetrebt and pahticipation 06 Me commwzities Mmelves. The saga 06 bm&pox dca- .tiOn wiee wa save ab a bouhce 06 bdd-con&idence .to Mmba Wes in bucc~b6~ .tack&g many 06 the hemaining 6onnidabLe heaeth pobLm in the coming decades. C * 8 Despcte in decisive viotohy oven. bmaUpox, .the u*~ ag&t oMa diseases wntinues. The vast majohilj 06 Me peopLe in developing counthies contiruce ,to 6ace .iuuuunehabLe heaeth pmbLm - Me hqh pevdence 06 comULe diseabes, maencLttLition and undm-w&&!ion - and have no accub .to even minimal heaeth cme oh such babh needs ab sahe dainking urata and A&- .tian. Tkid kegion has a popLLeatLon 06 neahey a bdlkon, conbUng a quetLtm 06 .the .total popueatcon 06 ihh phnet. The prredoninant piotwe in mobt w&es i.b i6 06 povetl*y, kbw Leveed 06 income and education, and high bh% Web. Fmm the point 06 viw 06 heaeth, ckiedhen, who mahe up u,&nos.t 40-45% 06 fie entihe popLeatian, dong with fithein rnofitheha, born Me m0b.i vcLenehabLe gmup. Economic develop&, wkich in .& de bhingb bociae phoghesb, ha6 been blow in m0bt Membeh Web owing to a numben. 06 6aotohb thut include pa~tcitq 06 hesowlces, lack 06 Mned manpowa, a Low Level 06 ~~ and .technoLogid devdopnent, Me enonmity 06 Me needs .to be 6u&j&ed and Me matib6actoh.y intWonal economic env&nm& due .to the widening g1d6 betwew .the "haves" and Me "havenoth" . SEA/RC33/2 Page viii It .i6 in thid context a%& .the maj0h devdopment 06 .the decade, .the movement 06 Heaeth doh Ace by .the Yeah 2000, h to be viewed - a movement wkich b a &pea b.igkLi&iU?tICe and meaning to to in South-East Asia. In the dace 06 donmidabee heaeth pmbem coupLed with the my 06 hesouhces doh theih b~kb%On, the Membeh SaMes have achieved wrnnendabee pmghesb in h&h deveLopnent. Thehe b been 6tdy phoghes6 in buildiq up the necesbahy inwhctwLe 06 heaeth ~ehvices, ulith expanding numbem 06 heaeth centned manned by di,j&~ertt categohies 06 heaeth wohkm. The hem peanning capaWes 06 the cocLnthies have ghdy hpmved as a hesu& 06 the intaoduotian 06 b~e~6k planning me,tho&. Most counthied today have adopted the dydt~mb apphoach to planning, ruith 6i.x 06 them haw &ed oLLt c0u.nh.y haaeth phage erUk2hQ.b. ~6 doh phimahlj h 2 me, vhich ha been uuLivemuUy accepted at &a Pvtn as a key appmach to the attainment 06 Heaeth doh A&!, the pbneehing eddohts made by .&i~ h bn have been luideLy acknodedged. It in the cocLnthie~ 06 tkis iregion %at nummu expchnentae pm jeh on evoLving &&we appwaches totowrvlds dLLe&LU.iq the basic heaeth needs 06 the pwple have been wohked out ova the kbt &m decades in an e66oht to ovmome the l%niAa%ns 06 conventional heaeth behvbiceb. In pmv&g bade wteh to the people, the cowU~~Les 06 the Region have been giving gheateh phioUy to the hwlae mu. By .the end 06 1979 aboLLt 30% 06 the hwrae popueation had been pmvided with huonabee aCCe6b to sade luLteh compahed with the -e,t 06 25% bet by WHO doh the Second UN DeveLopent Decade. The pmghU6 with hegd to exOILeta di6pobd has, howeveh, been disconcehtingLy &bur, onLy 16% 06 the .tow poph2on having acces6 to 6uch 6Wes as 06 the end 06 1979. In ApLte 06 the ;themdous phubuhes on theih meaghe hesowlces, accentuuted by the chippling oil &ce ininchmu, many counthies have 6ubstmLi~Uy incheased uUoc&nd to toeh supply, and have bet hUiic Rahgct.6 doh the Intennatiand Dhinhi42g Watetr Supply and SanLtmXan Duade, hoping to achieve mund 90% covuqe 06 wrban and & popueations with withade uateh, 90% 604 uhban d~nihhkn bLLt no mohe .than 25% covuqe in hegd to hwrae banitation. Aethough &em& invesbntment in the dieed 06 envhnmentae h&h uad US$ 2000 million gbb&y in 1979, the South-East Asia Region, with 41% 06 the wo&!d'b pawn, did not get iA due bhe. The 6LtuuXon has not hpmved appkbey A&C~ 1970, when hueived a mehe 2% 06 the gbbd &em& aid. Even though many phob&mh 6.tiee hemain to be 60~Ved, the heaeth 6aixh.A 06 the pwple in OWL Membeh SaMes has di6My hinr)uroved ova .the .ht SEA/RC33/2 Page ix decade. The expa&ztion 06 Lide at mh ha &Wed no.zkeabLy 5 modt coWLthiu. The ovU cnude mohtaeity /late 5 the Region dmpped &om about 19 pu .thouband population 5 1965 .td 16 & 1977-78. Thue have aedo been btdy imptovement6 5 the counthied the phovAbn 06 heaeth sehuiced. The numbm 06 doctom peh million popueation hincneased, doh exampee, &om t70 5 I965 .to toost 200 by 1977-78; 60 did hobpitae beds pm Wn poplLeation &om about 650 & 7965 .to 735 5 1977-78. It mud4 howeveh, be sa2edse.d xk€ urkiee one can viw the Went b.ihUhn with dome bati6&&&7n- .that .th A gmuring weness 06, as w& as 5incneasing eddohtb don, heaeth devehpnent - we have da2l a Long way .to go 5 ackievhg an accephbLe bh& 06 heat%. H&h doh kee by the Yean 2000 me no empty WJU& oh a sbgan. AA .the RegLon wkich A one 06 .the modt popcLeoub and, at the hame he, ptobabey the poohebz 5 inedowrceb, urith a heavy bden 06 didease and LU heaeth, Sow%-Eas.t Ash ia hash bXake6 5 the aMLLinment 06 .thLb god. It .b aght tkis backgnound xk€ I view with b&d&n the gmwivrg poWcaL W, medt cotm&nent and the intenbive eddohtb by out Memba States .to achieve h&h don &. OWL& fithe cwrnent be66i0n o 6 the Regional ComhXee, the Mmben Sta.teb wued be phebuihg Zheh national bthaikgies and coUectivdy evolving nqbd appwnches .to heLp pave the way don acceLWed activLties .tom& attainivlg .thLb god. What me the himpeication.4 06 thebe devehpnents .today? It mem tht the emLia accent on ecowmic devehpnent a6 the pnacea don utt U ha now given way .to the ~eaeiz&n .that the hwtlaM being A .the centtre 06 & devehpnentae eddom2, .that hdh A not evehytking but evehy.th&g eede without he& A no-thing. In o.th w&, the docud 06 so&-economic devehpnent A nun, &ode heaeth and @dme me the ulXim&e objective 06 & deveLopnent. FwLthm, it woued do mean ohganiz&nal and managehiae eddom2 06 un-ded dimmionb .to channd coohdinated enehgieb &.om & sowes to& he& devehpnen-t a.6 a paht 06 ov& so&-economic ptog~~ebb. Ivtteh6ectoRae coWbom.thn rcliee hemein an eluhivive concept unkhd @IULJ~ ~g~ed me deveLoped don enbWLing concu.ted conthibu20nb &om all dectohb, in~a5,tuthnb and ohganiz&nb - govennmentae as W a6 wn-govennmentae - don the bettment 06 the hdh 06 the people. White .the A gmwing expehtise 5 the coWes, thme .ih aedo the parradox xk€ not much 06 the avaieabLe Ment idugkt .to bbea on povidiq anbw .&J the nwne.houb uRgent ,@tobeems ~ahg fie comdes. Thib A whm innovative mechanhms don mobi.Pizing duch expehtise 5 a aahztqic 6namwnk UJLC vM. In the ukXmate andybi.6, it A ededdew5.d to enbwle .thaX those don wham today the Matiod heaeth on othm social behviceb me beyond teach, neceive the &uk2 06 deveeDpnent 60h a b&m quaeity 06 eide inchding ih m0b.t edbentiae component, namdy, an adequate bhndahd 06 he&. What does .the ~lLtUhe pohtend? Gazing at the c.hqbM M A a hazahdaub ptwccqxztbn, yet one can discm a dw t~~t'lends baed on contempomy devehpnents. 15 we RhaveL on SU/RC33/2 Page x ;the pdth we have chosen with the Acme wigow and edmiabm one AeU today, the 6-e bhodd Meed be @kt. It mudt be emphized that though thene me no ZechnoLogid bahhietld to wzivehbat heaeth devetopmeni and the 4esoluces needed me n&v@ bmdl (compmed with what govenwnents bpend on mament61, 6We buccesb wiee bqdy depend on the devetopnent 06 an e66ective managmid p~ocesb. Tkis wdd be mane cnuciae 604 the ak than any othen b.&gLe 6aoto4, .in- devdapnent 06 the *it6m- ba7Luhe. The boUonb to mobt h&h pmbLem Me mone management- dependent than technobgidy ahiented. One can aedo vbWze pmgmes 06 pop~&LL~n coM.t)LoL neslLeting 6nom devdapnentae activ&es oLLt 06 sheen necesbdy. EvidWy buch popcLeation cowkoL pmgmes wiee abume kcghat MatioMae Whity, and in ozden .to be e66eotive, they bhoLLed &y p/rapen emphabb on matehnd and child hd and he& education. Equdy evident me the 6u;tuhe Lxend~ 06 ~~ked and coo~ed pgnamnes addtubing themsdves mcLetidectohaeey to phiohity ah6 buch ad hedudion 06 in6ant moWy though popen nu&LLhn, dhtthoeal cLideade cont~~oL prrogmmeb and the expanded phogme on hwzization. * * * A6 ,5011 the nesowrceb needed 604 such a ~CUIU.~~, a 6ew a7Lend-5 me evident. Despite the unb&6a&o/rg 6Me 06 the nohth-bouth diaeogue, the key act04 that woued 6a-e majot mab&zcLtion 06 ex.tennal )L~~OWLC~A wdd !7 e &impnowed managehiae pmcesbes at Me Mational Lewd. Tkis tuoLLed Lead to betten pknning, management and evacuation, 4eslLeting in a mone eqlLitabLe &odon 06 dod 4esoluceb. It wiee thw be been that my opa%n&~ penception ad .the dme .id by no meanb mene myb.tae gazing on baed on undenes.timaLion 06 the .innumetlabee conbW that Ut bLLt /lathen. on an app4"reon 06 the 6m-4mkiY19 pobave changes ktakuzg place in the bociae, poeitid and technobgid envirronment .in OWL c0wzthie.b. My tecent vb& tc home 06 OWL codes in connexion cuith the bigning 06 the Cham2.4 60h Heaeth DeveXopnent have bLxeng.thened my op.thnhm. The bigning 06 &e Hem Chahten ;tddd at high leveed 06 poUcd decibion- making .id a conmete rnni6esAztLon 06 the gnawing comhitment to, and deep appxeciation 06, .the hpohtance 06 h&h a an integd paht 06 bob- economic development. The Chahteh 604 Hd Devdopnent, bignidying a bociae upbwge .in Me Region, ib indeed designed to pmvide mechanidmb to accdtmte Zkis way pmcesb. A6 I come tc the end 06 tkis neviw, Looking back oven. a bpa.n 06 12 yemb that 1 had the phiv.iLege to toenwe owl Memben Sfdes, 1 am oveh~~heI!med by a deep benbe 06 gWe don the kindncbb, conbidehztion and uv~stinted coopUon extended to me. 16 WHO co&ba&on and technid coopUon have Led to dome glrati6ying achievements, they me to a Laqe meabue due ,to oawr govennments' ow 6&, commitment and pemevmce. VwLivlg thue yw, 1 had nwnmus occadionb .to vhd the codes 06 tkis kegian and bee 604 mybd6 the ph0g4UbiVe voyage ~uu4dd betten hedth in action .in di66enent ~cttugs. Thebe vb& enabLed me not ody to maintain a SEA/RC33/2 Page xi m&ng6d and intimate diaeogue with national uthohities, noientis&, academioiand and ofim leadem, blLt &o phov.ided uahabLe indomaLion, indight and knodedge 06 the advances htahing @ace. We urme abLe to document some 06 .these pehceptiond in de~ehae pubeicatiom and boob such as "Chaeeenges and Re6pondeV\ "A Decade 06 Hmh DeveLopmeMA."' and "Voyage To& H~LUY~''~. Today, Membm codes and WHO me indeed at the ~1106dR.oadb. Poded on .the heshold 06 a bigiguLi6icant bheak.ih,tough doh b&m he& ,504 a&! peoples, .thA dose pahtnehskip behveen the ~KM had ahsumed an even mom chuoiae . . impohtance than in Me pat. At such a chctccae time, we ahe indeed dohtwlate to have a OWL Dhectoh-GenM DR. Hdddan Makem, uho d gglLiding .the Oganizaibn with vdhn, imaghuXan and ~~y leademkip. He has been the mckitect 06 Lhe movement OR. heaeth doh a&!, wkich pvides, as nevm bedofie, both a chance and a chdlenge to the codes doh bettm h&h. To me, who almys enjoyed hid Ou~t, cond.idence and @~Len&hip, kid guidance has been invahabLe. I am po~oundeq gmtedd .to him. 7 am do ghatedd Lo coUeague~ at WHO Headquahtetld 60h theih un,$ziLing coop~on and nuppoht. To all my coUeeeagues in the Regional Oddice, .ta WPCA and the nh66 in the dield, I owe a deep debt 06 ghatitude. I.t i~ theh devotion, dedicbn and W wohk lukich have been nespouibee doh the success 06 om e660h.td. To my co.Ueagues in fie United NaLiou &vnLLy, wbse coopenation I have almyn v&ed, I Widh to o6dm my sincme thanfu. Z * * TO my hUCCUbOh, dl0 ~ be asbwning 066.ice a 2k.Jdb1~J point *n tht kidtohy 06 the Oqanizdon, I o66m my vmy best wishes. I.t wiee be kid p~vaege now to 6ostm, M((htU/Le and bt~~engthen thid splendid pahtnehship in h&, and I am con&ident that he wiee keceive the name coop~on, help and guidance &om the Membm SMes that I had the good 6ohhne 06 enjoying, .ta enabLe the O~anization to give 06 Li% vmy best. V.T.H. Gunoatne, F.R.C.P., D.P.H., D.T.M.t; H. Regional Dhectoh 1'3~ublished by Tata McGraw-Hill Publishing Co. Ltd., New Delhi 'published by WHO Regional Office for South-East Asia, New Delhi PART I GENERAL REVIEW OF ACTIVITIES 1. STRENGTHENING OF HEALTH SERVICES 1.1 Planning and Development of Health Services During the period under review, several countries have successfully undertaken mid-term evaluations of country health programming (CHP). Medium-term health plans have been formulated or are in the process of being formulated. Governments are now endeavouring to extend the health planning process to the provincial and district levels so as to make it more relevant, and also to improve the managerial process for better implementation and operation. The monitoring and evaluation of priority health programmes using practical and useful indicatorsarenow receiving greater attention. The acceptance of primary health care as the key approach to the extension of health services implies, for most countries, the promotion of health and the provision of health care to all communities through the use of community health workers and the stimulation of community participation in health development. There is a clear understanding that primary health care is the key approach and not just an alternative. The extension of primary health care to the whole population entails inescapable implications for the entire health system. All levels of the government health services must be geared to provide the support needed at the village level, where the majority of the population lives. Training, supervision and the provision of supplies and referral facilities become essential activities of the basic health services. Primary health care in many of the countries includes the use of traditional medical practitioners, calling for a reorientation of thinking throughout the health system. 1.1.1 Health Phing, Progrme Fomlation and Evaluation The health planning and management activities which began in the countries of the Region in the early seventies continued during 1979- 1980. More countries joined those which had already applied country health programming for sound programme planning and management. The translation of the objectives of national health planning into broad programmes continues to help in clarifying the linkages needed between the planning, management and evaluation of major priority health programmes in a medium-term perspective. Early in 1980, an inter-country consultative meeting was held to review the medium-term programme in health planning and management and to revise it for the remaining years of WHO'S Sixth General Programme of Work. This meeting confirmed that several common areas of planning and management development warrant collaboration with external agencies and among the countries themselves. These include health programme SEA/RC33/2 Page 2 evaluation, the design and implementation of information systems, the analysis and formulation of current and future health policies, the creation of national foci of policy and technical support to health development (such as national health development centres or networks), the conduct of health services research, the provision of management training, the design and strengthening of support systems such as budget and finance, supply and logistics, personnel administration, and the planning and management of health services manpower. Three inter-country projects dealing, respectively, with research and development, training in planning, and information systems development, have continued to provide technical support to the countries in health planning and management and to provide back-up support to country projects. National training courses were organized and consultant services were provided in the field of information systems. Support was given to the conduct of studies on costs of health care and the financing of primary health care. A number of countries participated in a regional assessment of country health programing aimed at identifying the strengths and weaknesses of the process. As part of this review, national case studies were prepared and presented at an inter-regional seminar on country health programming held at Dubrovnik (Yugoslavia) in November 1979. Although it was evident that the countries of the South-East Asia Region were in the forefront of applying systematic health planning, much more remained to be done in extending this process to the areas of programme imple- mentation, management and evaluation. BangZadesh completed a review of its First Five-Year Plan and formulated the Second Five-Year Plan with emphasis on primary health care. A national training workshop for district-level health administrators was conducted in May 1979 in active collaboration with the Dacca university Faculty of Business Administration. National health policies have been formulated and a national committee for the implementation and coordi- nation of primary health care is being constituted. Preparations are under wayto develop a health manpower plan. These efforts are supported by a country project in planning and management to which a WHO public health administrator has been assigned. Buma continued its efforts to develop a system for the monitoring and evaluation of the CHP programmes under the Third People's Health Plan. In addition, a special analysis was undertaken to identify management problems within primary health care and the basic health services. The results of this analysis are being used as a basis for a management training programme for staff at all levels of the health services. Preparations are now under way for conducting the second cycle of CHP, taking into account the policy review carried out during the national seminar on health for all held in April 1980 and the mid-term evaluation of the People's Health Plan. SEA/RC33/2 Page 3 The focus of support to health planning and management in India was on training. A workshop on health planning organized for state-level officials stimulated further interest in training and planning activities at this level. A workshop on health economics and management was also held at the National Institute of Health and Family Welfare. This is to be followed by a series of state-level case studies in health economics which will form the basis of subsequent workshops. Steps have also been initiated to develop programme profiles. Indonesia is in the midst of its Third Development Plan, which was formulated by using the CHP approach. Extensive participation of health managers at the provincial level was achieved during the formulation of this plan and has set the tone for the future. The services of a WHO public health administrator, an economist and a statistician were provided to support the Bureau of Health Planning. The activities of the Bureau included preparation of plans and budgets, review of budgetary guidelines, evaluation of selected projects, analysis of the health financing system, collection of data for long-term policy formulation, and manpcwer planning. Formulation of the policy for health for all and designing the health services system constitute the major activities in 1980. Early in 1980 Maldives joined the ranks of those countries which have carried out the CHP exercise. A streamlined version of that planning process was used to formulate the policy for health for all and the operational strategies for the medium-term. For the first time, the community,and ministries other than health were also intimately involved in the planning process. A conrmunity survey was conducted and a seminar on health development was organized in a northern atoll. The resultant short-term strategies and programmes are lending support to primary health care. In Mongolia, activities during the year included the preparation of background material for the national health plan, organization of a seminar on health information, and the completion of programme formulation in maternal and child health. The national health information system also continued to receive priority attention. Nepal carried out a series of planning and management activities leading to a thorough mid-term plan review and the formulation of its Sixth Five-Year Plan. In addition, work on a national health manpower plan has begun, as has planning for the related teaching hospital. A WHO public health administrator assists in the development of the health information system and the design and implementation of health planning procedures at the district level. Sri kmka followed up the CHP exercise held earlier with the detailed formulation of the health service system for the Mahaweli development area. Subsequently, a WHO management officer was assigned and steps taken to review and revise the health manpower system and strengthen planning and management capabilities at the divisional and district sEA/RC33/2 Page 4 levels. Two workshops in health management were held during 1979 for district-level health administrators with WHO support, and a guideline for district health plans was formulated. ThaiZmzd continues to strengthen its health planning and management capability through the conduct of workshops and training courses. Nanagement data in six selected areas were collected preparatory to an expanded programme in health management training. A mid-plan evaluation of the Fourth Five-Year Plan was undertaken in preparation for the Fifth Plan, commencing in 1980. The Planning Division continued to evolve, in coordination with other ministries, a process of integrated provin- cial-level planning. The National Health Development Institute, set up with WHO assistance, has already carried out a number of activities such as policy analysis and formulation, evaluation and problem-solving in' management. It is establishing a mechanism to improve the national planning process through CHP and promote maximum inter-sectoral collaboration. A national health coordination commission has been proposed for monitoring health development. 1.1.2 Organization of Basic Health Services With efforts continuing for the strengthening of the health services infrastructure, the major emphasis has now shifted to the reorientation and reorganization of the health services system to subsente the identified needs of health for all. Activities have been aimed at bringing about improvements in the planning, management and evaluation of health services through appropriate training courses. Integrated multi-sectoral programmes such as the Mahaweli project in Sri Lanka and integrated rural development projects in Bangladesh and India have continued to make steady progress. Technical assistance in the form of expertise, fellowships and supplies and equipment in support of these efforts of the governments continued to be provided. In Bangladesh, the imbalance in the health services as between rural and urban areas is being gradually rectified with the expansion of health manpower, the health infrastructure and facilities, and the procurement and production of essential drugs. Since the rural areas account for more than 80% of the country's population, the Government has taken steps to strengthen the rural health services and support ongoing primary health care programmes. By the end of 1979, 244 thana health complexes had been established and another 46 complexes are expected to start operating by mid-1980. The referral system for the thana health centre, involving the sub-divisional or district hospital, is being strengthened. Thana health centres will also provide continuing education for primary health care workers to keep them abreast of new medical skills. WHO collaborated in the planning as well as the preparation of the curriculum and training material for the PalZi Chikitshuks (village doctors) scheme. This category of health worker will be drawn from candidates of either sex who have passed secondary school, and also from practitioners without formal medical qualifications. The training of the second group of 10 000 PaZli Chikitshake has started SEA/RC33/2 Page 5 in 100 thanas; 65 000 such workers are proposed to be trained. A draft manual for training this category of workers is being prepared. In Bhutan, through the basic health sciences project, the conversion of dispensaries into integrated basic health units has continued. The Health School continued to train health assistants, basic health workers and auxiliary nurse-midwives for the 31 basic health units established so far. A WHO consultant was assigned to review the structure of the national health services and to recommend its strengthening in order to improve and expand the delivery of health care. Through this project various components of health care also received attention. Another consultant was provided to review the water supply and sanitation situation and to make recommendations for further development. A third consultant collaborated in a study of the technologies used by traditional practitioners, advised on the possibilities of their practising modern techniques through orientation and training, and suggested measures for the integration of traditional medicine with the system of medical care. Assistance was provided in conducting a seminar on the expanded programme on immunization, which was launched during the year. In Bunna, the People's Health Plan, since its launching in April 1978 starting with 15 townships, had covered another 25 townships by April 1979, and preparations are under way to extend this plan to 35 townships in 1980. At the end of the planned period (1981-82), comprehensive health care delivery is expected to cover 147 townships, or 50% of the total in Burma. At the village level, there are 195 station hospitals, 1107 rural health centres and 3335 sub-centres. In addition, 4000 midwives serve the rural areas. The township medical officers and township health officers, who will function as managers at the township level, have been given orientation in the management and evaluation process. In the first year of the Plan, 666 community health workers and 300 auxiliary midwives were trained and, in the second year, 800 CHWs and 300 ANMs are undergoing training. For purposes of evaluation, collection of baseline data in villages was undertaken by basic health service and voluntary workers under the supervision of township medical officers and township health officers. As a built-in process, evaluation is carried out quarterly, annually and after each plan period, with a view to assessing the impact of the programme. In India, in line with the ~overnment's health policy, considerable stress is being laid on the preventive and promotive aspects of health, with a change in the resource-allocation pattern from curative to preventive programmes. Each of the 106 medical colleges in the country has taken up one to three primary health centres as their rural field practice area where medical students are exposed to primary health care. To maximize the delivery of health care to the rural population, a separate division - Rural Health Division - has been established in the Central Ministry of Health and Family Welfare with the primary SEA/RC33/2 Page 6 responsibility of coordinating the efforts of the Centre and the states, drawing up plans and programmes, and undertaking regular reviews and evaluation. At present, primary health centres form the nucleus for the provision of health services in rural areas. There are about 5380 primary health centres functioning in the country, each covering between 50 000 and 100 000 people. It has been decided to upgrade one out of every four primary health centres into a rural hospital for providing proper referral services to the rural population. The community health workers scheme has been extended to 1689 primary health centres, and 114 213 persons have been trained as community health workers. Attempts have been made to link the community health workers programme with the multipurpose workers' scheme to ensure integrated supervision of and effective support to community health workers in health care delivery. WHO continues to collaborate in the training programmes, in the production of manuals and in the planning and implementation of this programme. Village communities have been involved in the supervision of the activities of community health workers to ensure their better functioning. The programme aims to have 600 000 such volunteers, broadly on the basis of one volunteer per village, by 1983. Another complementary scheme in the field of rural health involves traditional birth attendants or dais. These workers, at the rate of one per village, are being given appropriate training to enhance their useful- ness to the community. Already, more than 250 000 such persons have been trained, with special orientation in family planning and welfare objectives. Further, with a view to making the best use of all locally available resources, more than 200 000 practitioners of traditional medicine will be brought within the programme for the delivery of health care in the rural areas. Towards this end, it is intended to provide special short-term peripatetic training at local centres, to equip them to deliver services within the overall objective of the national primary health care programme. WHO is collaborating with the Government in establishing and strengthening the rural health administration at state and district levels by organizing group educational activities. In Indonesia, steady progress continued to be made in strengthening the infrastructureof ruralhealth services. There are now 4353 health centres covering all kecamatans (districts). The existing 7397 unipurpose health units (polyclinics and maternal and child health centres) are being integrated to become multipurpose sub-centres. More than 80% of the Puskesmas (primary health centres) are now headed by doctors and 91% of the target for the placement of para-professional staff has been achieved. The primary health care programme has been expanded to cover a total of 12 provinces. Several kecamatans and villages not formerly included in the programme have initiated programmes on their own. The programme for the training of trainers for village health workers has gone through the national, provincial and kabupatan levels. Kecamatan training teams will train village health workers during the first two years of Repelita 111 (Third Five-Year Plan). Under the primary health care programme self-learning materials for teachers at the kecamatan and village levels are being prepared with UNICEF support. A WHO consultant assisted in the assessment of the operation of the programme S~A/Rc33/2 Page 7 during the last two years of Repelita 11. Manuals for village health workers and their teachers have been developed and are to be field- tested soon. US AID has provided $ 5 million, representing part of its assistance programme for EPI, to the Directorate General of Community Health for strengthening basic health services. Assistance was provided in developing the "Country Needs Assessment Document" and the project proposals which were presented at the July 1979 Meeting on the Financing of Primary Health Care Programmes in Asia. Training courses were conducted for 540 health centre personnel in the team approach so as to increase the utilization of the Health Centre Reference Manual. Two hundred and ninety-six mobile health centres have been established. Two workshops were organized to review the family health care prograrmne in 11 out of the 16 provinces where it is operating. A national work- shop on public health nursing and supervision is to be organized for nursing personnel at various administrative levels. Areas of WHO collaboration with the Government include analysis of existing health and health-related policies, demographic projections, and the public sector financing of health services at national and provincial levels. Plans to develop health centre reporting and surveill.?~ce systems have been prepared. Two consultants assisted the Sub-Directorate of Community Health Services in examining the content and utilization of the Health Centre Reference Manual. In Maldives, the emphasis continued to be on the integrated health care approach. The Ministry of Health has drawn up a plan to open four regional hospitals through external assistance; out of these one is nearing completion. WHO has been collaborating in the training of community health workers and providing consultants in clinical specialties. The Government has carried out a national exercise involving all health and health-related sectors to prepare for country health programming, which will focus on strategies for health for all. MongoZia, which has made steady progress in improving the state of health of its population, now lays stress on providing a better quality of health care, in particular, maternal and child health. A long-term WHO hospital architect was assigned to assist the Government in developing functional designs of hospitals or remodelling the existing ones, as well as to train local designers. A consultant developed a draft project document for a pilot primary health care centre covering Khubsugal Aimak. In Nepal, where 96% of the population lives in rural areas in difficult terrain, successive development plans have given priority to the provision of health care to the maximum number of people. The health services, which in the past were mainly in urban areas and the terai region, delivered mostly curative medical care through hospitals and other institutions. During the last few years, there have been considerable improvements in rural health facilities, mostly directed at the un-served rural population. A further significant expansion of the health services is under way, as the Fifth Five-Year Development Plan envisages strengthening of the infrastructure of the health services SEA/RC33/2 Page 8 in rural areas by the establishment of 810 health posts to be supervised by 48 district health offices, with a referral system to hospitals (one in each of the country's 75 districts). These will be administered by the four regional health offices. A wide range of activities were accomplished, including the construction or conversion of more health posts; the in-service training of personnel in health posts and district health officers; the training of community leaders; the assessment of the nutritional state of children under five, and the expansion of the innnunization programme. A WHO team, in collaboration with other agencies, continued to provide active support to these efforts. Bearing in mind the constraints posed by shortages of capital and manpower resources, the Government conducted a mid-term situational analysis within the framework of the Fifth Five-Year Development Plan in collaboration with WHO, UNICEF, UNFPA and US AID. This exercise was timely, as it coincided with preparations for implementing a village-volunteer, primary health care scheme with the support of the basic health services. Basic training of village health workers and community leaders has been initiated. A major survey of the total health system and facilities, from the central level through the district and health post levels to the recipients of health care, was conducted. This study, in which WHO as well as UNICEF and US AID collaborated, is expected to facilitate reforms in the health system under Nepal's Sixth Five-Year Plan. The survey has provided particularly valuable information in the areas of family planning and integrated health services. In Sri Lanka, in order to achieve the balanced development of health services, the Ministry of Health is placing emphasis on preventive services and organizational changes which will result in the implementation of a strong primary health care programme throughout the country. The Institute of Hygiene, Kalutara, is being developed as the National Institute of Health Sciences, with a wider role and responsibility for training and health development. A pilot project for the training of community health workers was initiated in two districts under the charge of the medical officers of health. The village health volunteer programe, initiated in 1976, is being further developed. So far, 6000 village volunteers have been trained and are working. The Mahaweli Project - a major national development project with multisectoral inputs - continues to be developed in a coordinated way. The experience of this project will be particularly useful for ensuring intersectoral collaboration in health development towards attaining the objectives of health for all on a national scale. The expansion of the integrated rural health service infrastructure in Thailand in support of primary health care continued to make steady progress. The training of village health volunteers and village health communicators in collaboration with WHO has made considerable headway throughout the country. All 60 training modules for these workers have been printed and used in all the provinces involved. As of September Primary health care means reaching out to the people. HEALTH FOR ALL Health for the people and by the people. Health staff keep in close touch with the community to secure their participation. primary health coverage necessarily ~lves health care when people are invc ill. The traditional rural society in th€ Region likes its health worker to be from the community. accessible at all times and responsive to its needs TH FOR AL The popularity of health r pends largely on the exter they can meet the immedia those they serve. Norkers de- 11 to which te needs of AS some 401;/, of the Reg~on's nnnllla tion is under 15 vears of aaa. ---- - children need sp ion. Pro1 heal HEALTH FOR ALL per care of thl, ",".",th infants WI ."A . nrn ill ensure a ..., ,." ..... -,,- I w...ductive life. Malnutrition is not the result of an , inadequate diet alone, but also of poorly prepared food. Therefore 'A* ' mothers need to be guided in the #- - preparation of a healthy and balanced '--C diet far thefamily. - Traditional healers form a large res voir of health manpower in the rural areas of the Region. Their support is vital in providing health care to all. HEALTH FOR ALL .-..;hing by doing Health and nutrition education, parti- . - rrPPI cularly of mothers, can be of immense value in achieving health for all. HEALTH FOR ALL Prever 2ation from ltive measures such as immuni- of children ensure protection childhood diseases-still the maior killers in the Region. 1 I education ling programmes far medical stuoents need to be made more relevant to changing requirements of the ct munity. A student of medicine visits a home as part of her practical training. Health workers should identify them- selves with the needs. problems and aspirations of the rural masses to be able to serve them better. SEA/RC33/2 Page 9 1979, a total of 96 932 village health communicators and 3992 tambon trainers have been trained. A training programme in urban administra- tion and planning for personnel from 118 municipalities was completed. As part of this programme, two senior health administrators of Bangkok Metropolis were sent to Austria to attend a course on health planning development with special reference to urban areas. The Lampang Health Development Project was extended for two years with US AID assistance for the purpose of evaluation. It is proposed to prepare a series of monographs on the experiences of the Lampang Project. WHO collaborated closely in this project in various aspects, including evaluation, education and training. 1.1.3 Operational Studies " In pursuance of the objective of health for all by the year 2000 and in consonance with the guidelines evolved at the Alma Ata Conference on Primary Health Care, Member countries are making concerted efforts to develop result-oriented health services research in order to seek urgent answers to priority problems. Since 1976, when the South-East Asia Regional Advisory Committee on Medical Research identified health services research as a priority area, three research study group meetings have been held and have delineated several specific research areas relevant to the promotion of primary health care. WHO assistance was provided to a number of research projects in the Region. It was recognized that there was a need to enhance the research capability of the investigators to help bring the benefits of research to the people. Towards this end, a Regional Meeting on the Development of Health Services Research was held in November 1979 to give orientation in health services research to key persons in the health and other development sectors and in academic institutions so that they could function as a nucleus in their respective countries for the promotion of such research. The participants, who were high-level policy makers and research scientists, unequivocally expressed the need for the development of local cadres with capability in health services research. They also drew up a broad outline for a regional multidisciplinary course. In Bangladesh, assistance was given to the Bangladesh Institute of Development Studies in conducting a study on the financial aspects of health care delivery. This study provided an overview of the range of financing methods used presently, including innovative and experi- mental schemes. In Bma, as a follow up of the recently-completed Study on the Outcome of Pregnancy, including Perinatal Mortality and Morbidity and Low Birth Weight, a Study on the Application of Risk Strategies in Maternal and Child Care in Primary Health Care was initiated. Two studies, one on the role of health workers in the lay reporting of vital statistics and the other on the role of midwives in epidemiological surveillance, were completed. Assistance was given for a detailed study of the management SEA/RC33/2 Page 10 problem in the implementation of primary health care under the People's Health Plan. The findings of this study provided useful inputs for the formulation of a management training programme and the development of a training protocol. Assistance continued to be provided to India in studies of the factors influencing the adoption of practices related to the health aspects of family planning and in the development of courses in health education. The data from the Study of the Outcome of Pregnancy, including Perinatal Mortality and Morbidity and Low Birth Weight, are being anaIysed for the preparation of the protocol for the study on the Application of Risk Strategies in Maternal and Child Care in Primary Health Care. In collaboration with the National Institute of Health and Family Weflare, a five-day national workshop on health economics and management was organized in New Delhi in September 1979. The aims of the workshop were, among other things, to orient health planners and administrators in basic economic concepts and their application in the field of health; to identify cost centres and ways and means of effecting economies in health expenditure in the identified cost centres; and to identify areas of study in the field of health economics. A course in health planning and management for state-level officials was conducted at Shillong, also in collaboration with the National Institute of Health and Family Welfare, to expose the participants to the principles, practices and methodologies of health planning and to strengthen and improve health planning at the state level. In Indonesia, assistance continued to be provided to the study for the development of the disability prevention and rehabilitation component of public health care. The Study on the Outcome of Pregnancy, including Perinatal Morbidity and Mortality and Low Birth Weight, was completed. In Sri Lanka, the study to determine the effectiveness of health education by volunteers in the family health education programme continued to make progress. Field work for the Study on the Outcome of Pregnancy, including Perinatal Mortality and Morbidity and Low Birth Weight, has been completed and the data are being processed. A study on Sri Lanka Health Sector Commodity Requirement and Expenditure Flows was initiated in November 1979. A draft of the study on the role of indigenous medical practitioners has been prepared and one on the manpower and health personnel management system is being conducted. A number of studies are being undertaken in ThaiZand. The study on the Outcome of Pregnancy, including Perinatal Mortality and Morbidity and Low Birth Weight was, as in other countries, completed and the data are being analysed. An experimental Study of the Impact of the Age and Sex of Leaders on the Implementation of Health Programmes continued to make progress and an interim report is being prepared. Studies recently started include: Application of Risk Strategies in Maternal and Child Care in Primary Health Care; pilot study of a simplified maternal and child health data collection card; factors affecting Rural Low Birth Weight, and the strengthening of basic immunization programmes in urban SEA/RC33/2 Page 11 communities. The following studies are under consideration: comparison of the effectiveness and impact of corresponding supervision between qualified and non-qualified health educators at the provincial level; survey of community and government expectations of health delivery system, and a pilot study on village and neighbourhood cooperatives. Assistance was given in the mid-term assessment of the Fourth Five-Year Health Plan. The results and conclusions of the analysis and evaluation would serve as a valuable input for policy formulation and planning activities leading to the development of national strategies and plans of action for health for all. 1.2 Primary Health Care All the countries of the Region have unequivocally accepted the global * commitment of health for all by the year 2000 as their social goal with primary health care as the key approach. The thirty-second session of the Regional Conmittee, held in September 1979, reviewed the situation and evolved guidelines for the development of national and regional strategies to achieve the objectives of health for all through action programmes. To assist Member countries in this important task, a Regional Meeting on the "Formulation of Strategies for Health for All by the Year 2000 with Primary Health Care as the Key Approach" was held in the Regional Office from 1 to 6 December 1979, jointly sponsored by UNICEF and WHO. Twenty-five high-level national participants from the health and related sectors from nine countries attended the meeting, which was preceded by national-level preparatory activities in most countries, supported by WHO. The regional meeting focused on the clarification of the concepts and connotations of "Health for All by the Year 2000" in national terms, and reviewed the existing and proposed national mechanisms for developing appropriate national KFA policies, strategies and plans of action with particular emphasis on inter- sectoral collaboration and community participation. It also considered issues for drawing up broad plans for the period 1980-2000 for health development as a part of overall national development. The participants also discussed specific critical issues related to the planning, implementation and evaluation of primary health care as the key approach to HFA and identified areas for active WHOIUNICEF support. The deliberations of this meeting led to intensive activities at national level which consisted of critical reviews of national health systems for the purpose of reorientation, perspective planning, implementation and evaluation of primary health care programmes, resource-need analysis, and the use of appropriate indicators for setting targets and for monitoring performance. As a logical sequence to the December meeting, yet another Regional Meeting on Strategies for Health for All by the Year 2000, again jointly sponsored by UNICEF and WHO, was held in the Regional Office from 24 to 30 June 1980 to review the national strategies for HFA/2000 as well as to formulate the regional strategy. Political commitment and national resolve are indeed the primary factors in making the universal goal of health for all by the year 2000 a SEA/RC~~/~ Page 12 reality. A significant milestone in this regard is the Charter for Health Development, which was finalized and endorsed at the thirty-first session of the Regional Committee and which has so far been ratified by five countries in the Region. For the South-East Asia Region, the Charter is indeed a milestone as it not only denotes a firm commitment to the cause of health but also provides a powerful mechanism to trans- late such commitment into reality. In BangZadesh, a National Health Council has been established to help ensure the implementation of national policies and guide the Ministry of Health in developing services, keeping health for all as the ultimate goal. The implementation of primary health care programmes will be guided by a central body which will be responsible for the planning, management and evaluation of health services in general and primary health care in particular. The Second Five-Year Plan (1980-1985) envisages the operation of thana health complexes, one in each of the 356 rural thanas, as well as 4500 union health centres and family welfare centres. These will chiefly give support to the primary health care activities at the village level, in terms of training,supply of drugs as well as the provision of guidelines and supervision along with the domiciliary health services of the government health institutions. In Bunna, a task force for HFAl2000 headed by the Minister of Health is being established to draw up a tentative national strategy with the participation of other ministries concerned, such as the Ministry of Planning and Finance, the Ministry of Agriculture and Forests, the Ministry of Education and the Ministry of Social Welfare. A meeting jointly sponsored by the Ministry of Planning and Finance, the Ministry of Health, WHO and UNICEF was organized for formulating national policies, strategies and plans of action for the future medium-term programmes and a long-term perspective programme for HFA/2000. The highlights of the primary health care programe in Burma include: (1) the deployment of two categories of voluntary health workers - the community health worker and the auxiliary midwife - and (2) community participation. The community is involved from the very beginning of the planning process and in the implementation and evaluation of various activities at the local level. The programme envisages provision of primary health care services through the recruitment of voluntary community health workers supported by the local community, and their training by the township health department. Supervision of the community health workers will be carried out by the basic health services. Guidelines, materials and manuals for teaching are being developed by the Health Department to support the training and field activities of community health workers. India places great emphasis on primary health care with increased allocation for rural health and the strengthening of the infrastructure at the peripheral level. WHO and UNICEF are collaborating in the development of the primary health care programme. Assistance from WHO has been in the form of fellowships, equipment and grants. The grants have been used for the printing of manuals for multipurpose workers and SEA/RC33/2 Page 13 the payment of stipends to district medical officers and the trainers of health and family welfare training centres. Support was also given for the conduct of a national meeting for the formulation of strategies for health for all hich, among other things, recommended the establishment of central coordinating mechanisms between the existing centres of expertise in the health and health-related fields with a view to linking them in a functional network to facilitate their contribution to HFA activities. Steps have been initiated for establishing a coordinating mechanism between the various ministries and departments concerned at the central, state and district levels. Indonesia is formulating an appropriate national health system, as part of the essential steps for the achievement of the objectives of health for all. Similarly, the formulation of long-term health plans in relation to HFA is also receiving special attention. Since the begin- ning of 1979, the Ministry of Health has undertaken reorganization of the health services to improve intrasectoral coordination and strengthen the provincial and regency health offices to ensure programme imple- mentation. It has been decided to establish a national committee to review and reformulate the basic health policies, to formulate the long-term plan and to design the basic pattern of the Indonesian health system. In addition, a steering committee headed by the Minister of Health and consisting of all first-echelon officers in the Ministry of Health, and a planning team with the Secretary-General of the Ministry of Health as General Chairman, are being established. Working groups have been formed, to which national experts in the health and other sectors will be invited as necessary. Assistance was provided in the organization of a national seminar to formulate plans of action and national strategies for HFA/2000. In Maldives, a national conference with the participation of represen- tatives of different sectors discussed priorities in health as an integral part of national development. Using this national dialogue as a base, a country health programing exercise was carried out, in collaboration with WHO, to formulate strategies and plans for achieving the objectives of health for all. The Allied Health Services Training Centre continues to train community health workers. In order to strengthen the delivery of health care, the Government plans to increase the number of community health workers from one to two at each health centre. Another category of health personnel - the family health worker - is being trained for service in those islands where there is no health centre. In addition, the "foolumas", the traditional birth attendants, are being reoriented for maternal and child health as well as general health services. Mongolia considers the approach of health for all as relevant to the country's health situation. The priority programmes enunciated in the national health policy cover the main elements of primary health care, and efforts are being made to draw up a detailed and comprehensive PHC package. A task force has been established to define strategies for realizing the goals and targets of health for all. A national committee SEA/RC33/2 Page 14 is to be constitutedto coordinate and prepare detailed and concrete policy guidelines, reformulating in more explicit terms the goals and approaches in the field of health development to serve as a basis for a national inter-sectoral plan of action. The English version of a booklet, "Health Law of the Mongolian People's Republic", which deals comprehensively with all health aspects, was published in 1979. The most significant activities in Nepal were the preparatory steps taken by the Government for the elaboration of policies, strategies and plans of action in relation to health for all. Action was taken to set up a joint Government/WHO Management Group to support and guide the Department of Health and the Health Planning Unit in planning, imple- mentation, evaluation and intra and inter-sectoral coordination, including the coordination of all extra sources of support. In addition, a National Health Development Council, a top-level, policy-making body, has been set up to evaluate the progress made by primary health care programmes and take corrective measures to ensure balanced development. In Sri Lanka, concerted efforts are afoot to strengthen the health infrastructure in order to ensure that primary health care reaches the unserved and under-selved rural population. A multi-sectoral commitment has been made towards the achievement of health for all and primary health care has been accepted as the vehicle through which this will be realized. A National Health Council chaired by the Prime Minister and with the Minister of Health as the secretary has been established to ensure combined and collaborative action on the part of different ministries and departments. Under this council, a National Health Development Committee has been set up to coordinate and implement health programmes. In Thailand, the activities of the nation-wide primary health care project have been extended to cover approximately 15 000 villages in 69 provinces. The primary health care administrative unit in the Office of the Under-Secretary of State for Public Health has been designated as the focal point for the national inter-sectoral coordi- nating mechanism. The Government has approved the establishment of a formal mechanism for the coordination of collaborative efforts between the Ministry of Public Health and the Office of State Universities. Joint ventures in regional, provincial and local development planning are also being carried out under the auspices of the National Social and Economic Development Board and the Ministry of the Interior, in which the Ministry of Public Health is closely collaborating. In addition, a National Health Development Institute with financial assist- ance from WHO Headquarters has been constituted. The board of the Institute will have on it representatives from other ministries, departments and agencies, and will have functional linkages with them. A number of national seminars and workshops for various categories of officials from relevant divisions in the Ministry of Public Health as well as from other sectors, were held. An inter-regional committee on primary health care under the Chairmanship of the Deputy Minister of Public Health was established with a full-fledged secretariat. The SEA/RC33/2 Page 15 Government of Thailand constituted an ad hoc committee to undertake preparatory activities for national conferences on policies and strategies to achieve health for all. The first in the series of such meetings was held in November 1979 in which about 100 persons from all relevant sectors participated. With support from WHO and UNICEF, the Ministry of Public Health organized a bi-regional (South-East Asia and Western Pacific) workshop on primary health care in June 1980 in order to share experiences among developing countries. Case studies in four countries of the two Regions were used as inputs. 1.3 Traditional Medicine Most of the countries of the Region have recognized the importance of traditional medicine, particularly its potential usefulness in primary health care. Considering that the vast majority of the population, at least in this part of the world, depend largely on traditional practitioners for their medical care, it is heartening to note that traditional medicine has attained its rightful place. WHO has continued to develop and strengthen programmes of traditional medicine in the countries of the Region. This has been done through visits of specialists, the participation of educationists and research workers in international meetings and conferences and tours in the People's Republic of China (with UNDP support) and elsewhere. Research is also being stimulated in priority areas identified by the study group on traditional medicine of the Regional Advisory Committee on Medical Research. In addition, fellowships have been awarded and supplies made available in order to give further impetus to traditional medicine. A consultant who visited Indonesia and Thailand in June-July 1979 held detailed discussions with the national authorities and carried out surveys to find out the place of traditional medicine in ongoing or planned programmes related to primary health care. In Indonesia, he participated in the Second South-East AsiaIWestem Pacific Regional Meeting of Pharmacologists, held in Yogyakarta in June 1979. It is very encouraging that the Government of Thailand has made traditional medicine an integral part of primary health care. A very significant development during the year was the designation of the Gujarat Ayurved University, Jamnagar (India), as a WllO Collaborating Centre for Traditional Medicine (Ayurved), initially for a period of three years, in order to make the maximum use of the expertise available in the Region. This is the first such collaborating centre in South- East Asia. Action is under way to designate a similar centre at Varanasi. India. The project. "Research on the Efficacy of Ayurvedic Treatment of Rheumatoid Arthritis",continues to make progress at the Ayurvedic Trust and Research Institute in Coimbatore, India. WHO arranged for visits of some research workers from Sri Lanka to this institute. Some important group educational activities held outside the Region with participants from South-East Asia were: a training course on SEA/RC33/2 Page 16 acupuncture treatment, China, 1 September - 30 November 1979; a study tour on traditional medicine with emphasis on medicinal plants, hosted by the People's Republic of China to exchange experience on the role of traditional medicine in the organization of community health care delivery systems, June 1980; an International Conference on Traditional Asian Medicine, held in Canberra (Australia) from 2-8 September 1979, and a Consultation on Potential for Use of Plants Indicated in Tradi- tional Medicine in Diabetes Mellitus and Cardiovascular Diseases,Geneva, 30 October - 2 November 1979. In India, the indigenous systems of medicine have been accepted as integral parts of the country's health services. The authorities are very keen to develop these systems rapidly so that health care is delivered to the millions living in the rural and far-flung areas. The Government has launched many schemes to improve the quality of graduate and post-graduate education, promote research activities and the planned production of iierbalmedicines. Two important group educational acti- vities took place in India during the year - a national seminar on Ayurvedic Research, organized by the Gujarat University in November 1979, and the First Conference on "the Role of Ayurveda and Traditional Medicine in Primary Health Care", inaugurated by the Regional Director at the Institute of Medical Sciences, Banaras Hindu University,Varanasi, in March 1980. 1.4 Family Health In the regional programme in maternal and child health including family planning, the emphasis is on promoting national efforts to reorient this programme towards the social objective of health for all. Technical support was provided to ensure continuation of the emphasis on child welfare initiated during the International Year of the Child. Towards this end, national and regional programmes for the care of the pre- school child in the context of primary health care were formulated at a consultative meeting held in November 1979. Based on WHO'S long-term programme in maternal and child health as adopted by the World Health Assembly in May 1979, stress was laid on stimulating countries to include concrete plans for maternal and child health care as essential elements of primary health care. Care during pregnancy and child health, family planning, infant and child care with added emphasis on nutrition, prevention of infections, promotion of the physical and psychosocial development of the child and education for family life were also suggested as important components. In the field of training in maternal and child health and family plan- ning, the main objective was to promote self-reliance through the strengthening of national capabilities for training all levels of workers. Special attention was given to the training of front-line workers and their supervisors as well as workers of other related sectors. A programme that received particular attention was the development of a regional teacher education programme in maternal and child health, which has as its aim the strengthening of the capabilities SEA/RC33/2 Page 17 of national institutions and the promotion of technical cooperation among developing countries. Continued support was also provided for the revision of curricula for the teaching of paediatrics and maternal and child health to medical undergraduates and interns. In addition, research in some priority areas of maternal and child health relevant to future studies of health services research continued to receive assistance. Various group educational activities in maternal and child health carried out during the year are described elsewhere in the report (see Section 7.2 Education and Training in Maternal and Child Health, Section 7.7 "Group Educational Activities" and Annex 4). Activities carried out in the different countries during the period under review are briefly described below with special reference to project targets and evaluation. In Bangladesh, as a follow-up of an inter-regional course in fertility management and maternal and child health care held earlier, a national workshop was organized and two curricula - one for peripheral workers in family planning and maternal and child health and the other for intermediate personnel (district and supervisory officers) - were developed with the support of a WHO consultant. To strengthen the maternal and child health services in Bhutrm, two projects to be funded by UNFPA have been formulated. One of the projects is designed to develop and strengthen training in maternal and child health and family health, since the major constraint has been the lack of trained manpower. In Burma, assistance was given to the family health component of the People's Health Programme for the further extension of coverage and improvement of the quality of maternal and child health services and of school health and nutrition services. Programmes of orientation and training for basic health workers, community workers, township education officers and headmasters of schools also received support. Fellowships were awarded for training outside the country to develop health manpower in maternal and child health to provide referral services for primary health care. Detailed analysis of the data on the perinatal study continued, and preliminary steps were taken to carry out a study on the Application of Risk Strategies in Maternal and Child Care in PHC. A WHO consultant was assigned during the year to advise on the managerial and training aspects of the family health programme and to review the organization of maternity services. The programme targets were achieved. In India, through technical cooperation extended to maternal and child health activities, support was given to national efforts to strengthen the family planning programme. SEA/RC33/2 Page 18 The care of the newborn at the district level was supported through national educational programmes for paediatricians at this level. WHO continued to collaborate in disseminating further the re-modelled curriculum in paediatrics and in demonstrating the integrated teaching of maternal and child health, including family planning, to medical undergraduates and interns. A WHO temporary adviser carried out an evaluation of the programme on undergraduate paediatric education which revealed that the programme has been satisfactory and the fellows have benefited and have become reoriented, but that less than one-fifth of the medical colleges in the country have availed of the programme so a. It has, therefore, been recommended that the programme should continue and be strengthened by the addition of another demonstration centre, in order to benefit as many paediatriciana as possible from the "prototype" or "average" medical colleges in the country. The evaluation results have been communicated to the Government. The Organization continued its collaboration in the family welfare programme. A study tour for senior health administrators and obstetricians was arranged through an inter-regional project. Two other activities supported through the inter-regional programme were a Seminar on Social Distribution of Conventional Contraceptives, and a Workshop on Medical Termination of Pregnancy and Advanced Techniques of Maternal Care. The second year's data on the collaborative study on perinatal mortality and morbidity are being processed. Assistance was given to preliminary activities for formulating a research protocol for the second phase of the study. In Indonesia, through the project "Medical Services in Family Health", the development of an integrated approach to the delivery of family health services is being strengthened; observation tours to countries in the Region having successful programmes are being organized. Under the "Health of Family" project, fellowships are provided in maternal and child health and school health. A new component, "Community Health Nursing", has been added to this project in order to strengthen community health services further. The perinatal study which was started two years ago has been completed and a detailed analysis of the data is under way. In Maldives, a consultant assisted with the strengthening of the child health programme as well as the teaching of maternal and child health to community health assistants. The country health programming exercise carried out in February-March 1980 has set targets for improving the situation concerning complications of delivery and for reducing maternal and infant mortality rates. Accordingly, within two years, 50 per cent of the pregnant women are to receive antenatal care in the second and third trimesters of pregnancy and 50 per cent of all deliveries will be attended by trained women. The infant mortality rate is to be reduced from 120 to 90 by 1990. SEA/RC33/2 Page 19 WHO'scooperationwith MongoZiawas directed towards further expanding and improving the integrated family health programme,especially at the aimak level. Together with UNICEF, support was also given to pre-school care, the nutritionof mothers and children,and the rehabilitation of handicap- ped children. All activities were carriedouton schedule,exceptfor the tripartite evaluation of the programme by the Government,UNICEF and WHO. The first phase of the UNFPA-funded project, "Epidemiological Studies of Population Growth", was completed in December 1979. A review of the preliminary phase of the programme, carried out in August 1979, revealed satisfactory implementation of planned activities with an obligation of 78 per cent of the approved budget. Activities related to health educa- tion that could not be completed in time have been carried over to the new project. During the preliminary phase of the project comprehensive maternal and child health services were established in ten districts with emphasis on the preventive and promotive aspects and on improvement in the quality of specialist care for mothers and children. Advice was given on developing a study protocol on the nutrition of infants and young children. A consultant in statistics assisted in the analysis of data from research studies completed earlier. WHO collaborated in the preparation of a new project proposal for UNFPA assistance which was reviewed by the UNFPA Needs Assessment Mission to Mongolia. Pre-project funding has been approved by UNFPA. In Nepal, based on the findings and recommendations of the UNFPA Needs Assessment Mission, technical support was provided in the formulation of projects, especially those related to the strengthening of the inte- grated community health project in the Ministry of Health, the service delivery system, the family planninglmaternal and child health project, and the use of traditional medical practitioners in family health. These projects were planned to start operations from July 1980. Assistance was also given in the further development of the health A manpower requirements in maternal and child health, mainly at the district level, through national and regional training programmes. A consultant collaborated in the formulation of a training programme in tubectomy (minilap technique), and assisted with the training. WHO also helped in the procurement of some equipment required for the programme. Another WHO consultant was assigned to the country to help review and assess the child health component of the national family health programme, to make recommendations for strengthening the child health programme, especially at the primary care level, and to identify areas for further technical cooperation. A research study on the growth and development of children, using the WHO Growth Chart, is being initiated as a follow-up activity. In Sri Lunka, the UNFPA-funded projects, "Strengthening of the Hospital- based Family Health Services" and "Family Healthl',were revised in August 1979 for further extension. A WHO consultant was assigned to assist with the execution of these projects. SEA/RC33/2 Page 20 As planned in the first project, 32 district hospitals have been upgraded through additional inputs, including equipment and supplies, and a further 55 hospitals and peripheral units are being upgraded in 1980 to provide sterilization facilities and maternal and child health services. Further, a programme to train district medical officers in performing sterilization operations has already started. To promote family health in rural areas, a manual for family health workers has been published in English and Sinhala and the Tamil version is under production. To introduce this manual, supervisors and peripheral health workers are being given on-the-job training. Orientation and training in maternal and child health and family planning for groups of medical officers and paramedical staff in municipal areas is under way. In order to evolve optimal strategies for the delivery of family health services in the rural areas, field research and management studies have been undertaken in selected places. WHO'S technical cooperation in Thailand was extended, mainly through the execution of UNFPA-funded projects, for the further strengthening of the national family planning programme, which continued to make good progress. A consultant was assigned under the Regional Team on Family Health to provide support to the national family planning programe. The project targets were achieved on schedule. In the field of maternal and child health, support was given to develop a simple, effective information system for maternal and child health, including family planning. A pilot study of a simplified maternal and child health data collection card was initiated for this purpose. Support was also given to a study on perinatal mortality and morbidity. including low birth weight, in one of the provinces. Work on the WHO collaborative perinatal study was continued with the analysis of research data. Assistance was provided in developing a research protocol for the Study on the Application of the Risk Strategies in Maternal and Child Care in PHC. 1.5 Nursing In the year under review, emphasis has been laid on the development of nursing manpower planning at the national level. Special efforts are being made to enable the integration of nursing with the total health manpower development. Despite all attempts to increase the number of nurses/midwives in the Region, there is still a shortage of these categories of health workers. To ease this problem, special attention has been given to the utilization and management of nursing manpower. Nursing activities in the context of primary health care are carried out by various categories of nursing personnel at different levels. Since there is still a great need for the training and utilization of different categories of nursing personnel, their role and responsibility, as well as their contribution to primary health care,should therefore be clearly defined. With the support of WHO nursing field staff, task analyses and the preparation of job descriptions have been undertaken. SEA/RC33/2 Page 21 Nursing Education In nursing education, continuous support is given to the countries in reviewing and improving curricula with a community orientation. A plan is to be developed for implementing a "conanunity health-oriented nursing education planning and teaching guideline" in one country. The prepara- tion of nurses in special clinical areas as a back-up service for primary health care has received greater attention. The development of innovative training programmes for community health workers has been undertaken by national and WHO staff. Nursing Research The need for nursing research is recognized in this region. The major constraint, however, is the inadequate number of qualified nursing research personnel. Technical cooperation among developing countries, therefore, plays an important role in this area. Special efforts have been made to assist in the development of research protocols which can be used to identify problems affecting nursing education and nursing service or to modify nursing education programmes to prepare nurses for their role in primary health care. Lists of nursing resource persons for primary health care in this region are being compiled by WHO. Nursing Service Administration In the field of organization and management of nursing services some progress has been made in setting standards of care and relating the achievement of these standards to the most economical and efficient ways. Activities have focused on strategies for the improvement and refinement of existing programmes keeping in mind community orientation. When required, radical changes and programme substitutions were made to produce a category of nursing personnel for utilization outside the institutional framework. d. Assistance was provided to clinical specialties in improving nursing practice. Examples are: neurological nursing; mental health/ psychiatric nursing; orthopaediclrehabilitation nursing, and community health nursing. Continuing education programmes were organized and national plans formulated for continuing education for existing staff. There is need to strengthen further the participation of nursing administrators in country health programmes and to develop skills in the planning and management of the nursing component of the health care delivery system. Country Activities The Organization has been collaborating closely with the countries in the development of nursing. The following is a summary of activities in each country, reflecting the needs, problems and progress during the period under review. SEA/RC33/2 Page 22 In Bangladesh, basic nursing education through 18 government training centres continues to show improvement. The preparation of teaching personnel for the training of nurses for primary health care was undertaken. A plan for developing a division of continuing education is in the initial stages and further details are being worked out. In Burma, an assessment of the pilot project on the training of traditional birth attendants was completed in December 1979. The project proved to be very successful as a model for training, and the Government has extended it to other areas of the country. During the year WHO consultants have worked with the national staff in India to develop specialists in clinical nursing in different areas. Special efforts are needed to strengthen mental health and psychiatric nursing in the RAK College of Nursing in New Delhi and the College of Nursing in Bangalore. The need to revise national curricula with emphasis on community orientation has been recognized. In Indonesia, a plan for converting more nursingfmidwifery programmes to the PK (health nurse) programme has been finalized. WHO staff have been giving assistance in planning the details of the course content. In order to prepare teaching staff for those schools which are planning to convert soon to the new training programme, some assistance is needed in the form of orientation to the concept of PK curricula, planning and implementation. The progress made by the nursing component of the family health care programme has been very satisfactory. The WHO public health nurse educator has developed the functions and activities of the nurse in primary health care, which can serve as a very useful guideline. A WHO consultant collaborated in the successful development of an in- service training programme for health centre staff to introduce and encourage the utilization of the Health Centre Reference Manual. The new project on nursing manpower development in Irian Jaya commenced in March 1980. The Government of MaZdives has decided to increase the student intake for various training programmes at the Allied Health Services Training Centre to meet the health manpower needs of the country. Emphasis is therefore placed on designing appropriate teaching strategies. The revision of curricula for various auxiliary health workers based on task and competency is under way. A task analysis of all categories of health personnel was undertaken and job descriptions for communityhealth workers and health aides were developed. In Mongolia, the translation of three nursing text-books from English into Russian was completed. A group of authors has been identified who will write text-books for middle-grade health workers. Seven workshops for 102 teaching staff were conducted at Ulan Bator, Darkhan, Gob-Altai, and Sanshand. The architectural design and location of a nursing school SEA/RC33/2 Page 23 in Ulan Bator were approved. Approximately 35 nursing graduates from the post-basic courses in teaching and administration became available to assume the teaching responsibilities in basic nursing programmes as well as nursing administration in various institutions. Much progress in the field of nursing has been made by the national staff with the assistance of the WHO nurse educator, but there is a need for further strengthening of many aspects of the programme. In Nepal, the training programme in community health nursing is being formulated for implementation in 1980. This will be the second major effort in the post-basic school. The post-basic course for the preparation of midwifery tutors is progressing satisfactorily and the first group is expected to graduate this year. A short-term consultant assisted in the assessment of existing auxiliary nursing programmes and the development of a community-oriented basic nursing curriculum. The Post-Basic School of Nursing in Sri mka has a one-year diploma course in teaching and supervision in schools of nursing and a course in management and supervision. In addition, the National Institute of Health Sciences in Kalutara offers a post-basic diploma course in public health nursing. Much attention is given to basic nursing and midwifery education. The programme to train an increased number of public health midwives was implemented with the assistance of a WHO consultant. In ThaiZand, the nursing practitioner programme is being evaluated to strengthen the basic nursing programme in primary health care. Initial steps were taken to formulate and carry out nursing research. Training in research methodology has been undertaken by the national staff in selected nursing faculties. 1.6 Health Education a, Health education efforts in the countries of the Region have steadily been intensified towards the attainment of the social goal of HFA 2000. The following is a sumnary of activities in individual countries. In BmtgZadesh, two WHO long-term health education specialists provided assistance during the period under review. One of them, who completed his assignment at the end of 1979, was concerned with the further development of health education at the central, regional, district and sub-divisional levels. To meet the manpower requirements resulting from this development, 114 sub-divisional health education officers were recruited and trained within the country, partly with WHO support, and assigned to the sub-divisions. Since the country needs a much more expandedand strengthened health education service, a plan was prepared for possible assistance from the World Bank. The other health education specialist, who left at the end of March I I 1980, mainly assisted in the development of health education in primary '+ health care and in the planning, initiation and development of the SEA/RC33/2 Page 24 post-graduate programme in health education at the National Institute of Preventive and Social Medicine. A short-term consultant in educational technology also assisted the Institute in developing curricula in the field of audio-visual aids for health education. In Burma, health education officers assigned to the divisions and townships as well as to the Health Education Bureau provide support to primary health care and other major health programnes. There are, however, constraints on account of limited manpower, equipment, supplies and training. A major programme to extend the present health education services in support of health care is required. In India, the expanding programme of community health workers with heavy responsibilities for health education has made greater demands on health education specialists assigned to the central, state and district health education bureaux. This, in turn, led to the organization of a national workshop on the current status of health education services in India, held in New Delhi in February 1980. This workshop was followed by a National Workshop on Teaching Aids for Health Education and on Health Education in the Undergraduate Medical Curriculum. The Central Health Education Bureau is also engaged in training the trainers in health and family welfare, and in assisting state and district health education units, medical schools and the National Council of Educational Research and Training in their health education responsibilities. WHO continues to collaborate in all these activities. The Provincial Health Department of Irian Jaya in Indonesia is develop- ing health education as an integral part of health services, and to facilitate this, health education units in the Province and the districts are being established. Workshops on health management and health education were held during February-March 1980. In addition, short orientation courses were organized in the provincial capital and in the districts and sub-districts. The WHO health education specialist supported all these activities. Following the country health programming exercise conducted early in 1980, Maldives identified the educational aspect of its primary health care programme. A short-term consultant has been assigned under the inter-country project "Health Education in Family Health" (ICP HED 003) to provide technical support. The Government of Mongolia is engaged in the development of health education curricula for primary and secondary schools and teachers' colleges. In addition, it is proposed to prepare textbooks and other learning resource materials and also train teachers for school health education. The plan, which will come into operation later in 1980, will start as a pilot project and, based on the experience gained, will be extended to other areas. A WHO health education specialist has been assigned to assist the Government in this regard. SEA/RC33/2 Page 25 In Nepal, the acting Chief of Health Education as well as his colleagues are back in position after completing post-graduate training abroad in health education. With the augmentation of its limited health education manpower, Nepal is now expanding health education services in support of primary health care, environmental health, school health and other programes. During the year, Sri Lanka made significant progress in the field of health education. The Health Education Bureau in the Department of Health Services now has units dealing with school, hospital, dental and community health education, training, research and evaluation, field studies and demonstration. Professionally qualified health educators are in charge of these units and have also been assigned to each of the superintendents of health services to support the educational activities in the field. To augment the existing number of health education specialists, 35 graduate health educators have been recruited and are being given a three-month training within the country. Training in health education is a major activity. In addition to in- service training, the Government is now engaged in the basic health education training of health workers such as physicians, nurses and sanitarians. Textbooks and other learning resource materials are being provided. WHO collaborates in these efforts and has provided two short- term consultants, equipment and supplies as well as fellowships for the training of health educators. The main thrust of the health education progrannne in Thailand is in support of primary health care activities in the provinces. The Government is now engaged in establishing regional and provincial health education units to provide such support. In addition, facilities for training, planning and the production of audio-visual and communi- cation aids have been established. Together with support to school health education, efforts are being made to utilize mass communication media. WHO is collaborating in all these efforts and is proposing to assign a short-term consultant to review the progress. The Organization also recognizes the important educational role played by health workers, community leaders and village health volunteers, especially in primary health care programmes. Efforts were therefore intensified for collaboration with the countries in the training of these workers. Since primary health care involves health education utilizing minimally trained health workers and community health volunteers, preparation of new strategies and new material for the training of these workers was encouraged. In addition, the pre-service preparation of health personnel such as physicians, nurses and sani- tarians in health education was supported, The Organization concen- trated on the reorientation of health education specialists to meet the needs of primary health care. At the same time, WHO also took steps to review the curricula for preparing health education specialists in the Region. SEA/RC33/2 Page 26 Efforts for community participation and involvement in various health programmes supported by WHO emphasized the need for greater research into health behaviour. Successive working groups constituted under the Regional Advisory Committee on Medical Research also identified several aspects for such research. Two consultants in social sciences were recruited to survey the current status, appropriate institutions in the countries, as well as available manpower. Research projects on different aspects of health education funded by WHO Headquarters continued to make progress in India, Sri Lanka and Thailand. Programmes of health education research on community participation, nutrition and environmental health, supported by the Regional Office, are also going on in some countries. 1.7 Nutrition Following significant advances made in the past and the profound change that has taken place in the overall approaches to health as a result of the commitment to achieve the goal of health for all, it became necessary during the year to assess the general directions in the field of nutrition. Nutrition activities must take into account the factors determining the growth of children and be in line with the pace of health development and other related areas. In this way nutrition is seen not as a vertical programme but as a technical input for operational units. One of the basic constraints in this regard at present is the lack of appropriate information, although in individual countries sufficient data were available to define the magnitude of the problem. By means of published information, reports of consultants and visits to some of the countries, it is evident that the magnitude of the problem, the national structures, the causative factors and national commitments differ not only from country to country but also within countries. Against this background, discussions were held with specialists in nutrition in different countries and, in line with the objectives and strategies for the development of health services, a tentative frame- work for a regional programme on nutrition was developed during the year. A study of the composition and role of nutrition units in all countries of the Region was made by a WHO consultant. The Regional Office is actively supporting these units. The definition of nutritional inputs into the primary health care services is being pursued through the inter-country project, "Nutrition in Primary Health Care". National seminars are being supported in different countries of the Region, and the outcome of these activities is to be discussed in depth at an inter-country meeting scheduled for 1981. The Regional Office also collaborated in the development of the nutrition component of family and primary health care programmes. SEA/RC33/2 Page 27 The utilization of data sources in the development of appropriate surveillance systems is a priority for most of the countries of the Region, and the Regional Office has supported this effort by means of distribution of pertinent bibliographies, technical collaboration and through the regional research programme. Preparations are being made for an inter-country meeting to evolve general guidelines and discuss new approaches. In the area of specific nutritional deficiencies, WHO has lent support to the world campaign against goitre in collaboration with the World Food Council and UNICEF. All countries have prepared detailed programmes for the solution of this problem and have expressed their needs for external support. What is now necessary is to enlist the support of external agencies. During the year a consultant visited most of the countries in the Region and had discussions with research groups to delineate the priority problems and seek solutions at the country level. Based on his findings, the Regional Office developed a research-cum-action programme in nutrition. A workshop held in June 1979 identified five areas, includ- ing 19 projects. Nutrition in primary health care was selected as the priority area for short-term development, as its components would support the overall nutrition programme. Background material on similar projects developed both within the Region and outside was prepared for a study group meeting held in October. This group drew up protocols to serve as a basis for projects to be implemented in the different countries, suitably adapted to meet local conditions and requirements. Funds were provided to six countries, and in some with limited research facilities, technical support was given for developing expertise. Assistance was provided to strengthen the nutrition units in the countries of the Region. A consultant assisted the governments of Bhutan and Maldives in ascertaining the need for setting up nutrition units. In Burma and Indonesia, a consultant reviewed the involvement of the nutrition unit in the design and evaluation of nutritional activities within the primary health care system. The Government of Bangladesh has requested the services of short-term consultants to help in reviewing nutrition activities, in developing the curriculum and syllabus for a diploma course in public health nutrition, in drawing up proposals for research in nutrition, and in establishing close liaison among all the institutions working in the field of nutrition throughout the country. Financial assistance was provided for the organization of a national seminar on "The Role of the Health Sector in Nutrition Activities", held in Dacca in November. In Bhutan, a consultant assisted in the training programme for the trainers of school teachers who later carried out an assessment of the nutritional and health status of school children through the measurement SEA/RC33/2 Page 28 of heights and weights and the examination for anaemia, goitre and angular stomatitis. In India, WHO continued to collaborate in the two nutrition courses organized annually by the National Institute of Nutrition, Hyderabad. TWO consultants cooperated with the Government of In&ne&a in planning a nutrition surveillance unit and its organizational structure and in devising a system of recording, reporting and processing of data on nutrition surveillance. In MaZdives, where a country health programming exercise was carried out during the year, priority was accorded to the implementation of nutrition programmes within the primary health care system. A consultant assisted the Government of Mongolia in the preparation of a design of an epidemiological study on infant nutrition. In NepaZ, a nutrition cell was established in the Ministry of Health. A national nutrition coordination committee was formed to suggest steps for the integration of nutrition in all relevant activities of the health services. A consultant assisted the Government in formulating a research protocol on weaning and other foods using village resources. Assistance was given to Sri Lunka in formulating a comprehensive health project for pre-school children, in reviewing the nutrition surveillance programme and in guiding the national staff in the preparation of the protocols for nutrition research projects. In Thaitend, assistance was provided for various training progrannnes. A national seminar was held in Kanjanaburi Province from 25 to 27 July 1979 in which 50 nutritionists, scientists and physicians participated. 1.8 Medical Care It is heartening to note that governments are seized of the problem of extending medical care to the vast unserved and underserved populations living in rural areas by providing medical care through hospitals and health centres. In Bangkdesh, a WHO staff member continued to assist in strengthening the Central Medical Stores Workshop to make it more effective and efficient to meet the needs of the country. He also helped to train manpower for other workshops. Medical care services are being strengthened in Bunna through the award of fellowships and the provision of supplies and equipment. A number of fellowships for advanced training were arranged for the Democratic PeopZels RepubZic of Korea to strengthen further the services SEA/RC33/2 Page 29 related to medical care, hospital administration and other important specialties. Supplies and equipment were also made available. In India, which has a considerable medical care infrastructure, the stress is on the development of interlinked referral services and logistic support to primary health care. Efforts continued for the strengthening of the different systems of indigenous medicine which form an integral part of the country's health care services. The Government is very keen to develop these systems so that health care becomes available to the millions living in the rural and far-flung areas The Government of Indonesia aims, under Repelita 111, which covers the period 1979-1984, to create better opportunities for every citizen to attain the highest level of health through efforts to deliver expanded, more equitable and more accessible health services, with priority to the low income rural and urban population. The main objectives of developing the health care system are to reduce mortality and morbidity, improve the nutritional status of the community, and ensure equal distribution and utilization of health care services. Although Maldives has qualified and trained doctors for the treatment of routine cases, assistance is required from outside the country in certain specialties. Towards this end, WHO assigned specialists in different fields - a surgical team, an ENT team and a bacteriologist - to Maldives during the period under review. The main aim of the teams was to treat patients with special problems and, at the same time, train national health personnel. Steps were taken to assign an electro-medical engineer to Sri Lanka to assist the national authorities in planning and conducting training courses for technicians and also to advise on the installation, maintenance and repair of health equipment. Some fellowships were provided in medical stores management, in addition to supplies and equipment. 1.9 Care of the Aged, Disability Prevention and Medical Rehabilitation Bearing in mind that 1981 has been designated as the International Year for Disabled Persons (IMP), the Organization provided consultancy services to Member countries to evaluate developments and to formulate programmes for implementing the objectives and goals of IYDP. In August 1979, an inter-country Seminar on the Prevention and Control of Accidents was organized with 23 participants from 8 countries of the Region, to assess the magnitude of the problem and the existing facilities and to plan regional and national strategies for the prevention and control of domestic, occupational, traffic and other accidents. A medium-term programme was formulated for the health care of the elderly. Two participants (one each from India and Thailand) attended the Preparatory Meeting for the WHO Conference on Road Traffic Accidents in Developing Countries held in Paris in December 1979. SEA/RC33/2 Page 30 As for activities during the year in the various countries, the Institute for Disability, Prevention and Rehabilitation in Bangladesh continued to make satisfactory progress. A WHO-sponsored National Seminar on Community Programme for Disability Prevention and Rehabilitation, held in Rangoon, Bm (3-7 December 1979), reviewed the existing situation,assessed the facilities and drew up a detailed national plan, including recommendations on legislation for disability prevention and rehabilitation. A specialist from India participated in an Informal Consultation on Community Training for the Disabled, held in Mexico in November 1979 to discuss the practical possibilities of implementing rehabilitation programmes in developing countries and to draft a manual on "Training the Disabled in the Community". This field manual is being tested in Trivandrum. Preliminary preparations were made for conducting a national meeting on the prevention of traffic accidents. The training of orthotic and prosthetic technicians at the National Institute of Prosthetic and Orthotic Training in Orissa and the development of the satellite centres affiliated to the orthotic and prosthetic manufactur- ing corporation, ALIMCO, Kanpur, progressed satisfactorily. At St. Martha's Hospital in Bangalore, the World Rehabilitation Fund conducted the annual prosthetic training course. Physical facilities at the Institute of Rehabilitation and the Hemiplegia Centre in Lucknow were organized and training courses were being planned. A national meeting for planning disability and rehabilitation facilities was organized in Indones'b in which more than 300 health personnel participated. The Regional Office provided documentation and background material for this meeting. The World Rehabilitation Fund awarded fellowships for training and collaborated in the development of rehabi- litation activities in hospitals in Jakarta, Bandung, Surabaya, Manado and Solo. In MongoZia, the training of health personnel and the organization of services for accidents, disability prevention and medical rehabilitation continued to make progress. In Nepal, a multisectoral and multidisciplinary group prepared a draft national plan for disability prevention and medical rehabilitation. Action was initiated for exploring the availability of extrabudgetary resources for the implementation of this plan. Community-oriented disability prevention and rehabilitation services at Ragama Hospital in Sri Mka were developing satisfactorily. A staff member of the School of Physiotherapy and Occupational Therapy, Colombo, assisted in the preparation of a manual on "Training the Disabled in the Community". In Thailand, a national meeting was organized to review the problem of traffic accidents and formulate a plan of action for the prevention and SEA/RC33/2 Page 31 management of emergencies. The training of health and allied personnel and the expansion of rehabilitation facilities at the intermediate and central levels of health care continued to record progress. Member States were requested to organize national meetings to review developments and prepare national plans for the health care of the aged, disability prevention and rehabilitation as an integral part of primary health care in the overall context of health for all. A consultant is under recruitment to assist in the planning and development of these programes. 1.10 Oral Health The problems connected with oral health are receiving increasing P attention in the countries of the Region. Although the dental health care of the people in many of the countries continues to be unsatis- factory, with growing awareness of the importance of public health dentistry and of oral health, governments are promoting programmes in this area with particular emphasis on the community aspects. Under the oral health project in Bangladesh, the curriculum for the bachelor's course in dental medicine has been reviewed with the accent on preventive dentistry. This project will also help improve the facilities at the Dacca Dental College. A national path-finder survey of oral health was conducted and a number of students were examined. Further assistance is planned, amongst other things, in organizing and conducting the training of dental health workers and also for a nation- wide programme of oral health education. In India, WHO collaborated in conducting a national Workshop on Dental Diseases and Orofacila Anomalies in Children, in November 1979 in New Delhi. ..~. To mark the 20th anniversary of the Faculty of Dentistry, University of Padjadjaran, Bandung, Indonesia, a symposium on the comprehensive management of paediatric patients was organized in September 1979. Several specialists from other countries also participated in this important activity, the subject of which was specially chosen to commemorate the International Year of the Child (1979). It is proposed to provide assistance in setting standards needed for epidemiological studies of oral diseases and for the integration of dental health in primary health care. In Sri knka,anisland-wide field training programme for school dental nurses in dental health education and prevention was completed. Workshops were held in various parts of the country, with field practice forming the core of the programme. As a result of these activities, emphasis is now placed on a prevention-oriented, community-based oral health care delivery system. The Government has developed a new project, "Preventive Oral Health Care in the Delivery of Primary Health Care in Sri Lanka". Steps were taken to implement progrannnes promoting SEA/RC33/2 Page 32 dental hygiene in the primary schools of Colombo. Further assistance is proposed for developing a national plan in preventive dental health and for strengthening dental health education. In ThaiZand, the oral disease programmes on the effect of chlorhexidine and fluoridated chewing gum are proceeding according to plan. In addition to financial assistance, the services of a specialist were provided to collaborate with the Government in the preparation and conduct of a national workshop on educational materials for dental health education, which was held in Bangkok in December 1979. The project document for the establishment of a Regional Training and Demonstration Centre in Oral Health in Chiang Mai was finalized and signed by the Government. The Division of Dental Health has developed., in collaboration with WHO, a plan of activities for the Centre for 1980, 1981 and 1982. A national conference on primary health care, held in Bangkok in November 1979, identified four more essential elements of primary health care that need strengthening, dental health being one of them. 1.11 Mental Health, Drug Dependence and Alcohol-related Problems Evidence increasingly continues to project the importance of this major programme area, not only in terms of the Organization's new programme classification structure but also as reflected by the greater attention and growing commitment that it commands in many Member countries. This area, which includes the prevention, treatment and rehabilitation of mental and neurological disorders, drug dependence and alcohol-related problems, is concerned also with the mental health implications of social, economic and environmental development, so much in evidence in this region. WHO, through its coordinating mechanisms at global and regional levels, has actively promoted and supported national policy formulation. In a number of countries this has led to commitments to include mental health as a component of primary health care and to take it into consideration in the development of strategies towards health for all. Collaboration within the Region in the important area of drug dependence, treatment and rehabilitation has continued and has extended to inter- regional activities with particular reference to narcotic drugs. It is, however, not without concern that attention is shifting to the emerging problems of other drug abuses and problems related to the increasing consumption of alcohol. Developing countries are by no means immune from these known hazards of industrialized societies. Important contributions have been made by countries in the Region to global and regional collaborative activities in all these fields, while some national programmes, too, have been developing satisfactorily. The commitment of Member countries to the integration of mental health activities is being pursued at different levels of the determination and SEA/RC33/2 Page 33 implementation of national policy. The Organization's medium-term programme in mental health has taken these developments into account. The Regional Office, under an inter-country project on mental health, supported the attendance of national representatives at a joint study meeting on child mental health convened by UNICEF, WHO and non-govern- mental organizations in Salzburg, Austria, in July 1979. The outcome of this meeting, leading to activities in child mental health and psychosocial development, is important for countries with relatively high percentages of children and young people among their population. In Bangtadesh, the second and third in the annual series of national workshops on mental health were held late in 1979. A consultant assisted these workshops, which help in the implementation of the national plan to integrate mental health in the general health services and in primary health care. A mental health service and training centre has been opened in Dacca with WHO support to provide training to all categories of health workers and those in other disciplines in community mental health. It will also be a focal point for specialist training in the country. A vehicle has been provided to this centre by the Yugoslav voluntary organization, "Hungry Child". Key national personnel have attended appropriate regional and global training programmes in community and social psychiatry on WHO fellowships. The mental health programme in Bm continues to receive WHO support through the United Nations/Burma Programme on Drug Abuse Control. Psychiatric centres in Rangoon and Mandalay play an important role in the provision of services and the training of staff. -. The extension of mental health services beyond these psychiatric centres to general hospitals and to other townships continues. The post- graduate training programme is now well established and there has been a perceptible increase in specialist manpower now available. In India, a series of national workshops on various aspects of mental health were held, with WHO support. At the National Institute of Mental Health and Neurosciences, Bangalore, which during the year celebrated its 25th anniversary, national meetings were held on post-graduate psychiatric education, and training given in clinical psychology. A meeting was convened by the Ministry of Health with WHO support to prepare a national plan for mental retardation services in the country. This meeting brought together representatives from not only the health sector, but also education and welfare and the national non-governmental organizations concerned with mentally retarded adults and children. SEA/RC33/2 Page 34 International collaboration in WHO activities within the medium-term programme in mental health continued to be strongly supported by a number of centres in India. Collaborative work includes the development of community mental health services and of manpower for mental health, as well as biomedical and pharmacological research. Two national centres for collaborative research and training in the neurosciences have been designated and recognized by WHO at TN Medical College and BYL Nair Charitable Hospital, Bombay, and the Institute of Neurology, Madras Medical College and Government General Hospital, Madras. These centres will provide the necessary linkages for the global programme on neurosciences being developed with emphasis on the needs of developing countries and the neurological problems of tropical diseases. 7 With WHO support, the Directorate of Mental Health in Indonesia held a national mental health teaching seminar on traditional healing with specific reference to psycho-socio-cultural mechanisms. Three consultants assisted in the conduct of the seminar, which was attended by partici- pants from the health and related disciplines. Observers from other ASEAN countries also attended this seminar. As the implementation of the national mental health plan proceeds, the rate of integration of mental health in the general health services is increasing. Together with the programme of integration in primary health care centres (PUSKeSMAS), there is now a programme for integrating mental health into district general hospitals. The framework for the collection of data on mental health is being established gradually to cover the new facilities and services. In Jakarta, an ambitious and innovative project on community mental health is being developed jointly by the Jakarta Metropolitan Health Department, the Directorate of Mental Health of the Ministry of Public Health, the Department of Psychiatry and the Faculty of Public Health of the University of Indonesia. This project is being developed through multisectoral coordination among all government, public, metropolitan, private and voluntary agencies in the city. A multidisciplinary team is being developed to which WHO is providing technical support and assistance. The Directorate of Mental Health of the Department of Medical Care in the Ministry of Health is being designated as a WHO Collaborating Centre for Research and Training in Mental Health. This centre will provide an additional base in the Region for training in community mental health and for international collaborative activities within the WHO medium- term programme. In Mongolia, following the pattern of implementation of the national mental health plan, WHO continues to provide support mainly through the fellowships programme for specialist manpower. This year a national staff member is to receive training in forensic psychiatric preparatory to the establishment of services and training in this discipline. SEA/RC33/2 Page 35 A WHO grant was provided in 1979 to assist the national activities undertaken to mark the twentieth year of the commencement of neuro- psychiatric services in the country. The national advisory body on mental health established in Sri Lanka during 1979 has been the focus for the development and implementation of national policy. Most of the major provincial. general hospitals now have functioning psychiatric units and at least one of the base hospitals has a psychiatrist attached to it. WHO support to the development of these services is being increased. Two consultants have been advising on the general administration of the two mental hospitals at Angoda and Mulleriyawa and have made recommendations for using these hospitals in the countrywide mental health service. The Post-graduate Institute of Medicine has introduced higher examina- tions in psychiatry, and the first part of these examinations was conducted in June 1980. WHO has, for many years, been assisting in the establishment of country-based specialty training. With this aim now realized, support will be increasingly directed at strengthening the necessary services. WHO support has continued to the University Department of Psychiatry in Colombo and useful epidemiological data on the use and needs for mental health services are now available for evaluation and the planning of appropriate services. In Thailand, the first national seminar on mental health was held in March 1980 with WHO support. Participants from many sectors and disciplines, including health education, justice, religion, administra- tion and planning, and voluntary and private mental health agencies made recommendations for a national mental health policy to improve and promote a comprehensive community-based mental health programme. The Division of Mental Health of the Ministry of Public Health is collaborating in two global projects. The monitoring of mental health needs, a project designed to establish the basic recording of mental health data for the evaluation and planning of mental health services, is being extended to two additional districts. The second project concerns the assessment of danger in forensic and administrative psychiatry. Case studies and assessment procedures are being reviewed in a number of countries including Thailand, which is the only country in this region with a functional and designated forensic psychiatry service. Drug Dependence and AZcohoZ-related ProbZems With assistance from the United Nations/Burma Programme for Drug Abuse Control, the renovation and construction of the Drug Treatment Centre at Mandalay has been completed and the Centre has been functioning since 1 January 1980. Since the beginning of this programme, the Health Department has continued to make substantial improvements in treatment SEA/RC33/2 Page 36 facilities at centres located in major drug-affected areas, with UNFDAC support. Six doctors responsible for drug addiction treatment in provincial hospitals attended a WHO training course on "Treatment and Rehabili- tation of Drug Dependent Persons" held in Hong Kong in November 1979. The Department of Health organized in Rangoon a national Seminar on Drug Dependency in September 1979. This meeting brought together health personnel from the 14 states and divisions to review major aspects of the drug abuse problems in the country. The participants recornended the strategy for the utilization of all resources made available nationally and from the United Nations and other agencies. In Thailand, the health sector of the United Nations Programme on Drug Abuse Control has continued to support the drug treatment centre in Chiang Mai and the seven major research projects being undertaken by the Drug Dependence Research Centre of the Institute of Health Research, Chulalongkorn University, Bangkok. During the year, the Institute of Health Research was designated as a WHO Collaborating Centre for Research and Training in Drug Dependence. Funds from the WHO regular budget supported national participation in a study tour of neighbouring countries having activities in drug control dependence and in the WHO Training Course held in Hong Kong on the Treatment and Rehabilitation of Drug Dependent Persons. The second in a series of national workshops on Drug Dependence, Treatment and Rehabilitation was also supported by WHO. This meeting developed a medium-term national training plan for physicians and other workers concerned with the detection, control and treatment of drug abuse. Thailand agreed to be one of those countries to be studied by WHO to provide a detailed evaluation of the national response to the United Nations Convention on Psychotropic Substances. Finland and Madagascar also participated in this study,and the information, after it is analysed, will provide a substantial basis for WHO'S submissions to the United Nations Commission on Narcotic Drugs. From this region, India, Sri Lanka and Thailand were contributors to the WHO International Review of Preventive Measures, Policies and Programmes on the Prevention of Alcohol-related Problems. This detailed compilation of country experiences was referred to in the report of the Director- General to the Thirty-second World Health Assembly, which urged Member States to deal with the prevention and control of these problems. Although no individual country projects or inter-country initiatives have resulted so far, the Regional Advisory Group on Mental Health and some national bodies and voluntary agencies are already seeking WO's technical assistance in the collection of information and the develop- ment of appropriate collaborative programmes, mainly of a preventive and educational nature. SEA/RC33/2 Page 37 1.12 Drug Policies and Management WHO has been assisting the countries of the Regioninevolving pharmaceu- tical supply systems to provide essential drugs of assured quality for the primary health care programme. Most countries have identified the essential drugs required for PHC and for higher levels of health care. In Bangladesh, a WHO consultant advised the Central Medical Stores on the manufacture of seven essential drugs. Further assistance is being planned through donor agenciesto increase the capacityof the country to manufacture all the31essential drugs requiredfor primary health care. In Burma, a master plan was prepared to provide assistance to the Burma Pharmaceutical Industry in producing the essential drugs required. WHO and UNDP collaborated with Indonesia in the development of a compre- hensive programme covering various aspects of the pharmaceutical supply system. Pre-feasibility reports were prepared for starting a new unit for the production of essential drugs, improvement in quality assurance, updating of drug legislation, improvement in the storage and distribu- tion system, and the expansion of BIOPHARMA. In addition, WHO provided assistance in improving and expanding the production facilities at the government manufacturing units at Manggarrai Factory. A meeting of ASEAN countries organized in Jakarta with support from WHO highlighted the problems regarding legislation, evaluation and quality assurance. A task force has been formed to implement some of the recommendations of the meeting. In MongoZia, plans are being made to develop a manufacturing unit for the production of biologicals such as vaccines and blood products. WHO will provide consultants to assist in preparing a techno-economic feasibility report. Assistance from UNDP and UNIDO is being provided to Nepal for improving the capacity for the production of essential drugs by the Royal DrugsCo. and for strengthening quality control, storage, distribution and drug utilization under the umbrella of the primary health care programme. In Sri Lanka, based on the pre-feasibility study of the State Pharmaceu- tical Corporation, Colombo, made by WHO, plans are under way to set up a unit for the manufacture of essential drugs. The supply of essential drugs,including vaccines, is of great importance to the PHC programme. A global meeting to define the role of WHO in pharmaceuticals is scheduled to take place in the Regional Office in the last quarter of 1980. 2. DISEASE PREVENTION AND CONTROL - COMMUNICABLE DISEASES Despite the efforts being made to control them, connnunicable diseases persist as the Region's number one public health concern. One of the SEA/RC33/2 Page 38 difficulties faced in the area of epidemiological surveillance is the dearth of trained epidemiologists and an inadequate infrastructure. The Organization has, therefore, initiated action to establish a regional training programe which will be task based and field oriented. The programme was scheduled to become fully operative in the first half of 1980 in Thailand as a joint effort of WHO, the Royal Thai Government and the Centre for Disease Control, Atlanta, Georgia, USA. Malaria continued to be a major problem in eight of the ten countries in the Region. The problem of resistance of vectors to insecticides and of parasites to anti-malaria drugs is yet to be solved. Nevertheless, the shift in the strategy from eradication to control has shown encouraging results, and the number of cases, when considered in the Region as a whole, has shown a marked reduction as compared to that in the previous year. This decline is, however, not uniform in all the malaria-affected countries, and there is therefore an urgent need to strengthen the programme in some of them. During the year, WHO supported research activities both in the field and in the laboratory. SIDA and US AID continued to give substantial assistance to some of the national control programmes. Leprosy and tubercutosis control activities are progressing either as independent or as combined programmes of the general health services in most countries. The problems of incomplete case-finding and unsatis- factory case-holding and treatment are being tackled with vigour. Research on the epidemiological aspects and the development of a more effective treatment regimen for leprosy has been continuing in India and Burma with WHO support. Acute diarrhoea2 diseases, especially in infants and children, continued to be a major cause of death among this group. Following the acceptance of oral rehydration therapy as a major tool in bringing down the death rate, countries of the Region have launched phased programmes for the control of diarrhoea1 diseases. A medium-term plan has been drawn up by WHO for collaboration with the countries in programe development, delivery, monitoring and evaluation of services. The production of sufficient quantities of oral rehydration fluids and the development of a supply and logistics system have been major constraints, and UNICEF has been assisting substantially in solving these problems. WHO provided funds to a number of research projects concerned with the technical and operational problems relevant to the delivery of oral rehydration services in field situations. In the case of. the Expanded Programne on Imnization, the Organization has assisted governments in developing national programmes and organiz- ing intensive training in both the technical and management aspects at country as well as inter-country levels. It has, in addition, provided technical support in developing cold chains and logistic systems, which are vital for the programme. UNICEF plays a significant role by supporting training, providing vaccines, and developing the cold chain. SEA/RC33/2 Page 39 In regard to dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS), the Organization has supported governments in the technical aspects of their programmes and organized research activities at the WHO Collaborating Centre on DHF in Bangkok and other institutions. Steps have been taken for starting work on developing a vaccine against DHF. An inter-regional seminar was held in the Regional Office in March this year to discuss the whole spectrum of haemorrhagic fevers due to various etiologic agents and to take stock of the situation in respect of DHF/DSS vis-a-vis other haemorrhagic fevers. The importance of DHF has been increasing due to the fact that sporadic cases have been appearing in countries other than Burma, Indonesia and Thailand, where the disease is endemic, and the number of cases has been rising steadily. In 1979, WHO provided a team consisting of epidemiologists, an entomologist, a virologist and clinicians to Maldives to investigate a suspected outbreak of DW and recommend measures for prevention. SexuaZZy transmitted diseases have been recognized as a public health problem in a number of countries, but because of social reasons, case finding and prompt treatment have posed difficulties. The problem of drug resistance in gonococcus is yet to be solved. The Organization has been assisting in the control of these diseases by conducting workshops and seminars for the dissemination of the latest knowledge to the medical profession and by providing technical support in developing national programmes. Countries in the Region have shown growing interest in the control of zoonotic diseases, especially brucellosis and rabies. Most of the countries are facing problems in the control of rabies. WHO has supported Mongolia in developing self-sufficiency in the production of brucella vaccine. The problem of zoonotic diseases was discussed at an inter-country consultation held in Delhi in November 1979. The participants from seven countries exchanged views on the technical and managerial aspects of these diseases and emphasized the need for strengthening WHO'S support in this area. 2.1 Epidemiolo~ical Surveillance During the year under review, the strengthening of epidemiological surveillance services in the Region continued to be supported by WHO. Emphasis was laid on manpower development, improvement of data collection procedures, and the utilization of epidemiological informa- tion for decision making, planning, implementation and evaluation of health services. Field-oriented training programmes at the national level received strong support. In BangZadesh, the epidemiological surveillance system has been expanded from the central level to the district and thana health complex levels. The Institute of Epidemiology, Disease Control and Research continued its activities pertaining to the development and consolidation of the surveillance of communicable diseases; the provision of diagnostic laboratory facilities for virology and supportive and referrallaboratory SEA/RC33/2 Page 40 facilities for entomology and parasitology; the provision of laboratory and surveillance training for health personnel, and the conduct of research relevant to the core programmes of communicable-disease surveillance and laboratory work. The services of a consultant were provided to demonstrate and teach the mosquito inoculatton technique for tt8.e isolation of arboviruses; to advise on arbovirus serological techniques, and to train national staff in the use of the fluorescent microscope in rapid diagnostic techniques. In &crma, a WHO consultant assigned from May to August 1979 assisted in further developing laboratory techniques for enterwirus isolation and serology as well as in introducing methods for the laboratory sunreil- lance of poliomyelitis. An epidemiological assessment of poliomyelitfs was carried out in August 1979 in Rangoon, which was followed by the visit of a WHO consultant in November to review the epidemiology of poliomyelitis in the country and give further advice. In India, WHO collaborated with the National Institute of Communicable Diseases, Delhi, in organizing workshops in such areas as epidemiology, medical mycology, imunochemistry and filariasis. A WHO consultant was assigned to the Institute from February to May 1980 to assist and advise on plague surveillance and the production of plague antigen. He also visited the Plague Surveillance Unit, Bangalore, and the Plague Laboratory of the Haffkine Institute, Bombay, for discussions. Another consultant assessed the epidemiological situation relating to DHF and advised on prevention and control measures. In Indonesia, a WHO entomologist assisted in the organization, develop- ment, implementation and evaluation of the entomological aspects of vector-borne diseases. A WHO consultant was assigned to the Special Hospital for Communicable Diseases in Tanjung Priok, Jakarta, to review the development of its various departments, assist in the organization and management of the Hospital and to advise on clinical and epidemio- logical studies on enteric diseases. Another consultant assisted in conducting a short in-service training course in epidemiology at the Directorate General, CDC, Jakarta. He also helped with the preparation of a plan to deal with the health aspects of natural disasters. In addition, he held discussions on the development of an M.Sc. course in epidemiology. A third consultant visited the country in December 1979 to review the epidemiological situation of arbovirus infections, dengue haemorrhagic fever and Japanese encephalitis and to advise on preventive and control measures and on planning for arbovirus research. At the Disease Ecology Centre of the National Institute of Health Research and Development, Jakarta, the WHO team consisting of an epidemiologist and a statistician assisted a number of research activities. Outbreaks of a dengue-like disease were reported in bkzZdives, and one of the Regional Advisers on Comunicable Diseases and other WHO staff assisted the national authorities in investigating the outbreaks. SEA/RC33/2 Page 41 In MongoZia, assistance continued to be given in the further development of epidemiological surveillance of diseases representing major public health problems such as meningococcal meningitis and viral hepatitis. The WHO epidemiologist assigned to the project from July 1978 to December 1979 assisted in the developmentof epidemiological surveillance and the control of communicable diseases; in health laboratory micro- biology and virology; in the planning and implementation of research on communicable diseases of public health importance,and in the training of epidemiologists and health laboratory personnel. Technical cooperation was provided to Sri Lanka through a consultant who assisted in analysing and interpreting epidemiological data on pyrexia of unknown origin and other unidentified fevers. Another consultant advised on the clinical diagnosis of dengue fever and the management of DHF patients. In ThaiZmzd, the epidemiological surveillance network at the district level was strengthened. Assistance was provided for improving facilities for the training of epidemiologists in the Region (see also section 7.4, "Training in Epidemiology"). A medium-term programme on epidemiological surveillance has been pre- pared for the Region. 2.2 Diseases Subject to the International Health Regulations For the fourth consecutive year no case of smallpox was reported in any country of the Region. Cases of cholera, however, continued to be reported from eight countries. Plague was reported from Burma, but the number of cases and deaths has come down significantly. 2.2.1 Smallpox Eradication As stated above, countries of the Region continued to be free from smallpox during the period under review. Nevertheless, surveillance continued to be carried out in all countries. Rumours of suspected smallpox were checked by national health staff on a number of occasions and found to be without basis. 2.2.2 Diarrhoea2 Diseases Including Cholera Diarrhoea1 diseases continued to be major public health problems, particularly among children, who constitute the most vulnerable group. The incidence of these diseases according to hospital statistics, which provide the only available reliable data, has been estimated to range from 9 to 32 cases per thousand population. In addition, diarrhoea1 diseases cause high mortality and morbidity and contribute to malnutri- tion in at least 30% of those under five years of age. The diagnostic techniques have been vastly improved and simplified. Knowledge about the etiology of most diarrhoeal-disease cases enables the choice of adequate preventive measures to be applied in different epidemiological SEA/RC~~/~ Page 42 Diseases Subject to the International Health Regulations Notified by Countries of the Region, 1977-1979 (Information compiZed from data made avaiZabZe to WHO Headquarters by Govements) *including one imported case 1 country Bangladesh Burma India Indonesia Maldives Nepal Sri Lanka Thailand 1 Year 1977 1978 1979 1977 1978 1979 1977 1978 1979 1977 1978 1979 1977 1978 1979 1977 1978 1979 1977 1978 1979 1977 1978 1979 Cases - - - - - - - - - - - - - - - - - - - - - - - - Cholera Cases 10 403 5 576 2 154 2 723 3 351 874 13 850 10 585 2 912 17 112 10 693 18 603 - 11 336 - 428 1 662 22 5 48* 46 383 4 183 1 788 Smallpox Deaths - - - - - - - - - - - - - - - - - - - - - - - - Deaths 354 81 21 210 372 75 739 246 165 780 507 728 - 220 - 4 10 - - 2 - 5 123 44 Cases - - - 591 171 7 3 - - - - - - - - - - - - - - - - - - Plague - Deaths - - - 26 6 2 - - - - - - - - - - - - - - - - - - SEA/RC33/2 Page 43 conditions. The most significant therapeutic measure is the rapid development of oral rehydration therapy which can prevent and treat dehydration, in most acute cases, at home. Stress continues to be laid on breastfeeding infants during and after diarrhoeal diseases, in addition to oral rehydration. The education of mothers, family and community members, and peripheral health workers is also emphasized. The objective of the diarrhoeal-disease programme is to reduce mortality xnd morbidity through appropriate treatment and preventive services at the primary health care level, the training of workers at all levels and support to research in designing new and better measures for control. During 1979, Indonesia reported the highest number of cholera cases, followed by India, Bangladesh, Thailand, Burma, Sri Lanka and Nepal. The total number of cases reported in 1979 in the Region was 26 399, with a case-fatality rate of 3.9196, as compared to 47 431 cases with a case-fatality rate of 3.29% in 1978. WHO has developed a meaningful collaboration with the International Centre for Diarrhoeal Diseases Research, Bangladesh, which is being designated as a WHO Collaborating Centre for Research and Training in the Control of Diarrhoea1 Diseases. It will train research scientists in selected fields as required by the regional research programme on diarrhoeal diseases; train health workers who will be responsible for training other workers concerned with the implementation of national diarrhoeal-disease surveillance and control programmes, and provide advisory services. WHO also cooperates in reviews of research protocols and training programmes. In India, technical cooperation was provided to the study on the health benefits of water supply in a rural area in Uttar Pradesh. A WHO consultant was assigned to the National Institute of Cholera and Enteric Diseases, Calcutta, in November-December 1979 to advise and cooperate in vibro-phage research and related cholera research activities. A consultant from WHO Headquarters visited the Institute in November 1979 and developed practical guidelines for training in the use of oral rehydration solution at treatment facilities, He also reviewed clinical research activities. In Indonesia, a WHO consultant assisted in reviewing the surveillance and descriptive epidemiology of cholera in different parts of Java and in conducting epidemiological studies to determine the important mode(s) of its transmission during epidemic and non-epidemic periods. He also cooperated with communicable disease control personnel in regard to methods of investigation, analysis and control of diarrhoeal disease epidemics. A WHO consultant was assigned to Nepal during February-March 1980 to study the protocol and the work plan for operational research in diarrhoeal diseases and to assist in the organization and conduct of a national workshop. Assistance was also given in finalizing the SEA/RC33/2 Page 44 required forms and cards for gathering information, in setting up laboratories, and in drawing up a list of laboratory equipment. In Sri Lanka, WHO staff, together with a consultant, assistedinreviewing the progress and plans of the national diarrhoeal-disease services and research programme and advised on setting up a research project to study the etiology of acute diarrhoea, revi.ew other diarrhoeal disease research activities, and perform laboratory demonstration of methods for the diagnosis of rotavirus and enterotoxigenic E. cot< diarrhoea. As a follow-up of this visit, plans are under way to recruit two WHO consultants. One of them will review project documents on diarrhoeal- disease control and research, devise curricula for senior health staff and other health workers, prepare teaching and educational aids and set up an evaluation mechanism. The other consultant will assist in con- ducting a feasibility study to determine how the country can best meet its annual requirement of 4 million packets of oral rehydration solution. The plan for a regional programme of services and research in diarrhoeal diseases, developed at an inter-country consultative meeting held in June 1979, was circulated to Member countries. A work plan has been prepared to support national programes. A WHO medical officer in diarrhoeal diseases has been in position in the Regional Office since November 1979 to promote and coordinate a services-cum-research programme in diarrhoeal diseases in the countries of the Region. Together with a consultant from WHO Headquarters he visited Bangladesh, India, Indonesia and Sri Lanka during January 1980 to carry out a feasibility study of the training centres and their needs for producing manpower for the control of diarrhoeal diseases. In order to cater to the need for regional training in services, research and related activities in diarrhoeal diseases control, it is planned to establish regional training centres as follows: (1) at the International Centre for Diarrhoea1 Diseases Research, Dacca, (2) the Faculty of Medicine, University of Indonesia, and the Communicable Diseases Control Division, Ministry of Health, Jakarta, and (3) the National Institute of Cholera and Enteric Diseases, Calcutta, as well as at the Institute of Preventive Medicine and the National Institute of Nutrition, Hyderabad. A consultant in diarrhoeal diseases visited Thailand in April 1980 to explore the feasibility of holding training courses for country programme managers in Bangkok in October 1980 and to review the activities of the national diarrhoeal disease control programme. WHO is collaborating with UNICEF in the production and delivery of oral rehydration packages to the comnunity. A consultant jointly assigned by UNICEF and WHO visited Bangladesh, India and Indonesia in September 1979 to study the supply and local production of oral rehydration solution packages to speed up the development of national diarrhoeal- disease control programmes. WHO has assisted with the organization and conduct of national workshops and seminars on oral rehydration therapy and other aspects of diarrhoeal diseases in the countries of the Region. At the national level, most of the countries have established co- ordination committees. Specialists from the countries have participated SEA/RC33/2 Page 45 in meetings of the Technical Advisory Group and of scientific working groupslsub-groups on various aspects of diarrhoea1 diseases organized by WHO Headquarters in Geneva. Through extra-budgetary resources the programme has received further impetus. UNDP input, which is being negotiated, will help stimulate the programme activities in the Region. WHO is supporting diarrhoeal-disease research in Burma, India,Indonesia, Nepal and Sri Lanka. Currently, five research studies are being conducted in these countries and more are being developed with WHO support. Plans are under way to hold an inter-country group educational'activity in the Regional Office in November 1980 to review the current national diarrhoeal-disease control programmes with reference to oral rehydration therapy and other aspects concerned with the delivery of this component. 2.2.3 Plague Em reported 73 cases with two deaths during 1979 as compared to 171 cases and six deaths in the previous year. The Rodent Control Demonstration Unit (a WHO inter-regional project) continued to under- take studies and surveys on plague serology and epidemiology. The Unit has developed a protocol for a comprehensive study of the ecology of plague. It has been able to establish clearly that all species of small mammals collected by it in Rangoon were involved in some degree in the epidemiological picture of plague and that the appropriate flea vector species are present and abundant. In India, a WHO consultant, assigned from February to May 1980, assisted and advised the National Institute of Communicable Diseases on the production of plague antigen. A grant was given in support of a WHO cooperative study on tests for the detection of plague antibodies. At the request of the Government, arrangements are being made to train a group of scientists in Burma, where human cases are occurring,in human and rodent plague and also study actual cases - typical or atypical - and the epidemiological situation. 2.3 Malaria and Other Parasitic Diseases Malaria continues to be a major public health problem in eight countries of the Region, namely Bangladesh, Burma, India, Indonesia, Maldives, Nepal, Sri Lanka and Thailand. 2.3.1 Malaria An overall improvement was reported in the epidemiological situation in the Region but, as stated above, malaria remains a major health concern. Significant reductions in incidence occurred in India, Indonesia and SEA/RC33/2 Page 46 Sri Lanka, and lesser decreases were noted in Maldives, Nepal and Thailand. Bangladesh and Bum, however, showed marginal increases. The reduction in the microscopically diagnosed malaria positive cases in 1979, compared with the previous year, was about 25X, the annual parasite incidence being 3.35 per thousand in 1979 (4.60 in 1978). In this connexion, however, there appears (on the basis of incomplete data) co have been a reduction of 4% in the annual number of blood slides examined, films being collected from 6.8% of the population in 1979 (7.3% in 1978). The slide positivity rate fell to 4.9% (6.3% in 1978), but the slide falciparum rate increased slightly to 0.99% (0.95% in 1978), there being a marginal increase in the absolute number of P. falcipanrm infections, the proportion vis-a-vis other species being 20.2% (14.8% in 1978). Vector resistance to pesticides in general use continues to be a serious problem in India, Indonesia, Nepal and Sri Lanka. Susceptibility testing for such resistance has been intensified to detect and delineate its development and distribution. Testing materials are supplied by WHO to the malaria control programmes on a regular basis, and assistance and training in the use of the test kits are provided where necessary by WHO entomologists. The Organization directed its efforts in technical cooperation towards the development of medium-term programmes, the evaluation of programmes, the development and implementation of applied field research, and the organization of and participation in training activities. Attention was also paid to the promotion of inter-sectoral coordination and coopera- tion in border areas, to the provision of assistance in developing national self-sufficiency in the production of insecticides and anti- malarial drugs, and to support in the procurement of supplies and equipment. WHO provided consultants for the annual assessments of the programmes in Burma, India, Nepal, Sri Lanka and Thailand. These assessments were undertaken jointly with representatives of the governments and the bilateral agencies assisting each programme. The role of WHO in respect of malaria border coordination meetings was maintained, the Regional Office acting as a focal point for the exchange of information arising from the meetings. Applied field research in malaria was undertaken vigorously throughout the Region during the year under review. A principal aspect of the research was the study on sensitivity of P. faL&pan~n to 4-amino- quinolines. Important regional studies are in progress on AnopheZes species complexes and on resistance to insecticides by vectors. Studies were additionally undertaken into the operational, epidemiological and ecological aspects of malaria control work. The Regional Collaborative Studies on Drug Resistant Malaria, with special emphasis on P. fak?+lm7n resistance to 4-aminoquinolines, which were started in 1977 in Thailand and extended during 1978 to Bangladesh, Figure 1. SOUTH-EAST ASIA REGION INCIDENCE OF MALARIA AND F.FALCIPARUh! INFECTIONS ......... :.:...:.:.. ............. ..:,:.::.,::i ..... ".-l ......... ..." .......... - Slide Positivity Rate % - Slide fazcipamun Rate % BANGLADESH BURMA NEPAL MALDIVES Mill. Z 6-- 12 % 4-- 8 - 3--6 2 -- 4 200 20 1 -- 2 100 10 75 76 77 78 79 75 76 77 78 79 75 76 77 78 79 75 76 77 78 79 INDIA INDONESIA (Java and Bali) SRI LANU THAILAND SEA/RC33/2 , Page 47 Burma, India, Nepal and Sri Lanka, were further extended to Indonesia in 1979. The progress made by all these countries was reported at a seminar attended by the principal investigators in Chiang Mai, Thailand, in October 1979. Data produced have made it possible to commence mapping the sensitivity levels of strains of the parasite throughout the Region. National follow-up refresher courses in the in vitro technique on the response of P. fa2cipanrm to chloroquine were organized with WHO technical support in India, Indonesia and Sri Lanka. During these courses the opportunity was taken to demonstrate the micro in vitro technique to the monitoring teams. During the year a manual on the clinical management of severe falciparum malaria was prepared and published in the WHO South-East Asia Regional Publications Series. A regional workshop on field research methodology was conducted in Bangkok in December which reviewed the programme of applied research and explored avenues for future studies. In addition, the participants were instructed in practical methods of preparing research study designs, protocols and proposals relating to chemotherapy, insecticide resistance, and the role of the community and the primary health care system in anti-malaria operations. Progress has been made by the countries in developing research cells within their anti-malaria organizations. External assistance required for some of the resultant activities is being met partly from regional funds and partly from the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR). Regional support with assistance fromTDRwas also extended to strengthen research capabilities within malaria programnes, institutions and universities. One of the more important results has been the establishment in institutions in Burma, India and Thailand of continuous in vitro cultivation of P. faZcipanrm, essential to further advances in the immunology and chemotherapy of malaria, and particularly in vaccine development. Of equal importance in the context of HFA/2000 is applied field research into anti-malarial delivery systems at the community and primary health care levels. Proper utilization of these systems is increasingly essential for the delivery of drugs, and studies are being initiated to find ways by which the systems may be strengthened and enabled to deliver mosquito control methods and eventually vaccines. Training continues to be a fundamental aspect of the malaria control programmes in the Region, and is strongly supported at various levels by WHO. Fellowships were awarded to anti-malaria personnel, wherever possible within the Region, and subsidies made available for national training programmes. An inter-regional project, "Coordination of the Malaria Training Programmes in Asian Countries", based in Kuala Lumpur, SEA/RC33/2 Page 48 has become operational. Member countries have been informed of the activities of the project and requested to indicate their requirements for assistance under this programme. The overall state of anti-malaria programmes in the Region is as follows : Millions (mid-1980) Population in the Region 1044.1 Population in originally malarious areas 964.9 Population in areas under anti-malaria operations 906.5 In areas under control programme 872.4 In areas under eradication progrannne 34.1 Population in areas with no specific anti-malaria operations 58.4 Highlights of anti-malaria activities in different countries are given below: In Bangladesh, the expansion of the areas requiring insecticide spraying reflects the deteriorating malaria situation. There was hardly any change in the annual blood examination rate, which continues to be low, but the slide positivity rate of 3.3% in 1979 was the highest recorded for the decade. Another disturbing feature in the epidemiological situation was that 66% of the cases recorded in 1979 were from the low malaria risk areas. The proportion of P. faZcipmwn incidence, however, continues to decline. Studies on P. falciprma sensitivity to chloro- quine continued to be conducted at the Institute of Epidemiology, Disease Control and Research. These studies have shown the presence of resistant strains in the high malaria risk areas along the entire eastern border. The degree of resistance recorded ranges from the RI to the RIII level. Results of susceptibility tests for vector resistance carried out do not indicate any evidence of resistance among the known vectors. Some of the recommendations contained in the 1978 assessment report have been implemented. A national Malaria Coordination Committee with representation from other sectors has been established and similar committees are being formed at divisional and district levels. It is hoped that this would lead to improved intersectoral coordination and cooperation with the Malaria Control Programme. The pace of imple- mentation of the recommendations has, however, been tardy; this has hampered operations and not been conducive to attract external assistance which is urgently needed for antimalaria supplies and transport. WHO has been closely associated with the Government's efforts to secure Case detection and treatment can help in pre- venting the spread of malaria. Insecticide spraying against the mosquito vector still remains the first line of attack to control malaria. FIGHTING MALARIA ~idemiologicar surveluance ana proper record deping help in taking effective control measures. , THE ANCENT SCOURGE i Leprosy has tew equals as a cause 01 numan suffering and social degradation. Sutveys reud a far higher prevalence of the disease in the Reuion than is apparent. Leprosy victims, who are usually looked u,,., as outcasts. need help with rehabilitation and to engage in produ~live vocations. Treatment for leprosy requires regular intake of drugs over a long period. SEA/RC33/2 Page 49 external resources. The Government of the Netherlands will provide 1000 tons of DDT and 700 tons of benzene for the DDT factory, while the response of potential donors is awaited. The supplies from the Swiss Government donation of US$ 26 882 were received. WHO provided anti- malarials costing US$ 140 000 as an emergency measure. Training has received a boost with the implementation of an extensive programme for personnel at the district and thana levels involved in the antimalaria programme. A total of 85 personnel at the district level received one week's training between June and September 1979. A five-day training course for 356 thana health administrators was undertaken by two teams from January to April 1980. These courses were supported by WHO through local cost subsidy. In Bma, out of a population of 33.1 million, 30.7 million lived in malarious areas, in 73% of which control activities were in progress. Drug distribution continued to be the mainstay of the programme, intra- domiciliary spraying with DDT covering only 6.9 million people although resistance to this insecticide occurred in A. mnukris and A. bala- bacemis. The estimated morbidity due to malaria was 45 per thousand population. Consistent with the pattern of epidemiological dynamics in past years, the malaria situation showed no significant change during the period under review. The projected annual blood examination rate remained at a low level of 1.2%, resulting in an unrealistically low annual parasite incidence of 0.56 per thousand (0.57 in 1978), and the slide positivity rate was 4.8% (4.9 in 1978). The proportion of P. fatcipamrm increased from 69.6% to 73.9%, and the slide falciparum rate from 3.4% to 4.8%. Strains of this species resistant to chloro- quine at RI and RII levels were widely distributed, in vivo and in vitro testing conducted by the programme and by the Department of Medical Research in Rangoon, Phaungyi, Akyab and Sandaway confirming their presence. Assistance extended to the programme by WHO was used largely for fellowships and supplies. Support was also given by UNICEF and Canada (CIDA) for the supply of DDT, drugs and equipment, and by theNetherlands in respect of two WHO specialists in vector-borne disease control. In India, 640 million people, out of an estimated total population of 675 million, lived in malarious areas, all of which were under surveil- lance. A population of 405 million was protected by anti-vector measures. In 1977, in order to counteract a deteriorating malaria situation, the Government introduced a modified plan of operations aimed at the prevention of mortality due to malaria, reduction of morbidity, and elimination of the adverse effects of the disease on development projects. Presently 70% of the central health budget is spent on these activities, with Rs 750 million budgeted for the National Malaria Eradication Programme during the current financial year. The modified plan has resulted in an overall decline of malaria incidence in the SEA/RC33/2 Page 50 country. Increased reliance is placed on community participation. liberal distribution of anti-malarial drugs through community health workers and volunteer drug distributors being responsible for much of the reduction of morbidity and mortality in rural and inaccessible areas. Available data indicate a total of 2.7 million cases during 1979 (morbidity 4.0 per thousand population) - a reduction of nearly 30% over the figures for 1978. A major technical problem of growing significance is pesticide resist- ance. The principal vector in the rural areas, A. culidfacies, has in many districts developed double resistance to DDT and HCH and in others, in western India, shows multiple resistance to DDT, HCH and malathion; A. stephemi, in urban areas, shows double resistance to DDT and HCB. In response to the increasing need for a variety of insecticides, national production of DDT, RCH and malathion is being expanded. Strengthening of the National Malaria Eradication Programme in areas where falciparum malaria is prominent has been organized through the P. faZdpomrm Contailnnent Programe (PfCP), supported by the Swedish Government (SIDA) and WIIO. During the year, a third zone was added to the area covered, the work already in progress in north-eastem India and in Bihar, Orissa and West Bengal being extended to Andhra Pradesh, Madhya Pradesh and Maharashtra. Despite this intensified programme of intradomiciliary spraying with DDT, chemotherapy and surveillance, there has been a slight increase in the absolute number of P. faZdpanrm cases, while the proportion of this species in relation to other species has increased from 10% to more than 15%. Five international staff have been assigned to the Programme during the year, and are involved in its epidemiological and applied research components. In many parts of north-east India resistance of P.faZdpm to 4-aminoquinolines is suspected on clinical grounds; in vivo and in vitro tests carried out by the monitoring teams of the Indian Council of Medical Research attached to the NMEP regional offices confirm that resistance is present in Nagaland, Assam, Meghalaya, Arunachal Pradesh and Mizoram, and during 1979 it was also confirmed in Orissa, indicating an ominous spread westwards. WHO support was extended to the Programme in a number of areas. Fellowships were provided and grants and subsidies arranged for insti- tutional and field training, including a workshop on malaria serology, held in October 1979 at the National Institute of Communicable Diseases. At the NICD, regular courses on malariology and entomology were held for medical officers and biologists from NMEP (including PfCP) and from the Defence ~e~arbent and the Railways, while the regional coordinating organizations of NMEP also trained malaria and other health workers (primary health centre personnel). The Progrlunae also received from WHO supplies and equipment, and personnel who provided advice in respect of research, training, and pesticide toxicity and etorage. The N~EP and PfCP were separately SEAfRC3312 Page 51 subjected to independent assessment by joint Government, SIDA and WHO teams during the period January-March 1980, and the recommendations are being considered by the Government. Periodic review meetings of the PfCP were also held. The malaria control programme in Indonesia covers the entire population in Java and Bali but in the other islands coverage provided is for priority areas of socio-economic importance and transmigration projects. Extensive training needs and development of the health infrastructure have been identified in the preliminary data collection for expansion of population coverage in the other islands. The US AID loan agreement terminated in February and negotiations are under way for the revival of assistance and also for support from other sources for the programme. Strengthening of the central organization with technical staff needs urgent consideration. The establishment of a National Malaria Coordi- nation Committee with representation from other sectors and similar committees at the provincial level would promote support from and cooperation of other sectors in anti-malaria activities. There has been a dramatic reduction in the number of malaria cases recorded in Java and Bali - 56% less than in 1978. Although there has been a 27% decrease in the annual blood examination rate, the lowering of the slide positivity rate by 40% is an indication of an improving malaria situation in these two highly populated islands. Despite an increase in the proportion of P. faZcipamrm, the number of infections has been less than in 1978. Monitoring teams established in East Kalimantan and Irian Jaya have confirmed, by applying both in uiuo and in vitro methods, that chloroquine-resistant P. faZcipanrm is widespread in the two provinces at RI and RII levels. Suspected foci of resistance have been reported from the provinces of Lampung and E. Nusa Tenggara. Recent findings in Java point to a rise in the level and extent of DDT resistance in A. aconitus. Assistance was provided in carrying out trials with other insecticides, methods of insecticide application and other vector control measures. In Kabupatan Banjannegara, a high case incidence area, fenitrothion thermal fogging with intensive case detection has been instituted to reduce transmission. Two seminars for provincial staff in Java/Bali and the other islands were held in September and November 1979 respectively. A 12-day training course for medical staff of health centres in Java/Bali was organized in October. A three-week training course on in vitro testing of P. falci- panrm sensitivity to chloroquine was conducted by the WHO laboratory specialist in May. WHO also provided funds for printing an illustrated key to 'Anopheline Mosquitoes in Indonesia' in Bhasa Indonesia, prepared by the WHO entomologist. In Maldives, 56% of a population of 150 000 was screened during the year for malaria by blood examination. The case incidence was 3.3 per thousand population, all attributable to P. viva, a decrease by 16% SEA/RC33/2 Page 52 since the previous year. Of the 329 confirmed cases, 19 had been imported. Nearly 90% of the cases occurred in four northern atolls and Laam atoll, the remainder being found in the other islands inhabited by 74% of the population. The slide positivity rate registered a slight decrease,Erom 0.42% in 1978 to 0.39% in 1979. Since June 1975 no falciparum infections have been detected. Control measures employed continued to be intradomiciliary spraying of DDT, to which the vectors A. subpictus and A. tessetatus remained susceptible. The latter mosquito, after an apparent absence of from 7 to 13 years following a single-spray cycle, was found in 1979 on three atolls. Anti-larval measures, including attempts to restock fish in wells, drug distribution, and surveillance, were also undertaken. Community participation in these measures, led by the island chiefs and health volunteers, continued to be indispensable. Timely execution of the work, particularly the spraying, was, however, hampered by transport problems between the atolls. WHO support for the programme continued during the year, in terms of personnel, training fellowships, and supplies and equipment. In Nepal, malaria is still regarded as a major health problem. The annual number of cases has since 1974 fluctuated between 12 000 and 13 000, and during 1979 a total of 12 131 were detected. In the foot- hills and hilly areas of the country, where the main vector, A. fluvia- ti& is susceptible to DDT, the incidence of malaria has gradually declined. In the nine Terai districts, cultivated areas in the plains, there has, however, been some deterioration due to ecological changes brought about through the implementation of development projects, extensive population movement,and the presence of DDT resistance in the principal vector there, A. annutaris, which in 1979 continued to extend its range. During 1980 a population of 880 000 is scheduled to be protected by malathion spraying in these areas. A large proportion of the P. faZcipancn cases continued to be imported from the north-eastern parts of India, and many of the parasites were found to be resistant at RI and RII levels to chloroquine upon in vivo and in vitro testing by the programme monitoring teams. The incidence of falciparum malaria acquired within Nepal, however, showed a decline. Following a situational analysis by an internal assessment team, an independent assessment was carried out during January and February 1980. At a seminar conducted in March 1980, detailed proposals for applied field research were formulated. An Asian Development Bank/WHO mission is currently involved in preparing a project proposal for malaria training and research, to be considered by the Asian Development Bank for support. To ensure an inter-sectoral approach to anti-malaria operations, a co- ordination committee has been established. A task force has been formed by the Malaria Eradication Board to study the present organizational structure in relation to the management aspects of the programme. SEA/RC33/2 Page 53 WHO continued to assist the programme with advisory personnel. Support was extended also in respect of fellowships and supplies and equipment, and a large quantity of malathion was provided to augment the amounts supplied through bilateral aid by the Netherlands, United Kingdom and USA. The last named Government, together with UNDP, supplied DDT. In Sri kka, 9.8 million people of a population of 14.7 million lived in malarious areas. The number of detected cases was 47 855, indicating a decrease in incidence of 31% over the previous year. The annual parasite incidence decreased from 6.4 per thousand to 4.9, and the slide positivity rate from 7.1% to 4.8%. In respect of P. falcipurwn, which remained sensitive to 4-aminoquinolines, the number of infections diminished by 30% and their proportion remained stable at 2.7%. Control measures included intradomiciliary spraying using malathion in selected areas, the vector A. cuZicifacie8 continuing to be susceptible to this insecticide but not to DDT. A main storage building for malathion is under construction in Colombo district and a chain of district stores would also be built. Anti-larval measures, including intermittent flushing of rivers and elimination of breeding places by filling abandoned gem pits, space spraying at pilgrimage centres, drug distribution and surveillance, were undertaken. Community participation in the form of volunteer treatment centres proved valuable in this regard. Useful information was provided by the island-wide network of indicator institutions containing activated passive case detection agents. The principal problem areas continued to be those where illicit gem mining and chena (slash and burn) cultivation occurred. The programme was supported by WHO through advisory staff, fellowships, and supplies and equipment. Bilateral aid was extended for the supply of malathion and other commodities by the Netherlands, United Kingdom, and USA, and representatives of these countries and of WHO joined the Government in undertaking the second annual evaluation of the programme in February-March 1980. The recommendations arising from this evaluation included the establishment of an epidemiological unit within the programme, intensification of existing control measures, including malathion spray coverage, enhancement of surveillance and evaluation procedures, particularly monitoring for the development of vector resistance to malathion, and the promotion of community participation and political support. In Thailand, though the rate of increase in malaria cases has slowed down from 1977, it was only in 1979, for the first time in seven years, that there was a decrease in the number of cases detected. The decrease in case incidence was nearly 10% and was more marked for P. vivare than P. fazciparwn. The improving situation may be the outcome of the revised strategy implemented in 1977178. In recent years there has been a steady flow of immigrants from the riparian countries who uponinvitro testing show malaria parasites 100% resistant to chloroquine and pyrimethamine. This emphasizes the need for prompt and appropriate anti-malaria measures to be carried out in and around refugee camps to prevent the occurrence of outbreaks in neighbouring villages. SEA/RC~~/~ Page 54 A $4.5 million loan-and-grant agreement was entered into between the Government and US AID commencing October 1979 for three years. This assistance would be directed for training, applied field research activities, health education and the establishment of malaria clinics at strategic points. With the resumption of US AID assistance the anti- malaria budget in 1980 would be operating at the required level, in contrast to the previous years when it was considerably less than the amount required. The Regional Collaborative Studies on in vitro testing for P. faZcipanrm resistant to 4-aminoquinolines have progressed satisfactorily with 14 provinces covered. It is hoped to complete these by the end of 1980. It is now evident that there are few areas where chloroquine-sensitive strains of P. faZcipamrm exist, all areas tested having highly resistant strains. Assistance has been provided for the planning and monitoring of vector resistance to insecticides. In 1979, a total of 117 susceptibility tests were carried out in index villages specifically selected for this purpose. These tests have revealed that in some parts of the north there is a decrease in susceptibility to DDT in A. minimus and A. baMacewis. An independent assessment of the prograrmne was carried out jointly by the Government and WHO in August/September 1979. The team was impressed with the determined efforts of the Government to cope with the malaria situationin spite of administrative, operational and technical problems. The team was also satisfied with the progress made since the launching of the new strategy in some regions, but was concerned over the critical situation in others. Its recommendations stressed the management and operational evaluation system,budgetary requirements, training, research and the role of the rural health services in anti-malaria activities. A national seminar on malaria sponsored by US AID and a meeting of regional epidemiologists to plan epidemiological activities at the regional level and to discuss the implementation of the assessment team's recommendations were held in February 1980. A training course for malaria workers was held in March, supported by WHO. In a small area in the Central Sulawesi region of Indonesia, where the disease continues to persist, control measures are being taken, based on epidemiological studies carried out earlier. Filariasis is a major problem in this region, with an estimated 236 million people exposed to the infection in India alone. Other affected countries include Bangladesh, Burma, Indonesia, Sri Lanka and Thailand. Following a meeting of the Joint Western Pacific/South-East Asia Working Group on Brugian Filariasis in Kuala Lumpur in June 1979, a meeting of SEA/RC33/2 Page 55 the Bi-Regional Research Study Group on Culex-borne Bancroftian Filariasis was held in the Regional Office in November to review the situation of Bancroftian filariasis in the various countries of the Region and discuss chemotherapeutic and vector control problems. A number of research protocols were developed, to explore more effective ways of controlling the disease. In India, a national workshop on filariasis was supported by WHO. ., In :ndia, the surveillance and control of this disease continued to be carried out by the Government following the outbreak of Kala-Azar in 1977 in Bihar. An international symposium on leishmaniasis was held at the National Institute of Communicable Diseases, Delhi, in January 1980, in which the Regional Office was represented. 2.4 Bacterial Diseases 2.4.1 TubercuZosis Tuberculosis continues to be a major public health problem in the Region. In Bangladesh, where the national control activities continued as planned, it is estimated that there are 350 000 sputum-positive and 3 million radiologically positive cases of tuberculosis. An assessment of the BCG vaccination campaign done in June 1979 through a scar survey indicated that it covered 26.75% of the child population. It is estimated that about 37% of the child population of the country has received BCG vaccination. Training activities consisted of the training of medical officers from the referral institutions, of epidemiological surveillance teams in scar surveys, and the retraining of family welfare workers. The main operational task, namely, organization and implementation of the BCG campaign to cover the child population through family welfarelprimary health workers, has been a success. A WHO consultant is under recruitment to advise on programme formulation for the maintenance phase of BCG vaccination, to assist in the preparation of a manual for maternal and child health workers engaged in BCG vaccination during the maintenance phase, and to advise on case-finding and treatment for mycobacterial diseases in thana health complexes. The aim of the national tuberculosis control programme in &ma continues to be reduction in the annual risk of infection from 1.6% to 1% by 1982, i.e., 5% annually. The strategies employed to achieve this consist of direct BCG vaccination of children up to 14 years of age with emphasis on new-borns and pre-school children, and ambulatory chemotherapy for all detected cases. Under the Expanded Programme on Immunization, the programme envisages tackling childhood diseases of public health importance, including tuberculosis. SEA/RC33/2 Page 56 In India, assistance continued to be provided to the Tuberculosis Chemotherapy Centre and the Tuberculosis Prevention Trial, Madras. New areas in the field of immunology and biochemistry have been taken up at the former and further research is going on in short-course chemotherapy. A WHO consultant reviewed the progress of the studies at the Centre and discussed the current activities during a visit in January 1980. Particular attention was also paid to the organizational and administrative activities of the Centre's clinical studies, especially in regard to coordination and interim assessment of thera- peutic results and of toxicity. The consultant also visited the National Tuberculosis Institute at Bangalore to review its progress. This institute has the responsibility of monitoring the national programme by collecting, compiling and analysing data on the work of district tuberculosis centres and suggesting remedial action for further improvement. The Tuberculosis Prevention Trial in Madras, which has been going on since 1971, has already completed its third examination round, i.e., the observation time of 7% years. A WHO temporary adviser essisted in the analysis of the data of the Trial during January 1980. The first scientific report of the findings of this trial has been brought out and shows that BCG vaccination affords no protection against lung tuberculosis in the southern part of India. In order to consider the findings of the Trial, a Joint ICMRIWHO Scientific Group Meeting on Vaccination Against Tuberculosis was convened in the Regional Office in May, which recognized the high scientific quality of the Trial. The evidence available indicated that BCG did not protect against bacillary pulmonary tuberculosis but that this result should not be regarded as applying automatically to other parts of the world. The lack of protective effect of BCG vaccine might be related to the interaction between a variety of epidemiological, environmental and immunological characteristics of the population of Chingleput (near Madras). The meeting therefore recommended various investigations to test hypotheses relevant to these possibilities and a full and detailed analysis of the follow-up results in various vaccination groups when the ten-year follow up would be complete, so that the maximum scientific information on BCG vaccine could be obtained. The Group felt that the report on the Trial provided insufficient information on the effect of BCG vaccine in infants and young children, and that further studies on this topic were needed. In Mazdives, a case-finding survey for tuberculosis has been completed in all islands except Kaafu (Male atoll) and Male. In addition, immunization of the eligible population was undertaken in the islands surveyed. As of 31 December 1979, there were 598 tuberculosis cases under treatment. BCG vaccination was carried out in Nepal, as planned. Assessment, follow-up, case-detection and scar surveys were also undertaken according to schedule and training given to various categories of staff The progrannne delivery was effective and community participation SEA/RC33/2 Page 57 encouraging. A WHO consultant, assigned to the country from December 1979 to April 1980, reviewed the project activities as detailed in the project formulation for tuberculosis control in general and the technical quality of each activity in particular,and also the work of the Tuberculosis Association and other voluntary agencies. He also assisted the integrated and cmunity health services and EPI in imp1ementir.g a comprehensive tuberculosis control programme as an integral part of basic health services, including the maintenance of BCG vaccination as a part of EPI. Advice was also given on the training of all categories of health workers in tuberculosis control. Plans are under way to organize the second national seminar on tuber- culosis in November 1980. 2.4.2 Leprosy The problem of leprosy is big in terns of numbers, accounting for over five million cases in this region. It is a matter of great concern that despite scientific advances in its management, millions should still be afflicted by this mutilating disease. It is estimated that in BrmgZadesh, there are 200 000 cases of leprosy, mainly in Rangpur, Mymensingh, Rajshahi, Sylhet and Dacca districts. Both active case-finding and the clinical approach for case-detection continued. As of August 1979, there were 30 446 registered leprosy patients, of whom 10 051 (33%) were of the lepromatous type. Efforts have been made gradually to introduce passive case-finding activities in 150 thana health complexes. Assistance continued to be given to the training of all categories of staff. A protocol was prepared for "an epidemiological study of dapsone-resistant leprosy" in Nilphamari area of Rangpur district. A WHO operations officer was assigned in February to assist, among other things, in the development of leprosy control activities and the BCG vaccination programme at all levels, in relevant training programmes, and inthe regular evaluation of the operational and epidemiological aspects of the mycobacterial disease control programme. m &uma, under the rifampicin trial, the administration of rifampicin was well planned and executed. The activities include rifampicin treatment of open cases in the field and the collection of random urine samples; DADDS injections to rifampicin-treated open cases; urine dapsone tests, mouse-foot pad tests and mass survey. Follow-up treatment and clinical reviews indicate that the patients are benefiting from more regular dapsone treatment. Reactions have not become markedly more frequent or severe and have been successfully treated in the field. Treated patients are being regularly followed up. The WHO statistician in the project also continued to assist with the BCG cohort study and the coding of data. In July 1979, a WHO temporary adviser assisted with the planning of a dapsone resistance survey in relation to the Chemotherapy of Leprosy (THELEP) trials. A consultant assigned from August to November 1979 participated in the rifampicin mass survey, to - diagnose and classify newly detected cases, and to conduct a complete ~EAlRC3312 Page 58 reassessment of all patients listed for the BCG cohort evaluation study (multibacillary cases). Another consultant visited Mandalay in September 1979 to observe the activities of the mouse-foot pad laboratory in connexion with the dapsone resistance survey. A statis- tician from WHO Headquarters visited Burma during January-February 1980 to investigate the statistical and data handling facilities that could be made available for the BCG cohort study and the rifampicin trial (both WHO-assisted leprosy projects) and to suggest a procedure for the smooth and orderly transfer of the data handling responsibility from Geneva to Rangoon. m India, the national leprosy control programme, which is implemented as a special programme, is steadily gaining momentum with the aim of controlling leprosy by detecting and treating all cases so as to prevent the spread of the disease. Through consultants WHO has been collaborating in the evaluation of the problem and in exploring the possibility of opening reconstructive surgery units for the correction of deformities among leprosy patients. Vehicles, equipment, including microscopes, and publications and drugs (as an emergency measure) have been made available to different leprosy control units, centres and institutions. A number of workshops covering various aspects of leprosy such as health education, statistics, epidemiology control, reconstruc- tive surgery, trophic ulcers, prosthetics, management of insensitive hands and feet and claw hands deformity have been supported. Several institutes and individuals received funds for research on different aspects of the disease. The Swedish International Development Authority has agreed to provide rifampicin and lamprene capsules for intensifying the treatment programe in India. A large part of the SIDA support to the national leprosy control programme is channelled through WHO. A new SIDA-funded pilot project for multi-drug trials (an intensified programme involving a closed, supervised treatment with more effective drugs such as rifampicin and clofazimine) is being started in Purulia and Wardha. The Damien Leprosy Foundation of Belgium has agreed to help in carrying out limited epidemiological surveillance, in establishing some model leprosy control units and to the supply of drugs through WHO. A consultant from WHO Headquarters visited the All-India Institute of Medical Sciences, New Delhi, and the Schieffelin Leprosy Research and Training Centre, Karigiri, in September 1979, in accordance with the direction of THELEP (Chemotherapy of Leprosy Programme) thatsite visits be made to these institutions to assist them in their work. The Central Leprosy Teaching and Research Institute, Chingleput, has been under- taking THELEP multicentre drug trials for quite some time. In November- December 1979, a THELEP-sponsored Workshop on Mouse-Foot Pad Standardization and Application was held at Chingleput to train the participants in mouse-foot pad methods for the cultivation of M. Lepme and in the application of the technique for research in leprosy. In Indonesia, where the Danish "Save the Children" Organization is providing assistance, the WHO leprologist continued to assist in the SEA/RC33/2 Page 59 training of leprosy supervisors and leprosy workers as trainers, at the National Leprosy Training Centre at Ujung Pandang. Random surveys were undertaken in Maluku and South Sulawesi. A trial is being planned in two regencies for a WHO-sponsored project on a "Recording and reporting information system for leprosy control activities". A WHO temporary adviser visited Indonesia in September-October 1979 to assist in the development of the protocol for a dapsone resistance survey in South Sulawesi, and to assess the potential for developing an institution- strengthening proposal from the Department of Microbiology, University of Indonesia, Jakarta. The possibilities were further explored during a visit in May 1980 of the Secretary, Immunology of Leprosy and THELEP Steering Committees from WHO Headquarters, and the Medical Research Officer (Tropical Diseases) from the Regional Office, to conduct a dapsone resistance survey as well as clinical trials in the chemotherapy of leprosy under the TDR. In Maldives, the case-finding survey for leprosy has been completed for every island except Kaafu (Male atoll) and Male. As of 31 December 1979, there were 1500 leprosy cases under treatment. A representative of the Danish "Scouts Aid" (which is assisting the project) visited Maldives in November 1979 for discussions with the national health officials and WHO staff concerned. In Nepal, work on leprosy case-detection, health education and the setting up of treatment clinics has been completed in Mohattari (Central Region) and Jhapa (Eastern Region) districts. In the Western and Far- Eastern Regions, control activities have been completed in Tanahu, Lamjung, Bardia and Banke districts. The completion of these leprosy surveys brings the number of districts where control activities have been established to twenty-one. A mid-term review has shown that the leprosy special programme in two districts has had a significant impact on community behaviour and knowledge about the disease. The activities have also included training of all grades of medical workers. A WHO consultant is to be assigned to Nepal in mid-1980 to collaborate in planning the strategy for community involvement in leprosy control measures and to advise the Government on defining the role of national and international voluntary organizations. The Second International Workshop on Leprosy Control in Asia, sponsored jointly by the Government, the Sasakawa Memorial Health Foundation and WHO, was held in Kathmandu in October to review the status of comunity involvement and participation, to identify the social, cultural and other factors inhibiting or fostering the participation of the patients, the family and the community in leprosy control activities, and to suggest approaches to secure greater participation. In addition to countries from this region, some countries from the Western Pacific were also represented. This provided a good opportunity to lay adequate emphasis on the rather neglected area of comunity participation in leprosy control. In %iZand, support was provided for an Evaluation Project of Inte- grated Leprosy Control Services in Uthai Thani Province. AWHO consultant SEA/RC33/2 Page 60 was assigned during March-April 1980 to assist in the planning stage. assess and evaluate the operations of the epidemiological survey, and to design parameters for further analysis of epidemiological and operational surveys. A medical officer has been assigned to an inter-country project and based at the Regional Office since January 1980 to promote leprosy control and research activities in the Region and to stimulate programme proposals in leprosy control projects funded by voluntary contributions. The Japan Shipbuilding Industry Foundation has provided support to various leprosy control activities in the Region. Leprosy research is expanding rapidly both under the regional research programme and under the UNDP/World Bank/WHO Special Programme for Research and Training in' Tropical Diseases. Pressing problems have been recognized which require urgent consideration. The foremost among these are inadequacies in case- finding, case-holding and release from control of inactive cases. Equally important is the problem of persistence of infection and resist- ance to DDS. An inter-country consultative meeting was held in the Regional Office in June 1980 to consider these problems and to assist in formulating a coordinated regional approach to their solution. 2.4.3 sexually-TMnsmitted Diseases Sexually-transmitted diseases, particularly syphilis and gonorrhoea. continue to pose serious public health problems. Though reliable data on their prevalence are not available, permissiveness, promiscuity and tourism tend to spread these diseases. Health education, community awareness, social motivation, professional cooperation in notification and case-finding and, above all, enlightenment and active participation of the people in promoting personal hygiene, can result in effective prevention of these diseases. In India, grants were provided for workahops for paramedical and medical personnel to exchange vim and to focus attention on various lacunae in the control of sexually-transmitted diseases. Also, supplies and equipment were given for strengthening appropriate institutions. 2.4.4 Diphtheria, Pertussis and Tetunue These diseases. which are covered under the activities of the Expanded -~ .--- ~~-- ~~ ~. Programme on Immunization, continue to be public health probleme of considerable importance in the countries of this region. 2.5 Viral, Chlamydial, Rickettsia1 and Related Diseases 2.5.1 Trachoma Trachoma is still a public health problem in this region. WHO assist- ance consists essentially of advisory services, fellowships, the provision of supplies and the processing of records. SEA/RC33/2 Page 61 Poliomyelitis is endemic in most countries of the Region. Polio vacci- nation is administered in some countries under the Expanded Programme on Immunization. On the basis of the results of a seroanalysis of limited numbers of blood samples in Rangoon in early 1979, it was decided to hold a statistically acceptable random sampling sero-survey of antibodies of all three types of polio viruses in Rangoon city to elucidate the current epidemiological picture of the disease. One of the Regional Advisers on Communicable Diseases visited Rangoon in August 1979 to assistthenational authorities in organizing the sero-survey. Following this a WHO short-term consultant was sent to Rangoon in November 1979 to review the epidemiological situation regarding poliomyelitis in Rangoon based on the data obtained through the sero-survey and other available information. From the results, it can be concluded that the status of poliomyelitis in Rangoon in 1979 was the same as in 1966. A phased programme of polio immunization in Rangoon is to be launched in the second halfof1980 under the national programme on immunization. 2.5.3 Dengue Haemorrhagic Fever Dengue haemorrhagic fever continued to be endemic in Burma, Indonesia and Thailand, where the available data in respect of the calendar year 1979 were as follows: Sporadic cases of dengue fever with haemorrhagic manifestations were also reported from Maldives and Sri Lanka. Country Burma Indonesia Thailand In Em, dengue haemorrhagic fever was reported from Rangoon as well as other states and divisions. Clinical manifestations including encephalopathy were reported which need further in-depth studies. A clinical trial on corticosteroid for the treatment of dengue shock syndrome has been completed. In Indaeeia, research on clinical trials was completed. Cases 4 684 3 203 11 276 Deaths 158 153 102 Case fatality rate 3.6% 4.8% 0.9% SEA/RC33/2 Page 62 Outbreaks of a dengue-like disease were reported in Maldives in May-June 1979. One of the Regional Advisers on Conmunicable Diseases and the WHO staff stationed in Male assisted the national authorities in investi- gating the outbreaks at Male and Edhyafushi island. Serological studies revealed that the disease had been caused by dengue viruses. Advisory services were provided through four h'H0 consultants to (1) study the epidemiology of dengue fever in Male and other atolls and assist in a serological survey of the dengue antibody level in the population in Male; (2) assess the overall epidemiological situation of dengue infection and advise on long-term preventive and control measures; (3) assist with clinical diagnosis and management of patients of dengue fever and DHF, and (4) assess the situation of Aedes mosquitoes in the country for arboviruses and other vector-borne diseases. In Sri Tanka, a WHO consultant-paediatrician carried out a follow-up survey of the clinical aspects of the dengue haemorrhagic fever situation in January 1980. A WHO consultant (virologist/epidemiologist) visited India and Sri Lanka during January 1980 to follow up on the recommendations of the Research Study Group Meeting on the Epidemiology of Dengue Haemorrhagic Fever held in March 1979. Collaboration with the Medical Research Institute, Colombo, to test the blood specimens of DHF cases collected from Maldives has been arranged by WHO. Epidemiological studies, including clinical-virological, prospective-serological and entomological studies in Male, have been planned for 1980-1981, with laboratory support from within the Region. The WHO Collaborating Centre for Research in the Imunopathology of Dengue Haemorrhagic Fever, Bangkok, Thaitand, continued its studies on morphology, the morphogenesis of dengue antigen and virus, immuno- pathology and immunochemistry. The Centre was redesignated as a WHO Collaborating Centre for three more years, with modified terms of reference to include the development of a dengue vaccine. A WHO consultant was assigned in November-December 1979 to assist in preparing the protocol for the development of the vaccine. He also assisted the National Virus Research Institute in strengthening its arbovirus laboratory and in preparing the research protocol for epidemiological studies on dengue haemorrhagic fever in a DHF endemic area in the country. A meeting on research in viral haemorrhagic fevers (dengue and chikungunya haemorrhagic fevers, Crimean-Congo haemorrhagic fever, Rift Valley fever, yellow fever, Korean haemorrhagic fever, lassa fever, Marburg and Ebola haemorrhagic fevers) in the Eastern Mediterranean, South-East Asia and Western Pacific Regions was organized in the Regional Office in March 1980. This meeting reviewed the state of knowledge regarding those viral haemorrhagic fevers of relevance to these regions and identified the areas in which research could be carried out within the framework of technical cooperation among countries and Regions. TRADITIONAL MEDICINE Reliance on the traditional forms of medicine has increased and countries are taking advantage ot the rich heritage available thrnughout the Region. DHF The unmistakable marks of dengue haemorrhagic fever. DHF is among the ten leading causes of hospitalira- tion as well as of deaths in children in at least three countries of the Region. EPI The expanded programme on im- munization has been established in most countries and is making progress as an integral part of the health services (right, top). BCG Extensive BCG vaccination is being continued as part of anti-TB pro- grammes in most countries of the Region. The Regional Director. Dr V.T.H. Gunarat Health Day 1980. which highlighted the ha; yours". sting a talk from All India Radio on the occaslon ot WOI kinq under the theme "Smoking or Health: The choice Mr Gamani Jayasuriya. Minister of Health. Sri Lanka. inaugurating the meeting of D~rectors of Medical Re- search Councils and Analogous Bodies and Concerned Research Foci in the Relevant Ministries. which took place ~n Colombo in December 1979. Sitting to his left on the dais are: Mr B.C. Perera. Secretary. Ministry of Health. Sri Lanka. Dr V.T.H. Gunaratne. Dr Prakorb Tuchinda. Under Secretary of Statefor Public Health Thailand,and Dr K.H. Notaney. WHO Programme Coard~nator in Sri Lanka. SEA/RC33/2 Page 63 2.5.4 Viral Hepatitis The disease has been reported from Burma, Mongolia and Sri Lanka as a major public health problem. WHO staff from Headquarters and theRegiona1 Office, together with a consultant, visited Burma in August 1979 for discussions with the national health authorities on a research project on viral hepatitis B. The prevalence of the hepatitis B surface antigen in normal population in Burma is about 10% and the vertical transmission from mothers to newborn babies is relatively high. A project document has been prepared for joint support from WHO and CDC, Atlanta, for a study in Burma to define the incidence and transmission of hepatitis B virus infection to offspring and to determine the efficacy of trans- mission intervention with immunoglobulins in infancy. A future study to determine the efficacy of hepatitis B vaccine in reducing the carrier state in infancy and early childhood is also planned. The establishment ofanetwork of national centres for viral hepatitis in the Region is under way to facilitate the surveillance ofthedisease and the standardization of methods and reagents at the international level. 2.5.5 Japanese Encephalitis Technical guidelines to deal with Japanese encephalitis were given wide distribution in the Region. In India,an epidemic of Japanese encephalitis was reported in the States of Karnataka, Andhra Pradesh, Maharashtra and West Bengal during 1979, with a high number of cases and deaths. At the request oftheGoverment, WHO arranged for the supply of 30 000 doses of freeze-dried vaccine. Training in the use of specialized spraying equipment was given to a national worker in Nepal. 2.6 Expanded Programme on Immunization Recognizing that the Expanded Programme on Imunization (EPI) is one of WHO'S priority efforts to foster the development of primary health care, and that the programme's success is an essential element in achieving health for all, governmentsand WHO continued to pay particular attention to the implementation of the programme in all countries of the Region. During the period under review, special efforts were made to train national programme managers and health workers responsible for vaccine logistics. With WHO'S support an inter-country course on the planning and management of EPI was held in Bangkok for 39 participants. Also, three inter-country courses on vaccine logistics and cold chain were organized - 2 in India and 1 in Thailand - in which training was given to 51 national personnel. Training of mid-level EPI managers started with an inter-country course in Bangalore, India, in November 1979. A similar inter-country course was held in Bangkok in March 1980, and 14 trainers from 3 countries completed it; one more course was held in Calcutta in April 1980. Following these activities, national EPI . SEA/RC33/2 Page 64 training courses for health staff at all levels were held in 7 countries, with WHO'S support and participation. Operational manuals on EPI were prepared in three countries. Twenty- three WHO fellows from four countries went on EPI training and orientation tours during the year. Staff from the Regional Office visited 9 countries to take part in programme planning, review and evaluation, training activities, research meetings, and the collection of epidemiological data on EPI target diseases. They also assisted in finding solutions to managerial and technical problems. For the same purpose, 12 consultants (including three staff members from WHO Headquarters) visited nine countries of the Region during the year. Cold chain equipment, locally produced in the countries of the Region. was tested for its "cold life". In two countries, plans were finalized to install solar-powered refrigerators to test them for storing vaccines. Assistance was given in installing regional cold stores for vaccines in two countries. Vaccines were supplied to one country through WHO in 1980, utilizing voluntary contributions. In November 1979, a regional meeting on EPI management was held in New Delhi with the participation of national EPI managers and other senior health workers involved in the programme in all ten countries of the Region. The national programmes were reviewed and discussed, especially community participation in EPI implementation. Also in November 1979, a meeting of the EPI Global Advisory Group was held in the Regional Office. Plans were made for conducting EPI operational research in the Region, with WHO support. In one country, an EPI research and training area is to be established which will also serve other countries. As a result of all the above-mentioned activities, the programme in the Region was further expanded during the year, and it covered a greater number of children and women. The following is a summary of activities in individual countries: In Bangladesh, a five-year plan of operations for EPI has been prepared by the National Advisory Committee. Implementation of the programme started in seven immunization centres in mid-1979, and it is planned to have a total of 3000 health centres by the end of 1984, to provide immunization to children and women. In addition to BCG, DPT and TT vaccines, polio and measles vaccines will also be available for urban populations. While vaccines and cold chain equipment were supplied by UNICEF, national staff were trained for EPI with WHO assistance. A review of progress of implementation was undertaken in March 1980 with WHO participation. SEA/RC33/2 Page 65 The EPI plan of operations for Bhutan was finalized in 1979. In selected areas of the country, children have been immunized against tuberculosis, diphtheria, tetanus, whooping cough and poliomyelitis. A feasibility study on measles immunization is to start during 1980. Vaccines, supplies and equipment for the programme have been procured with WHO and UNDP cooperation. The national EPI managers, who have been assigned, and other health staff involved in EPI have undergone training abroad. A consultant visited the country during the year and assisted in collecting epidemiological data on neonatal tetanus. In Bma, the programme has been extended from Greater Rangoon to Phase I1 areas in 22 townships all over the country. An assessment of immunization coverage based on area reports was conducted by the national authorities in Phase I areas. The best coverage was for BCG vaccination (68.5% of newborns and over 99% of children aged 5-6 years). Lower figures were obtained for DPT immunization of children and tetanus toxoid vaccination of pregnant women. Areas for improvement were identified and recommendations made regarding the managerial and technical aspects of the programme. A serological survey was conducted in the Greater Rangoon area during which sera were collected from 1000 children aged 0-5 years who had not been immunized previously; 15% of these sera were found to be negative to all three types of polio virus. The remaining 85% of sera contained antibodies to one, two, or three types of the virus. The results of this survey indicated the "natural" immunity level among children in the urban areas of the country and provided epidemiological information necessary for setting priorities for the further expansion of the programme. In India, training in EPI continued to be carried out during the year - two courses each on vaccine logistics and mid-level management. The progress of EPI implementation was reviewed with WHO participation in 7 States (Orissa, West Bengal, Karnataka, Gujarat, Haryana, Tamil Nadu and Rajasthan) and recommendations made for further improvement and expansion of the programme. Immunization coverage was evaluated by the cluster sampling method in six states and union territories. In the urban areas of Bangalore, 38% of pregnant women surveyed had received two or three doses of tetanus toxoid; DPT coverage of children was found to be: 62% one dose and 52% three doses of the triple vaccine. Medium-term EPI plans of operations were prepared at state level. To study the problem of measles, a WHO consultant visited several states, collected epidemiological data and evaluated the public health importance of the disease, which seemed to contribute heavily to the high mortality among infants and young children. A study on the operational feasibility of measles immunization was also launched in cooperation with UNICEF. This study indicated that before immunization could be introduced on a large scale, it was necessary, among other things, to expand the cold chain and ensure its smooth functioning. SEAIRC3312 Page 66 Cold chain equipment was supplied during the year. Refrigerators specially designed for use in areas with irregular supply of electricity and voltage fluctuations, were supplied for testing. Plans were made to establish EPI demonstration and training areas in several states and personnel sent abroad for orientation. UNICEF and SIDA continued to extend full cooperation in the implementation of the programme. In Indonesia, the programme further expanded during the reporting period. By the end of 1979, EPI had covered 1195 kecamatans - 37% of the total. The target is to cover 51% of all kecamatans by 1981 and 80% by 1984. A survey of immunization coverage was conducted in the last quarter of 1979 in randomly selected areas. The survey indicated that 55% of children received two doses of DPT, as well as BCG and smallpox vaccinations. A strong and well staffed central EPS Unit was established in Jakarta. The national EPI manual was printed and distributed. A draft booklet on immunization for use by students and the medical profession was also prepared. Training of national staff in EPI continued during the year. Eleven participants from Indonesia completed WHO courses on EPI management and vaccine logistics. EPI management training courses of two weeks' duration were organized at the provincial level for 200 health workers. Also, a course on vaccine logistics was conducted for the staff responsible for vaccine handling in most of the provinces. The central vaccine cold-room and three provincial cold rooms became operational at the end of 1979; three more rooms are under construction. With assistance from a consultant, the cold chain for vaccine distri- bution was improved further, with equipment produced locally and also received from abroad. An agreement was finalized with a bilateral agency for assistance amounting to US$ 13.2 million to be made available during 1980-1984. Data on EPI are also included in the national health information system and plans made for establishing a supplementary surveillance system through "sentinel areas" in 26 kecamatans. A symposium on immunization was held in Jakarta in November, in collaboration with WHO, UNICEF and the International Children's Centre. Senior health staff from the provinces and scientists from a number of other countries participated. In Maldives, BCG and DPT imunizations were given to children in atolls by the mobile unit team of the leprosy and tuberculosie control SEA/RC33/2 Page 67 programme, which has reported satisfactory coverage in the islands visited. In Male, children were also immunized against poliomyelitis. The EPI programme in Mongolia was expanded further during the year. Cold chain and sterilization equipment was supplied. A trial was conducted on the use of disposable syringes for the immunization of children in selected urban areas. Two workers went abroad on WHO fellowships to study problems related to the implementation of EPI. A seminar was held in Ulan Bator for EPI managers from the aimaks and an instruction booklet on EPI printed and distributed to the health staff. A WHO consultant assisted in studying the epidemiological situation of viral hepatitis and reviewed the present practice of sterilizing syringes and needles. The reported immunization coverage in 1978 was: 100% for BCG, measles and smallpox, and 98% for DPT, DT and polio. No cases of tetanus, diphtheria or poliomyelitis were reported in Mongolia during the year. In Nepal, immunization continued to be provided by the staff of the smallpox eradication programme, the integrated community health services, family planning personnel, staff of the tuberculosis control programme and by voluntary organizations. A WHO consultant visited the country and assisted in the further development of the cold chain for vaccine storage and distribution. Another consultant assisted in conducting an epidemiological survey of neonatal tetanus, which revealed that the mortality caused by the disease was 15 per 1000 live births in the southern part of the country (Terai) . During the first quarter of 1980, the programme was independently evaluated with WHO and UNICEF participation. Nine districts were visited by a group of senior national health workers, UNICEF workers, a WHO consultant, and two staff members from WHO Headquarters. The results of the evaluation indicated that the major problems were managerial and organizational. Recommendations were made in regard to coordination, management, reporting, epidemiological studies, community participation, training, and the operational aspects of EPI. In Sri &ka, all health divisions in Phase I and 11 areas had been covered by EPI activities by the end of 1979. Healthstaff from Phase I11 divisions received training in EPI. Cold chain equipment and vehicles for the programme have been supplied and distributed to all health divisions in the country. A National Advisory Committee on EPI has been appointed and met several times to review the progress of implementation. Immunization coverage reported in Phase I areas in 1978 was: BCG 67%, DPT (3 doses) 34%, polio (3 doses) 32%, and TT (2 doses) for pregnant women 32%. WHO .. participated in a review of the programme in 1979. SEA/RC33/2 Page 68 Training was given to staff in the cluster sampling technique for assessing immunization coverage and plans made for extending the programme to plantations. The national EPI manual was printed and distributed to health staff. In cooperation with UNICEF, plans were made to establish a mobile unit for the maintenance and repair of the cold chain. In Thailand, polio vaccine supplied by UNICEF was given to children in selected urban areas in 23 provinces in 1979. In 197811979, the reported immunization coverage was as follows: BCG-54% of all infants; smallpox-48%; DPT (2 doses)-43%; oral polio vaccine (3 doses)-78% (only in selected areas) and TT (2 doses) for pregnant women-15%. The cluster sampling method was used for the assessment of coverage in Bangkok and in two provinces. Refrigerators and other cold chain equipment were supplied to all district hospitals, health centres and midwifery clinics all over the country. The local production of BCG, DPT and TT vaccines was gradually expanded in 1978-1979 and vaccine samples tested for potency. Twenty-six senior health workers completed WHO-sponsored EPI courses conducted in the country. Following this, over 1600 health workers received EPI training, which is continuing. Sixteen thousand copies of the national EPI manual were printed and distributed to health staff. 2.7 Veterinary Public Health The countries in the Region are interested in strengthening veterinary public health programmes, particularly the control of priority zoonoses (rabies, brucellosis, echinococcosis, etc.) and food hygiene. An inter-country seminar for the planning of national and regional programmes for the surveillance, prevention and control of zoonoses and related food-borne diseases was held at the National Institute of Communicable Diseases,Delhi, in November 1979. The seminar identified rabies, brucellosis, echinococcosis, leptospirosis, plague and food- borne infections and intoxications as priority diseases. It reviewed the strategies and methods for surveillance, prevention and control and recommended the most suitable ones for inclusion in national control programmes. The meeting also approved a medium-term programme covering the period 1980-1983 and recommended the establishment of a zoonoses control centre. This centre will be the focal point for the coordination of national and inter-country projects and programmes and will take into full consideration the principles of technical cooperation among developing countries. A new post of veterinary public health officer is being established in the Regional Office, with resources made available by the Federal Republic of Germany. Zoonoses and food-borne diseases are assuming public health importance in the countries of the Region, the major zoonotic problem being rabies. WHO has been providing assistance in the control of canine rabies and the production of anti-rabies vaccine. SEA/RC33/2 Page 69 India received assistance from a consultant in strengthening the programme of plague surveillance and the preparation of plague antigens required for surveillance. Nepal received assistance in rabies control. A WHO consultant advised the rabies control programme in Sri Lmka on the strategies for control- ling the population of stray dogs and on the preparation of veterinary anti-rabic vaccine. 2.8 Vector Biology and Control Vector biology and control activities were pursued in countries of the Region, in respect of the mosquito carriers of malaria, filariasis, dengue and Japanese encephalitis, and in certain areas also of the vectors of plague and typhus. The principal problems encountered during the year were the changing habitats of vectors caused by human inter- ference with the environment, as in areas of widespread deforestation and agricultural and water developments, expansion in areas of vector resistance to insecticides, and the uncertain role played by species complexes in the transmission of malaria. Increasing stress was laid on the multi-sectoral approach to vector-borne disease control through bio-environmental methods built into hydroelectric, irrigation and water supply projects. A particularly important contribution of the Regional Office to the control of epidemics or threat of epidemics of mosquito-borne virus diseases was the setting up of a Regional Emergency Unit for Vector Abatement (REWA), capable of providing space spraying anywhere in the Region at short notice. To make use of this unit in the countries of the Region, a training course in the methodology of such spraying in particular, and also in vector control measures in general, was organized by WHO in June 1980 in Delhi and Bombay. Participants from Bangladesh, Burma, Indonesia, Nepal, Sri Lanka and Thailand attended this course. Earlier, a national worker from Nepal received this specialized training in USA during 1979. Activities in individual countries are smarized as follows: In Bagtadesh, colonies of mosquitoes were established and maintained in the insectary of the Institute of Epidemiology, Disease Control and Research, Dacca, for research activities. The integration of vector- borne disease control with basic health services has necessitated the establishment of a multi-purpose entomological task force. In Bwma, 1.5 million kyats have been allocated for the construction of a building in Rangoon to serve as the headquarters of the Vector-borne Disease Control Programme. With financial assistance amounting to US$ 452 000 over a three-year period from the Government of the Netherlands, two long-term WHO staff members - an entomologist and a technical officer (sanitarian) - were assigned to the programme and a team leader (under the WHO regular budget) is being recruited. The SEA/RC33/2 Page 70 programme has also received supplies and equipment from UNICEF, and 5.65 million Canadian dollars over a five-year period from the Canadian Government (CIDA). In April 1980, an external assessment team consist- ing of representatives of the Governments of Canada and the Netherlands, together with WHO, reviewed the programme, which deals with malaria, filariasis, dengue haemorrhagic fever and Japanese encephalitis. To cope with the problem of DDT resistance in Anopheles annutaris and the breeding of A. swrdaicus in the coastal areas, larvicidal trials are being carried out using Fenitrothion, Pirimiphos methyl and Temeph0sE.C. The work of the WHO Rodent Control Demonstration Unit (RCDU) continued during the year, and several important scientific publications were produced. In India, the increasing use of malathion for vector control made it necessary in April 1980 for a team of national and WHO staff members to visit the spray areas in western India to assess the safety precautions being taken in the storage and utilization of this potentially hazardous insecticide. The steady progression of Anopheles cuZicifacies doubly resistant to HCH and DDT,andtrebly resistant to HCH, DDT and malathion, and of A. stephensi resistant to HCH and DDT, is causing increasing concern, and appropriate studies were undertaken in Gujarat by the Indian Council of Medical Research with support from the WHOITDR programme. In regard to the biological aspects of vector control, WHO is assigning a consultant to assist in establishing a colony of the larvivorous fish Nothobranchius guentheri, in identifying local fish with similar habits, and in drawing up protocols for field trials. With financial assistance from the Swedish International Development Authority (SIDA), a WHO entomologist has been assigned to the P. falcipam Containment Programme to study the distribution, bionomics and control of Anopheles in eastern India. The filariasis control activities continue to be an integral part of the national malaria eradication programme. The Government of Indonesia is strengthening the M.Sc. course in medical entomology at the Bogor Agriculture University to provide personnel required for the vector control programme; this course may receive financial support from the WHOITDR programme. Several research studies were undertaken, notably to identify methods for preventing the further spread of DDT-resistant AnopheZes aconitus and to determine the effectiveness of larvivorous fish against anophelines. The work of the Vector Biology and Control Research Unit (VBCRU-11) and its sub-unit in Semarang continued during the year. The activities included a number of research projects dealing with malaria vectors, rodents and ectoparasites, vectors of filariasis, insecticide trials and methods of insecticide application. In addition to these activities, the Unit and its sub-unit are providing the national staff with opportunities in training. A WHO consultant visited Maldives to review anti-mosquito measures with particular reference to Aedes. Trials of Ecopro 1700 chips as a SEA/RC33/2 Page 71 long-lasting larvicide are being planned under local conditions where conservation of potable water is a major priority. Re-stocking of wells with larvivorous fish is again being attempted, despite the adverse effects on the fish due to the chlorination measures taken to combat cholera transmission. A set-back occurred in 1979 to the anti- malaria programe when one of the two traditional vectors, Anopheles tesselatus, was detected on three atolls after an apparent absence (following a single round of DDT spraying) of seven years or more. Both A. tesselatus and the principal vector, A. subpictus, fortunately continue to be susceptible to DDT. In Nepal, WHO is providing a consultant in entomology to assist the anti-malaria programe in the planning and implementation of its activities, with emphasis on identifying problems requiring applied field research. Studies are also being planned on the cytogenetics of DDT-resistant Anopheles annularis, the principal vector in the development areas of the Terai. In Sri Lunka, UNDP has agreed to continue its assistance to Phase I1 of the vector control project until the end of 1981. This project, which coordinates the activities of the Anti-Filariasis Campaign (Ministry of Health), the programe of Colombo Municipality and that of the Medical Research Institute, is primarily concerned with the transmission and control of filariasis and dengue. Mapping and surveillance of permanent and temporary mosquito breeding sites in the Colombo municipal area is continuing. In rural areas, trials are planned with slow-release abate chips in coconut husk soak pits, which are the main source of CuZa quinquefasciatus (C. fatigans). A consultant is under recruitment to examine this problem and others connected with the control of Aedes aegypti. Following visits in 1979 and 1980 by a consultant in the transmission and cultivation of viruses, particularly dengue, the virology laboratory at the Medical Research Institute became fully operational. In Thailand, mappingofmalarious areas according to their degree of receptivity has been completed. A trial is being undertaken of surveillance activities based on different levels of malariogenic potential. In the five malaria control regions, monitoring of vector susceptibility to pesticides has been pursued systematically. In south-east Thailand, trials were undertaken on slow and controlled release larvicide formulations against Anopheles balabacensis in gem- mining pits. A trial of methods to control dengue haemorrhagic fever in four provinces of south-east Thailand is proceeding, with emphasis on community participation and health education of school children. The Organization sent a consultant to Thailand early in 1980 to examine research capabilities in the identification and cultivation of bacterial pathogens of mosquito larvae. 3. DISEASE PREVENTION AND CONTROL - NON-COMMUNICABLE DISEASES With the continuing rise in the average life expectancy at birth, there has been a change in the pattern of mortality and morbidity registered SEA/RC33/2 Page 72 in the Region. To deal with such emerging health problems, technical collaboration with Member countries needs to lay emphasis on the strengthening of facilities for training, services and research for the prevention and control of non-connnunicable diseases as an integral part of primary health care. Formulation of national plans for prevention and control, preparation of medium-term programmes and mobilization of extrabudgetary resources received priority attention. During the year, inter-countrylinter-regional group educational activities were organized on: (1) the prevention and control of accidents; (2) the prevention and control of pulmonary hypertension; (3) community control of rheumatic fever and rheumatic heart diseases; (4) histopathological diagnosis of tumours, and (5) the quality control of nuclear medicine imaging devices. Technical collaboration was planned for stimulating national activities in health care problems of the elderly, the prevention and management of deafness, including rehabilitation of the deaf, and the epidemiological investigation of diabetes mellitus amongst the poor in rural and urban areas. Promotion of appropriate technology in low-vision and auditory aids also received attention. 3.1 Cancer The inter-country seminar on histopathological diagnosis of tumoura, mentioned above, was held in Bangladesh and attended by 32 participants from 7 countries. The participants agreed on closer regional colla- boration, exchange of interesting and difficult material for diagnosis, development of a regionallnational information system for the exchange of scientific knowledge and skill relating to cancer, and the publica- tion of the WHO standardized nomenclature of tumours in local medical journals. The inter-country collaborative research on prospective and retrospective studies on chronic liver diseases, including liver cancer, progressed satisfactorily in Bangladesh, Burma, India, Indonesia, Mongolia, Nepal, Sri Lanka and Thailand. A consultant visited Burma, Indonesia, Sri Lanka and Thailand to review the progress and advise on further technical collaboration. In Bangkdesh, a consultant visited a number of medical colleges and some selected hospitals, organized group meetings of faculty members and doctors, assessed the magnitude of the cancer problem, evaluated existing facilities, and advised on the formulation of a national plan for the prevention and control of cancer. He recommended strengthening of facilities for early detection and diagnosis, establishment of stationary and mobile cancer detection units, development of cancer health education, setting up of registration and treatment facilities, organization of training courses in oncology, and eventual establishment of a national cancer institute for research. In Burma, preparations were made for developing a cancer control plan as part of the country health programing exercise. Technical collaboration was maintained with DPR Koma in training ontological specialists, strengthening cancer research and in planning SEA/RC33/2 Page 73 and implementing the national cancer control programme. Action was initiated for a team to visit the country and assist further in plan- ning prevention and control measures. A preparatory mission visited selected cancer centres in Idia and drew up a project document which was forwarded to the Government for UNDP assistance. The Indian Council of Medical Research established a standing committee under the Director-General of Health Services to prepare a national plan for cancer research. This committee has recommended the organization of epidemiological, operational, applied and basic research on oropharyngeal, cervical, oesophageal and liver cancer. Regional and state cancer centres are being strengthened and a referral system for the management of cancer patients is being developed in a phased manner. Audio-visual material based on epidemiological studies has been developed at the Dental Research Unit of the Tata Institute of Fundamental Research, Bombay. An educational film on the carcinogenic hazards of chewing tobacco has been produced in local/ regional languages. The services of a short-term consultant were made available for conducting a course on pulmonary cytology at the Cytology Research Centre, Maulana Azad Medical College, New Delhi. The magnitude of the cancer problem in Indonesia was reviewed by a consultant, who also assessed facilities for prevention, earlydiagnosis, treatment, training of health manpower and research. He formulated plans and recommendations for the phased implementation of a national cancer control programme which were forwarded to the Government for action along with suggestions for medium-term and long-term plans for prevention and control. Another consultant assessed the available radiotherapy facilities for cancer treatment and advised on initiating extension of radiotherapy treatment to more provincial hospitals. He also indicated the type of treatment units to be installed. In MongoZia, the programme for cancer screening in the aimaks was completed and the construction of the cancer hospital in Ulan Bator made further progress. A WHO/IARC/UICC team visited Sri kmka and assisted in the development of a national cancer policy and plan. Technical collaboration was extended for the implementation of the national plan with preliminary emphasis on training in oncology, strengthening facilities for early detection and organization of referral services for treatment. Assistance was also provided for epidemiological research, cancer registration and standardization of treatment procedures. Training of primaryhealth workers in the early detection of oral pre-cancerous and cancerous lesions was undertaken to enable them to refer patient$ to the intermediate levels of health care. In Thailand, a consultant advised and assisted in the organization of radiotherapy treatment at the National Cancer Institute in Bangkok. A meeting of health professionals from the provincial hospitals discussed the details of implementation of the cancer control plan. The National SEA/RC33/2 Page 74 Cancer Institute continued its training activities in cancer registra- tion and exfoliative cytology. Research on liver cancer and anti-cancer drugs is under way. 3.2 Cardiovascular Diseases During the year under review, group educational activities were organized for discussing the prevention and control of cardiovascular diseases. An inter-country seminar on the prevention and control of pulmonary hypertension was held in the Regional Office in October. Eighteen participants from nine countries reviewed the magnitude of the problem of chronic obstructive pulmonary disorders in the countries of the Region, developed protocols for epidemiological investigations, prepared guidelines for management, including rehabilitation, at different levels of health care and formulated plans for collaborative research at regional and national levels. An inter-regional meeting on the connnunity control of rheumatic fever and rheumatic heart diseases, also organized in the Regional Office, reviewed the results of ongoing collaborative studies and discussed strategies for prevention and control. The importance of detection of streptococcal carriers, identification of risk groups amongst school children, prophylactic measures to be adopted, and community-oriented prevention and control activities received detailed consideration at this meeting, which was attended by 24 participants from all over the world. As for activities in individual countries, a consultant visited Bangladesh and assisted a national meeting in developing a plan for the prevention and control of cardiovascular diseases. The training and research activities at the National Institute of Cardiovascular Diseases continued to develop with bilateral assistance. Strengthening of educational and training facilities in the medical colleges and the establishment of services for cardiac resuscitation and rehabilitation in district hospitals and thana health complexes, and epidemiological investigations on hypertension are making progress at the Post-graduate Institute of Medicine and Research. A consultant was assigned to DPR Korea to assist in organizing a streptococcal microbiology laboratory and planning a national programme for the study of streptococcal infections, the carrier problem and prophylactic measures to protect school children. Technical collabora- tion continued to be extended for training specialists in cardiology and cardiac surgery and for strengthening facilities for research in cardiovascular disease prevention and control. In India, a meeting was held at the Post-graduate Institute of Medical Education and Research in Chandigarh to formulate a national plan for the prevention and control of cardiovascular diseases. The Indian Council of Medical Research continued to support national collaborative studies on rheumatic fever and rheumatic heart diseases, hypertension SEA/RC33/2 Page 75 and risk factors relating to ischaemic heart disease. A consultant was assigned to assist with training in streptococcal microbiology at the Sree Chitra Tirunal Centre, Trivandrum, and in conducting an ICMR/WHO- sponsored workshop at the Sucheta Kripalani Medical College, New Delhi. In MongoZia, a course in cardiology for aimak physicians was conducted and a registry of sudden deaths due to myocardial infarction was established. Screening to identify risk groups with high blood pressure and rheumatism was also introduced. Epidemiological studies on chronic pulmonary obstructive disorders and cor pulmonale, and community- oriented preventive measures including demonstration of building smokeless fire-places in village houses continued to be undertaken. Negotiations were continued with bilateral agencies for implementing a cmunity-oriented epidemiological survey and a cardiovascular diseases prevention and control programme in Sri Lanka. The Cardiology Unit in the Colombo Group of Hospitals has plans for expansion to provide paediatric cardiology and cardiac surgery. Departments of cardiology are being established in other medical faculty centres for improving the training of undergraduates in the management of cardiovascular diseases. Technical collaboration was provided to Thailand for analysing epidemiological data already collected on cardiovascular diseases in the country. A subsidy was providedfor conducting a national seminar on the prevention and control of cardiovascular diseases. A consultant was under recruitment to assist the Government in finalizing the national plan for the promotion of cardiovascular health. 3.3 Prevention of Blindness The development of national activities for the prevention and control of blindness gained further momentum with increasing interest from donor agencies in developed countries. The International Agency for the Prevention of Blindness, the Royal Commonwealth Society for the Welfare of the Blind, the Christoffel Blindenmission, the Operation Eyesight Universal, the Japan Shipbuilding Industry Foundation, DANIDA and the National Eye Institute of USA collaborated with the Regional Office and provided resources for the implementation of eye health programmes in many countries of the Region. A team of two consultants (an epidemiologist and an ophthalmic pathologist) visited Burma, India, Indonesia, Nepal and Thailand and assessed the existing facilities and pattern of eye health problems, and recommended a plan of action for promoting epidemiological investigations and the training of ophthalmic pathologists. A consultant was assigned to Bungtadesh to evaluate existing facilities for training, services and research in eye health and formulate a national plan of action for the prevention and control of blindness. An ophthalmic training and services complex is under construction in Chittagong with bilateral assistance from the Australian Government. SEA/RC33/2 Page 76 A National Institute of Ophthalmology is in the early phases of develop- ment in Dacca. The International Agency for the Prevention of Blindness provided financial assistance and organized a training programme for ten doctors in Singapore. During the second phase of this programme, these doctors had their clinical and practical training in Chittagong. This agency also supported the practical training of 15 doctors and 30 para- medical workers in eye camps conducted in Bangladesh. Continuing education activities were also organized. The Royal Commonwealth Society for the Welfare of the Blind continued to support eye camp activities. In Burmu, the strengthening of training facilities for ophthalmologists and other health personnel, and the expansion of community-oriented ophthalmic services received further technical support through resouroes made available by the Sasakawa Health Foundation and the British National Committee for the Prevention of Blindness. Two consultants were assigned to Burma during the year: an ophthalmic pathologist assisted in the teaching and development of ophthalmic pathology services. The second consultant advised on the development of training facilities and the organization of comprehensive eye health services, and also discussed the details of collaborative research on glaucoma and corneal injuries. The national plan for the prevention of visual impairment and control of blindness in India continued to receive technical assistance from DANIDA. A consultant studied the implementation of the programme at different levels of the delivery of ophthalmic services and made recommendations on the development of a system of monitoring progress in collaboration with the National Informatics Centre in New Delhi. Another consultant visited selected centres, institutes and departments of ophthalmology to review research activities and evaluate the potential for further research. His findings indicated the need for rapid development of the scientific base for the implementation of the national programme and identified priority areas and opportunities for research in ophthalmic problems. Recommendations were made for continuing training and coordination of research at the national level. The Regional Office sponsored national meetings/workshops on topics such as ophthalmic research, community-oriented eye health services, rehabilitation of the blind, the role of voluntary organizations in the implementation of the national plan, eye health education and mobile eye camps. The national coordination committee decided to publicize the national plan in local languages to promote community awareness and participation. "The Operation Cataract" project in Medak District of Andhra Pradesh progressed well with the implementation of its objectives. Health education material for training in eye health was prepared by the Indian Registry of Pathology and distributed to training institutions. A consultant visited Indonesia to study the pattern of eye diseases and assess the potential for epidemiological investigations. He also had discussions with ophthalmologists and epidemiologists on the research methodology for the investigation of glaucoma. Supplies and equipment SEA/RC33/2 Page 77 were made available for strengthening eye health services at provincial hospitals. In Nepal, based on a sample survey, a project proposal for a national programme for the prevention and control of blindness was prepared and submitted for funding from the Netherlands, and action taken for the implementation of the first phase. The Operation Eyesight Universal continued to provide assistance to the Nepal Eye Hospital. Supplies and equipment and fellowships for specialization in ophthalmology were made available from contributions from the Japan Shipbuilding Industry Foundation and the Sasakawa Health Foundation. A consultant partici- pated in the meeting which formulated a national plan for the prevention and control of blindness. A team of two consultants - an epidemiologist and an ophthalmic pathologist - reviewed the pattern of ocular.morbidity and recommended epidemiological investigations of fungal keratitis resulting from ocular injuries. In Sri Lunka, a consultant assessed the status of eye health services and advised on the training of ophthalmologists and the organization of comprehensive services at different levels of the public health system. Another consultant was assigned to formulate a plan of action for the establishment of a school for the training of ophthalmic auxiliaries, and later to participate in a national seminar convened to elaborate the details of the training curriculum, job responsibilities, employment potential and the resources for the project. A mobile ophthalmic unit was presented by the Regional Director to the Colombo Eye Hospital for providing ophthalmic services, including eye health education, to the people living in rural areas. A consultant was assigned to advise on the organization and demonstration of services through mass eye camps. Similar services will be provided to assist in organizing a school for ophthalmic auxiliaries. In ThaiZund, comprehensive ophthalmic services in five provincial hospitals staffed by doctors and nurses trained in Bangkok and the hospital in Buriram commenced operation. Five doctors and five nurses working in these provincial hospitals were awarded fellowships to visit selected ophthalmic institutions in India and acquire knowledge on the conduct of community-oriented eye camps. Supplies and equipment and additional fellowships for training were provided from contributions made available through the Sasakawa Health Trust Fund. Two consultants were also assigned to help promote epidemiological research and develop facilities for ophthalmic pathology services. 3.4 Immunology The WHO Collaborating Centre for Research and Training in Innnunology established in 1970 at the Department of Clinical Chemistry, All-India Institute of Medical Sciences, New Delhi, received further assistance during the year. Support was given to a national Workshop on HLA Antigens held at the Institute in 1979. A similar workshop was also organized by the ICMR at the Blood Group Reference Centre in Bombay. SEA/RC33/2 Page 78 A workshop on immuno-diagnosis of parasitic infections was held at the Post-graduate Institute of Medical Education and Research, Chandigarh. 4. HEBLTH LABORATORY SERVICES Il.1 Organization of Laboratory Services Laboratory services have now developed a pyramidal structure, with the peripheral, intermediate and regional laboratories giving support to the diagnosis and epidemiology of most diseases. The apex laboratories function as referral centres for training, for the preparation of manuals and the supply of reagents and media. WHO collaborated with the countries of the Region in strengthening the structure and functions of these laboratories at different levels of the health care system to improve their capabilities to play a more effective role in comprehen- sive health care development. The Organization's support was mainly to develop expertise in advanced laboratory techniques, help train technologists and promote training in laboratory management, and the production of manuals on standardized laboratory procedures. In Bangladesh, a WHO microbiologist assisted in organizing training courses, particularly in microbiology and serology, to strengthen intermediate laboratories. Sero-surveillance studies of brucellosis, typhoid, diphtheria and tetanus were undertaken. A training course in microbiology was organized with the assistance of DANIDA. In Bumta, following the assignment of a WHO consultant to assist the Virology Unit in regard to methods of isolation and the characterization of arboviruses, further assistance was provided to strengthen the programme of surveillance of entero-viruses. A consultant trained national staff in virus isolation and identification techniques. Laboratory services were reorganized; twenty 'C' type laboratories were established, and training programmes completed as planned. There are plans by WHO Headquarters to undertake operational studies on health laboratories in support of primary health care. WHO continued to assist India in strengthening state public health laboratories and reference laboratories. The WHO microbiologist assinned to the countrv trained the staff of the central and district - - publyc health laboratokies in Rajasthan, Uttar Pradesh and Andhra Pradesh in the microbiology of water and enteropathogens, as well as in laboratory management and quality control. Attempts were made to bring about coordination and collaboration between public health and peri- pheral laboratories. WIIO assisted with two workshops - one on histocompatible antigens system (HLA), held at the All-India Institute of Medical Sciences, New Delhi, and the other, on the standardization of procedures and quality control in blood banking, which took place in Chandigarh. A workshop on hospital infections with special reference to gram-negative bacilli was held at the National Pseudomonas Centre, All-India Institute of Medical Sciences, New Delhi. Further, SEA/RC33/2 Page 79 a Seminar on Transferable Antibiotic Resistance in Bacteria and its Control was organized at the WHO Collaborating Centre at the Sucheta Kripalani Medical College, New Delhi. In Indonesia, laboratories at the provincial and district levels were assisted by WHO staff, who conducted on-the-bench training in micro- biology to improve the quality of work. Short training courses for laboratory workers of health centres were held in support of the PHC programme. A WHO consultant assisted provincial and regional laboratories in developing expertise in entero-microbiology, particu- larly in the techniques of phage and sero-typing of organisms. A training course was held at the Centre for Biomedical Research, Jakarta. A WHO consultant was assigned to Matdives to assist in improving laboratory facilities, particularly in microbiology. In MagoZia, a WHO consultant assisted in further strengthening diagnostic and public health laboratories through training; supplies and equipment were also provided. The laboratory services programme in Nepal received further WHO support for strengthening district and regional laboratories. The Central Regional Laboratory has become operational. In Sri hka, a WHO consultant assisted in the evaluation of laboratory support to primary health care and in the strengthening of laboratory services at the higher levels of health care. In ThaiZamI, where the project is aimed at increasing laboratory support to the primary health care programme, more district and health-centre laboratories are being developed and regional laboratories upgraded. 4.2 Quality Assurance The countries in the Region have over the last decade developed an infrastructure for health laboratories, with WHO assistance. In order to improve the quality of work, particularly in clinical chemistry, the programme of internal and external quality control, initiated in 1977, was further strengthened. In Burma, a lyophilized serum for use in the external quality control programme has been prepared and is being evaluated. In India, a conference of directors of laboratories participating in the clinical chemistry quality assurance scheme was convened with WHO technical support. The meeting reviewed the performance of the participating laboratories and suggested steps to strengthen the programme further. It recommended that the national programme should create facilities for the production of control sera for distribution. The director of the national control laboratory was awarded a WHO fellowship in clinical chemistry to study the preparation of control sera and quality control techniques. SEA/RC33/2 Page 80 A WHO consultant assisted Indonesia in evaluating the performance of quality control laboratories. He recommended several measures to improve the status of clinical chemistry in diagnostic and public health laboratories. In !lkikind, quality control continues to be strengthened at various levels. Participants from Burma, Indonesia, Nepal and Thailand attended a WHO-supported Workshop in Clinical Chemistry Quality Control, held at Kuala Lumpur and Singapore. Following the training course in haematology held in Bangkok earlier, external quality control in haematology has been initiated in labora- tories in India, Indonesia and Thailand. 4.3 Quality Control of Pharmaceuticals and Biologicals Most countries in the Region have developed strategies for improving the supply of essential drugs and vaccines for their national health programmes. WHO has assisted in this activity and has especially strengthened the laboratory facilities and training programes in the field of quality assurance. In &mgtadesh, assistance was provided to the Government Pharmaceutical Laboratory and WHO long-term staff helped with the training of personnel of the Pharmaceutical Production Unit. Training was also given in quality control. In Burma, the quality control laboratory was further strengthened with UNDP support. National personnel received training in quality control techniques, pharmacology, food and water microbiology and also in drug control administration, quality assurance in foods and drugs and in the drafting of legislation. WHOIFAO consultants were assigned to assist in the development of a food safety programme. In India, the Drug Control Laboratory was provided supplies and equip- ment for further improving procedures for drug analysis. The Laboratory participates in the WHO programme of evaluation of basic tests developed by the Organization for drug quality assurance. A consultant was provided to assist in developing a national control laboratory for the testing of oral polio vaccines prepared at the Haffkine Institute, Bombay. He visited the &££kine Institute and the Central Research Institute, Kasauli, and tested two batches of vaccine for neurovirulence in monkeys. National personnel were trained in the testing procedures and in neurovirulence testing. Five batches of vaccine will be tested and the programme will continue until consistency in the quality of vaccine is established. Another consultant was assigned to the BCG Vaccine Laboratory, Guindy (Madras) and to the National Institute of Communicable Diseases, Delhi, to give further assistance in improving quality assurance facilities and procedures and to evaluate the performance of these laboratories in the production and testing of freeze-dried vaccine. SEA/RC33/2 Page 81 In Indonesia and ThaiZand, quality control programmes in pharmaceuticals and biologicals were strengthened with WHO assistance. WHO, with UNDP support, assisted in the training of national staff in the quality control of bacterial and viral vaccines. Batches of DPT and BCG vaccines produced by BIOPHARMA, Indonesia, were tested in WHO reference laboratories. In order to develop and strengthen national quality assurance programmes in vaccines, particularly used in EPI, two inter-country workshops were conducted by WHO. A workshop on DPT vaccines was organized in Jakarta in September 1979 to provide on-the-bench training to participants from Bangladesh, India, Indonesia, Nepal, Sri Lanka and Thailand. The participants were trained in the techniques of quality control of diphtheria, pertussis and tetanus vaccines as per WHO protocols and also in the preparation of reference standards. Since most of the countries in the Region are introducing polio and measles vaccination in the EPI programme, a Workshop on Quality Control of Polio and Measles Vaccines was held at the Central Research Institute, Kasauli (India). The Workshop provided an opportunity to participants from Bangladesh, Burma, India, Indonesia, Mongolia, Nigeria, Sri Lanka and Thailand to learn the techniques of virus titration and potency testing, neutralization tests, and antibody titration. 4.4 Vaccine Production WHO has continued to strengthen the national laboratories involved in the production of vaccines, particularly those required for EPI. Assistance was provided to BangZadesh in strengthening further its programe for the production of vaccines at the Institute of Public Health, Dacca. Trial batches of BPL inactivated vaccine have met the minimum WHO requirements. National personnel received training in the production of DPT vaccine. In India, facilities for the production of DPT vaccine at the Central Research Institute, Kasauli, were further strengthened through the provision of supplies and equipment. A WHO consultant advised on improving the facilities for the production of freeze-dried vaccine at the King Institute, Guindy, Madras. The Haffkine Institute now produces working seeds and vaccines of Types I, I1 and 111. In !7'kaihnd, a WHO consultant assisted the Government Pharmaceutical Organization in improving the technology of tetanus, diphtheria and pertussis vaccine production. 5. PROMOTION OF ENVIRONMENTAL HEALTH ~r With the development of the medium-term programme for the promotion of environmental health in 1978-79, the stage has been set for attempting SEA/RC33/2 Page 82 a greater degree of rationalization of external inputs in support of national programmes. This process has been started first in the sub-programme of basic sanitary measures and, in particular, community water supply and sanitation, as countries are developing master plans for the Inter- national Drinking Water Supply and Sanitation Decade (1981-1990) and reorienting their sector plans, yearly programmes and annual imple- mentation priorities. The external cooperation sought by countries for such reprogramming has provided the opportunity also to reprogramme the external inputs required. Although such a rationalization is at the moment restricted to WHO inputs for the sector, it is expected that the inputs of the whole United Nations system will supplement and complement country plans through UNDP as the focal point, eventually leading to joint programing. The coordination of bilateral inputs by governments would thus be facilitated. As examples of this initial attempt at rationalization, the reprogram- ming of consultant and fellowship inputs for India and Sri Lanka for the 1980-1981 biennium can be cited. 5.1 Environmental Health Most countries of the Region have established national mechanisms to coordinate policy and action for the International Drinking Water Supply and Sanitation Decade, and have forwarded their reports on the state of preparedness for the Decade to the Secretary-General of the United Nations. These will be reviewed at the one-day Special Session of the General Assembly in November 1980 to inaugurate the Decade. A consultation was held in November 1979 at the Regional Office to review the regional targets, strategies and actions in the preparatory phase of the Decade. Senior national officials responsible for overall socio-economic and sector planning, administrativelengineering heads of national water and sanitation departments and health officials participated, in addition to representatives of United Nations agencies Following this consultation, national workshops are being organized by the countries to review and reorient their programmes. Under the UNDP/WHO inter-regional cooperation project, technical support has been given to Bangladesh, India and Nepal for programme development and project identification. In the second phase of the WHO/GTZ (Federal Republic of Germany) inter-regional project, similar action has been initiated in Burma, Indonesia and Thailand. In Sri Lanka, the programme plan for the Decade being developed by the Government with assistance from US AID is also supported by WHO. With DANIDA support, an inter-country project was initiated to develop, in the Region, information services in enviroamental health, especially in relation to community water supply and sanitation. WATER AND SANITATION The supply of safe drinking water and the provision of facilities for proper excreta disposal constitute the corner- stone of health development, particularly , rural areas. The first consequence of lhe lack of these vital needs is disease. Safe and plentiful water will be a major step towards health for all. Deep wells with raised parapet walls help prevent water-borne infections. which are a major cause of ill-health in the Region. Regular chlorination ensures the safety of well water for drinking. For uninte er supply. main- 3 is as imDortant WATER AND SANITATION Pit latrines for rural populations will prevent infection and solve the problem of excreta disposal. - ,. . , The expenditure on providing safe drinking water is always a good in- vestment. Piped water supply needs to be pro- vided to more and more rural areas in the Region. SEA/RC33/2 Page 83 The pre-investment studies on water supply and sewerage for Madras City in India with UNDP assistance continued as planned. Similar studies for a rural water supply project in East Java in Indonesia maintained progress. A new pre-investment project for rural water supply and sanitation in the province of Nusa Tenggara Timur with UNDP assistance was approved and arrangements were under way to start it in mid-1980. In the sub-progrannne of recognition and control of environmental pollution, a regional seminar was organized to assess the environmental impact of developments, including health impacts. A UNEP-funded pilot project on biological monitoring was started with India's participation. Assistance was continued to several countries in the development of more systematic and continuous monitoring programmes for water and air . pollution through participation in the UNEP/WHO/UNESCO/WMO Global Environmental Monitoring System (GEMS). Efforts were continued to collect information from the countries on major potential pollution sources for a regional inventory and for the formulation of a regional pro gramme. Under the food safety sub-programme, within the framework of the regional medium-term programme for the promotion of environmental health, some countries in the Region have formulated strategies for the implementation and management of activities in this field (see also Section 5.4 "Food Safety Programmes"). An evaluation was made in November 1979 by World Bank and WHO staff of the regionalized WHOIIBRD Cooperative Programme in South-East Asia. The assessment revealed that regionalization had led to considerable improvement in the operational cost effectiveness of the Programme. It also showed that the Programme needed to be strengthened in its inputs for national sector planning and programming for the Water and Sanitation Decade in the countries of the Region. This activity has since been strengthened and the staff have been assisting national planning activities through sector memoranda in India, in reviewing plans for national projects in Nepal and Sri Lanka, and specific projects in Indonesia and Thailand. The staff of the Programe assisted the Bank in identifying and prepar- ing water supply projects in Indonesia and Thailand; in reviewing the billing and collection systems for the Water and Sewerage Authority project in Bangladesh, and in supervising the water and sewerage project in Punjab, India, both supported by the Bank. The Regional Office continued to collaborate actively in the UNDPIWorld Bank Global Project on Low-cost Water and Sanitation Techniques - Develop- ment of Demonstration Projects, and participated in the International Seminar on Low-cost Techniques for the Disposal of Human Wastes in Urban Communities, held in Calcutta in January. -, The major developments in the countries of the Region during the period under review are summarized below. SEA/RC33/2 Page 84 In BangZadesh, with the tubewell water supply programme registering record coverage of population, the Government, in close collaboration with WHO and UNICEF, finalized the various steps to improve operation and maintenance with substantial community involvement. Inputs into project support communication were considerably increased to ensure higher utilization of safe tubewell water for domestic use. A sub- sidiary plan of operations, exclusively directed to provide sanitary pour-flush latrines in rural homes, came into effect with the participation of both the Health and Local Government ministries in this venture. The UNDP-assisted project for the DaccafChittagong Water and Sewerage Authorities brought better revenues for them through substantial reforms by way of reducing wastage of treated water, better systems of, tariff, metering and collection of water charges as well as improved techniques of stores management, quality control, etc. Technical support was also extended to the country's Water Pollution Control Board to develop further its capabilities in the detection and assessment of environmental impacts. In Burma, technical support was extended through a sanitary engineer and two short-term consultants to recast and develop the proposed UNDP-funded project for water supply to ten towns covering an estimated population of 384 100 by 1990. A project for improving the conditions of the existing piped water supply in the 34 villages of Taung Zin, including their extension to 7 villages in the first phase and 49 more villages in the second phase, was also drawn up to meet the needs of 102 400 people by 1990; this project will receive assistance from the Australian Development Assistance Bureau. The tempo of activities in India was accelerated to prepare a country sector master plan for the Decade by October 1980. Three meetings of state chief public health engineers have been held; two UNDPIWHO consultants are assisting in the sector master plan, and sector memoranda have been completed for all states and union territories. A special feature in this UNDP/WHO Cooperation Project with World Bank assistance is the use of local consultancy services. A guide to the preparation of project feasibility reports is also being developed in India with WHO, UNDP and World Bank collaboration. Technical advice was provided, through short-term consultants, on specific problem in water and air pollution control identified by the Government. In Indonesia, activities for the promotion of environmental health were carried out mainly through enhancing drinking water supply and sani- tation of premises, the control of environmental pollution affecting health, and other sanitation measures. The UNDP-funded project on pre-investment studies for the East Java Province rural water supply development completed its work plan as scheduled. Final designs, construction drawings and material take-offs for different piped water supply systems were completed and implementation started. A new UNDP- SEA/RC33/2 Page 85 funded project - rural water supply in Nusa Tenggara Timur - was signed and was scheduled to begin in June. It will assist in the preparation of an implementation plan for rural water supply and sanitation in the Province, based on an appropriate institutional organization and the resources available. Another similar project for Central Java, to be funded by the Government of the Federal Republic of Germany and executed by WHO, made a good headway and is likely to begin in AugustlSepternber 1980. A further two projects to be executed with UNDP support - rural water supply in South Sulawesi and the training of consultant firms for pre-investment studies - are under review and are expected to connnence during the latter part of 1980 or early in 1981. In Matdives, the WHO sanitary engineer has assisted the Government in finalizing the UN Capital Development Fund-f inanced project, wldch provides for a grant of US$ 1 238 000 for the construction of 15 health centres, 64 rainwater storage tanks and 83 community latrines in selected islands benefiting about 100 000 people. A plan of action for providing basic sanitary measures was also finalized and signed by the Government and WHO. In MongoZia, a plan of operations for strengthening and improving the environmental health services was signed in March 1980. In addition, a proposal was drawn up for possible UNEP assistance in establishing a National Environmental Health Centre. In NepuZ, where the second post of WHO sanitary engineer was filled during the year, the WHO staff are assisting the launching of the first small-scale project on school sanitation. Activities funded by WHO have included the provision of consultants to prepare the "Ten-Year Plan for Water Supplies and Sanitation", "The Large-Scale Shallow Tubewell/Handpump Scheme for the Terai", and a "Field Manual for Handpumps in Nepal", and a tour for senior government personnel to study tubewells, handpumps and related matters in Bangladesh and India. In Sri Lanka, a program plan for the Decade is being developed following a discussion of the first draft plan at a national workshop organized by the Government. The programme plan should enable the Government to identify and formulate priority projects for investment. A major constraint in achieving the Decade targets will be the critical manpower situation at the professional and artisan levels. Resulting from the tripartite review of the UNDPfWHO project - Institutional support to the National Water Supply and Drainage Board - the scope of its activities is to be enlarged. In ThaiZand, technical support to the Government was continued, under the ongoing UNDP-funded project on environmental health and the WHO/ IBRD Cooperative Programme, in the expansion of basic sanitary facilities in urban and rural areas, in the development of environmental health policies, programmes, services and institutions, and in the abatement and control of environmental pollution. The Government agreed SEA/RC33/2 Page 86 to participate in the DANIDA-funded inter-country project on building up information systems/services in environmental health in South-East Asia, and a mission visited the country to review the existing systems/ services and to prepare a work-plan for their further development. On the basis of the report of the preparatory mission in early 1979 under the WHO/GTZ inter-regional cooperation project for the Decade, the Government of the Federal Republic of Germany has agreed to provide technical support under the second phase. 5.2 Occupational Health With the growth of industrial development and the greater use of toxic substances in agriculture, problems related to workers' health are increasing both in number and seriousness. The situation is further aggravated by the fact that the health services available to workers are very limited. Also, there is an acute shortage of trained personnel in occupational health. While the number of institutions in this field is limited, there is a great need to provide all possible assistance for their development. It is against this background that WHO continued to provide assistance to the countries of the Region in carrying out appropriate studies of occupational health problems. BangLadesh received assistance in the further development of the industrial hygiene laboratory at the National Institute of Preventive and Social Medicine, Dacca, and in the training of national staff. The UNDP-assisted project on the "Strengthening of Health Services in the newly Industrialized Areas (West Bank of Irrawaddy River)'' in Burnm is making good progress. Steps were taken to assign specialists to demonstrate, collaborate and train national personnel in the maintenance of field and laboratory equipment; to advise on the recognition, assessment and control of occupational health hazards, and on the methodology of assessing the environmental sanitation situation, sample checking and laboratory testing. During the year, a number of national courses dealing with various aspects of occupational health were organized with the active participation of the national project manager. Tvo school health teams and five dental units were established in the project area. WHO'S assistance to India during the year was in the form of fellowships for advanced training abroad to strengthen occupational health services. The services of a consultant in agricultural hygiene chemistry were provided to Indonesia. He advised the national authorities on air sampling and analysis of agricultural chemicals and their metabolites and on the designing of experimental toxicology. SEA/RC33/2 Page 87 A specialist in education and training helped Sri Lunka in the organization and conduct of several short courses on subjects such as "Policy Development for Occupational Health and Safety Programmes", "Planning and Implementation of Occupational Health and Safety Services in Industry", and "Occupational Health and Safety Practice £orIndustrial Medical officers". These courses were attended by a large number of top management executives from many organizations and establishments. A consultant visited Thrriknd in January 1980 to advise the Government on laboratory techniques related to occupational health. A staff member from WHO Headquarters visited Bangkok in March to discuss with the Director of the Division of Occupational Health in the Ministry of Public Health WHO'S collaboration in the field of occupational health. - Occupational health activities in the countries of the Region are being further strengthened through fellowships for advanced training abroad and the provision of supplies and equipment. 5.3 Radiation Medicine Technical collaboration continued for strengthening radiation health services and for standardizing radiotherapy dosimetry through a joint WHO/IAEA programme. In this context, one of the secondary standard dosimetric laboratories in the Region initiated an independent regional postal dose-intercomparison programme. An inter-country workshop on the quality control of nuclear medicine imaging devices was conducted in collaboration with the United States Bureau of Radiological Health and the Radiation Medicine Centre, Bombay. WHO was represented at the General Assembly of ZAEA which was held in New Delhi in December. The peaceful uses of nuclear energy for irradiation was among the subjects discussed. During the year, documentation on non-ionizing radiation was made available to Member States. The radiation protection services in BangZadesh and Burma were provided with regular supplies of films. In India, two consultants were assigned to the Radiation Medicine Centre, Bombay, to conduct an inter-country workshop on the quality control of nuclear medicine imaging devices. Participants from Bangladesh, Burma, India, Indonesia and Thailand attended this workshop, for which the Radiation Medicine Centre was supplied with phantoms, isotopes and chemicals. An evaluation of the workshop indicated the need for further workshops on quality assurance, radiopharmaceuticals and instrumentation every year or every alternate year at the regional and national levels. A publication on the layout and equipment for a radiopharmacy laboratory in different types of hospitals was considered necessary. The Radiation Medicine Centre published a report on a WHO- sponsored national seminar on radioimmunoassays held earlier, which was widely distributed. A consultant was assigned to Indonesia to assess the existing facilities and standard of radiotherapy for cancer control. He recommended the SEA/RC33/2 Page 88 training of radiological physicists, extension of radiotherapy facilities to provincial hospitals by providing conventional X-ray units, cobalt therapy units and an after-loading unit for the treatment of gynaecological cancer, as well as the establishment of national radiation protection services. In Mongolia, a consultant assisted in training health personnel in radiation dosimetry and radiation health protection. He advised on the construction of radiology, radiotherapy and nuclear medicine labora- tories and the training of radiological physicists. He also evaluated the availability of instrumentation for dosimetric purposes and made suggestions for improvement. In Sri Lanka, a consultant advised on the organization of radiotherapy services in the Government Cancer Institute, Maharagama, and the training of personnel for this institute and other zonal centres being developed. The Radiotherapy Department at the National Cancer Institute in Bangkok, FhaiZrmd,was assisted by a consultant in the organization of treatment procedures. A second consultant is to be assigned to assist in treat- ment, planning and the training of radiotherapists. The Secondary Standard Dosimetric Laboratory in Bangkok continued to provide and expand calibration and personnel dosimetric services in the country. 5.4 Food Safety Programme The development of rational food safety programmes suited to the situation in the Region is still in its infancy. The low standards of environmental sanitation in most countries and the acute shortage of manpower, as well as fragmented institutional responsibilities in some, have been serious constraints in this regard. The Organization has continued to assist countries in reviewing food laws and regulations and in initiating training activities. WHO fellowships have been instrumental in enabling key national staff to acquire the latest knowledge in the sphere of food safety and control. Country reports on the food control situation and needs in respect of seven countries of this region - Bangladesh, Burma, India, Indonesia, Nepal, Sri Lanka and Thailand - as well as Bhutan were prepared and submitted to a technical consultation organized under the auspices of the Food and Agriculture Organization and UNDP and held in Manila in September 1979. The Consultation recommended priority areas for the provision of training in food inspection, analysis, development of laws with regulations and standards, exchange of information, monitoring of contaminants, etc. Action programmes recommended at national level call for measures in ten priority areas. Simultaneously, regional-level support activities, both medium-term and long-term, have been identified. Arising from a consultant mission to Indonesia, recommendations have been made to the Government for coordinating the work and assigning responsibility among different directorates, such as Food and Drug, CDC and Fisheries; for developing simple codes of practice for itinerant vendors; for drafting regulations governing the sale of food in markets, and on operational matters concerning routine inspections, record keeping, monitoring and enforcement as well as health education. Recommendations have also been made in regard to training, management and staffing. 6. HEALTH INFORMATION AND STATISTICS The development of national health information systems (NHIS) in the countries of the Region was continued through the inter-country project "National Health Information Systems Development", with health statistics largely incorporated as a component. The Consultative Meeting on National Health Information Systems Development organized in December 1978 provided most of the basic guidelines and stimulated the interest of countries in the development of NHIS, recognizing it as an essential requisite for the planning, management and evaluation of health programmes. As a result, projects on NHIS or its component sub-systems were initiated or strengthened in Bangladesh, Burma, India, Indonesia, Mongolia, Nepal, Sri Lanka and Thailand. In Bangladesh, assistance in the development of health statistics and medical record keeping was provided from time to time. A long-term systems analyst is under recruitment to assist in the development of a functional health information system to provide support to health services management. In addition, national training courses in health statistics and medical records science will be organized, in collabora- tion with WHO. A long-term systems analyst has been provided to &uma to assist in evaluating health programmes and the use of computers for the develop- ment of the national health information system. The training of national staff in health information systems, computer science, demography and biostatistics and medical record science was supported. The statistician assigned to the Mycobacterial Disease Project (Rifampicin Trial) continued to assist with the trial in selected areas of the country where leprosy is still highly prevalent. In India, WHO collaborated in strenghening the information/statistical systems at both the state and national levels and in providing training in medical records through two projects, "Strengthening of Health Statistical Services" and "Development of Medical Health Records in Hospitals". Further attempts are being made by the national authorities to explore the feasibility of adopting a lay reporting system for the collection of information on morbidity and mortality. Field trials were organized in this connexion in several states. The offices of the Registrar- General and the Central Bureau of Health Intelligence, in collaboration SEA/RC33/2 Page 90 with WHO, held a three-day national meeting on Medical Certification of Cause of Death. The bi-annual training courses for medical record technicians and the annual course for medical record officers continued to be held. In Indonesia, a detailed study was made of the organization and infra- structure of the information sub-systems of various health programmes with a view to promoting the coordination and integration of information at national and sub-national levels. Also, a review was made of the country's hospital recording and reporting system to provide technical collaboration for the new project, "Strengthening of Hospital Statistics as a sub-system of the NHIS". The development of a country progrme profile for Indonesia was initiated. Direct assistance was provided in the computer processing and statis- tical analysis of the data collected in a perinatal mortality survey conducted in hospitals within Bandung and a rural area outside the city. The survey, which also includes a component, "hypertensive disorders of pregnancy", is a collaborative study being conducted in five countries of the Region and coordinated by the Regional Office. Two WHO temporary advisers assisted in the organization and conduct of three training courses on the application of the International Classi- f ication of Diseases, Ninth Revision (ICD/9). Necessary training material was also provided for this purpose. In MongoZia, a consultant assisted the project on epidemiological studies of population growth in regard to the statistical aspects. Among these were the design of a study on maternal mortality and another on nutritional feeding patterns. He also helped in developing programmes for data processing and visited maternal and child health institutions in a number of aimaks to evaluate their performance. The national health survey using the sample method is continuing and the statistical analysis of the data on population, morbidity and mortality and the health service activities in 1978 has been completed. A ten-day work- shop on health information system was organized for 30 participants. A short-term consultant (statistician) was assigned to Nepal to help with a project on health planning and programming. He also assisted in the statistical aspects of the project's activities such as a mid-term review of the Fifth Five-Year Plan, formulation of the Sixth Plan, and the procedures and methodology of the health planning process at district level. The activities also included a field study of reporting and recording procedures at the peripheral and district levels and their standardization, identification of information needs of project/programme chiefs, and modification of existing information sub-systems to meet the needs of development planning and the management process. Assistance was also provided in the statistical analysis of a leprosy study. WHO collaborated in a review of the proposed project on NHIS development as well as a study of the existing situation in respect of information SEA/Rc33/2 Page 91 systems development for all health programmes. The data bank system and the inventory for information at the Planning Unit of the Ministry of Health were also studied and recomnendations were made for the commence- ment of NHIS. Assistance was provided in the development of a curriculum for the training of statistical assistants by the integrated community health project. In Sri Lanka, a preliminary study was made and work programmed for the establishment of a new project "National Health Information Systems Development". A long-term health information specialist is being recruited for this project. A review was undertaken of the development work on medical records in teaching hospitals with a follow-up on the evaluation on medical record procedures, made by a WHO Headquarters consultant earlier in the year. + A team from the Regional Office visited Sri Lanka in connexion with the development of a management information system on water supply. Discussions were held with senior officials of the Ministry of Local Government and the National Wacer Supply and Sanitation Board and, as a result, two pilot studies were initiated to develop management infor- mation systems on piped water and tube-well water supplies. Statistical assistance was also provided to the Food and Nutrition Policy Planning Division of the Ministry of Plan Implementation, which undertook a number of surveys to obtain baseline data for evaluating the Integrated Rural Development Programme. The surveys covered nutritional status, socio-economic indicators and agricultural data. The assistance mainly consisted of detailed advice on data processing and arrangements for analysing the data. In Thailand, a study was made of the newly reoriented health information services and the health planning and management information system at the Ministry of Public Health, and also the development of central and provincial health information centres, for further collaboration. . A consultant from WHO Headquarters was assigned to assist and supervise the coding of data according to ICD/9. Appropriate training material was also provided. Another team of two WHO consultants assisted in the development of NHIS. especially in the context of developing an appropriate technology for this purpose. A further two-man team visited Thailand to brief national programme managers and their staff on the preparation of country programme profiles. Profiles covering a wide range of programme areas have been completed and are in use. Thailand was another country visited by the joint enviromnental health and health statistics mission, which assisted the Provincial Water Authority and the National Economic and Social Development Board in arranging a pilot study for the development of the management informa- *7 tion system on water supply. SEA/RC33/2 Page 92 As stated earlier, action was taken to develop the management informa- tion system on water supply. Water supply involves a wide range of activities undertaken by a number of different government departments and semi-government organizations. Pilot studies were undertaken on particular aspects of the problem in four countries of the Region. The inter-country project on National. Health Information Systems Development assisted in organizing group educational meetings at country level for executing more user-oriented statistical projects. It also helped in evaluating statistical techniques and the quality of informa- tion gathered within the Region, in designing special studies and surveys and in analysing the results. In addition, it provided statistical support and information to various health services and programmes. An effort has been made to establish a data repository service in the Regional Office. The information obtained from countries for the World Health Statistics Annual as well as from various reports and technical documents has been included in "A Bulletin of Health Statistical Information, 19809', which will be distributed to Member countries. It is hoped that this will initiate a continuous process of information exchange between the countries and the Regional Office leading to improvements in future issues. National training courses on the application of ICD/9 were organized by Burma, India, Indonesia and Thailand in which WHO assisted by providing consultant services or background material or both. The team leader of the project attended a meeting on the International Classification of Diseases in Taromina, Sicily, in November 1979. Since the holding of the consultative meeting on the development of NHIS in the Regional Office in December 1978, collaborative assistance has been provided in the development of national health information systems or subsystems (hospital information sub-system, environmental health sub-system) through visitsto countries. Such assistance was provided to Indonesia, Nepal, Sri Lanka and Thailand. An inter-country working groupon information systems development is being planned for 1981 to initiate collaborative action for promoting the development of NHIS. 7. DEVELOPMENT OF HEALTH MANPOWER The focus of the health manpower development (HMD) programme is on: fostering coordination among the training programmes for all types of health workers and the way in which those personnel are used in primary health care; ensuring that the training is oriented towards the needs of PHC within the framework of health for all; assisting the countries of the Region in collaborating with and helping each other in all areas of health manpower development, and on promoting regional acceptance of SEA/RC33/2 Page 93 the need for newly-emerging priorities such as "team training", "continuing education" and "research in health manpower development". The Organization has, therefore, attempted to assist Member countries in: developing effective mechanisms to coordinate health services' and health manpower planning; reorienting the content of basic training programmes towards community needs; developing curricula for various categories of health workers which are competency-based and learner- centred; fostering the development of centres of educational excellence in the Region, and carrying out and reporting on relevant research in health services and manpower development. The Medium-Ten Progrme in Health Manpower Development 'I The Medium-Term Programne (MTP) constitutes the basis for all the activities in health manpower development. In the past year a great deal of effort has been made in reviewing the MTP and relating it to specific contributions to the achievement of health for all. Health Manpower Planning A Consultation on Coordinated Health Services and Manpower Development was held in the Regional Office in August 1979. The Consultation reviewed the experiences of the countries in the linkage between the educational and health sectors, discussed the obstacles and constraints to coordination and developed general and country-specific strategies to bring about closer collaboration between the health service and manpower development sectors. A workshop on health manpower planning was conducted in Nepal and was followed by a project formulation exercise. In Bangtodesh, preparations have been made to conduct a health manpower planning exercise. Tmining in Health Services Management Contractual agreements were signed between &urncr, Sri Lanka and India to develop training programmes to improve the management of primary health care personnel. Under this agreement, &uma has undertaken a systems analysis of the management problems of primary health care programmes and, based on this analysis, is now developing a training programme for all levels of managers of PHC programmes. In Sri Lanka, models for the delivery of primary health care are being developed and are expected to provide the training ground for promoting those administrative and management skills most lacking among all categories of primary health care workers. Discussions are being held with the authorities in India to develop a management training programme for primary health care personnel in the country. SEA/RC33/2 Page 94 fesearch in Health Manpower Deuelopient Following the Research Study Group meeting on Health Manpower Develop- ment and the recommendations of the Regional Advisory Committee on Medical Research on the proposals to be developed and implemented in selected institutes in the Region, a consultant visited several countries during 1980 to stimulate the development of the research protocols. The reactions of the governments of Bangladesh, Burma, Indonesia, Sri Lanka and Thailand have been obtained and action is being initiated to promote studies in priority areas. 7.1 Medical Education Undergraduate Medical Eduoation The Organization continued to assist medical colleges in the Region in reorienting the medical curriculum and making it more relevant to the needs of the community. In BangZadesh, a consultant assisted the medical colleges in the teaching of physiology. The Government has reconstituted the National Committee for Medical Education, which will be responsible for assessing the existing curricula, syllabi, laboratory facilities and teaching staff required for the medical schools. A Teacher Training Cell has been formed and sub-connnittees on undergraduate and post-graduate medical education have been set up. In Ma, the UNDP-assisted project on medical education was completed during the year. A short-term consultant was assigned to Institute of Medicine I to help with basic and advanced training courses in immunofluorescence. In DPR Korea, WHO continues to collaborate in the programme for pre- paring medical and health professional~ for the international health community by improving their linguistic skills. In India, fellowships were awarded to teachers in medical colleges to enable them to keep abreast of the latest knowledge in their respective specialties and also to prepare them for planning and improving the educational processes so as to meet national needs. During the period under review, the National Teacher Training Centre at the Jawaharlal Institute of Post-graduate Medical Education and Research, Pondicherry, held two national courses on educational sciences for teachers of health personnel from a number of medical colleges. A consultant assisted the Centre in one of these courses. SEAIRC3312 Page 95 In Indonesia, a WHO staff member assisted the Consortium of Medical Sciences until March 1980 in training in curriculum development at government and private medical schools. An evaluation of the programme indicated that all the thirteen government medical schools now have mechanisms for self-sustaining educational development; that nearly three-quarters of them have developed all their training programmes so that these are competency-based and their objectives are stated in measurable terms; that the teachers in those medical schools are equally responsive to changes in the methods of teaching that they use, and that all these developments are geared to the production of a curriculum which is community-oriented. A short-term consultant on internal medicine was assigned to the State Medical Institute, Mongo~ia, during the year. In Nepat, assistance was continued to the Institute of Medicine, Tribhwan University, in conducting the Diploma Course in General and Community Medicine. Short-term consultants in anatomy, physiology, clinical pharmacology and surgery were assigned during the period under review. Sri Lanka has been provided with a number of fellowships for the teaching staff of training prograuanes in undergraduate medical schools. Assistance has also been given in upgrading the teaching programmes in medical microbiology for both undergraduate and post-graduate medical students. A similar, specific programme has also been implemented concerning the teaching of hlrman reproduction. In Thaitand, a national seminar was held to review the status of medical education and the need to reorient it towards achieving the goal of health for all. A short-term consultant assisted in developing a programme to train health personnel, including physicians, in primary health care and to assess the possibility of utilizing peripheral health care institutions for teaching medical students. Post-pduate Medical Eduaatwn The Organization has continued to provide overall support to the development of post-graduate medical education in the Region. In Bangtadesh, a consultant, assigned to the National Institute of Preventive and Social Medicine, assisted in developing the curricula for its training programmes and reviewed the organizational arrangements. Consultants in health education, audio-visual aids and biostatistics were also assigned to the Institute. In Burma, a consultant assigned to the Post-graduate School of Radiology studied the feasibility of starting a Master's Degree Course in Radiology. SEA/RC33/2 Page 96 The long-term staff member attached to the Faculty of Public Health in Indonesia until December 1979 assisted in developing the curricula based on the needs of the community and in replanning its approaches to the teaching-learning process. A short-term consultant was also assigned to the Consortium of Medical Sciences to review the post-graduate training programmes in other fields and to advise on the establishment of such programmes, particularly for the basic sciences. The document for a new UNDP project has been signed in Mo?qoZia to develop a program of post-graduate education for health personnel in the country, as a follow-up of the previous project on assistance to the State Medical Institute. It is expected that under this project post- graduate training institutes will be established in several aimaks, apart from those at Ulan Bator. The programme of post-graduate medical education in Sri Lmka gathered momentum during the year, and a consultant was assigned to review the situation and make recommendations. WHO also provided consultants to assist in the M.D. examinations in surgery, obstetrics and gynaecology, internal medicine and community medicine, with a view to identifying the needs. A further consultant assisted the Post-graduate Institute of Medicine in the formulation of plans to develop a diploma course in occupational health. Fellowships have also been provided for the candidates of M.D. in community medicine to undergo training for one year after their examina tion. Continuing Education Member countries realize the importance of continuing education not only to enable health personnel trained long ago to catch up on new kaowledge or to bring them up to date, but also as a necessary mechanism for maintaining and increasing those skills which become necessary because of changing circumstances. The importance of providing continuing education for all categories of health workers was underscored at the thirty-second session of the Regional Committee held in 1979. During the year an inter-country project on continuing education has assisted the countries through the organization of workshops and consultations, the distribution of curricula guidelines, and the development of appropriate learning materials, particularly for nurses. In India, the National Academy of Medical Sciences has started a pro- gramme of continuing education for doctors which will later be expanded to include other categories of health workers. WHO has assisted in this programme. In Sri Lanka, a pilot project on continuing education for primary health workers has already been initiated. SEA/RC33/2 Page 97 Teacher Training Programmes The development of teacher training at local, national and regional level continues to be an essential ingredient of many of the Organization's support programmes. These training progranunes have many functions of which the more significant are: to help teachers of health personnel to plan, implement and evaluate their training programmes in a systematic way; to assist the teachers in making informed educational decisions for themselves; to promote mechanisms at the level of the individual institution or for the country as a whole so that they can take over the responsibility for developing their own programmes, and to create a regional network of training centres to foster technical cooperation among developing countries. " The two Regional Teacher Training Centres - in Peradeniya, Sri Lunka, and in Bangkok, ThuiZand - have continued to provide basic two-week courses in educational science, and have also accepted teachers from medical colleges on short-term fellowships. In Bangladesh, late in 1979 a two-week workshop on teaching methodology was held for teachers of medical assistants. The National Committee for Medical Education has formed a teacher training cell to organize workshops. In Sm, a short-term consultant assisted in the development of a national-level workshop on "Educational Science for Teachers of Health Personnel for Primary Health Care". The Medical Education Unit at Institute of Medicine I, Rangoon, has been conducting workshops to train teachers from this institute as well as those from other health institu- tions in educational science. In India, the National Teacher Training Centre in Pondicherry has held workshops in educational science for teachers from other medical colleges. A second teacher training centre is being developed in Chandigarh which will primarily cater to the needs of the medical colleges in the northern part of the country. In Indonesia, a network of national-level centres is being developed and a short-term consultant was assigned to assist in making the final plans and programmes. 7.2 Education and Training in Maternal and Child Health The activities in this area were directed towards responding to the needs of the Region for training in maternal and child health care in the context of PHC. The preparation of paediatricians, obstetricians and maternal and child health managers for their new roles in the light of the primary health care strategy, and in the context of overall development, is considered important. SEA/RC33/2 Page 98 As a training strategy for maternal and child health care, a regional teacher education programme was developed at a consultative meeting attended by senior teachers of child health, obstetrics and gynaecology, preventive and social medicine, medical educationists and maternal and chFld health planners. This programme is to be implemented during 1980. As a follow-up of the UNICEF/WHO Course for Senior Teachers of Child Health, technical support by way of educational materials was provided to strengthen teaching progranmes, especially in the social aspects of paediatrics. In Bm, the training program in maternal and child health was geared primarily to orient health personnel in basic health services in the context of primary health care and to train community-level auxiliary midwives and personnel of health-related sectors such as township education officers and headmasters of schools. In India, the demonstration and dissemination of the remodelled under- graduate paediatric curriculum continued with the provision of intra- country fellowships. At the request of the Government, this progrw was evaluated by a temporary adviser. The review found that the programme had been successful and that there was a need to accelerate its implementation by setting up a third demonstration centre. The draft of a Handbook on Child Health to be used as a teaching/training tool for this curriculum, which was completed by a panel of authors, was reviewed by the Ad hoc Cormnittee on Paediatric Education. Many useful recommendations were made for its improvement both in content and presentation. The second draft is under preparation. The implementation of the education programme in the teaching of maternal and child health including family planning to undergraduates and interns proceeded according to plan. District-level paediatricians were trained in the care of the newborn through national seminars supported by grants-in-aid. Under an inter-regional project the educational programme for senior obstetricians and senior health administrators on the medical termination of pregnancy and advanced techniques of maternal care was continued through support for one study tour and one national seminar. In Maldives, a consultant assisted in giving training in maternal and child health to community health assistants at the Allied Health Services Training Centre. Training programes in maternal and child health in Mongotia were directed towards developing health manpower at the aim& level. especially in the ten model aimaks where integrated family health services have been set up. SEA/RC33/2 Page 99 In Nepal, health manpower training in maternal and child health including family planning was supported mainly through national and regional training programs, especially for health personnel at district level. In %itand, support was given to selected personnel for advanced training outside the country to prepare them for the increased responsi- bilities inherent in the expansion of the service outlets in famfly health and improvement in the quality and comprehensiveness of the services. Technical support was also provided for training in maternal and child health, including family planning, to peripheral and primary health care workers. Continuing education in maternal and child health for all levels of health workers through national seminars and workshops was supported . 7.3 Education and Training in Sanitary Engineering An attempt has been made to orient the practical training of sanitary engineers to the objectives of the United Nations International Drinking Water Supply and Sanitation Decade. Action is being taken to recast the fellowships programme in such a way that practising engineers can study field experience in other developing countries. An example of this reorientation is the plan to study solid wastes management in Asian cities such as Bangkok, Hong Kong, Singapore and Kuala Lumpur. A study programme of piped water supply to small communities with appropriate technology and involving the communities themselves is being organized. Courses in practical management concepts and principles for senior engineers are planned at regional level. With the collaboration of the World Bank, proposals are being developed for giving practical in-service training to senior engineering staff in project formulation, feasibility reports, project appraisal and evaluation. In the field of environmental pollution, the Regional Office is studying the development of special courses for groups of trainees on specific environmental pollution problems prevalent in the Region. Simultaneouely, there will be less emphasis on fellowships for fulltime post-graduate studies in sanitary engineering in the industrialized countries. Assistance is also being offered to universities in the Region to attune their sanitary engineering courses to the needs of the countries. With support from GTZ (Federal Republic of Germany) and UNICEF, workshops are also being arranged for orienting both key national staff as well as staff from the multilateral agencies working with them, in the concepts and strategies to be adopted for attaining the goal of the Decade. SEAlRC3312 Page 100 7.4 Training in Epidemiology Further efforts have been made to strengthen facilities for the training of epidemiologists in the countries of the Region. A regional training programme in epidemiology has been formulated to strengthen the existing national training institutions and improve training strategy and methods. Following discussions that the Regional Director and the Director of the Division of Communicable Diseases from WHO Headquarters had with the national health authorities in Thailand regarding the establishment of a training programme in epidemiology with the assistance of WHO and CDC, Atlanta, such a programme has been launched in that country, and a WHO epidemiologist has been in position since April/May 1980. 7.5 Training of Auxiliaries and Community Health Workers To overcome the shortage of health manpower, especially in the rural areas, the recruitment of community health workers who have undergone a brief period of training to work for their own comunity voluntarily or with minimum incentives, is being ancouraged in most countries of the Region. Such a programme is gaining momentum and the activities which have been undertaken include the training of trainers, the preparation of learning materials relevant to the needs and priorities of the workers, the developwant and use of audio-visual aids in training, the organization of in-service training programmes for supervisors and the conduct of research to support development at the peripheral level. In Bangladesh, domiciliary visiting services at the village level are undertaken by the multi-purpose family welfare worker (FWW) and the family welfare assistant (FWA), whose activities are mainly in the field of family planning and maternal and child health. The village health workers, who will be community-based, will be guided and supervised by the FWWs and the FWAs. The village health workers are being trained in the six thanas in the pilot project areas for primary health care. Under the patti ohikitshak scheme, which was launched in September 1978, one p~lli chikitehak, or village healer, will be made available in each of the 65 000 villages in the country; 2 400 such workers have already been trained. The village health worker and the palti ohikitshak will be the grass-roots workers 'located in the village. The medical assistant training programme, which was started more than two years ago, is now firmly established and so far 478 medical assistants have completed their training from the four schools. The Government plans to open four additional schools, and the course for medical assistants has been lengthened from 2-112 years to 3 years. Primary health care was initiated in Burvia in 17 townships and has gradually expanded to 75 townships; the aim is to cover 50% of the total of 65 320 villages by 1982. Community health workers are being trained for both rural and urban areas, the aim being to have 26 000 such workers for the rural and 6 600 for the urban areas. So far, more than SEA/RC33/2 Page 101 10 000 of them have been trained and posted. A national workshop in educational sciences was held in 1978 for the trainers of connnunity health workers and in 1979 a follow-up evaluation workshop was organized in addition to a second national worbhop on educational sciences for the trainers. A WHO consultant assisted the national personnel in conducting tests and assessing the readability, comprehensibility and relevance of the community health workers' manual. In Indk, the community health workers scheme continued to train more such workers. The Government has changed the name of the scheme to "community health volunteers' scheme". WHO provides assistance in the educational aspects and in the production of manuals. Already 130 000 volunteers have been trained and are in position. Apart from this category of community health volunteers, 250 000 dais (traditional u birth attendants) have been trained, with special orientation in family planning and maternal and child health. The Bureau of Health Planning in Indonesia is intensifying its efforts to formulate a long-term health manpower plan to support primary health care. WHO has continued to collaborate in the training of the health nurse or perawt kesehatun (the PK) nurse by assigning three long-term staff members. Revision of the curricula and the development of learning materials have been undertaken. In ~Yuldives, a long-term WHO staff member has been assigned to the Allied Health Services Training Centre in Mal6. The training of community health workers has continued and their job description has been revised. Training programmes for nurse aides, community health aides, dispensers and footwnas have been undertaken as well as programmes of continuing education for the trainers of these workers. A new category of primary health worker, known as the family health worker, is being developed in the country. In Nepal, training is given to village health workers, who are an . important link between the integrated health posts and the people in the delivery of basic health services. These village health workers are selected by and are under the direct administrative supervision of the village panchayats. A pilot scheme for the training of community leaders to develop ward health volunteers who in turn will assist and support the village health workers has been undertaken, and plans are being made for its expansion. So far 1 400 village health workers have been trained, and a mid-term review has reported that these workers have had a significant impact, especially in raising the community's awareness about family planning, oral rehydration and nutrition. In Sri Lanka, a consultant was assigned to the National Institute of Health Sciences, Kalutara, to assist in its further development. In Thailand, the training programme for nurse practitioners at the Faculty of Public Health has continued. ., SEA/RC33/2 Page 102 Two types of health volunteers at the village level have been trained: village health communicators and village health volunteers. The Government aims to have 448 000 village health communicators and 44 800 village health volunteers. So far more than 100 000 village health communicators and more than 15 000 village health volunteers have received training. 7.6 Group Educational Activities During the period under review, 128 group educational activities were organized, of which 79 were at the national level, 37 inter-country, 10 inter-regional and 2 of a general nature. Emphasis was laid on increasing the activities at the national level to cater to the needs and requirements of individual countries. The subjects covered in these meetings were primary health care, expanded programme on immunization, malaria, nursing, diarrhoea1 diseases, mental health, maternal and child health, environmental health, traditional medicine and health manpower development. There has been an increase in the nwnber of research study group meetings, in which priority areas such as malaria, diarrhoea1 diseases, chronic liver diseases, health services research, traditional medicine and health manpower development were dealt with. The first meeting on Regional Cooperation in the Implementation of the WHO Fellowships Programme was held in September 1979 in the Regional Office (see under 7.7 "Fellowships"). 7.7 Fellowships During the twelve-month period 1 May 1979 - 30 April 1980, a total of 846 fellowships was awarded using various sources of funds: 681 (80%) from the Regular Budget, 64 (8%) from UNDP, 82 (10%) from UNFPA and 19 (2%) under inter-regional and other projects funded by WHO Head- quarters. The fellowships awarded consisted of: 144 (17%) against the 1978 budget, 624 (74%) against the 1979 budget, and 78 (9%) against the 1980 budget. Under the Regular Budget for 1979, a sum of US$ 3 371 610 waa provided for fellowships, constituting 17% of the total budget and involving a total of 813 fellowships. Up to the end of 1979, 566 had been awarded (70%). Of the remaining fellowships, 117 (14%) have been awarded so far during 1980, and the balance of 130 (16%) is expected to be awarded before the end of June. UNDP provided US$ 519 994 for fellowships during 1979. Of the 190 fellowships planned during 1979, 138 (73%) have been awarded, 14 (7%) are being processed and applications are awaited in reapect of 38 (20%). SEA/RC33/2 Page 103 Under UNFPA funds, a sum of US$ 259 575 was provided for fellowships during 1979, constituting 7% of the total UNFPA budget for the Region. The number of fellowships planned during 1979 was 123, of which 92 (75%) have been awarded; applications have not yet been received in respect of 31 (25%). During 1979, fellowships awarded totalled 940, of which 222 (24%) were against the 1978 budget. The table below shows that 43% of all fellowships were awarded for study within South-East Asia; of the other Regions, the European Region took most, and 9% of fellowships involved travel to the USA. It also shows that about 50% of the fellows were professional health workers such as doctors, nurses and environmental health engineers and that 76% of the DISTRIBUTION OF FELLOWSHIPS (a) By Budget and By Region 'Three fellows visited Egypt (EMRO) as part of the Czechoslovakia/ USSR/Egypt training course in epidemiology. (b) By Type, Sex, Age and Duration HQ and others - - 13 6 19 SEAR0 PRO EURO USA TOTAL n. TYPe Professional 421 (50%) Others 425 (50%) UNDP 31 7 20 6 64 Total 367 (43%) 75 (9%) 327 (39%) 77 ( 9%) 846 . 275 68 273 6 5 681 UNFPA 61 - 21 - 82 Sex Male 644 (76%) Female 202 (24%) Age Under 25 24 ( 3%) 26-34 150 (18%) 35-44 379 (45%) 45-54 274 (32%) 55+ 19 ( 2%) Duration Under 1 month 135 (16%) Upto 3 months 297 (35%) Upto 6 months 214 (25%) Upto 12 months 162 (19%) Above 12 months 38 ( 5%) SEA/RC33/2 Page 104 awards were for males and 24% for females. The table also shows the distribution of the fellowships among age groups: 45% were awarded to candidates between the ages of 35 and 44 years. Of the fellowships awarded, 135 (16%) were for a duration of one month and less, 297 (35%) for up to 3 months, 214 (25%) for up to 6 months, 162 (19%) for up to 12 months and 38 (5%) for durations beyond 12 months; 439 (52%) of the fellows were placed for study in one country, 145 (17%) in two countries, 151 (18%) visited three countries, 75 (9%) four countries and 36 (4x1, five countries. Of the difficulties experienced in the speedy implementation of the fellowships programme, special mention should be made, with one or two exceptions, of the poor response to furnishing the terms of reference and the long delay in receiving applications. The position in respect of the 1980 programme is, out of 979 fellowships planned, terms of reference for 211 (22%) and applications for 441 (45%) are still awaited, though half of the programe year is nearly over. This gives insuffi- cient time for processing placements during the programme year itself. It is noted that utilization reports on returned fellows' employment and contribution and government evaluation are received only for a small proportion, e.g., about 20%, which makes any meaningful attempt at evaluation of the fellowships programme difficult. An analysis of 244 utilization reports received during the reporting period demonstrated that 100% were suitably employed, 82% introduced new activities and 84% imparted lcnowledge to others. A Conference on Regional Cooperation in the Implementation of the WHO Fellowships Programe was held in the Regional Office from 26 to 29 September 1979 and was attended by representatives of the countries of the Region and one representative each from EMRO, EURO, WPRO, the Department of Health and Social Security, UK, and the British Council, London. The aims and objectives of the Conference were to review the planning and administrative mechanisms to improve the implementation of the fellowships programe. The recommendations of the Conference have been brought to the notice of the governments with a view to their full implementation. There is an increasing trend towards regionalization of the fellowships programme, as seen from the table below: Numberof regional fellowshius awarded 145 (29%) 196 (34%) 299 (44%) 280 (47%) Calendar year 1976 1977 1978 1979 Number of fellowships awarded 500 578 676 591 SEA/RC33/2 Page 105 Subjects of Fellowships The following table shows distribution of the fellowships awarded, by country and by subject. Fellowships Awarded (Under all Budgets) by Subject of Study and Country of Origin of the Fellow (1 May 1979 - 30 April 1980) Fellows from other Regwns 0 Z a Y 0 h w 1. 2. 3. 4. 5. 6. 7. 8. . During the period under review, 68 fellows from the following countries and territories outside South-East Asia visited this region: Afghanistan, Benin, Canada, Egypt, Fiji, Iraq, Japan, Republic of Korea, Malaysia, Mauritius, Philippines, Somalia, Sudan, Syria, USA, Western Samoa and Yemen. + 5 0) 1 m 3 a a0 m dm* m a muJ-4 g $ U Subject a2-1 C m U u !4 0) Public Health 14 9 3 8 23 6 7 13 5 18 106 13 Environmental Health Nursing Maternal and Child Health Communicable Diseases Clinical Basic Medical Sciences Others Total I 1 7.8 Regional Office Library During the period 1 July 1979 - 31 May 1980, the Regional Office Library received 8023 books, pamphlets, WHO publications, current periodicals and reports; 2798 persons (2327 WHO staff and 471 others) visited the Library and 1354 books and periodicals were issued on loan to Regional Office and field staff as well as on inter-library loans. Photocopies of 9420 pages were supplied. For references needed by the Regional Office, field staff and Headquarters, 82 loan requests were sent to local libraries. The SEAlRC3312 Page 106 Library continued to supply reference material in connexion with various seminars and meetings held in the Regional Office and outside. Twenty-four student loan libraries were established in 1979 and 1980 in Bangladesh, Burma, India, Indonesia, Mongolia, Nepal, Sri Lanlca and Thailand. The Library actively participated in the planning and organization of an "Inter-country Consultative Meeting on Network of Health Literature, Library and Information Services", held in New Delhi in August 1979, and presented several papers. The Library, which is the MEDLINE Coordinating Station for South-East Asia, continued to provide, free of cost, MEDLINE searches requested by Member countries. It scrutinized the requests and obtained print-outs. for searchable requests from the National Library of Medicine, Betheeda, Md., USA, under a special agreement. A proposal to bring out an "Index to South-East Asia Health Literature" was submitted to Headquarters and is under consideration. The Regional Office Library took part in (1) an ESCAP Expert Group Meeting to Develop a Guide for Establishing a National Population Information Clearing House and Network System, held in Bangkok in September 1979, (2) a National Seminar on Health Science Librarier in India (Bangalore, February 1980) and (3) an ISIS User Seminar (Delhi, February 1980) organized by the Centre for Development of Instructional Technology (CENDIT) . The Regional Office Librarian visited Burma and Nepal in March 1980 in connexion with the organization of the libraries of the WHO Programme Coordinators' Offices. 8. RESEARCH PROMOTION AND DEVELOPMENT Under the regional research programme, which has entered its fifth year, action was taken to cover most of the priority research fields identified by the Regional Advisory Committee on Medical Research (SEA Am). In keeping with WHO'S efforts towards attaining the goal of health for all, steps have been taken to orient the research programme accordingly, with consideration being given not only to disease-related research but also to research on health services and health promotion. In addition, the programme is promoting technical cooperation among developing countries, including the transfer of technology not only among themselves but also from the developed nations. The activities to promote research have been aimed at collaboration in those critical areas which could stimulate national and bilateral action. In addition, the programme is now structured to facilitate closer SEA/RC33/2 Page 107 involvement of administrators and policy-makers together with research scientists to secure greater national codtment and also increase the utilization of the results of research. Recognizing the dearth of manpower and the need for better coordination of research among Member countries, the Regional Office has concentrated its efforts on strengthening research capabilities through the organi- zation of courses in research methods. Through such initiatives greater commitment has been generated at the national level. A limited number of research training and visiting scientist grants have also been provided for specific training. In view of the fact that medical research councils or similar bodies could play a vital role in promting research at the national level with WHO playing a promotive and coordinating role, a Meeting of Directors of Medical Research Councils or Analogous Bodies and Concerned Research Foci in the Relevant Ministries was held in December 1979 in Sri Lanka. This meeting drew up guidelines for overall research promotion and develop- ment at the country level on those vital issues which need further strengthening, such as ethical review mechanisms, a career structure for research scientists, organization of mission-oriented research on national priority problems, coordination, and utilization of the available manpower and institutional potential existing within the countries. Through national follow-up meetings the recommendations will be implemented which would, in addition to strengthening the national organizations, give WHO an opportunity to identify clearly its own actions pertaining to its catalytic and coordinating role for the development of the Organization's medium-term programme in research. In addition, through this mechanism of bringing together heads of research councils and other concerned national bodies further collaboration in the spirit of TCDC has been generated and will be pursued. The members of the SEA ACMR have willingly assisted the Regional Office in strengthening its role in the development, implementation and monitor- ing of the regional research programme. It is proposed to set up three ad hoc sub-committees, concerned, respectively, with research needs for health for all, diarrhoea1 diseases and nutrition. The sub-committee on research for health for all will review the research needs as per national strategies at its first meeting in July. It will suggest priorities for research for consideration at the seventh session of the SEA ACMR to be held in April 1981. Within the Regional Office the management mechanisms for implementing the inter-country research programme have been completed. The procedure of peer review of research proposals has been introduced and an "in-house" ethical review mechanism set up to complement the institutional and national review bodies as and when they are set up. Specific criteria for the award of research training and visiting scientist grants have also been laid down. Aa regards specific subjects, a compreheneive regional research progrme in dengue haemorrhagic fever is in operation which includes clinical, epidemiological, immunopathological and vector studies. A research programme for the development of a dengue vaccine has been initiated at the WHO Collaborating Centre on the Inrmunopathology of Dengue Haemor- rhagic Fever in Bangkok. It is proposed to strengthen further research activities in the field of epidemiology and vector biology. In regard to diarrhoea1 diseases, the research-cum-action progrm developed on the basis of national requirements through a series of meetings is progressing satisfactorily and several operational research activities are currently in progress. Further studies will be promoted. In nutrition, the research-cum-action programme developed in 1979 at two consultative meetings involving scientists and policy-makers has resulted in the development of 19 projects of importance to the Region. As an initial step, the Organization has actively promoted those projects falling within the field of nutrition and primary health care. Most of the countries are actively participating in these studies, which are currently in their initial phase. In order to generate further studies in health services research and recognizing that the approach to such research has to be country and culture specific and multidisciplinary in nature, the Regional Office organized a meeting of policy makers and research scientists to seek their guidance on the development of inter-country and national training courses. The aim is to help develop a multidisciplinary core group of scientists who could undertake research into problems at the country level and provide timely answers to policy makers and' administrators. Research study group meetings on leprosy and traditional medicine are scheduled to be held later in 1980 to develop research protocols on the specific priority topics identified. Research in these fields will be promoted in due course with the active collaboration and concurrence of governments. The studies on P. fa~c6pw.m. resistant to 4-aminoqufnolines are progres- sing satisfactorily and a meeting of the principal investigators was held to reviewthestatus of the studies and plan future work. me retrospective studies on liver diseases have been completed and a report is awaited. In the meantime, prospective studies proposed as per the medium-term research program on this subject are being actively pursued and the Regional Office is taking steps to identify centres of excellence in the Region which could be designated as collaborating centres to undertake the specific tasks spelt out in this WHO medium- term programme. Regarding research on the development of appropriate technology for improving environmental hulth at the village level, tw major studies are progressing in India. These concern the health benefits of water supply in rural areas and the field testing of integrated water supply and waste-water utilization systems for villages. SEA/RC33/2 Page 109 Following the meeting of the research study group on filariasis held in 1979, specific research areas have been identified and protocols on these topics have been invited. The two WHO Special Programmes - Research, Development and Research Training in Human Reproduction and the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases - have continued to provide a major source of encouragement to research in this region. The Regional Office is actively collaborating with WHO Headquarters in promoting these, and two full-time staff members are engaged in the activities. Several centres of excellence in the Region are in the process of being designated as WHO collaborating centres for undertaking specific activi- ties of the regional research programe. It is envisaged that a network of institutions in each programme area would be set up which could function as a source of technical expertise to the Regional Office as well as collaborate among themselves in the spirit of technical coopera- tion among developing countries. In 1979 seven countries in the Region developed projects on research promotion and development utilizing WHO'S Regular Budget. The Regional allocation, together with these country allocations, forms nearly 10X of the overall Regular Budget of the Regional Office. WHO has been able to attract modest extrabudgetary funds so far, but considerable national and bilateral support has been generated in the Member countries through the limited catalytic resources provided by the Regional Office. Mobilization of further extrabudgetary resources will be pursued in collaboration with WHO Headquarters. The sixth session of the South-East Asia Regional Advisory Committee on Medical Research was held in the Regional Office in April 1980 to review .. the progress of research projects in the Region. The total number of research projects supported in the countries rose to 85 in 1979, includ- ing 45 projects financed during that year. Taking into consideration the inter-country and country allocations, the total amount available for research activities in the 1980-1981 biennium is $3 979 600 as against $2 357 100 in 1978-1979. 9. TECHNICAL INFORMATION AND REFERENCE SERVICES Two titles in the WHO Regional Publications, South-East Asia Series, were brought out during the year under review. These were: (1) The Eradica- tion of Smallpox from Bangladesh, and (2) A Manual on t!le Clinical Management of Acute Malaria. Two other publications, "A Guide to the Care of the Low Birth-Weight Infant" and "Appropriate Technology for Environmental Health in Villages" are under print. A total of 160 assignment reports of short-term consultants and long-term staff, final SEA/RC33/2 Page 110 reports on projects and those on meetings and seminars was edited, pro- cessed and issued. Reports brought out under special printed cover for wider distribution included those on (a) Establishment of a Regional Network of Health Literature,Library and Information Services; (b) Research-cum-action programme in nutrition for developing countries; (c) Technical information on Japanese encephalitis and guidelines for treatment; (d) Financing and management of water supply and sewerage; (e) Formulating strategies for health for all by the year 2000; (f) PZasmodiwn FaZcipanrm resistance to 4-aminoquinolines, and (g) the Eighth WHO Meeting of Directors or Representatives of Schools of Public Health. 4 publication entitled "Health Law of the Mongolian People's Republic" and a "Directory of Health Science Libraries in South-East Asia" were also brought out under special printed cover. In addition to the above, wide distribution was given to a large number of other documents. The report and minutes of the thirty-second session of the Regional Committee and the report of the technical discussions held during the session on "Drug policies, including traditional medicine, in the context of primary health care", were, as usual, edited and issued with a printed cover. A "Supplement to the Handbook of Resolutions and Decisions of the WHO Regional Committee for South-East Asia" was brought out, incorporating the resolutions adopted at the thirty-second session. Documentation and reference services were provided during meetings organized by WHO, including the Regional Cornittee, and requests for documents were complied with. Sa Zes The total sales during 1979 amounted to US$ 78 772, of which subscriptions accounted for US$ 42 572 and other sales US$ 36 200 (as compared with US$ 57 389 In 1978). The sales for the first five months of 1980 amounted to US$ 45 239. The Regional Office took part in the Fourth World Book Fair, held in New Delhi from 29 February to 11 March. In addition, regional publications were displayed at a number of national, international and WHO-sponsored meetings held in the Region. Also, groups visiting World Health House were briefed on WHO publications and their availability at concessional rates. PART $1 ORGANI ZATI ONAL AND ADMINISTRATIVE HATTERS SEA/RC33/2 Page 111 1. REGIONAL COMMITTEE The thirty-second session of the Regional Committee for South-East Asia was held in the Regional Office in New Delhi from 18to 24September1979. The session was attended by delegates from Member States in the Region. Representa~ives of the United Nations and other agencies as well as from thirty-two non-governmental organizations in official relations with WHO and eight observers were also present. The session was opened by the outgoing Chairman, Professor Jambaa (Mongolia). Conveying the good wishes of his government for a success- ful session, he said that the Regional Committee session every.year provided an excellent forum at which to review the regional programme of work and to exchange views on common problems. In his inaugural address, Mr Charan Singh, Prime Minister of India, paid tribute to WHO for the "magnificent work it has been doing to promote health as a vital investment in man's development". He expressed concern for the uplift of those living in poverty, hunger and ill-health and said that more funds were being spent on technological advances than on the provision of basic needs to the rural areas. He added that those responsible for administering nations had to give greater and urgent recognition to the fact that economic development without simultaneous health development was an infructuous activity. Referring to the Alma Ata Declaration, he said that it would be hailed as the "Health Magna Carta" if the goal of "Health for All by the Year 2000" were implemented with sincerity by the countries of the world. Addressing the meeting, Mr Rabi Ray, India's Minister for Health and Family Welfare, praised WHO for the role it had been playing in "build- ing bridges, in healing wounds and in ameliorating the health of man". He called for collaboration at regional and international levels to tackle newly emerging problems through the sharing of experience, expertise and resources. Dr Prakorb Tuchinda, President of the Thirty-second World Health Assembly and leader of the delegation from Thailand, who also addressed the meet- ing, observed that while WHO stood for the promotion of collaborative efforts and acted as a catalyst in many areas, it was for the countries themselves to carry out appraisals of their policies and programmes and to reorient them to the changing situations and challenges. In his address, the Regional Director said that a survey of the health scene in many countries showed many encouraging trends and augured well for the launching of a major health offensive in the coming years. With the emergence of primary health care as a great conceptual advance and a key approach to better health, the universal social goal of "Health For All by the Year 2000" had become a feasible and logical objective. SEAIRC33/2 Page 112 To achieve this objective, political commitment at the highest level was necessary and considerable hard work was required to mobilize such political support and ensure adequate resources for health development. In his message, presented by the Regional Director, the Director-General of WHO emphasized that the struggle t:o attain an acceptable level of health for all by the year 2000 had become a political reality. He pointed out that only combined multi-sectoral national and international action could yield results. The Regional Committee elected Mr Rabi Ray (India) as Chairman and Mr M.K. Anwar (Bangladesh) as Vice-Chairman. In presenting his Annual Report, the Regional Director recalled that the most important development during the year had been the International Conference on Primary Health Care and the adoption of "Health for all by the year 2000" with primary health care as the key to its attainment as a universal social goal. The Committee was informed of the meeting which had been held to discuss the financing of primary health care programmes. This had provided an opportunity for the development of a closer understanding between the countries and the financing agencies. Countries were vigorously working towards strengthening their maternal and child health services, which were a vital component of the primary health care programme. Family planning programmes were also being implemented, mostly as part of comprehensive health Services, with the support of WHO and UNFPA. Among the communicable diseases, the Regional Director made special mention of malaria, particularly the programme to contain P. fakipanon resistance by strengthening the infrastructure of control programmes, training technical and managerial manpower, and through laboratory and field research. These measures had already produced encouraging results. The other priority areas mentioned included the provision of drinking water supply and basic sanitation, health manpower development and the regional research programe. WHO'S effort had mainly been to facilitate the transfer of technical information and the training of manpower in collaboration with the World Bank and UNDP. Research activities in all the priority areas identified by the South- East Asia ACMR had been promoted and supported. In addition to support- ing actual research programmes in the Region, efforts had been made to strengthen the research capabilities of the countries. Two comprehensive programmes of research - nutrition,and diarrhoea1 diseases of children - had been developed during the year. SEA/RC33/2 Page 113 The Regional Commirtee took up the discussion of the Annual Report of the Regional Director section by section. On the subject of strengthening of health services, attention was focused on the importance of health educa- tion as an integral part of health programmes. It was recognized that for primary health care the training of paramedical workers was at least as important as the training of health professionals, and the traditional practitioners of medicine should also be oriented in the principles of primary health care. Efforts were being made in many countries of the Region to increase the coverage of health services, especially in rural areas, through primary health care programes. It was accepted that for this, community participation was crucial and effective intrasectoral and intersectoral collaboration essential. One of the constraints in health care delivery to underserved populations was the paucity of doctors in rural areas. In regard to the prevention and control of communicable diseases, the Regional Committee concentrated its discussion on malaria, the expanded programme on immunization and leprosy. It was noted that, although malaria had shown a declining trend in the countries of the Region as a result of the strengthening of national anti-malaria activities, the problem of resistance of parasites to anti- malaria drugs, vector resistance to insecticides and the shortage of insecticides and anti-malaria drugs continued to pose difficulties. The establishment of multisectoral coordinating committees formalaria control was reported by some countries. Support to the national malaria programmes of some countries by bilateral agencies, principally CIDA, SIDA, US AID, and the governments of the Netherlands and the UK, was appreciated. While discussing the problem of leprosy, the Committee made a reference to resolution WHA32.39 and expressed concern that this region accounted for about 40% of the total number of leprosy cases in the world. The importance of early diagnosis and prompt and adequate treatment, especially of children, in order to achieve rapid cure and the prevention of deformities, was emphasized. The support to national leprosy control programmes by UNICEF and non-governmental and voluntary agencies such as the Sasakawa Foundation, the Danish Scouts Organization and the Order of Malta was recognized. While noting the progress made in establishing the expanded programme on immunization with WHO collaboration in most countries of the Region, the Committee expressed concern about the difficulties being experienced with regard to the cold chain facilities for the storage and transport of vaccines, and the monitoring and assessment of immunization activities, especially in remote rural areas. The Regional Committee emphasized the importance of stimulating and encouraging community involvement. It expressed the hope that adequate SEA/RC33/2 Page 114 priority would be given and resources at national and international level made available for the planning and implementation of community water supply and sanitation programmes in order to achieve national goals within the framework of the International Drinking Water Supply and Sanitation Decade. There was considerable discussion on health manpower development. The need to synchronize the development of both training and services so as to ensure proper health care delivery was emphasized. The Codttee also discussed the desirability of introducing degree qualifications and reducing diploma courses. WHO was requested to assist the countries in reviewing and revising existing curricula of various categories of health personnel to make these more need-based. With regard to research, the activities of the South-East Asia ACMR so far had been what could be considered as promotive or developmental in nature. Priority areas had been identified and links established between global, regional and national research activities, which had been progressively expanding. Two major efforts of the RACMR during the year had been the development of a diarrhoea1 diseases research programme and a comprehensive research-cum-action programme in nutrition. While appreciating the efforts in the field of research, the Regional Committee stressed the importance of making quicker progress towards enhancing national research capabilities and maximizing the utilization of national research centres in developing countries. Noting that 75% of the WHO collaborating centres were located in Europe and North America, while the South-East Asia Region had a mere 6%, the Committee requested that steps be taken to correct this serious imbalance. In considering organizational and administrative matters, the Committee raised the subject of the implementation of resolution WHA32.37 Rev.1 on the recruitment of international staff in WHO. It was pointed out that the new system of distribution of posts still reserved a high percentage of the posts to be allocated in relation to assessed contributions and did not sufficiently take into account the population and the capabili- ties of the Member States in this region to provide the Organization with skilled staff. In accordance with the usual practice, a Sub-committee on Programme Budget was established. The Sub-Committee reviewed the detailed elabora- tion of the 1980-1981 programme and noted the detailed project activities and agreed that the programme was in accordance with the General Programme of Work and policies of the Organization. The Regional Committee approved the Report of the Sub-committee. Technical discussions were held on "Drug policy, including traditional medicine, in the context of primary health care". "Health manpower plan- ning and community participation for primary health care" was selected SEA/RC33/2 Page 115 as the topic for the technical discussions to be held during the thirty- third session in 1980. Among other items included in the agenda of the session and discussed by the Regional Committee were: (i) technical cooperation among developing countries (TCDC); (ii) strategies for achieving health for all by the year 2000; (iii) the contribution of health to the New International Economic Order; (iv) the Seventh General Programme of Work of WHO, and (v) study of WHO'S structures in the light of its functions. The Regional Committee, which adopted a total of 14 resolutions, decided to hold its thirty-third session in the Regional Office if no formal invitation was received." 2. REGIONAL PROGlWIME PLANNING AND DIRECTION The planning, direction and coordination of the regional programme have been under constant scrutiny with continued efforts to improve the development and delivery of programes in response to the dynamics of national health development efforts and the directives of the World Health Assembly, the Executive Board and the Regional Committee. Consultations with countries have continued on the nature and method of preparation of the Seventh General Programme of Work, which is poised to become an intermediate programme towards the long-term goal of HFA. Close consultation with the Regional Committee and Member countries will be maintained in further developing the regional contributions to the global programme. Medium-term programmes have been completed for all programme areas in consultation with the countries. The implementation of these programmes has been under continuous review to enable a flexible response to the changing national priorities and programmes thus lending strength and usefulness to the collaborative programme as a whole. The regional medium-term programme for health planning and management (country health programming) was evaluated and brought up to date at a consultative meeting held in January 1980. A guideline for action in TCDC in health planning and management in the Region was also developed. A Regional Office working group developed a strategy paper on support to the managerial process of national health development for the Global Prograpme Development Working Group. A detailed plan of action to implement the strategy is under preparation. The Regional Programme Committee supports and advises the Regional Director on programme matters, promotes policy and programme development, *At the invitation of the Government of Maldives, the thirty-third session is to be held in Male in September 1980. SEA/RC33/2 Page 116 monitors the delivery of programmes periodically, and carries out technical and budgetary reviews in coordination with and guidance from the Headquarters Programme Committee (HPC) and the Global Programme Commit tee (GPC) . The programme budgeting procedure, as a flexible instrument to formulate country-based collaborative programmes, is now better established, having been used in the formulation of preliminary proposals for the 1982-1983 biennium. The Regional Office focal group for information systems development was reorganized. Earlier, the programme management information system was replaced by a simpler programme delivery status report, which has been kept under review in consultation with WPCs and necessary additional information was included to enable periodic monitoring of programme deli- very by Member States. The project milestone reporting system has been further reviewed and a simplified procedure introduced to enable techni- cal monitoring of programme implementation. A regional "guideline for programe evaluation" is being developed to enable a more effective evaluation of both inter-country and country programes. 3. ADMINISTRATION 3.1 General The Director-General visited the Regional Office in October 1979 for discussions with the Regional Director. In February 1980 he, along with the Regional Director, visited Bangladesh, India, Sri Lanka and Thailand to sign the Charter for Health Development. During the period under review, a number of important persons, including the Ministers of Health of the Republic of Maldives and of the Democratic Socialist Republic of Sri Lanka, the Ministers of Health of Gujarat and of Tamil Nadu States in India, as well as senior officials of health ministries of Member States and senior staff from United Nations agencies visited the Regional Officeandheld discussions withtheRegiona1 Director and other staff. In November 1979, Dr I.D. Ladnyi, Assistant Director-General, visited the Regional Office to attend the EPI Global Advisory Group meeting and in February and March 1980 he travelled to Indonesia, Thailand and India to observe EPI activities in the field. He again visited the Regional Office in April-May for a meeting of the Scientific Group on Vaccination against Tuberculosis. Mr W.W. Furth, Assistant Director-General, visited Bangladesh, Sri Lanka, Thailand and the Regional Office in March 1980 to study programme budget- ing at country level and discuss the aubject with the Regional Director and the Regional Programme Comittee. SEA/RC33/2 Page 117 Dr H. Nakajima, WHO Regional Director for the Western Pacific, visited the Regional Office in March 1980 and inaugurated an inter-regional meet- ing on Research in Viral Haemorrhagic Fevers. During the year, the Regional Director visited Indonesia to sign the Charter for Health Development and hold discussions with the national health authorities. He also went to Burma, Thailand and Sri Lanka and various parts of India where, in addition to conferring with government authorities, he inaugurated and attended a number of meetings. In March 1980, Banaras Hindu University, India, conferred upon the Regional Director the honorary Degree of Doctor of Science. Administrative arrangements were made for a large number of WHO-sponsored meetings, seminars, etc.,held in the Regional Office and in the countries of the Region (see Annex 4). Among the important activities heldinthe Regional Office werethemeeting on Financing of PHC Programmes in Asia (July 19791, the Joint UNICEF/WHO Regional Meetings on Strategies for Health for All by the Year 2000 (December 1979 and June 1980) and the sixth session of the Regional Advisory Committee on Medical Research (April 1980). In pursuance of the discussions at the thirty-second session of the Regional Committee and resolution SEA/RC32/R10, the Regional Director established a sub-committee to develop effective mechanisms for the formulation, monitoring and evaluation of inter-country projects and to review the criteria for the establishment of inter-regional programmes. The Committee, consisting of representatives from Bangladesh, India and Indonesia, met in February 1980 in the Regional Office. The report of the Sub-committee is being submitted to the thirty-third session of the Regional Committee. 3.2 Organizational Structure The organizational structure of the Regional Office as on 31 May 1980 is shown in Annex 1. Subsequent to the establishment of a discrete Environmental Health Unit in 1979, the post of Director, Planning and Coordination, whose functions had previously included the supervision of activities pertaining to environmental health, was replaced by that of Chief, Planning and Coordination. 3.3 Personnel 3.3.1 Staffing The distribution of professional staff in the Region by nationality as on 31 May 1980 is shown in Annex 2. A column giving the worldwide distribution of WHO staff by nationality has also been included. SEA/RC33/2 Page 118 The following table shows the number of posts in the professional category in the Region and the number actually filled as on 31 May 1980. Ten posts were inactivated because (i) 3 were to be filled by short-term consultants, (ii) 1 post was not to be filled and (iii) recruitment for 6 posts was held in abeyance. Organizational Location Regional Office Field Programmes Total Fourteen of the posts were actually filled by short-term consultants. During 1979,208 consultants were employedin field programmes for periods ranging from 2 weeks to 11 months. From 1 January to 31 May 1980, 70 consultants were employed. In accordance with resolution SEA/RC32/R14, the distribution of consultants recruited during the period 1 June1979 - 31 May 1980 by nationality is shown in Annex 3. 0 m m r1 r 0 w m o u 60 m m o rl a 71 m al z 54 dm 4 D w m 0 U m w wm 16 174 190 During the period 1 June 1979 - 31 May 1980, 36 professional and ten general service staff members left WHO service. Ten general service staff completed 30 years of service with WHO, one general service staff 25 years, and 12 general service staff 20 years. al 2 1 al u D PI m u m c $ 4 -4 uu 0 0 8 z rl u .r( m s u r m u 0 01 & r - 10 10 3.3.2 Staff Training A Management Workshop was held in New Delhi from 16 to 25 January 1980, attended by 18 participants. This workshop was designed specifically for a cross-section of WHO staff - from the Regional Office and the field and from both the technical and support services. The objectives of this m 4 c .r( a PI rl r1 d w QJ n 0 u m U m 0 & 16 164 180 u PI rl rl d w r1 rl 2 u U a m u m 0 & 15 136 151 m al u m m 3 h: -3- r m a o OOM u r a a .c PI 5 d al 3 rmal " $2 O mmg ualu muu Or1 01 &mr 1 24 25 . c 0 .d u u al PI rl m .. 2 r do 3 PI U PI ru m r1 ual m m au 0 PI - 4 4 Figure 2. OBLIGATIONS INCURRED ON FIELD ACTIVITIES IN THE SOUTH-EAST ASIA REGION (1975-1 979) US$ (Millions) Source: Off. Rec. 230, 237, doownents A31/29, A32/14 and A33/17 60.92 Regular Budget UNDP 0 other Sources Obligations US$ (millions) 22.0 SEA/RC33/2 Page 119 workshop were to help the participants develop and improve their own personal effectiveness in office management and in implementing collaborative programmes, the overall objective being to strengthen the regional capacity for programme delivery. The Director-General granted study leave for short periods to four staff members to receive training in their respective fields of work. 3.3.3 EmpZoyment Conditions The salary scales of the general service staff in Burma, India, Indonesia, Maldives, Nepal and Sri Lanka were revised. A consultant reviewed the General Service Post Classification Plan of the Regional Office. The representatives of the various agencies of the United Nations system in New Delhi held meetings from time to time to discuss matters of common concern. A regular dialogue also continued with staff representatives on matters of mutual interest. 3.4 Budget and Finance The total obligations incurred on field activities during 1979 were $28 650 522, an increase of 25.4 per cent as compared to 1978. The regular budget allocation for the South-East Asia Region in 1979 was increased during the year by $380 000 from funds originally budgeted under the Director-General's Development Programme. The obligations incurred on field activities in the last five financial years under different sources of funds are shown in Figure 2. Details of the financial implementation of the 1979 programmes under the regular budget are given in Annex 7. 3.5 Regional Office Building The purchase and installation of the new telephone exchange, as agreed to by the sixty-third session of the Executive Board, have been completed and the new system is functioning satisfactorily. Since the construction of the Regional Office building in 1962 and of an extension in 1972, there has been a considerable increase in programme activities, but the needs for additional space have been met through internal re-arrangements and by reducing the office space allotted to staff members. However, owing to the fact that a number of new posts have been established under programmes financed from voluntary contribu- tions, new programmes implemented at the regional level such as medical research, and a general extension of country activities for which support is provided from the Regional Office, the occupancy of the space avail- able has reached the ultimate limit. It has, therefore, become necessary SEA/RC33/2 Page 120 to provide additional accommodation, and a separate document giving detailed space requirements and a preliminary costing is under prepara- tion and will be presented for discussionat the thirty-third session of the Regional Committee, prior to being submitted to the Executive Board and the World Health Assembly for funding from the Organization's Real Estate Fund. 4. PROCUREMENT OF SUPPLIES AND EQUIPMENT During the period 1 July 1979 - 31 May 1980, procurement action was taken for supplies and equipment and medical literature amounting to $10 094 689. (a) Supplies and Equipment . . These consisted of laboratory items, hospital supplies, X-ray equipment, supplies for environ- mental programmes, material for teaching programmes, drugs, vaccines, biologicals, pesticides and spraying equipment, vehicles and administrative supplies. (b) Medical Literature . . $ 247 039 Where possible, having regard to prices and quality, purchases were made within the Region in accordance with the principle of technical coopera- tion among developing countries. The total amount spent on such purchases was $ 825 780 for supplies and equipment and $ 54 585 for literature. Plrchases on a Reimbursable Basis Purchases amounting to $26 961 were made as follows: For Bangladesh .. Yellow fever vaccine and anti-venom snake serum. For Nepal . . Anti-rabies vaccine and bleaching powder. Revolving Fund During the period under review purchase authorizations in respect of requests amounting to $ 133 786 were raised. Thirteen requests are being processed. 5. COLLABORATION WITH OTHER AGENCIES With the increasing demand for funds for activities in health and allied fields, and in view of the limited resources available to WHO under its SEA/RC33/2 Page 121 Regular Budget, it has become essential to explore extra-budgetary resources and reformulate proposals so as to attract potential donors. With this objective in view, a meeting on the Financing of Primary Health Care Programmes in Asia was convened in the Regional Office in July 1979 at which eight countries from this region and two countries from the Eastern Mediterranean Region were present. In addition, there were representatives from 15 countries and development agencies, UNICEF, UNDP, UNFPA, WFP, the Asian Development Bank, the Islamic Development Bank and three non-governmental organizations. The purpose of the meet- ing was to bring together the potential donors and the countries so that discussions between donor and recipient could result in the funding of projects. It is hoped that the countries will follow up the discussions with the agencies concerned and the efforts will bear fruit. 5.1 United Nations The United Nations High Commissioner for Refugees is seized of the refugee problem in Thailand and Indonesia. WHO has collaborated closely with the United Nations and the Government in the work of a relief medical officer to look after the health aspects of the relief opera- tions in Thailand. The United Nations Office of Technical Cooperation has provided two consultants to the UNDP-funded project "Tamil Nadu Water Supply and Sewerage Pre-investment Studies: Madras Metropolitan Area" in India. 5.1.1 United Nations Development Progrme (UNDP) UNDP, which continued to be the largest source of extra-budgetary resources, provided funds amounting to US $3.9 million during 1979. With increased inputs and greater absorbability on the part of the countries and with better implementation and management, it is expected that the programme delivery will increase further by the end of 1980. UNDP inputs to projects in the Region covered a variety of areas: water supply, drug production, health education, nutrition, epidemiology - almost the entire spectrum of WHO'S activities. A UNDP Mission on Least Developed Countries visited the Regional Office in May 1979 after visiting Bangladesh, Bhutan and Nepal. UNDP has agreed to fund two inter-country projects involving Bangladesh, Maldives and Nepal from this region and Afghanistan from the Eastern Mediterranean Region. The continuing interest of UNDP in the activities of WHO in this region was evidenced by the presence of its representatives not only at the Regional Committee session, but also at the Meeting on the Finanang of Primary Health Care Programmes in Asia and at the Regional Director's Meeting with the WHO Programme Coordinators. Steps were taken to fomu- late proposals for the third UNDP programme cycle (1982-1986) with regard to inter-country projects. SEA/RC33/2 Page 122 The Regional Office was represented in the joint UNDPIagency missions for the examination of country programming experiences. The missions visited Bangladesh, India and Nepal in this region during October 1979. The major purpose of these visits was to engage in a direct dialogue with the respective governments on the United Nations approach to the programming of UNDP resources and the effects of that approach on UNDP-funded development activities in the countries, aiming at the identification of specific, viable measures for improving the country programming process and the participation and contribution of the United Nations system. 5.1.2 United Nations ChiZdrenls Fund (UNICEF) The traditional close, cordial and fruitful relations between WHO and. UNICEF continued during the year. Contacts between the staff of the two organizations at different levels - regional, country and the field - have not only been maintained but further strengthened. The UNICEF Regional Director for South Central Asia in New Delhi and his staff took an active part in a number of meetings called by WHO, includ- ing the Regional Director's twenty-eighth meeting with the WHO Programme Coordinators. The presence of UNICEF country representatives at the Joint UNICEF/WHO Regional Meeting on the Formulation of Strategies for Health for all by the year 2000, held in the Regional Office in December 1979, enabled WHO and UNICEF representatives to exchange information on programme development, implementation and evaluation of their country programmes and ways and means to achieve more effective coordination and collaboration. 5.1.3 United Nations Fund for Population Activities (UNFPA) Consultations between the UNFPA coordinators in the countries concerned and the WHO Programme Coordinators and Regional Office staff have been frequent and fruitful. The UNFPA Coordinator in Sri Lanka visited the Regional Office to discuss projects relating to that country. The opportunity of a visit to New Delhi by the Assistant Executive Director and Chief of the Programme Division of UNFPA was utilized to discuss UNFPA-funded inter-country projects; she also addressed the WHO Programme Coordinators during their meeting with the Regional Director. Based on a visit by a Regional Office team to Bhutan, a project for assistance was formulated and submitted to UNFPA. Funds were approved for the implementation of an immediate programme and it is expected that the UNDP Governing Council will approve funds also for the remaining activities. At the end of June 1980, four UNFPA-funded projects were handed over to the Government of Bangladesh for execution. WHO will, however, continue to provide technical advice needed by the Government for the implementa- tion of these programmes. SEA/RC33/2 Page 123 WHO project staff participated in the Basic Needs Assessment Mission that visited India in 1979. The WHO Programme Coordinators in Nepal and Sri Lanka provided assistance to the Needs Assessment Missions that visited these countries in 1979 and 1980 respectively. A number of proposals for UNFPA assistance were reviewed in the Regional Office and sent to UNFPA for possible assistance. 5.1.4 Economic and SociaZ Conmission for Asia and the Pacific (ESCAPI The WHO Programme Coordinator in Thailand, who acts as the WHO Liaison Officer to ESCAP, assisted by a medical officer for liaison work, participated in a variety of activities of ESCAP, ranging from the traditional subjects such as nutrition, human environment and population to integrated rural development and environmental pollution. The WHO staff in Maldives participated in a project sponsored by ESCAP on integrated rural development in Alifu atoll. WHO is represented on inter-agency task forces and working groups set up by ESCAP. The inter-agency working group on TCDC is exploring ways to set up a coordinated information system. WHO also contributed a section on 'Health' for inclusion in the regional strategy paper prepared by ESCAP for presentation to the preparatory committee on the New Inter- national Development Strategy. 5.1.5 IntemtionuZ Atomic Energy Agency (IAEA) Collaboration with IAEA continued with a number of institutions in the Region participating in the IAEAIWHO Postal Dose Inter-comparison Studies for Cobalt-60 therapy and the comparative study of personnel film badge services to monitor radiation to which health personnel are exposed. 5.2 Specialized A~encies 5.2.1 United Nations Industria2 DeveZopment Organization (UNIDO) The Regional Office represented WHO at the Third General Assembly of UNIDO held in New Delhi in January 1980. Discussions were initiated with UNIDO for assistance to Nepal in the production of drugs under a UNDP-funded project on primary health care with WHO as the executing and WID0 as an associate agency. 5.2.2 Food and AgricuZture Organization of the United Nations (FAOI/WorZd Food Programme (WFPI WHO closely collaborated with FA0 in a number of activities. The Organization was represented at a number of group activities and meet- ings called by FAO, including the FA0 Regional Conference for Asia and -- SEA/RC33/2 Page 124 the Pacific, held in New Delhi in March 1980. A joint FAO/W~~O/UNICEF comprehensive programme on nutrition was developed in Burma. The Regional Adviser on Nutrition participated in a joint FAO/WHO/UNICEF team visit to Sri Lanka to review the nutrition surveillance programme and strengthen the Food and Nutrition Planning Unit. Funds were provided to Burma to enable a national staff member to participate in the PA01 UNDP Technical Consultation Among Developing Countries of Asia and the Pacific on Food Control Needs and Means, held in Manila in September 1979. The Director of the Food Policy and Nutrition Division of FA0 visited the Regional Office in October 1979 for discussions with the Regional Director. The schedules of forthcoming FAOlWorld Bank missions have been circulated to all WHO Programme Coordinators intheRegion to identify those in which WHO might be interested in participating. Cooperation with the World Food Programme continued to be good and fruit- ful, and close contacts were maintained. The Regional Office as well as field project staff participated in joint evaluation missions in Bangladesh and Sri Lanka; a similar mission to Indonesia is scheduled for September 1980. Proposals, as well as exten- sions to existing proposals, for WFP assistance to Bangladesh, India, Indonesia, Nepal, Sri tanka and Thailand were reviewed in the Regional Office and commented upon for eventual transmission to WFP through WHO Headquarters. 5.2.3 United Nations EducationaZ, Scientific and CuZturaZ Organization (UNESCO) WHO was represented at a number of meetings sponsored by UNESCO in different countries of the Region. WHO participated in the Regional Meeting of Experts from South and Central Asia on the Follow-up of UNCSTD (United Nations Conference on Science and Technology for Development) Recommendations for the Development of National and Regional Programmes and Projects in Science and Technology, held in Colombo in May. The WHO Programme Coordinator in Nepal and some of the field staff took part in the Philosophical Investigation of the Condi- tions for Endogenous Development of Science and Technology and the Sub-Regional Consultation for Identifying Training Needs in the Least Developed Asian Countries, held in Kathmandu in December 1979 and March 1980 respectively. The Organization was also represented in the Regional Meeting on the Development of Scientific and Technological Information Cooperative Programmes in South and Central Asia, held in New Delhi in September 1979. The Regional Adviser on Bealth Manpower Development attended the UNESCO Committee of Experts called in New Delhi in November to define SEA/RC33/2 Page 125 - the outline of a Preliminary Draft Convention on the Recognition of Studies, Diplomas and Degrees in Higher Education in Asia and Oceania. 5.2.4 InternutionaZ Ldour Organisation (ILO) Relations with ILO at different levels have continued to be close and cordial. ILO participates in two UNDP-funded projects - one in Burma (Strengthening of Health Services in the Newly Industrialized Areas, West Bank of Irrawaddy River) and the other in Indonesia (Development of Central and Regional Occupational Health and Industrial Hygiene Laboratories). In Augustfseptember 1979, the WHO Programme Coordinator in Dacca took part in a preparatory mission for UNDPfILO assistance on human resources development and employment planning to the Ministry of Planning of Bangladesh. 5.2.5 The Intemtionaz Bank for Reconstruction and Development (IBRD) The Regional Office continued its involvement in the WHOIIBRD Coopera- tive Programme through a Financial Analyst and a Sanitary Engineer. both stationed in Xew Delhi. The staff of the Cooperative Programme assisted the Bank in identifying and preparing water supply projects in Indonesia and Thailand, and in reviewing the billing and collection systems for the Bank-supported Water and Sewerage Authority project in Bangladesh. In India, the team helped in supervising the Bank-assisted water and sewerage project in Punjab, and in preparing Sector Memoranda for various states; this latter work was expected to be completed by mid-1980. A joint BankfWHO evaluation of the Cooperative Programe activities in this region was made in November 1979 and the review panel concluded that the Programme had effectively demonstrated the benefits of decentralized operations. 5.3 Asian Development Bank Relations with the Asian Development Bank improved further with frequent contacts during the year. The Regional Office fielded an assessmentfreview mission to Nepal for the Bank during January - April 1980 to review the existing organization for health care and plans for the future. The team consisted of a malariologist (team leader), a specialist in malaria research, an ecolo- gist and an architect. It is hoped that the findings of the team would help the Bank to determine its assistance to Nepal. A consultant on logistics recruited for the Bank by WHO is stationed in * the Regional Office. He made visits to Bangladesh, Burma, Indonesia and Nepal to study their pharmaceutical supply systems. SEA/RC33/2 Page 126 5.4 Bilateral and Other Agencies Frequent contacts were maintained both at the Regional Office level and in the countries of the Region with agencies such as the Swedish Inter- national Development Authority (SIDA), the Canadian International Development Agency (CIDA), the Danish International Development Agency (DANIDA) and the Norwegian Agency for International Development (NORAD) in respect of the assistance that is being provided by these agencies. Regular consultations were held with representatives of bilateral agencies such as US AID and the Overseas Development Ministry of the United Kingdom on their collaboration with the governments in the Region. 5.5 Non-governmental Organizations in Official Relations with WHO Close and cordial relations continued to be maintained with the national organizations in various countries of the Region affiliated to inter- national non-governmental organizations. Regional Office as well as field staff participated in a number of activities of these agencies,and WHO was represented at meetings sponsored by them. Representatives from 32 non-governmental organizations in official relations with WHO were present at the thirty-second session of the Regional Committee,andtheir presence was utilized for fruitful discussions and exchange of ideas. 6. PUBLIC INFORMATION During the year, activities aimed at dissemination of information on health coverage and on the work of WHO continued to be expanded in both urban and rural areas. Greater use was made of the satellite television facilities in India on an experimental basis by providing them with rele- vant information material and films. The thrust was on motivating and involving the people, through the mass media, to take up the challenge of achieving the goal of health for all by the year 2000. In this connexion, a monthly newsletter, HFA 2000, is being published regularly since December 1979. The response to this newsletter has been most encouraging. The signing of the Charter for Health Development by five countries in the Region also provided a good opportunity to highlight the conrmunity of interest in health and to underscore the importance of the subject to overall socio-economic development. This event, as well as the joint WHO/UNICEF inter-country meeting to formulate strategies for health for all, received wide coverage in the media. To ensure that information material gets to the most prominent leader- writers and media men in the Region, a media directory was compiled and the mailing lists suitably amended. Regional Cononittee: The thirty-second session of the Regional Committee was widely covered by the press, radio and television. The press releases were picked up by all the major publications in the Region and an end- of-the-session press conference addressed by the Regional Director, the Signing of the Charter for Health Development by Mr B. Shankaranand, India's Minister of Education, Health and Social Welfare (second from right), Dr Halfdan Mahler. Director-General, WHO (second from leit), and Dr V.T.H. Gunaratne, Regional Director, WHO (extreme left), in the presence of H.E. Mrs lndira Gandhi Prime Minister of India. On extreme right is Mr N.R. Laskar Minister of State for Health and Family Welfare. CHARTER FOR HEALTH DEVELOPMEN1 The Charter for Health Development wassigned in Jakarta in the presence of H.E. Dr Adam Malik. Vice-President of the Republic of Indonesia (centre). Picture shows Dr Suwardjono Surianingrat the Indonesian Minister of Health (right) and Dr V.T.H. Gunaratnesigning the document. CHARTER FOR HEALTH DEVELOPMENT Signing ceremony in Bangla. desh. H.E. Mr Justice Abdus Sattar. Vice-President of the People's Republic of Bangla- desh (right), and Dr Halfdan Mahler signing the Charter. It was also signed by the Minister of Health and Popu- lation Control. Dr M.A. Matin and Dr V.T.H. Gunaratne (not seen in the picture). Signing of the Charter for Health Development by H.E. Mr R. Prernadasa. Prime Minister of Sri Lanka (fourth from left). Mr Gamani Jaya- suriya. Minister of Health (second from left) Dr Halfdan Mahler and Dr V.T.H. Guna- ratne. The Minister for Public Health. Tha!land. Mr Boon- som Martin (right), slgning the Charter for Health Deve- lopment in Bangkok. Dr Halfdan Mahler and Dr V.T.H. Gunaratne signed on behalf of WHO. The Prime Minister of Thailand. H.E. General Kriangsak Chomanan, also signed the Charter. SEA/RC33/2 Page 127 Chairman and the Vice-Chairman of the Regional Committee, was very well attended. World Health Day: The theme for the 1980 World Health Day, "Smoking or Health: the choice is yours", evoked great interest. There was a large demand for information material and over 7000 sets were distributed in the Region. These included articles, posters, wall-charts and photo- graphs, and were sent to health education bureaux, social welfare organizations, educational institutions and the mass media. In India, on an experimental basis, information material was sent to all the zonal headquarters of the railways to be used as appropriate by the medical officers in their dispensaries and at railway stations. A broadcast by the Regional Director for All India Radio was translated into different languages and beamed to listeners in South-East Asia, Africa and West Asia. ~ndis's satellite television network also mounted a special programme on the occasion, which included a message by the Regional Director. Health education authorities in various countries of the Region organized special programmes, including seminars, workshops and exhibitions, to highlight the theme of World Health Day. The accent was on warning the younger generation and educating them about the dangers of smoking. Group Educational Activities: A number of group educational activities held in the Regional Office during the year were covered by the media. Facilities were provided to national and international media representa- tives to cover subjects of interest to them. The topics that were widely covered included malaria, pzevention of accidents, malnutrition, and "Health for All". The WHO Chronicle also published excerpts and write-ups based on reports or proceedings of various activities organized in the Regional Office. World Health carried a number of articles devoted to health development in the Region. A special contribution was prepared for the comemorative issue on smallpox eradication. The Information Unit continued to participate in various seminars and symposia devoted to health and socio-economic development aimed specifi- cally to involve and motivate the media. Cooperation with United Nations and other Agencies: The Regional Office continued to contribute material to the weekly newsletter published by the United Nations Information Centre in New Delhi. Efforts were also made to strengthen collaboration with the United Nations Information Centres in other countries of the Region. Photographs and Fihs: To meet the increasing demand for photographs, both by the media and by others interested in health informationand SEA/~c33/2 Page 128 education, arrangements were made to augment the Regional Office photo library. In collaboration with WHO Headquarters, the Regional Office was involved in producing a film on primary health care in Thailand. This is one of a series of six films depicting various aspects of PHC in different parts of the world. Visitors: More than 600 health educators, medical and nursing students and others visited the Regional Office and were briefed on the Organiza- tion's working, its aims and objectives. PART 111 ACTIVITIES UNDERTAKEN BY GOVERNMENTS WITH THE HELP OF WHO SEA/RC33/2 Page 129 PROJECT LIST Thispart of thereport contains programme sunnnariesin respectof each country, giving a brief account of the major health problems of the country and highlighting the government's efforts duringtheyear,withspecial reference and in relation to WHO collaboration. The infornation is complementary to that already given in Part I. Each programme summary is followed by a list of the projects in the country for which WHO has given assistance during the whole or part of the period under review. Inter-country projects are listed at the end. In the project list, in the first column (under "Project Number and Source of Funds"), "R" means Regular Budget; "UNDP" United Nations Development Programme; tvFp~~ United Nations Fund for Population Activities, and "VF" Voluntary Fund for Health Promotion - all sub-accounts. The projects are listed in accordance with the programme classification. SEA/RC33/2 Page 131 1. BANGLADESH The Government of Bangladesh has underscored its commitment tothe provision of minimum health care to all citizens by including in the health sector of the Second Five-Year Plan (1980-85) all the major components of primary health care and the supporting programmes. The main thrust of the health sector of the plan is in the delivery of primary health care, the control of communicable diseases and the develop- ment of health manpower, especially at the middle and grassroots levels. Supporting services are also being strengthened. There is a significant diversion of the health sector's development resources towards rural health care, and health workers are being given orientation training in community health. A study of the thana health complex scheme has been undertaken to assess the building and staff facilities. A management training programme for district-level health administrators has been conducted. The Government has completed preparatory work for programme formulation in primary health care by holding a series of regional seminars for civil surgeons and health administrators on the policies, strategies and methodo- logies. In line with the objective of primary health care to deliver basic health services and make them accessible to all citizens, involvement of the community is being secured by engaging village health workers and establishing village health committees. The village workers will be supervised and supported by the regular government workers in health centres. Traditional birth attendants have been trained and supplied with midwifery kits for conducting safe and hygienic deliveries. Thana health centres are being strengthened with the establishment of 31-bed hospitals to provide referral support and continuing education to primary health workers. The referral system will also be extended to the sub-divisional and district hospitals. The fast rate of population growth is recognized by the Government as an obstacle to socio-economic progress of which health development is an integral part. The target of further reducing the annual birth rate from 2.8% to 2% has been set for the Second Five-Year Plan. Malnutrition is common and the worst affected are infants, adolescents, and pregnant and lactating mothers. Vitamin 'A' deficiency causes blindness in largenumbers of children; anaemia due to lack of iron is also wide- spread. Two nutrition surveys have been conducted and the standard growth chart for children in Bangladesh is being established. To popularize nutrition education amongst the masses, posters, pamphlets and booklets on nutrition have been produced. The health education service is being re-organized and the Health Education Bureau is being strengthened. The Bureau initiated training courses for SEA/RC33/2 Page 132 health education officers. A post-graduate course leading to the Master of Public Health degree in health education has been started at the National Institute of Preventive and Social Medicine. Occupational health services to protect the working population against health hazards have been supported with surveys, training programmes, personnel, and the provision of equipment for a laboratory to be based at the National Institute of Preventive and Social Medicine. The Institute of Epidemiology, Disease Control and Research has been further strengthened and has organized a number of training courses for health officials in addition to conducting continuous epidemiological studies in the field. Diarrhoea1 diseases, tuberculosis, malaria and other parasitic infections, tetanus and measles continue to register a high incidence and result in considerable morbidity and mortality. The programme for the control of malaria and mycobacterial diseases has received special inputs. Malaria surveillance has been strengthened through domiciliary visits; emergency measures for the control of malaria outbreaks have also been implemented. Inter-ministerial committees have been formed at the national, divisional and district levels to coordinate the control activities. Surveillance by health workers to detect malaria cases continues, with the gains made in the low risk areas being maintained. Entomological technicians, civil surgeons and other health personnel have been trained in malaria control and the mass administration of anti- malaria drugs to the non-immune population has been undertaken. The development of an effective health structure and logistics support,however, remains a problem. The BCG vaccination campaign has been further extended and supported by case finding and case holding activities in the thana health complexes. Active and passive case finding to register leprosy patients also continues to be carried out. The National Advisory Committee for EPI approved the medium-term plan of operation, which has the objective of setting up seven immunization centres in each rural thana and attaining full coverage in all urban areas. Health personnel have received training in planning and management for EPI through WHO inter-country training courses. An ophthalmic training and services complex is under construction in Chittagong with bilateral assistance from the Australian Government. A National Institute of Ophthalmology is in the initial phase of develop- ment in Dacca. Even as communicable diseases, which constitute a major menace to public health, are being tackled, there is an awareness also about emerging chronic diseases of metabolic and degenerative origin. SEA/RC33/2 Page 133 The Institute for Disability Prevention and Rehabilitationmade satisfactory progress. The existing facilities were assessed anda detailed national plan, covering also legislation on disability prevention and rehabilitation, prepared. With the assistance of WHO, the magnitude of the cancer problem has been assessed, the existing facilities evaluated and a national plan for prevention and control formulated. A national plan for the prevention and control of cardiovascular diseases has also been developed. The training and research activities at the National Institute of Cardiovascular Diseases continued to make progress with bilateral assistance. The Institute of Public Health has been strengthened to undertake the production of biologicals, particularly tetanus toxoid. Bacteriological monitoring of drinking water has been extended to all districts. The second rural water supply and sanitation programme continues to make satisfactory progress with material support from UNICEF. The Department of Public Health Engineering has undertaken a health education and motivation campaign to secure the people's fuller participation in the field of sanitation. A comprehensive maintenance programme has been developed to provide training for 45 000 mechanics. A village sanitation scheme has been approved by the National Economic Council; the scheme includes an educational programme and caters to the production of slabs, pans and rings and the setting up of a number of distribution centres. The World Bank and the Asian Development Bank are also supporting this activity. The policy on health manpower development is aimed at training a large number of personnel, especially at the district, sub-district and village levels. There is continuous feedback between field work and training and the thana health complexes are utilized as training bases. The training of "F'uIZi Chikitshaks" (village doctors) has been making progress. While the second Paramedical Institute has started training laboratory technicians, health inspectors, radiographers and dental technicians, the National Institute of Preventive and Social Medicine has been conducting training courses in community medicine. The Institute is offering a post- graduate diploma in public health and community medicine and other courses in public health disciplines. There are plans to train auxiliary nurse-midwivesto overcome the current shortage of nurses; they will provide maternal and child health, school health and general nursing care. Work is in hand for constructing more nursing schools. The improvement of basic nursing education through 18 government nursing training centres continues and the training of trainers of nursing personnel for PHC has been undertaken simultaneously. Plans to develop a division of continuing education are in hand. SEA/RC33/2 Page 134 Projects in Operation Number and Source of Funds Title - BAN CHP 001 Country Health Programing R BAN RPD 001 Research Promotion and Development R BAN SPM 001 Organization of Health Services Planning and Administration R BAN SPM 002 Strengthening of Thana Health Complexes and Development R of Primary Health Care BAN SPM 003 Repair and Maintenance of Electro-Medical Equipment R BAN HSD 003 Hospital Administration R BAN ATH 001 Development of Health Laboratories and Allied Laboratory R Services BAN HWP 001 Occupational Health R BAN MCH 001 Development of Family and Child Health Services R BAN NUT 002 Institute of Public Health Nutrition UNDP BAN BED 002 Health Education R BAN MNH 001 Mental Health R BAN PHB 001 Pharmaceutical and Biological Quality Control R BAN ESD 001 Strengthening of Epidemiological Services R BAN ESD 002 Epidemiology and Disease Control UNDP BAN MPD 001 Malaria Control R/VF Number and Source of Funds Title BAN BVM 001 Mycobacterial Disease Control R BAN SPI 001 Smallpox Eradication VF BAN EPI 001 Expanded Programme on Immunization R/VF BAN PBL 001 Prevention of Blindness R BAN CAN 001 Cancer Prevention and Control R BAN CVD 001 Cardiovascular Disease Control R BAN ORH 001 Oral Health R BAN OND 001 Other Non-conrmunicable Diseases (Diabetes, Endocrinology) R BAN EHP 001 Assistance to Water and Sewerage Authority, R (Dacca and Chittagong) BAN BSM 001 Community Water Supply and Sanitation R BAN PTR 001 Training of Mid-level and Peripheral Health Workers R BAN PTR 002 Training of Medical Assistants UNDP BAN PTR 003 Strengthening of Health Manpower Development UNDP BAN PTR 005 National Institute of Preventive and Social Medicine UNDP BAN EDS 001 Nursing Advisory Services and Training R SEA/RC33/2 Page 136 2. BHUTAN Bhutan, also called "the land of medicine" (5hmn Izongs), has a rich heritage of traditional medicine. In the northern, central and eastern regions the Tibetan system of medicine is mostly followed, while in the southern region the ayurvedic system is in vogue. Since 1971, the country has made steady progress in the planned development of modern medical and health services. Institutionalized care is provided through 38 dispensaries, 36 basic health units, 3 sub-zonal hospitals and 8 zonal hospitals, with the Thimphu General Hospital serving as the apex referral hospital. The WHO project funded by UNDP to develop health services in the country is making steady progress. The training of health workers to enable them to man the basic health units continues. The expanded programme on immunization is proceeding as planned with WHO assistance, which has also been extended in the fields of nutrition and leprosy control. Lack of personnel for taking up the fellowships planned for the project continues to be one of the constraints. The health school at Thimphu, which began in 1974 with the collaboration of WHO and UNICEF, is the only centre in the country for the training of health personnel. It trains health assistants, basic health workers and auxiliary nurse-midwives. WHO assisted in the preparation of syllabi for the training of these workers and in the development of an operatione manual for basic health units. The school needs to be expanded further by way of buildings, equipment and staff to meet the growing demands of the health services. The concept of primary health care is spreading gradually. Village health workers, who are volunteers drawn from the community, are given training in first aid, sanitation, hygiene and nutrition to assist the basic health workers. The school for traditional medicine, started in 1971 and reorganized in 1974, admits 15 students annually. An inter-country programme funded by UNDP will assist in the further development of-traditional medicine. The school feeding programme, supported by the World Food Programme (WFP), now covers 2 central schools, 15 junior high schools and 77 primary schools. There has also been an increase in the energy and protein content of WFP rationsperchild per day. Teachers have been trained to assess nutritional status through the measurement of height and weight and the examination of children for anaemia, goitre and angular stomatitis. UNFPA has recently approved a Government request for a project on the development and strengthening of maternal and child health and family planning services; approval has also been obtained for preparatory activities to be undertaken in 1980. SEA/RC33/2 Page 137 In addition to controlling the population growth rate and improving the health of mothers and children, the project aims at, among other things, the strengthening of the administrative and technical infrastructure to provide appropriate, comprehensive maternal and child health and family planning services with a supporting referral system. The project's activities are so designed that they will also help in developing and strengthening an information network for the continuous monitoring and evaluation of the programme. Projects in Operation Number and Source of Funds Title - BHU SPM 001 Development of Health Services UNDP BHU MCH 001 Development and Strengthening of Maternal and Child Health FP and Family Planning Services SEA/RC33/2 Page 138 3. BURMA The People's Health Programme, which coneists of six priority aervice programmes and six support programmes, is being implemented in a phased menner since April 1978 by progressively increacling the number of townahips to be covered every year. Thus it is expected that some 147 out of the 314 townships in the country will be covered by the end of the planned period. The country profile and individual programme profiles for the 12 programmes referred to above have been prepared and are regularly updated for manage- ment purposes. The health information service and system programme was formulated by reorienting the existing health statistics activities and in conformity with the information needs of the People's Health Programme. The training of national personnel in health information systems, computer science, demography, statistics and medical record science was supported. The Government has devised a built-in monitoring and evaluation system based on the guidelines evolved by WHO for programme evaluation. Orientation courses on monitoring and evaluation were organized for health personnel at different levels. Primary health care and basic health services are at the centre of health development efforts. There are, at present, 1107 rural health centres and 50 urban health centres with 8254 workers assigned in the rural areas and 2594 in the urban areas; these workers include basic health service staff such as health assistants, lady health visitors, midwives, and public health supervisors. During 1979-1980, 800 trained community health workers were stationed at underserved village tracts, and in addition, 1080 workers were selected and given three weeks' training with WHO support. With UNICEF assistance, necessary medicine chests and first-aid kits have also been provided. The replenishment cost of the medicine chests and first-aid kits was borne by the community resources, and these supplies were purchased from standard packs manufactured by the Burma Pharmaceutical Industry. In the field of traditional medicine, the Institute of Indigenous Medicine in Mandalay conducts a three-year course with 50 new enrolments a year. Besides, reorientation and refresher training courses are organized from time to time. Ten new indigenous dispensaries were established during 1979-1980. In regard to referral laboratory services, the emphasis is on upgrading and strengthening facilities at the periphery, including the training of personnel at different levels. Facilities for drug abuse control work were strengthened in selected laboratories. A three-year UNDP project, "Food and Drug Control Laboratory", was started in 1979. Maternal and child health activities continued to expand, 296 maternal and child health centres and 53 school health teams having been established SEA/RC33/2 Page 139 so far. Nine hundred auxiliary midwives, selected and supported by the community, were given six months' training and were provided with midwifery kits by UNICEF. Manuals for lady health visitors, midwives and auxiliary midwives were prepared and distributed. The supplementary feedingprogramme for school children was continued and studies and research activities on different aspects of family health care were carried out. During 1979-1980, the Burma Pharmaceutical Industry produced 420 800 doses of DT, 1.2 million doses of TT, 2.3 million doses of smallpox vaccine and 651 560 doses of anti-rabies vaccine. There was alsoa substantial increase in the production of VDRL reagents. The integrated vector-borne disease control activities against malaria, filariasis, dengue haemorrhagic fever and Japanese encephalitis continued - during 1979-1980. The organizational set up at the central as well as the divisional and state levels is being strengthened. Malaria continued to be a major public health problem with a significant increase in P. falcipanrm infection, and the anti-malaria spraying activities as well as the distri- bution of anti-malaria drugs for prophylaxis and treatment have been stepped up. In regard to filariasis, case detection, treatment and larviciding continued to be carried out. In the rifampicin trial against leprosy, the second round of mass survey is in progress and about 80% of the population of the study area have already been examined, with supervised treatment of bacteriologically positive cases with rifampicin. Follow-up of the BCG trial is also progressing according to schedule. The environmental health programme made further progress. A total of 500 tubewells has been completed against the targetof3000 for the period 1978- 1979 and 1980-1981. Designs have been completed for improving and extending a rural water system for a population of approximately 80 000. ." WHO assistance has been provided in engineering designs of rural water supply, development of bio-gas systems, design of preventive maintenance systems, and methods for the surveillance of water quality. A survey of existing tubewells is also under way for formulating a rehabilitation project. UNICEF assisted in the demonstration of the execution of a typical hydro-geological investigation. Preliminary planning is under way for a project on the social aspects of rural water supply. In the field of health manpower development, the existing training is being reviewed. WHO has collaborated in training various categories of workers in support of the People's Health Programme. During the year, a management training programme was initiated with WO collaboration. The project document for a new UNDP-funded project, "Planning and Manpower Development for Primary Health and Basic Health Services", is being finalized and implementation is expected to start during 1980. Aa regards research promotion and development, high priority is given to health services research. The proposed activities include (a) assessment SEA/RC33/2 Page 140 of the effectiveness, utilization and performance of peripheral health workers and institutions, and (b) malaria and leprosy reeearch, especially on drug resistance. The evaluation of the performance and utilization of community health workers and auxiliary midwives and the assessment of the nutritional activities under the People's Health Programme are in the initial stages. In addition, mouse foot-pad inoculation in experimental studies on drug resistance in leprosy and a study of choloroquine remistance of P. falcipcmrm are being carried out. Preparatory activities for developing national strategies for health for all by 2000 A.D., started during 1979, were strengthened further. WHO an& UNICEF collaborated in these activities. Projects in Operation Number and Source of Funds Title - BUR CHP 001 Country Health Programming R BUR RPD 001 Health Research in support of the People's Health R Programme BUR SPM 001 Hospital Services Management R BUR PHC 001 Primary Health Care and Basic Health Services R/VF BUR WKH 001 Strengthening of Health Services in Newly Industrialized UNDP Areas (West Bank of Irrawaddy River) BUR ATH 001 Supply System and Maintenance and Repair Workshop for R Health Equipment BUR ATH 002 Promotion of Health Laboratory Technology R BUR ATH 003 Food and Drug Quality Control Laboratory UNDP BUR MCH 004 Family Health R BUR PHB 001 Development of Production and Quality Control of R Biological and Pharmaceutical Products SEA/RC33/2 Page 141 Number and Source of Funds BUR ESD 003 UNDP BUR BVM 001 VF BUR EPI 001 R BUR VBC 001 R/VF BUR Em 001 R BUR BSM 002 R BUR PTR 001 R BUR PTR 002 UNDP BUR HST 001 R BUR DHS 002 R Title Expansion of Epidemiological Surveillance in Community Health Services Leprosy Control/Research Activities Expanded Programme on Imunization Vector-Borne Disease Control Environmental Health Planning and Management Environmental Sanitation Development of Procedures and Staff Training Education and Training of Health Manpower Development of Health Information Services Department of Medical Research SEA/RC33/2 Page 142 With Juche principles as the guiding political philo~ophy and in accordance with the concept that "the world18 most precious possession is man", the Government of the Democratic People'r Republic of Korea cowtantly striven tc accelerate the pace of health development. The health situation in the country has been improving steadily, with emphasis on prevention as the main approach. There have been improvauants in quantity as a result of expanrion of coverage through new health ertablirhmutts, ar well ar in quality through the delivery of better and more effective servicer. The health of the people has been the sole responsibility of the Government aince 1960, when the integrated health service8 system was developed, particularly by using the "section doctor" method. Health institutiom, which are evenly distributed throughout the country and are within the reach of the entire population, conrtitute the bare for rocial and community health services. Special attention is given to the health and welfare of children. Since August 1975, when the Six-Year Plan (1971-1976) achieved its target one year and four months ahead of schedule, the health services in the country have been implemented within the framework of the current Plan (1976-1981). During the previous plan period, the number of hospitals had increased 2.8 times, hospital beds increased 1.5 times, and supplieaand equipment as well as drugs and medicines by 7.2 times. As a result, there were 23.3 doctors and 120 hospital beds per 10 000 population aa at the end of 1979. The death rate was 4.4 per 1000. The country has been free from epidemic diseases such as smallpox, cholera, relapsing fever, malaria, Japanese encephalitis and measles for the past several years. The average life expectancy at the beginning of the current Plan was 73 years - 70 for males and 76 for females. The Government is fully committed to the social goal of HFA/2000 with PHC as the key approach. In order to improve the health care system in the country in the context of HFA, WHO has been collaborating with the Government in increasing the medical facilities by training health personnel in newer techniques as well as by procuring modern scientific equipment. Having attained complete health coverage, the Government is endeavouring to improve the quality of medical care rendered to its people, particularly in rural areas, thus narrowing the gap between the urban and the rural situation. The training programme for medical and health personnel covers not only the technical aspects of health delivery, but also includes language training to prepare DPRK physicians for effective collaboration with the international scientific community. The average life expectancy of the people being over 73 years, emphasis is, appropriately, being placed on the provision of facilities for treating diseases of old age. Technical collaboration between the Government and WHO continues in strengthening the existing facilities for early detection, SEA/RC33/2 Page 143 diagnosis and treatment and promoting biomedical research activities in regard to these diseases. Fellowships have been awarded for training in different aspects of cancer control and research. Twelve physicians were trained abroad in cancer surgery for the treatment of gastric, lung, pancreas, liver and breast neoplasms. Some of them received training in radiotherapy, chemotherapy and experimental oncology and others were trained in early detection using cytodiagnostic and endoscopic methods. Equipment and supplies were made available for strengthening laboratory facilities for endoscopy, cancer research, oxygen therapy and anaesthesia and audio-visual aids supplied for education and training in exfoliative cytology. In regard to cardiovascular diseases, three physicians were trained in the *. ultrasonic diagnosis of heart diseases, cardiac resuscitation and treatment, and drugs, reagents and surgical equipment were provided for investigation, treatment and research. WHO assisted in reviewing the status of strepto- coccal microbiology, in demonstrating selected techniques and in establish- ing a specialized streptococcal laboratory. In addition, an operating protocol was prepared and recommendations made for a streptococcal screening programme for children with special reference to the prevention and control of rheumatic heart disease. Environmental health is another area where there has been close collabora- tion between the Government and WHO, specifically in regard to the post- basic training of public health physicians in different aspects of industrial and environmental hygiene, including food safety. Technical support has been given in the form of fellowships in selected specialties as well as supplies and essential equipment. Projects in Operation .& Number and Source of Funds Title KRD SPM 001 Strengthening of Medical Care Services R KRD ATH 001 Laboratory Sciences and Techniques R KRD PHB 001 Drug Quality Control R KFXI CAN 001 Cancer Control R KRD CVD 001 Cardiovascular Diseases R SEA/RC33/2 Page 144 Number and Source of Funds Title - KRD RCE 001 Environmental Health R KRD FSP 001 Food Hygiene R KRD MPM 001 Strengthening of Health Manpower Development R SEA/RC33/2 Page 145 5. INDIA In recent years there has been considerable re-thinking in India on the social, technological and philosophical bases of the development of health services in the country. The existing pattern of medical and health care services, with its emphasis on hospitals and the provision of specialized services by highly trained doctors mainly to urban and peri-urban areas and catering largely to the affluent segments of the population, is being re-examined. A search for alternative models of health care which can adequately meet the needs of the poor and deprived sections of the popula- tion has, therefore, been on for some time. The excellent results obtained from experiments with alternative models have been carefully analysed in this search. During the Sixth Five-Year Plan considerable * attention will be given to the development of a model which will emphasize the promotive and preventive aspects, be fully geared to the rural areas and which will promote the development of a large group of health workers from among the community itself to deal with common health problems. In the revised draft Sixth Five-Year Plan, an outlay of Rs 12 635 million has been provided for programmes in the health sector in addition to Rs 7650 million for family welfare. Out of this amount, Rs 5300 million will go to rural health and Rs 4000 million will be ear-marked for the control of communicable diseases. For the year 1980-1981 an amount of Rs 2999 million has been provided as plan outlay for health, including Rs 1899 million in the state sector; the allocation for family welfare programmes is Rs 1400 million. The Central Council of Health and the Central Family Welfare Council, which are the highest policy-making bodies in the field of health and family welfare, have been meeting regularly for the last few years in joint sessions. The meeting in April 1979 reviewed the implementation and progress of the community health volunteers scheme and the family % welfare programme and discussed the national policy on medical and health education. In 1979-1980 the Planning Commission had approved extension of the community health volunteers training programme to 1265 additional primary health centres. However, owing to a change in the pattern of central assistance, with 50 per cent of the share being borne by the state governments, it was possible to extend the programme to 692 PHCs only. WHO and UNICEF are providing assistance for the development of the primary health care programme, and grants have been utilized for the printing of manuals for multi-purpose workers and the payment of subsidies to district medical officers and the trainers of health and family welfare workers. Sustained efforts have been made to revitalize the family welfare programme. The revised policy envisages a wholly voluntary programme, which will be an integral part of a comprehensive policy covering education, health, maternal and child care, family welfare, women's rights and nutrition. Vigorous efforts have been made at all levels to implement the programme. SEA/RC33/2 Page 146 WHO assistance has been mainly in the field of research and under its Special Programe of Research, Development and Training in Human Reproduction. Substantial financial support has been given to help devise appropriate technologies and services for the provision of family planning care, for the prevention and treatment of infertility and the strengthening of resources for research in this field. The total input during the aix years, 1972-1978, has been of the order of US$ 6.1 million. Substantially increased targets for the tetanus immunization of expectant mothers, DPT for pre-school children and prophylaxis sgainet nutritional anaaoia and blindneme have been set for the yaar 1980-1981. Technical cooperation ha8 been extended for the disnemination of the remodelled medical undergraduate curriculum in child health, for which WHO provides fellowhipe within the country. The other educational prograarme is the demonstration, in two medical colleges, of the new curriculum on the teaching of maternal and child health and family planning to medical undergraduates and interns. WHO assistance to the Central Health Education Bureau, which continues to function as a regional training centre, has been increased to strengthen further the various health education activities in the areas of services, training, communication, media development and research in relation to PHC, the national health education programme and school health education. Collaboration also exists in the development of laboratory services at the state and regional levels. The performance of the regional laboratories has been evaluated with WHO assistance. Assistance has been provided for the neuro-virulence testing of polio vaccine at the Haffkine Institute, Bombay. In the field of epidemiological surveillance, a workshop was organized at the National Institute of Communicable Diseases, Delhi, to identify priority diseases for surveillance and to discuss the organizational pattern of epidemiological activities, including laboratory and other support services at different levels, and coordination. Workshops on medical mycology, immuno-chemistry of parasitic diseases and filariasis were also organized, WHO providing grants, laboratory equipment and chemicals in support of these activities. The Government has taken intensive measures to control malaria through health education and greater public cooperation and participation. Primary school teachers and other workers have been involved in setting up fever treatment depots and drug distribution centres in remote and inaccessible areas. Additional steps have been taken to carry out basic and operational research in malaria, with 14 research schemes having been sanctioned for implementation. Under theNationa1 Leprosy Control Programme, with which WHO has been associated for a number of years, most of the 80 highly endemic and 170 moderately endemic districts have been brought under surveillance. SEA/RC33/2 Page 147 The National Tuberculosis Programme provides BCG vaccines and anti-tuber- culosis drugs free of cost to all the states and voluntary agencies participating in the programme. A research study undertaken by the ICMR regarding the efficacy of the BCG vaccine has been reviewed at a scientific meeting held in April 1980. Under the expanded programme on immunization, covering tuberculosis, smallpox, diphtheria, whooping cough and tetanus, the Central Government arranges for the supply of vaccines to the states and union territories. WHO has assisted, along with UNICEF and UNDP, in expanding the production of vaccines by supplying necessary equipment. Control measures against Japanese encephalitis (JE) were supported by WHO, which also procured 25 000 doses of freeze-dried vaccine for use in e emergencies. Under the cancer research and treatment programme, the Government is developing four regional centres and giving assistance to the states to set up cobalt therapy units. A cytology research centre has been set up at the Maulana Azad Medical College, New Delhi, for which equipment has been procured by WHO. With WHO assistance the Sri Arignar Anna Memorial Cancer Institute, Kancheepuram, has been contributing considerably to the cancer control programme by integrating education, training and services in primary health care. The Government has undertaken a large-scale national programme for the prevention of visual impairment and the control of blindness. The Danish Government is providing through DANIDA, assistance amounting to Rs 85 million. WHO has been collaborating with the Government in conducting workshops and in developing a central information system for the monitoring and evaluation of the national plan. In the field of environmental sanitation and water supply, India is making t rapid progress to fulfil its commitments under the International Drinking Water Supply and Sanitation Decade (IDWSSD). The Government has set up a high-level committee on the possible hazards of pollution due to non- sewered sanitation, on which the Regional Office is represented. Sector memoranda for the WHOIIBRD Cooperative Programme in water supply and sanitation have been prepared for several states and are being updated further. An international seminar on the development and management of groundwater resources was organized in November in collaboration with UNESCO, FA0 and the Indian National Committee for the International Hydrogeological Programme. In active collaboration with WHO, the Radiation Medicine Centre, Bombay, has developed training services and research activities in nuclear medicine. A number of technical and health personnel trained at the Centre are establishing other nuclear medicine centres in the country. Facilities for the manufacture of equipment and the production of isotopes for clinical services and research are being developed. SEA/RC33/2 Page 148 The number of medical colleges in India has increased from 25 in 1947 to 106 at present with an annual intake of about 13 000 students. The number of doctors has also increased from 47 000 in 1946 to 154 000 in 1978, thus giving a doctor-population ratio of 1 : 3730. However, there is a gross imbalance in the distribution of doctors between rural and urban areas, and efforts are being made to correct this situation. The thrust of WHO assistance has been in providing support in re-orienting and aupplcmenting the existing training programmes. Efforts have been made to increase the number of paramedical personnel and enhance their skills and knowledge. In regard to nursing, there are nine colleges and two post-graduate institutions engaged in nursing education in addition to 265 nursing schools. The Indian Nursing Council has recently modified the curriculum to suit the job responsibilities under the multi-purpose health workers scheme. WHO has continued to support the development of state and regional centres for continuing education, based in the College of Nursing in New Delhi and selected institutions. The Organization also collaboratee in preparing nurses for teaching and administering nursing specialties, in nursing research and in studies aimed at planning for nursing manpower. W.0 has closely collaborated with the Government's programme on biomedical rzsearch in areas such as immunohaematology, human reproduction, occupa- tional health, virology, pathology, industrial toxicology, medical statistics and vector control. Projects in Operation Number and Source of Funds Title - IND CHP 001 Country Health Programming R IND ISP 001 Building of National Information System R IND RPD 001 Biomedical Research R IND SPM 001 Health Economics and Management R IND PHC 001 Strengthening of Health Administration (Rural) including R Planning and Evaluation IND ADR 001 Medical Rehabilitation R IND ADR 002 Prevention of Disability Related to Road Traffic Accidents R SEA/RC33/2 Page 149 Number and Source of Funds Title - IND ATH 001 Development of Medical Uses of Ionizing Radiation and R Radiation Protection Programme IND ATH 002 Promotion of Health Laboratory Services and Health R Laboratory Technology IND ATH 003 Laboratory Quality Control and Standardization R IND ATH 004 Virological Techniques R IND ATH 005 Radiation Health Protection R IND LAB 004 Standardization of Laboratory Methods in Blood TransfueFon, R I~mnunohaematology and Control of Coagulation Therapy IND RAD 002 Radiation Medicine Centre, Bombay R IND MCH 003 Strengthening of Maternal and Child Health Services R IND NUT 005 Nutrition Programmes R IND HED 003 Health Education UNDP IND HED 005 Development of National Health Education Services R IND MNH 002 Mental Health R IND PHB 001 Quality Control of Pharmaceuticals and Biologicals R IND PHB 002 Production of Freeze-dried BCG Vaccine R IND PHB 003 Technology in Vaccine Production R IND ESD 001 Epidemiological Surveillance R SEA/RC33/2 Page 150 Number and Source of Funds Title IND ESD 003 Port Health R IND MPD 001 Malaria Eradication R/VF IND BVM 001 Leprosy Control RIVF IND BVM 002 Tuberculosis Control R/VF IND BVM 003 STD Control Programme R IND SPI 001 National Smallpox Eradication Programme R/ VF IND EPI 001 Expanded Programme on Immunization R IND PBL 001 Prevention of Blindness R IND CAN 001 Cancer Control Pilot Project, Tamil Nadu VF IND CAN 006 Cancer Control and Prevention R IND CAN 007 Cancer Control and Research - Preparatory Assistance UNDP IND CVD 002 Cardiovascular Disease Control R IND ORH 002 Oral Health R IND OND 001 Prevention and Control of Diabetes R IND EHP 001 Assistance to National Environmental Engineering Research R Institute, Nagpur IND BSM 005 Community Water Supply and Sanitation R SEA/RC33/2 Page 151 Number and Source of Funds Title IND BSM 006 Madras Metropolitan Water Supply and Sewerage Board UNDP IND RCE 001 Environmental Pollution Control R IND CEP 005 Pollution Investigation and Control, Maharashtra UNDP IND FSP 002 Food Standards Programme R IND PTR 001 Training of Basic Health Workers R IND EDS 001 Medical Education and Training R IND EDS 002 National Medical Library R IND EDS 003 Nursing Development R IND HST 001 Strengthening of Health Statistics Services R IND HST 002 Development of MedicalfHealth Records in Hospitals R SEAlRC3312 Page 152 6. INDONESIA During the year under review intensive efforts were made to develop policies, strategies and plans of action for achieving the goal of health for all. A ministerial decree was issued in September 1979 to develop the n.~tional health system for achieving health for all. Activities included a review of national health policies, formulation of the long-term plan for the health sector up to the year 2000 within the framework of national development planning, and reformulation of the national health system, including the development of the public and private sectors with community participation. The strategy lays emphasis on inter- sectoral cooperation and collaboration in health development. In order to formulate the national health system two workshops were held in collabora- tion with WHO and the outcome was discussed at the National Health Conference held in March 1980. The Conference unanimously decided to re- formulate health policies and the long-term plan with the national health system with a clear definition and role of primary health care and village health development (PKMD). The Ministry of Health has a significant programme of activities in health planning at the central level, and serious efforts are being made to strengthen these capabilities at the provincial and regency levels with emphasis on monitoring and evaluation. In this regard, WHO collaborated in developing country programme profiles, initially in the areas of community health services, hospital care, malaria, EPI, environmental health and drug policy. It is planned to prepare profiles in respect of all programmes included in Repelita 111. The Government has assigned high priority for strengthening health services, developing various categories of health workers, improving environmental health and the supply of essential drugs. The budget allocation for the Ministry of Health in Repelita 111, which started on 1 April, amounts to Rp.667.6 billion, constituting 3.1% of the total Government budget as against 1.6% in Repelita 11. The budget of the Ministry of Health has increased from Rp.76.7 billion in 197811979 to Rp.112.5 billion in 19791 1980 and to nearly Rp.150 billion in 1980/1981. The targets set for the development of health centres in the Repelita I1 INPRES (Presidential Instruction) programme were achieved. There are now a total of 4553 health centres (all districts have at least one health centre), 7387 sub-centres and 729 mobile clinics, most of which are adequately staffed and equipped. Reorientation courses were held for 1005 health centre personnel, including doctors, and about 1000 midwives were trained in laboratory techniques. Guidelines for the utilization of the Health Centre Reference Manual were developed with WHO collaboration. School health services now cover 75% of all primary schools in the country. By the end of Repelita 111, these activities will cover all primary schools and will be extended to secondary schools. SEA/RC33/2 Page 153 The health education programme continued with intensive work in selected villages in all provinces. Health Education is recognized as an effective means for motivating the community to bring about self-reliance and health consciousness. In Irian Jaya health education activities have been promoted with WHO/UNDP collaboration. The work on improving family nutrition now covers 2009 villages in 25 provinces with more than 1500 nutrition volunteers trained with UNICEF assistance. WHO collaboration in planning a nutrition surveillance unit and in the design of a nutrition surveillance system continued. The nutrition programme is also assisted by the World Bank and the World Food Programme. The family planning programme is actively promoting the nutrition of mothers and children in more than 30 000 villages. Efforts to improve the management of the family health care programme were initiated in all provinces which would be covered by the end of Repelita 111. WHO provided technical cooperation in the areas of nursing registra- tion and improving the content of the mental health component of the curriculum. In strengthening maternal and child health services, the main thrust continued to be in the training and supervision of dukuns (traditionalbirth attendants). It is planned to train 5000 dukuns each year during Repelita 111. Eight more health nurse (PK) schools have been converted, making a total of 66 PK Schools. Efforts are being made to place graduates of 1978 and 1979 in health centres and hospitals. Nine school buildings were constructed with World Bank assistance channelled through the family planning project. The curriculum and teaching methods for both health nurses and nurse teachers are under continuous review and improvement. A new programme for the supplementary training of auxiliary nurse/midwives was started in Lampung in August. 1979, and a WHOIUNDP-assisted project, "Nursing Manpower Development in Irian Jayat',in March 1980. Other external x sources providing assistance to nursing manpower development are the Governments of New Zealand and the Netherlands, the Japan International Cooperation Agency and the World Bank. Formulation of drug policies and self-sufficiency in the production of essential drugs is a priority programme, to which WHO and UNDP have extended technical collaboration. A comprehensive feasibility study is to be finalized shortly which will be the basis for attracting external assistance in this field. Negotiations are under way with the Asian Development Bank and the Federal German Government for assistance in this regard. Also, WHO supported an ASEAN meeting on drug policies, legislation, evaluation and quality assurance which was held in November 1979. In addition, support was given to an ASEAN Task Force which visited different countries in April/May 1980. The malaria control programme covers a total population of 86.2 million in Java and Bali, and an additional 2.7 million persons are protected by .. insecticidal spraying in the priority areas of the Outer Islands. The SEA/RC33/2 Page 154 control of malaria has been assigned priority in the strategy of health for all. As a result of specialthermal fogging measures and the intensifica- tion of surveillance and treatment, the incidence of malaria in certain pockets of high incidence in Banjarnegara/Wonosobo in Central Java has been reduced considerably. Assessment and monitoring of P. fa2cipanrm response to chloroquine was conducted in East Kalimantan, Irian Jaya and Riau Province. Priority consideration was given to refugee relief operations under the aegis of UNHCR. Support continued to be given to staff development, intensive training and planning, programming and evaluation, and applied field research activities. The expanded programme on immunization has further increased its coverage; an evaluation showed that 55% of the eligible children in EPI areas had received a full course of immunization. The target set by the end of Repelita I11 is to cover 78% of all pregnant women and infants. The national programme receives assistance from WHO, UNICEF, US AID and the Australian Development Agency. Central EPI staff were trained in the management and logistics of EPI. In regard to leprosy control, 337 medical officers, leprosy supervisors and workers were trained as trainers at the National Leprosy Training Centre at Ujung Pandang, and they in turn trained 13 614 local health personnel. Random surveys were undertakeninMaluku and South Sulawesi and a survey on dapsone resistance in South Sulawesi. The project in North and Central Sulawesi is supported by the Danish "Save the Children" Organization and other agencies; the Netherlands Leprosy Relief Association has also started providing assistance. WHO collaborated in organizing group educational activities on the entomological aspects of malaria, filaria, DHF and plague. Malaria and DHF entomological surveys and adult susceptibility tests were conducted in six localities. Local fellowships were awarded to entomologists for the M.Sc. course in medical entomology at Bogor Agricultural Institute. In the environmental health programme stress continued to be laid on facilities for providing safe drinking water supply and sanitary disposal of excreta. Close cooperation and coordination continued with US AID and UNICEF, which are also active in this sector. Preparatory activities for the International Drinking Water Supply and Sanitation Decade continued with UNDP as the focal point with the participation of a number of multi- and bilateral agencies. The WHOIUNDP project on East Java Rural Water Supply was scheduled to be completed in May 1980 after preliminary engineering and feasibility studies of seven systems and socio-economic organization, management, and water tariff reviews. A WHO/UNDP project for water supply and sanitation in Nusa Tenggara Timur Province is to commence in July. SEA/RC33/2 Page 155 The community-oriented medical education programme at the Airlangga University is in its third and final year and intensive efforts were made to evaluate the project with respect to both its impact as well as the service accomplishments. Additional funding was secured from the Asia Foundation for the evaluation. Planning for the next three-year period is under way. Efforts to improve teaching methods in all government medical faculties were promoted, and the experiences of the pilot project at the Airlangga University were shared with several faculties through consultative visits. With WHO collaboration the Faculty of Public Health held a series of work- shops for its teaching staff on systematic curriculum development and active learner-centred methods of teaching. Institutional and departmental objectives were developed for core courses. Repelita I11 gives priority to the strengthening of research institutes and improving the expertise of research workers. Emphasis will be laid on action-oriented applied research, and the research activities will be subjected to periodic monitoring and assessment. An important activity will be to improve research methodology leading to high quality designs. WHO technical cooperation will continue in all these efforts. The Disease Ecology Centre at the National Institute of Health Research and Development continued with various research studies in areas such as disability rehabilitation, leprosy, perinatal mortality and low birth weight, the health impact of improved rural water supply and a pertussis vaccine trial. Support was given to these activities as well as in drawing up proposals for further studies. Projects in Operation Number and Source of Funds Title IN0 CHP 001 Country Health Programming R IN0 RPD 001 Strengthening of Health Research and Development R Capabilities IN0 SPM 001 R Health Services Development IN0 SPM 002 Health Care Delivery in the Context of Primary Health Care R IN0 SPM 003 Strengthening of Health Services (Province of Irian Jaya) UNDP SEA/RC33/2 Page 156 Number and Source of Funds Title - IN0 HSD 004 Medical Equipment to Upgrade Jayapura Hospital, Irian Jaya UNDP IN0 HWP 001 Development of Central and ~egional Occupational Health UNDP and Industrial Hygiene Laboratories IN0 ATH 001 Laboratory Services Development R IN0 RAD 001 Radiation Health R IN0 MCH 001 School Health R IN0 MCH 003 Medical Services for Family Health R IN0 NUT 003 Nutrition R IN0 HED 001 Health Education R IN0 HED 003 Development of Health Education in Family Health FP IN0 MNH 001 Strengthening of Mental Health Services R IN0 DPM 001 Preparatory Study for the Establishment of Comprehensive UNDP National Drug Policies IN0 PHB 001 Quality Control of Food and Drugs R IN0 ESD 002 Research in Communicable Diseases Ecology R IN0 ESD 003 Strengthening of Epidemiological Surveillance and Control R IN0 MPD 001 Malaria Control Programme R IN0 BVM 001 Control of Bacterial and Intestinal Diseases R SEA/RC33/2 Page 157 Number and Source of Funds Title IN0 BVM 002 Leprosy Control VF IN0 BVM 003 Campaign for Control of Yaws in Sub-District of North VF Morotai IN0 EPI 001 Expanded Programme on Immunization R IN0 CAN 001 ' Cancer Control R IN0 ORH 001 Dental Health Services Development R IN0 EW 001 Environmental Health Planning and Management R IN0 BSM 001 National Community Water Supply and Sanitation R IN0 BSM 003 Rural Water Supply for East Java Province UNDP IN0 BSM 005 Rural Water Supply, Nusa Tenggara Timur (NTT) UNDP IN0 FSP 001 Food Safety R IN0 MPM 001 Education and Training for Manpower Planning and R Management IN0 PTR 001 Post-graduate Medical Education in Public Health R IN0 PTR 002 Nursing Education and Services R IN0 PTR 003 Nursing Manpower Development UNDP IN0 HMD 007 Strengthening of Teaching of Human Reproduction, Family FP Planning and Population Dynamics in Medical Schools IN0 EDS 001 Undergraduate Medical Education R IN0 HST 001 Strengthening of Hospital Statistics R SEA/RC33/2 Page 158 7. MALDIVES Health development activities in Maldives are based on the Government's policy to bring about planned development of health care services through continuing medical care and the strengthening of the atoll "rural" services. In the context of health for all, the Government lays stress on a signi- ficant reduction in maternal, neo-natal and infant mortality rates, the eradication of malaria, reduction of cases of severe malnutrition and gastroenteritis among children under five years of age, and drastic reduction in the incidence of communicable diseases. To actiieve these targets, the Government will ensure equitable distribution of basic health services through primary health care, and will lay emphasis on the accomplishment of critical health tasks through action strategies. In spite - of other problems competing for the Government's attention, the importance given to health is reflected in the national budget, with nearly 9% allo- cated to the health sector in 1980. Early in 1980, the Government carried out country health programming, which defined the goal of health for all in national terms and formulated appropriate strategies for action. Through an innovative and efficient planning effort, in which WHO collaborated, the Government obtained the participation and contribution of the community and external donor agencies, demonstrating the value of joint collaboration in health development. The Government has undertaken the development of the basic health services by improving the performance of community health and family health workers and by activating multi-purpose mobile health teams. The Ministry of Health has plans to open four regional hospitals, of which one is nearing completion. WHO has been supporting various aspects of health care delivery by assigning teams of specialists in the areas of ENT services, surgery and anaesthesia. The Allied Health Services Training Centre has been training an increasing number of basic health service staff, including community health workers, voluntary health workers, nurse aides, traditional birth attendants CfooZunaas), community health aides, dispensers and community first-aid workers. A new category, the family health worker, is also being trained. Fellowships were provided in gynaecology, surgery and disease control and drugs and vaccines were also supplied. As already stated in Part I, outbreaks of a dengue-like fever were reported at Male and Edhyafushi island in 1979. Advisory services were provided by WHO to study the epidemiology of dengue infections, to carry out a sero- logical survey, to undertake clinical diagnosis and management of dengue fever/DHF patients, and to devise long-term measures for prevention and control. As regards tuberculosis and leprosy, case-finding surveys have been completed in all islands except Kaafu (Male atoll) and Male. As of SEA/RC33/2 Page 159 31 December 1979, 598 tuberculosis and 1500 leprosy patients were under treatment. There have been repeated outbreaks of malaria, primarily in the northern atolls. In spite of considerable transport and communication problems, 45 islands have been covered by spray operations and 66 islands have been investigated. Entomological surveys revealed that there were two species of vectors for malaria transmission. P. faZcipm has been absent since its eradication in 1976. The causes of endemic diarrhoea among children attending Male hospital were investigated with the help of a WHO paediatrician. The findings confirmed that under-nutrition amongst children is widely prevalent. The water supply and sanitation programme is to undergo a major expansion. Current activities include the construction of rainwater tanks and the chlorination of mosque wells in Male. Chlorination is also undertaken in outlying islands whenever outbreaks of diarrhoea occur. A project proposal for constructing rainwater tanks in all atolls is being prepared. It is expected that UNCDF and other agencies will support this proposal. UNICEF is assisting this programme, which also includes the construction of public latrines. In addition to WHO, other United Nations and bilateral agencies such as UNDP, UNICEF, the United Nations Capital Development Fund and the Danish Scouts Aid are collaborating with the Government in its efforts to provide adequate health services to the people. ESCAP has undertaken a project for integrated rural development in Alifu atoll. A joint survey team has visited the atoll for this purpose, and WHO is actively participating in this inter-agency effort for development. Projects in Operation Number and Source of Funds Title MAV SPM 001 Public Health Administration MAV MPD 001 Malaria Control R MAV BVM 001 Leprosy and Tuberculosis Programme VF MAV BSM 001 Water Supply and Sanitation R MAV PIP 001 Water Supply and Sewerage, Male UNDP SEA/RC33/2 Page 160 Number and Source of Funds Title - MAV PTR 001 Training of Auxiliary Health Personnel RlUNDP MAV PTR 002 Fellowships (Medical Education) UNDP MAV PTR 003 Fellowships (Medical Education - Non-Communicable UNDP Diseases Prevention and Control) SEA/RC33/2 Page 161 8. MONGOLIA Mongolia continued to make marked progress in the field of health, as evident from basic health indicators such as the crude death rate (9 per 1000 population), the infant mortality rate (60 per thousand live births) and life expectancy at birth (65 years). The targets for medical care for 1980/81 are 1112 beds per 10 000 population and 25.9 physicians for every 10 000 persons. Major efforts for health development have been made through improvement in the maternity and child health services, the production and control of biologicals and pharmaceuticals, the improvement of environmental health, the development of health manpower and the better management of health services. The Planning Unit of the Ministry of Public Health has formulated preliminary guidelines for the development of health and medical services during the Seventh Five-Year Plan (1981-1985). The six priority prograrmnes identified are: improvement of the quality of the health services, particularly in rural areas and for industrial workers; maternal and child health; health education; promotion of training; production of drugs and biologicals, and the improvement of physical facilities. Through manpower training, WHO has collaborated in the planning, management and development of information systems. National health surveys with sample methods continued, and a statistical analysis of population, morbidity and mortality and the health service activities in 1978 has been completed. A hospital architect has completed the design of a 50-bed maternity home and is now developing the design for another 120-bed children's hospital with polyclinics. Two group educational activities were organized - a ten-day workshop on health information systems and a one-week course on health services management for the directors of aimak health services. Work is in hand to develop a model for an automated -. health management system. The final version of the five-year health develop- ment plan will be completed soon and a revision of the country health profile will be undertaken. Family health continues to be a priority programme with the collaboration of WHO, UNICEF, UNDP and UNFPA. Maternal and child health activities have been strengthened throughout the country and training courses and seminars conducted on various aspects of paediatrics and obstetrics and research studies on maternal morbidity and mortality have been carried out. Seminars and courses have been held, covering subjects such as emergency care for mothers and children, and specialized and advanced paediatrics. Laboratory services have been developed further with WHO collaboration. The epidemiological surveillance of communicable diseases was further strengthened. A seminar on the diagnosis, treatment and prevention of cormnunicable diseases was held for 177 physicians from three aimaks. A study was made of the storage, transportation and utilization of vaccines SEA/RC33/2 Page 162 in 18 aimaks in order to improve the logistic system. Preventive activities on infectious meningitis were carried out in Arhangai, Bulgan, Zavhan and Erdent aimaks, and ganrmaglobulin was given to 190 000 children as a preventive measure. A revised timetable for vaccination against infectious diseases has been prepared. During the first quarter of 1980, eight strains of S. typhimurim were isolated for the first time. Also ten enterobacterial strains, which had been isolated at the Central Bacteriological Laboratory, were sent to the Microbiological Institute, Czechoslovakia, for identification. In the control of non-communicable diseases, a training course for physicians from the aimaks was conducted with stress on the prevention of cardiovascular diseases. A national medium-term programme for the prevention of rheumatic fever and rheumatic heart diseases has been formulated for the period 1981- =. 1985. The surveillance of cardiovascular diseases through registration for myocardial infarction and stroke cases continued to operate. A national committee has been formed for the International Drinking Water Supply and Sanitation Decade and has prepared an assessment report with WHO collaboration. WHO collaborated in improving the organization of sanitary laboratories and in preparing a detailed plan for future supply requirements for the laboratories in aimaks. A project document for a new UNDP project "Assistance to MPR in establishing a National Environmental Health Centre", was developed. In preparation for a training programme, in sanitary engineering to be held in 1980 and 1981, a syllabus was drawn up for athree- month course. Studies are under way in seven state farms and three towns to assess the performance, operation and maintenance of sewage purification plants. The findings and conclusions will be incorporated in the instruction for the design and operation of purification plants in the country. In regard to the training of health manpower, a five-year plan (1981-1985) for the post-graduate training of medical personnel with higher education and training for middle-level health workers has been formulated. Three seminars on the technology of medical education have been conducted for teachers, and a national conference on post-graduate medical education was also held. Measures needed for strengthening post-graduate medical education have been identified. Fifteen specialization courses were held for 258 physicians, each lasting 5-6 months, and 9 advanced courses of three mnths each were also conducted for 153 participants. Projects in Operation Number and Source of Funds Title Country Health Programming MOG SPM 001 Management of Health Services R SEA/RC33/2 Page 163 Number and Source of Funds - Title M3G HSD 002 Strengthening of Emergency Health Services R MOG LAB 003 Modern Health Laboratory Technology R MG RAD 001 Strengthening of Radiological Services and R Maintenance of Electromedical Equipment MOG MCH 002 Maternal and Child Health R MOG MCH 003 Epidemiological Studies of Population Growth FP MOG MNH 002 Mental Health Services R MOG F'HB 001 Pharmaceuticals and Biologicals - Control and R Production MOG BLG 001 Brucella Vaccine Production UNDP MOG ESD 001 Epidemiological Services and Surveillance R MOG ESD 002 Communicable Diseases - Prevention and Control R MOG OND 001 Non-Communicable Diseases - Prevention and R Control MOG EHP 001 Strengthening of Environmental Health Services R MOG PTR 001 Health Manpower Development R/UNDP MOG HMD 003 Assistance to the State Medical Institute, R/UNDP Ulan Bator MOG HMD 004 Training of Health Manpower R SEA/RC33/2 Page 164 9. NEPAL During the final year of the Fifth National Development Plan (1979/80), the Government continued its efforts to expand the basic health services through a balanced mix of promotive, preventive and curative activities with a phased integration of existing vertical health programmes. During this period, the Government has also laid down the Fundamental Principles for the Sixth Plan (1980-1985) with three major objectives, viz., to increase production at a faster rate, to increase employment opportunities, and to meet the basic minimum needs of the people. In pursuance of these principles the Government has reoriented its policies and priorities in the health sector in relation to family health, family, planning, prevention of communicable diseases, provision of safe drinking water and basic sanitation facilities, promotion of the nutritional status of people and various other aspects of primary health care. WHO'S collabo- rative efforts continue to be directed mainly towards the implementation of health programmes in priority areas, identified through country health programing. A noteworthy development was the inter-sectoral planning for health for all, with the HMGIWHO Management Group, established in November 1979, as the main driving force. This long-term planning effort, carried out under the National Planning Commission, involved five sectors viz., health, water supply and sanitation, agriculture, education and communications, and has helped the comtry in strengthening inter- sectoral coordination in the formulation of strategies for health for all by the year 2000. A series of constraint analyses has been initiated in relation to the following factors - finance, manpower, physical infrastructure, supplies and logistics, and population. The first of such analyses has permitted refinement of the preliminary document produced earlier. A second revision . . will be carried out on the basis of the long-term forecasting. Finally, an in-depth study related to problems encountered by the sectors involved in HFA 2000 will also be undertaken. The health manpower planning exercise initiated in March 1980 with the collaboration of WHO and US AID has also greatly contributed to the efforts for HFA 2000. The first comprehensive meeting on Joint Programming of Resources (JPR) at the country level was held in February 1980, followed by a meeting of some United Nations agencies with the Finance Ministry in April. Sectoral review meetings are now being held and should be completed by August 1980. After reviewing again with the sectoral ministries and United Nations agencies, the final JPR document is expected to be sent to UNDP Headquarters for approval by the Governing Council. Inter-agency collaboration at the country level among WHO, UNICEF, UNFPA and US AID continued to be very good and fruitful through weekly coordination meetings. Close coordination has also been maintained with bilateral agencies and with Japan, the Netherlands and the United Kingdom. SEA/RC33/2 Page 165 While the planning activities have been considerably expanded in size and scope with the introduction of intersectoral planning for HFA 2000, the planning and management capabilities within the Ministry of Health have also at the same time been greatly enhanced through the introduction of health planning procedures at the district level, health manpower studies, and the annual preparation of the programme budget with built-in monitoring and evaluation systems. The National Data Bank, the first of its kind in the country, was initiated in conjunction with the development of the national health information system, which will become the main information base for future planning and management. The Community Health and Integration Project (CHIP), formerly called the Integrated Community Health Project, has entered the third phase of integration of community health services in ten more districts, bringing the number of integrated districts to 23. The five core services, viz.. maternal and child health and family planning, the control of malaria, leprosy and tuberculosis, and the expanded programme on immunization, were provided as integrated packages through regular home visits by village health workers, while the health posts provided basic medical care. Malaria control is, however, integrated only in 6 districts. Although CHIP has achieved considerable progress during the year, it is facing the same constraints as before, viz., inadequate resources, problems related to management, administration and supply logistics, and inadequate coordina- tion among the projects concerned. A high-powered multisectoral coordina- tion board for the development of comprehensive rural health services is being established. Steps are also being taken to strengthen the central office of CHIP, to establish three more regional training centres, and to improve the service delivery system with UNFPA assistance. UNICEF is continuing its assistance in maternal and child health care activities and the expanded programme on immunization. The project is receiving consider- able assistance from US AID. The primary health care programme utilizing ward-level health volunteers will be initiated in 13 districts during the Sixth Plan. CHIP has already developed a draft manual for the volunteers, which is being field-tested in two districts. This and other studies such as the feasibility of training the volunteers by health post staff, the capability of the volunteers to perform the tasks that are expected of them, the management and financing of the primary health care programme by the communities themselves, and the impact of the volunteers' services on the health status of the people are contemplated during the Sixth Plan so that the rest of the main programme can be satisfactorily implemented during the Seventh Plan. Japan, the Netherlands, UK, and US AID are quite active in this field. The project document for the Dutch/UNDP-funded and WHO executed project "Primary Health Support Services Progranrme" was signed in November 1979 and implementation started early in 1980. The project aims at promoting the village health volunteer scheme, developing traditional medicine and a comprehensive supply logistics system, and improving the production capacity of Royal Drugs Limited with emphasis on the production of essential drugs required for primary health care. Operational research related to diarrhoea1 diseases control was started in January 1980 to test the efficacy of home-made oral rehydration solution and the acceptability, feasibility and effectiveness of oral rehydration therapy through primary health workers and mothers. The Regional Laboratory at Pokhara, funded by the Government of Japan, became fully operational in June 1980. With the opening of nine new district laboratories, the number of fully operational district laboratories has gone up to 42. The twenty microscopists completed the first Government- recognized six-month course in February. The maternal and child health and family planning project met the planned targets in regard to maternal and child health care activities, imunization, establishment of mobile camps and clinics for surgical contraception, and delivery of contraceptives. Apart from WHO'S support to the project, UNFPA will assist in strengthening the service delivery and in teaching and research in family health with emphasis on population dynamics, human reproduction and family planning. UNICEF and US AID are also continuing their assistance to the project. The Nutrition Unit of the Department of Health Services, in collaboration with other related sectors, has undertaken nutritional promotion activities in two districts. The Unit has started the implementation of one of the two research-cum-action projects allocated to them, viz., "Situational analysis of the current status with regard to the content and implementation of the nutrition component of PHC". The programe of iodized oil injection to prevent goitre and cretinism has already started in three districts. WHO and UNICEF are actively collaborating in these areas. The Health Education Section, in addition to its regular activities, extended its collaboration to other health projects and in developing health education curricula in schools. The Epidemiology and Statistics Division was further strengthened to contri- bute to the development of a national health information system through surveys of communicable diseases and the introduction of lay reporting. Malaria continues to be a priority health problem. Vector resistance to DDT in the Terai areas has necessitated the use of malathion in residual house spraying, and the resistance of P. faLcipamrm to 4-aminoquinolines is creating a major problem in radical treatment. The rise in case incidence in nine Terai districts is a matter of grave concern because of the threat not only of creating a focus for the wider spread of malaria, but also of the consequent reduction in food production and other cultivation. The External Situational Analysis Team, however, found that the programme is making good progress. An ADB/WHO mission on malaria research and training visited Nepal in February/April 1980 to design a training centre and research complex, and to prepare a proposal for re-orienting the malaria control programme. SEA/RC33/2 Page 167 The tuberculosis control project met the planned targets in spite of the shortage of drugs, transportation problems and the continuing large number of defaulters to treatment. The leprosy control project is also progressing according to plan. Case detection of leprosy and health education was undertaken in six districts, bringing the number of districts surveyed to 26. The problems encountered were non-availability of female staff to examine the female population, inadequate staff for supervision and training, and lack of supplies and logistics. The Expanded Programme on Immunization was implemented in ten mre districts during the year, bringing the number of districts where EPI is in operation to 26. Nevertheless, lack of adequate epidemiological information, problems of logistics due to difficult terrain, and an inadequate cold chain still persist. An evaluation of EPI was conducted in February 1980 with the collaboration of WHO and UNICEF. The preventipn of blindness program, with initial funding by the Dutch Government and WHO as the executing agency, is expected to start during this year. Water supply and sanitation activities are being carried out by three agencies, viz., the Department of Water Supply and Sewerage, the Water Supply and Sewerage Board, and the Local Development Department. At the end of the year, 83% of the urban population and 6.6% of the rural population were being served with water supply. As regards sanitation, work was progressing in three urban areas, but there is presently no effective rural sanitation in Nepal. The Government, realizing the urgent need to alleviate the situation, has recently created the "Environmental Sanitation Division" within the Department of Health Services, with overall responsi- bility for public hygiene and sanitation. A detailed national programme for the International Drinking Water Supply and Sanitation Decade has been formulated. At the Institute of Medicine, the diploma programme in general and community medicine has entered its second and third semesters. Two groups - 30 students in all - have completed Part I of the diploma course in nursing. Projects in Operation Number and Source of Funds Title - NEP CHP 001 HMG Nepal/WHO Management Group R NEP RPD 001 Research Promotion and Development R SEA/RC33/2 Page 168 Number and Source of Funds Title - NEP SPM 001 Health Pla~ing and Programing R WP SPM 002 Development of Health Services VF NEP PHC 001 Community Health Services and Prinary Health R Care Development NEP PHC 002 Priaary Health Support Services Programme UNDP NEP ATH 001 Development of Laboratory Technology Services R NEP MCH 001 Family Health Aspects of Integrated Family Health FP Services, Siraha and Saptari Districts, Nepal NEP MCH 002 Strengthening of Family Health Services R NEP MCH 003 Development of Maternal and Child Health Services R NEPNUT003 Nutrition R NEP HED 001 Health Education R NEP ESD 001 Development of Epidemiological Surveillance R NEP MPD 001 Malaria Control R/VF NEP BVM 001 Leprosy Control R/VF NEP BVM 002 Tuberculosis Control R NEP VPH 001 Prevention of Rabies R NEP EPI 001 Expanded Programme on Immunization R SEA/RC33/2 Page 169 Number and Source of Punds Title - NEP PBL 001 Prevention of Blindness R/VF NEP BSM 001 Connuunity Water Supply and Sanitation R NEP PTR 001 Training of Health Manpower R NEP PTR 002 Institute of Medicine (Teaching Hospital) UNDP SEA/RC33/2 Page 170 10. SRI LANK. The planning unit in the Ministry of Health has been reorganized and strengthened. The national health information system is also being strengthened with WHO support. The Ministry of Health is establishing a decentralized pattern of health planning and management and divisional officers are being given increased responsibilities for the management of health programmes. The health care facilities in the greater Colombo and Mahaweli areas are being expanded and the Government is considering detailed programme formulation in several areas with emphasis on district-level management, including planning, reporting and problem-solving. The integrated planning system has also been initiated in a number of districts. The Government has taken a number of steps to translate into action the policy decision adopting primary health care as a vehicle to achieve health for all. A National Health Council headed by the Prime Minister has been established to advise and guide all multisectoral collaboration in health development. The National Health Development Committee under the chairman- ship of the Secretary, Ministry of Health, has set up six standing commit- tees to implement policies through well-coordinated programmes, Similar committees are planned at the district level. A new Ministry of Indigenous Medicine within the Ministry of Health has been constituted to prowte traditional systems of medicine. Two major projects have been developed to promote the accelerated develop- ment of family health with WHO technical support. These projects are designed to expand hospital-based family planning facilities and extend integrated maternal and child health and family planning services in the rural areas. A family health manual has been prepared in two languages and the supervisory staff are being trained to use it. To tackle the problem of malnutrition, surveys to locate pockets of mal- nutrition have been conducted and work on formulating comprehensive strategies for nutritional interventions has been taken in hand. A proposal to reorganize health education by setting up health education units in 103 medical officer of health (MDH) areas initially is under consideration. Meanwhile, a career structure for health education specialists has also been proposed. With WHO collaboration, the Government has formulated B project for manu- facturing drugs and intravenous fluids for primary health care. Financial assistance for this project is being explored from bilateral agencies. The malaria control programme continues to make progress; during 1979, the number of detected cases showed a decline. There is some concern about the resistance of malaria vectors to insecticides, although tests carried out SEA/RC33/2 Page 171 so far continue to establish susceptibility. Under the vector control programme of the Colombo Municipality, a population of 600 000 has been protected against Bancroftian filariasis. The well-equipped virus labora- tory in the Medical Research Institute has pursued studies on dengue fever. The populations in settlemeats in the Mahaweli development project are also being surveyed. A medium-term programme on rabies eradication is being initiated with technical support from WHO in formulating the strategies. The expanded programme on immunization continues to progress satisfactorily, and a manual for medical officers was prepared and distributed. With WHO support, the Government has completed a survey of health laboratory services with reference to primary health care in rural areas. It is plaaaed to provide laboratory support to 4100 field stations and 589 dispen- sary-cum-hospitals in the rural areas. Thus the referral chain of laboratory services will extend up to the district and provincial hospitals. Medical officers and paramedical staff have been trained in laboratory techniques, the maintenance of electro-medical equipment, medical rehabili- tation. and stores management. A national seminar was conducted to assess ophthalmic care in Sri Lanka. Since preventable blindness was identified as a major problem, the need for training middle-level health workers and re-training medical practitioners in ophthalmic care has been recognized. The creation of a new category of ophthalmic auxiliary to work with trained ophthalmologists is also being considered. A GMOIIARCIUNCC team visited Sri Lanka during the year and collaborated in the development of a national cancer policy and plan. Training was given to primary health workers in the early detection of oral pre-cancerous and cancerous lesions to enable them to refer patients to the intermediate levels of health care. Advice was given on the organization of radiotherapy services in the Government Cancer Institute. Maharagama, and on the training of personnel for this institute and other zonal centres under development. Negotiations continued with bilateral agencies for implementing a community- oriented epidemiological survey and a programme for the prevention and control of cardiovascular diseases. The laboratory services in Colombo and Kandy to strengthen the Post-graduate Institute of Medicine have been improved. The development of the community- oriented model programme on cancer control and prevention has made progress with support from WHO. Rural water supply and sanitation activities have been expanded considerably with support from UNICEF and WHO. A number of new programmes have been undertaken in environmental health. Community water supply has received greater attention and a ground water section has been established within the SEA/RC33/2 Page 172 National Water Supply and Drainage Board; hydrological investigations have been extended. The Government participated in the regional consultation on the Inter- national Drinking Water Supply and Sanitation Decade and a draft national plan was completed in March 1980 embodying the official policies on cornunity water supply and sanitation, including the operation and maintenance of rural water supply and rural sanitation. A national workshop was held with the participation of international and bilateral agencies, and specific programmes and projects within the national plan are now being identified. The Government is forging ahead to achieve self-reliance in health manpower development consistent with the strategy of primary health care., The redesignation of the Institute of Hygiene, Kalutara, as the National Institute of Health Sciences has been a major step in this direction. The Institute has already developed new training curricula for community health management. Its wider role and responsibility will include the training of assistant medical practitioners, public health inspectors and other categories of middle-level health workers. A national seminar on a primary health care model was held and its reconnnendations are expected to assist the Standing Committee on Primary Health Care in formulating policies and strategies. The formulation of a national health manpower plan is being actively pursued by the Government in the perspective of health for all. A pilot project to train community health workers has also been completed. Following an evaluation of the first group of village health volunteers, a five-year training programme is being developed. The Post-graduate Insti- tute of Medicine has been reconstituted and nine boards of studies have been established. Some post-graduate qualifying examinations have been conducted locally. To relieve the current shortage, the Government has increased the enrolment of medical students and assistant medical practi- tioners, while the eight schools of nursing have trebled their annual enrolment. The Government has approved a plan for the recruitment and training of midwives. WHO continued to provide support to all these activities in health manpower development. Projects in Operation Number and Source of Funds - Title SRL CHP 001 Country Health Programming R SRL RPD 001 Research Promotion and Development R SRL SPM 001 National Health Planning R SEA/RC33/2 Page 173 Number and Source of Funds Title SRL SPM 002 Medical Stores Management R SRL SPM 003 Strengthening of Electro-Medical Division R SRL SPM 004 Development of National Health Information Services R SRL PHC 001 Development of Traditional Medicine R SRL WKH 001 Occupational Health and Industrial Hygiene R SRL WKH 002 Epidemiology of Pesticide Toxicology and R Occupational Health (Teaching) SRL ADR 001 Medical Rehabilitation R SRL ATH 001 Strengthening of Laboratory Services R SRL RAD 001 Radiation Health R SRL MCH 001 Family Health FP SRL MCH 002 Strengthening of Hospital-based Family FP Planning Services SRL NUT 001 Public Health Nutrition R SRL HED 001 Health Education R SRL HED 002 Family Health Education FP SRL MNX 001 Mental Health R SRL PHB 001 Quality Control of Biological and R Pharmaceutical Products SEA/RC33/2 Page 174 Number and Source of Funds Title SRL PHB 002 Production of Improved Vaccines R SRL ESD 002 Strengthening of Surveillance and Control R of Communicable Diseases SRL ESD 003 Port Health Services R SRL MF'D 001 Malaria Control R SRL BVM 001 Veterinary Public Health R SRL BVM 002 Bacterial and Virus Diseases VF SRL EPI 001 Expanded Program on Imunization R SRL PBL 001 Prevention of Blindn@ss R SRL VBC 002 Vector Control Phase I1 UNDP SRL CAN 001 Cancer Epidemiology and Research R SRL CVD 001 Cardiovascular Diseases R SRL ORH 001 Oral Health R SRL EHP 001 Undergraduate Training in Public Health R Engineering SRL EHP 002 Institutional Support to the National Water UNDP Supply and Drainage Board SRL BSM 002 Provision of Basic Sanitary Services R SRL FSP 001 Food Hygiene R SEA/RC33/2 Page 175 Number and Source of Funds Title - SRL MPM 001 Development of Health Manpower Planning R and Management SRZ. PTR 001 Medical Education R SRL PTR 002 Nursing Education R SRL PTR 003 Post-graduate Medical Education R SRZ, PTR 004 Development of the National Institute of R Health Services SRL PTR 005 Training of Anaesthesiologists R SRL PTR 007 Teaching of Human Reproduction, Family Planning FP and Population Dynamics to Medical Students SRL HKD 005 Health Manpower Study FP SRL EDS 001 Educational Technology R SRL EDS 002 Strengthening of NursingfMidwifery Education FP SEA/RC33/2 Page 176 11. THAILAND The national policies, strategies and plans of action to achieve health for all have been formulated with wide national participation and active WHO collaboration. A national seminar was organized, followed by the estab- lishment of a working group which completed the necessary documentation. The activities of the Royal Thai Government/WHO Coordinating Committee in programme coordination and review have continued and have attracted the attention of neighbouring countries in the Region. A sub-committee appointed by the Committee closely collaborated in the formulation of proposals for the WHO country programme budget for 1982-1983. Thailand participated in a regional assessment of country health program- ming and hosted an inter-regional workshop on this subject held in Bangkok in June 1979. A case study was completed and presented at the Inter- Regional Seminar at Dubrovnik (Yugoslavia) in November. The Central Information Unit has been considerably strengthened with trained staff. Country programme profiles based on the ISP format have been established in respect of 14 national health programmes. This unit has been developing close working relationships with the Planning Division to improve the information system for management and planning. The Ministry of Public Health completed a mid-term assessment of the Fifth Five-Year Plan, which yielded useful information in the implementation of, and provided guidance in, the preparatory work to formulate the policies and programmes for the next (1982-19116) Plan. Through workshops and practice, management problems were identified, task- oriented educational objectives were formulated, and appropriate competency- based training curricula were developed. All these activities were meant especially for health managers at the provincial and district levels. The National Health Development Institute, with initial funding by WHO, has started field studies in health service management related particularly to primary health care. Although institutional arrangements are yet to be formalized, the Institute is pursuing the development of management guidelines through training workshops. Expansion of the rural health service infrastructure has progressed steadily in 20 provinces with inputs by the IDA population project. Simultaneously, district and health centre laboratories are being set up. The training of village health volunteers and communicators has made progress, and the Health Development Project at Lampang has been further extended to enable terminal evaluation and documentation of the experience and conclusions. The RTG/WH0 Coordinating Committee funded a number of health service research projects chiefly directed at the implementation and evaluation of primary health care operations in rural areas. SEA/RC33/2 Page 177 With the formal approval of primary health care by the Cabinet as official policy, various activities have gathered momentum; an inter-sectoral primary health care committee chaired by the Deputy Minister of Public Health is now fully operational. Tne promotional and developmental efforts through national seminars and workshops attended by cross-sections of officials in health and other sectors have generated considerable awareness of primary heatlh care and the reorientation of developmental activities to support it. Zn support of technical cooperation among developing countries (TCDC) the Government has initiated and conducted bi-regional workshops on primary health care to exchange knowledge and experience on a wider basis. Four country case studies on primary health care were key inputs in the workshops. Practitioners of traditional medicine and senior clinicians (modern medicine) participated in a national seminar at Mahidol University to exchange views and experiences towards harmonizing the systems in support of primary health care. Village health volunteers are being involved in nutrition surveillance. A number of workshops and a multi-sectoral seminar on nutrition have been conducted. The Government has approved the establishment of a training and demonstration centre for oral health at Chiang Mai, and a month-long WHO/DANIDA inter-regional course in dental public health was held. An inter-agency workshop on health education has been held and similar workshops are to be organized to improve coordination of the activities. Community-oriented mental health services are being promoted; the Division of Mental Health has supported the monitoring of mental health needs to establish basic data and inputs in planning and evaluation. An external assessment of the malaria control programme was carried out and the findings and recommendations are receiving the attention of the Government. With the support of US AID, malaria clinics have been estab- lished, training has been strengthened and applied field research is being conducted. An inter-country meeting of research investigators on parasite (P. fazcipama) resistance to drugs (4-aminoquinolines) reviewed the present status of research. Field research in filariasis is continuing at the Faculty of Tropical Medicine, Kahidol University, with WHO staff support. The WHO Collaborating Centre for Research on the Immunopathology of Dengue Haemorrhagic Fever is now engaged in vaccine production. Experiments in the biological control of the vector by larvivorous fish and insecticide is continuing. Physicians and nurses at a provincial hospital have been trained in cornunity ophthalmology. A programme for training ophthalmic assistants to strengthen the outreach of professional ophthalmologists was drawn up with SEA/RC33/2 Page 178 support from WHO, and comprehensive ophthalmic services started operating in five provincial hospitals with trained doctors and nurses. A national meeting was sponsored to review the problem of traffic accidents and formulate a plan of action for the prevention and management of emergencies. The training of health and other concerned personnel and the expansion of rehabilitation facilities at the intermediate and central levels of health care were undertaken. The National Cancer Institute continued its training activities in cancer registration and exfoliative cytology. A consultant in radiotherapy was provided to the Institute during the year. A national workshop formulated a plan of action for cancer control and prevention. Efforts have been made to develop a community-oriented prevention and control programme for cardiovascular diseases. Technical collaboration was provided by WHO in the analysis of epidemiological data already collected on cardiovascular diseases in the country. The United Nations Fund for Drug Abuse Control (UNFDAC) continued to support the treatment centre at Chiang ki; operations research at the Institute of Health Research, Chulalongkorn University, has continued. The provincial health laboratories are being brought under integrated management in the office of the Under-Secretary of State for Public Health. Training programmes for laboratory workers have been included. Some of the health laboratories at regional medical science centres are being upgraded. A national convention of nurses was held to orient professional nurses to the goal of health for all and primary health care; nursing education programmes are being oriented to couununity health. A national conference on medical education was organized by Mahidol University to reorientate medical education to the goal of health for all. Thailand is preparing to contribute to the regional training programe in public health with the Faculty of Public Health as a network facility. The influx of refugees from Kampuchea has resulted in health problems, chiefly acute malnutrition, diarrhoea1 diseases and outbreaks of malaria. WHO has been associated with other international agencies in measures to deal with the problems arising from this influx. Close collaboration was maintained with UNICEF in all health and health- related activities. This was fruitful in the training of provincial health office staff and others in EPI, in the preparation of EPI opera- tional manuals, vaccination cards and record forms, the organization of workshops on primary health care, the training of voluntary health workers and the strengthening of malaria control activities. Cooperation was also extended to the Japanese International Cooperative Agency in carrying out epidemiological surveillance on diarrhoeal diseases in three model areas of SEl?/RC33/2 Page 179 Chantaburi Province, to the Sasakawa Memorial Health Foundation and the Japan Shipbuilding Industry Foundation in promoting and further accelerat- ing national activities in the field of prevention of blindness, and close collaboration was maintained with US AID in malaria control. The Regional Office also assisted in the review of the curriculum of the joint Asian and Pacific Development Institute/Royal Tropical Institute (Netherlands) course on health planning to make it more relevant to the needs of the Member countries. Projects in Operation Number and Source of Funds Title - THA CHP 001 Country Health Programming R THA RPD 001 Research Studies on Mansonia Mosquitoes VF THA SPM 001 Planning, Management and Information Systems Development R THA SPM 002 National Centre for Development of Health Planning and R Management THA HSD 001 Urban Health Care Development R THA PHC 001 Development of Primary Health Care R/VF THA WKH 001 Development of Occupational Health R THA ATH 001 Development of Health Laboratories R THA LAB 001 Strengthening of Laboratory Technology R THA HSR 001 Development of Health Services Research R THA MCH 003 Fellowships in Family Planning and Related Fields FP THA MCH 004 Expansion of Family Planning Services and Support of FP Infrastructure of the National Family Planning Programme SEA/RC33/2 Page 180 Number and Source of Funds THA MCH 005 FP THA NUT 003 R THA HED 001 R THA MNH 001 R THA PHB 001 R THA ESD 003 R THA MPD 001 R m MPD 002 R THA EPI 001 R THA CAN 001 R THA CVD 001 R THA ORH 002 R THA EHP 001 R/UNDP THA BSM 002 R/UNDP THA FSP 001 R THA MPM 001 R Title - Field Trials on New Patterns of Family Planning Services Nutrition Training and Studies, Food Marketing and Distribution Development of Health Education Mental Health Development of Vaccine Production Development of Epidemiological Surveillance Malaria and Vector Control Filariasis Control Development of Expanded Programme on Immunization Development of Cancer Control Development of Cardiovascular Diseases Control Development of a training and demonstration centre for oral health Environmental Health Community Water Supply and Sanitation Development of Food Control Development of Health Manpower Planning and Management SEA/RC33/2 Page 181 Number and Source of Funds THA PTR 001 R THA PTR 002 7 THA HMD 003 R THA HMD 004 R THA HMD 011 R THA EDS 001 R THA HST 001 R Title - Promotion of Training Training and Follow-up Support of Peripheral and Primary Health Care Workers Faculty of Public Health Medical Education and Training Health Manpower Development Curricula and Faculty Development Development of National Health Information System SEA/RC33/2 Page 182 12. INTER-COUNTRY Number and Source of Funds ICP CHP 001 R ICP cwo 002 R ICP cwo 100 FP ICP RPD 001 R ICP RPD 002 RIVF ICP RPD 100 R ICP DGP 002 R ICP PPS 100 R ICP SPM 001 R ICP SPM 002 R ICP SPM 003 UNDP ICP PHC 002 R ICP PHC 004 R ICP ADR 001 R ICP ATH 001 R Projects in Opetation Title - Improvement of National Health Planning through Country Health Programming Liaison with ESCAP Coordination with other Organizations Biomedical Research Collaboration in Biomedical and Health Services Research Research Promotion and Development Urgent and Unpredictable Health Problems Health Services Development - Programme Planning and General Activities Health Research and Development National Health Information Systems Development Strengthening of Health Services Administration through Training in Planning Organization and Administration of Primary Health Care Traditional Medicine Care of the Aged, Disability Prevention and Medical Rehabilitation Standardization of Diagnostic Material and Laboratory Practices SEA/IPW3/2 Page 183 Title ICP ATH 002 R ICP MCH 003 R ICP MCH 011 FP ICP MCH 013 R ICP MCH 100 R ICP NUT 002 R ICP NUT 005 R ICP NUT 100 R ICP HRP 100 VF ICP HED 003 FP ICP HED 004 R/UNDP ICP HED 005 R ICP HED 100 R ICP MNH 003 R ICP MNH 100 R ICP DPM 001 R Development of Appropriate Technology for Health in Relation to Primary Health Care Education and Studies in MCH Regional Team on Family Health Promotion of Family Health (including Nutrition) Maternal and Child Health Nutrition Teaching in Education Institutions for Health Personnel Nutrition in Primary Health Care Nutrition Regional Research Adviser Development of Health Education in Family Health Programe Study Tour on Health Education in the USSR Workshops and Seminars in Health Education Health Education Regional Meetings on Mental Health Mental Health Development of Drug Policy in Relation to Primary Health Care SEA/RC33/2 Page 184 Number and Source of Funds ICP PPC 100 R ICP ESD 001 R ICP ESD 005 R ICP ESD 100 R ICP MPD 001 R ICP MPD 002 VF ICP MPD 003 R ICP MPD 004 UNDP ICP MPD 100 R ICP BVM 001 R/VF ICP BVM 002 R ICP BVM 003 VF ICP BVM 004 VF ICP BVD 004 R ICP SPI 003 R ICP EPI 001 R Title - Communicable Disease Prevention and Control - Programme Planning and General Activities Dengue Haemorrhagic Fever Surveillance and Control Strengthening of Epidemiological Surveillance System Epidemiological Surveillance Advisory Services in Malaria Control and Coordination of Anti-malaria Activities in the Region External Cross-checking of Blood Films Meetings on Anti-malaria Operations Regional Manpower Development Programme in Malaria Malaria and Other Parasitic Diseases Prevention and Control of Diarrhoea1 Diseases of Children Inter-country Training Activities for Sexually-Transmitted Diseases Control Leprosy Control Training in Veterinary Public Health Prevention and Control of Japanese Encephalitis Expanded Programme on Immunization Development of Expanded Programme on Immunization SEA/RC33/2 Page 185 Number and Source of Funds ICP EPI 002 UNDP ICP TDR 100 VF ICP PBL 001 R/VF ICP PBL 002 R/VF ICP PBL 003 UNDP ICP VBC 100 R ICP PPN 100 R ICP CM 001 R ICP ORH 001 R ICP OND 001 R ICP IMM 001 R ICP PPE 100 R ICP EHP 001 R ICP Em 002 VF ICP BSM 001 R Title - Strengthening of Expanded Programme on Immunization Strengthening of Biomedical Research Capability Prevention of Blindness and Visual Impairment Prevention of Blindness Control and Prevention of Blindness and Visual Impairment - Preparatory Assistance Vector Biology and Control Non-Communicable Disease Prevention and Control - Programme Planning and General Activities Cardiovascular Diseases Regional Oral Health Training Programme Other Non-Comunicable Diseases Training in Immunology Promotion of Environmental Health - Programme Planning and General Activities Sector Development in Environmental Health Building up of Information Services in Environmental Health in South-East Asia Community Water Supply and Sanitation ICP RCE 001 R Environmental Pollution Control SEAIRC3312 Page 186 Number and Source of Funds ICP PPM 100 R ICP PTR 001 R ICP PTR 002 R ICP PTR 003 R ICP PTR 004 R ICP EDS 001 R ICP HST 100 R ICP HLT 001 R Title Health Manpower Development - Programme Planning and General Activities Education and Training in Community Health Development of National Post-graduate Training Centres Continuing Education for Health Workers Training of Health Personnel (including Community Health Workers) for Primary Health Care Educational Technology Health Information - Development of Health Statistical Services Health Literature, Library and Information Services SEA/RC33/2 Page 187 13. INTER-REGIONAL ACTIVITIES OUTSIDE THE REGION WITH PARTICIPANTSFROM THE SOUTH-EAST ASIA REGION (1 May 1979 - 30 April 1980) Project No. and Source of Funds Title Number of Participants IRlIW MCH 0371 Inter-Regional Course in Fertility 3 (1 from Burma, ~~/80.32.05 Management in MCH Care (Singapore, 1 from India & 21 April - 31 May 1980) 1 from Sri Lanka) SElICP HED 0041 UNDPlWHO Study Tour in Health 12 (1 from Bangladesh, KB. 79 Education in the USSR (22 May - 1 from Burma, 22 June 1979) 3 from India, 2 from Indonesia, 1 from Mongolia, 1 from Nepal, 1 from Sri Lanka & 2 from Thailand) SE/ICP HSD 001/ Chinese National Symposium and WHO 2 (1 from Burma & RB.79 IR Seminar on Acupuncture, Moxi- 1 from Sri ~anka) bustion and Acupunture Anaesthesia in Health Care (Peking, 31 May - 15 June 1979) IRIIW MCH 0321 MCH/FP Inter-Regional Study Tour for 3 (1 from Bangladesh, FP/79 China (1-21 August 1979) 1 from Burma & 1 from India) IR/IRP HMD 0031 Inter-Regional Course in Fertility 6 (2 from Bangladesh, FP.79 Management and MCH Care (Singapore, 1 from Burma, 3 September - 13 October 1979) 1 from India, 1 from Sri Lanka & 1 from Thailand) Country Workshop on Planning and Organization 2 (1 from Burma & Allotments of MCH Care, Sofia (Bulgaria, 1 from Nepal) 13 September - 3 October 1979) Country Second Travelling Seminar in the 4 (1 from Burma, Allotments USSR on the Safe Use of Psychotropic 1 from India, and Narcotic Substances (1-12 October 1 from Mongolia & 1979) 1 from Thailand) SEAR0 Country Course on Planning, Organization and 4 (2 from Burma, Allotment and HQ Management of Health Care Delivery 1 from India & Allotments in support of Primary Health Care - 1 from Sri Lanka) People's Republic of Bulgaria, (10 October - 1 November 1979) IRIIRP MNH 0301 Training Course on Treatment and 12 (6 from Burma, FD/79/810 (SEAR/ Rehabilitation of Drug-dependent 1 from India, Country Allotment Persons, Hong Kong (30 October - 1 from Indonesia 6 for IN01 28 November 1979) 4 from Thailand) ANNEXES ORGANIZATIONAL STRUCTURE REGIONAL DIRECTOR c ............................. ........................ WHO PRCGRAFME DIRECTOR. COORDINATORS PROGWE MANAGEMENT I I I I DIRECTOR, DIRECTOR, DIRECTOR, - - - - - _ - - _ -- - HEALTH MANPOWER DEVELOPHENT OF 1 1 DEV::Z!ENT DISEASE CONTROL I CCElPREHENSIVE AN0 PREVENTION I HEALTH SERVICES I (DCH) (DDC) I I HEALTH LITERATURE I I-_--__ SERVICES h LIBRARY CHIEF, PLANNING I h COOROINATION I FELLOWSHIPS I I I-------' ,---------_-- J DIRECTOR, I I MEDICAL SUPPLIES I P=J ; I I 1 I I I /_--_ _--- _--- I I ZZi? I 2"' FIELD PROGRAMME __--__--_--__----~ m 4- 0 wm" -" . M I REGIONAL ADVISERS Comnunicable Diseases Medical Research Comnuni ty Health Services Mental Health Expanded Programne on Maternal and Child Health Irmunization (Family Health) Health Education Non-Comnunicable Diseases Health Laboratory Services Nursing Health Statistics Nutrition Health Manpower Development Organization of Medical Care Malaria SU/RC33/2 Page 190 Annex 2 GEOGRAPEICAL DISTRIBUTION OF INTBRNATIONAL STAFF ASSIGNED TO THE SOUTH-EAST ASIA REGION AS OF 31 MAY 1980 I South-Eaet hia Region I Country Australia BangZaaO8h Belgium Bulgaria Bunna Canada Colombia Cyprus Egypt France Germany, Federal Republic of Ghana India Indoneeia Iran Italy Japan Liberia Malaysia Malta MOngoZia Nepal. philippines Poland Republic of Korea sri LQnkJl Sweden Switzerland Tanzania Thaiw Union of Soviet Socialist Republice United Kingdom United States of America Yugoslavia Other countrier Grand Total I Total Office including WPCe & Reg. Advisers WllO (Global) I Total -- Not inoluded: Staff on Zwe vithout pcry SEAlRC3312 Page 191 Annex 3 DISTRIBUTIOl bF SHORT-TERM CONSULTANTS BY NATIONALITY 1 JlJNE 1979 - 31 MAY 1980 Nationality Australia Bang 2adesh Belgium Bulgaria Burma Canada Czechoslovakia Democratic PeopZe's Republic of Korsa Denmark Egypt France Germany, Federal Republic of Germany, Democratic Republic of India Indonesia Iran Ireland Israel Italy Japan Malaysia MaZdives Mongo Zia Nepal Netherlands Philippines Poland Singapore Spain Sri Lanka Sudan Sweden Switzerland Thai land Union of Soviet Socialist RepubUCs United Kingdom United States of America Yugoslavia Number of STCe Recruited 7 7 1 1 8 4 sEA/~C33/2 Page 192 Annex 4 MEETINGS AND COURSES ORGANIZED OR ASSISTED BY WHO AND HELD IN THE SOUTH-EAST ASIA REGION (1 JULY 1979 - 30 JUNE 1980) 19 79 - 2-6 July Consultation on Research Programme on Financing of Health Care Delivery (ICP RPD 002) New Delhi 9-13 July Meeting on the Financing of Primary Health Care Programmes in Asia New Delhi 16-20 July Annual Practitioner Preceptor Training Programme (THA HMD 003) Bang Sen (Thailand) Bangkok 16 July - 4 August Inter-regional Training Course on EPI Planning and Management (ICP SPI 002) 17-21 July National Seminar on Teaching of Human Reproduction, Family Planning and Population Dynamics (SRL HMD 007) Peradeniya (Sri Lanka) Dacca 23 July - 17 August Clinical Teaching in Nursing (ICP HMD 011) 25-27 July Workshop I1 on Food and Nutrition for Multi- sectoral Officers (nutritionists, scientists and physicians) (THA NUT 003) Kanjanaburi (Thailand) 30 July - 4 August Workshop on Low-cost Material Production and Use of Audio-visual Equipment for Health Educators and Faculties in Training Institutions (SRL HED 002) Colombo Country Course in Health Planning and Management (ICP PPS 002) Colombo 30 July - 9 August Training Course for Medical Officers of Referral Institutions in Leprosy Control (BAN BVD 001) Dacca July 6-8 August Follow-up Workshop on Educational Science (BUR PHC 001) Rangoon 6-10 August Inter-contry Seminar on Prevention and Control of Accidents (ICP HSD 003) New Delhi 6-10 August National Seminar on Drug Dependence, Treatment and Rehabilitation (IRP MNH 018) Cholburi (Thailand) Bangkok 6-18 August Inter-country Cold Chain Training Course for Logistical Cadre (ICP SPI 002) 12-25 August Second National Workshop on Educational Science for Teachers of Health Personnel for Primary Health Care (BUR PHC 001) Rangoon Curriculum Workshop, National Institute of Health Sciences (SRL PTR 004) Kalutara (Sri Lanka) 14-15 August ConsultationonCoordinated Health Services and Manpower Development (ICP HMD 006) New Delhi 20-24 August Short Course on Evaluation of Student Performance (ICP HMD 011) Bangalore 20-31 August SEA/RC33/2 Page 193 Annex 4 Medical Education Conference (IND HMD 014) New Delhi Kathmandu 25-28 August 26 August - 7 September EPI Seminar for Senior Supervisors and Refresher Training for District and Assistant Supervisors (ICP SPI 003) 27-30 August National Medical and Health Education Conference (IND HMD 014) New Delhi 27-31 August Consultative Meeting for the Establishment of a Regional Network of Health Literature, Library and Information Services (ICP HLT 001) New Delhi National Seminar on Post-graduate Training in Mental Health (IND MNH 002) Bangalore August- September Seminar on Neuro-Oncology (IND MNH 002) Bangalore August- September National Seminar for Clinical Psychologists (IND MNH 002) Inter-country Course on DPT Vaccine (ICP LAB 004) Clinical Teaching in Nursing (ICP HMD 011) Bangalore August- September 3-15 September 3-28 September Jakarta Bangladesh 19-28 September Sixth National Course on Educational Science for Teachers of Health Professionals (IND HMD 014) Pondicherry (India) 24-28 September Workshop on Health Economics and Management Planning (IND PPS 001) New Delhi 26-29 September Conference on Regional Cooperation in the New Delhi Implementation of the WHO kellowships Programme (ICP HMD 013) Research Study Group Meeting on Nutrition in Primary Health Care (ICP RPD 001) New Delhi 3-8 October Course on Operating Theatre Techniques and Management (BAN EDS 001) 4-27 October Dacca 8-9 October EPI Refresher Workshop in Phase I Areas in Colombo (ICP SPI 003) Colombo 8-12 October Regional Seminar on Environmental Impact Assessment (ICP CEP 002) New Delhi 8-12 October 8-13 October Workshop on Neonatology (IND MCH 003) New Delhi Meeting of Research Workers in Regional Collabora- tive Studies on P.faLcipm Resistance to 4-aminoquinolines (ICP RPD 002) Chiang Mai (Thailand) 11-14 October Second International Workshop on Leprosy Control in Asia (ICP BVD 001) Kathmandu 15-19 October Inter-country Seminar on Prevention and Control of Pulmonary Hypertension (ICP CVD 001) New Delhi 15 October (for 36 days) Workshop on the Immunochemistry of Parasitic Diseases (IND ESD 001) New Delhi SEA/RC33/2 Page 194 Annex 4 New Delhi 22-26 October Consultation on the Development of a Regional Teacher Training Programme in Maternal and Child Health (ICP MCH 013) 22-27 October National Mental Health Workshop No. 1 for Senior Medical Administrators (BAN MNH 001) Dacca 22 October- 2 November Regional Training Course on Water Quality Monitoring (ICP CEP 004) Nagpur (India) 22 October- 21 November Health Planning and Management Course (ICP PPS OOZIIND PPS 001) Shillong (India) 24 October- 9 November Workshop on the Epidemiology and Control of Leprosy (IND BVD 001) Calcutta 25-29 October Workshop on Neonatology (IND MCH 003) Trivandrua (India) New Delhi October Country Course in Health Planning and Health Systems and Management (ICP PPS 002) 1-30 November Workshop on Nursing Development (IND HMD 013) Pondicherry (India) 3-30 November 5-9 November Second Workshop on Medical Mycology (IND ESD 001) New Delhi Seminar on the Role of Education and Communication in Primary Health Care for Integrated Rural Develop- ment (IRP HED 002) Kanchanburi (Thailand) 5-10 November 5-17 November 7-9 November 8-11 November 9-22 November WHO Inter-Regional Workshop I1 on Prevention and Treatment of Drug Dependence (IRP MNH 018) Bangkok Course on Operating Theatre Techniques and Management (BAN ESD 001) Chittagong (Banglade&) New Delhi WHO Regional Meeting on Management of the Expanded Programme on Immunization (ICP SPI 002) Workshop on Urban Health Administration Planning and Supervision (TEA HSD 001) Bangkok National Mental Health Workshop No. 2 for Junior Medical Officers, Nurse Tutors and Teachers of Medical Assistants (BAN MNH 001) Dacca Inter-country Seminar for Planning of National and Regional Programme for Surveillance, Prevention and Control of Zoonoses (ICP VPH 001) New Delhi 12-16 November New Delhi Meeting of the Global Advisory Group, Expanded Programme on Immunization (IRP SPI 024) 12-16 November 12-16 November Chiang Ma1 hailan and) WHO Workshop on Epidemiological and Intervention Programme for Rural Opium-using Populations (IRP MNH 018) New Delhi National Seminar on Mental Health (Identification, Treatment and Community-oriented Mental Health Services, particularly with reference to the Mentally Retarded Child) (IND MNH 002) 12-17 November SEAlRC3312 Page 195 Annu 4 > 12-17 November Meeting on Delivery of Child Care to Pre-school Children in the Context of Primary Health Care (ICP MCH 003) Bangkok 12-30 November Workshop on Teaching Methodology (BAN HMD 003) Dacca Indonesia 12 November- 1 December National Training Courses on International Classification of Diseases (3 courses - each of 6 days' duration) (ICP HSD 007) 13-15 November MNHIHQ Project Meeting of Investigators in the Study of Psychotropic Drug Effects in Different Populations Bombay 17 November National Meeting of Principal Investigators of the Measles Immunization Feasibility Study (ICP SPI 003) New Delhi 18-20 November Workshop on Leprosy Control (NEP BVD 001) Biratnagar (Nepal) 19-23 November Meeting of the Bi-Regional Research Study Group on Bancroftian Filariasis (ICP RPD 001) New Delhi 19 November- 1 December Inter country Training Course for Instructors of Mid-level Personnel for EPI (ICP SPI 002) Bangalore 19 November- 6 December Workshop on Quality Control of Vaccine Kasauli (India) 20-22 November National Workshop on Research and Development Needs for Drinking Water Supply and Sanitation Decade (IND SES 001) Nagpur (Indta) 20-24 November National Workshop on Family HealthIBetter Family Living through Communication and Education for Integrated Rural Development (IRP HED 002) Dacca 21-23 November Inter-regional Meeting on the Community Control of Rheumatic Fever and Rheumatic Heart Diseases (ICP CVD 001) New Delhi 26-28 November Regional Consultation on Activities for the International Drinking Water Supply and Sanitation Decade (1981-1990) (ICP BSM 001) New Delhi 26-28 November National Seminar on the Role of Health Sector in Nutrition Activities (BAN NUT 002) Mohakhali (Bangladesh) Bangkok 26-29 November Workshop on Health Administration and Planning (THA HSD 001) 26-30 November Seminar on Histopathological Diagnosis of Tumours (ICY CAN 001) Bangkok 26 November- 15 December Training Course in Microbiology Dacca 28-30 November Meeting on Development of Health Services Research (ICP RPD 002) New Delhi SEA/RC33/2 Page 196 Annex 4 November Training Course for Family Welfare Workers in Leprosy Control (BAN BVD 001) All Thana HQs in Bangladesh November National Workshop on Mental Health (MOG OCD 001) Ulan Bator November 1979- January 1980 Three-month Certificate Course in Health Education (SRL HED 002) Colombo 1-6 December Joint UNICEFIWHO Regional Meeting on Formulation of Strategies for Health for All bv the Year 2000 New Delhi with primary Health Care as the KG Approach (ICP PHC 002) 3-13 December 3-27 December Seminar on Anti-Malaria Operations with Special Reference to Applied Field Research (ICP RPD 002) Bangkok Training in the Coding of Data according to the International Classification of Diseases (THA PPS 001) Thailand 4-8 December National Seminar on Appropriate Educational Technology for the Training of Comunity-oriented Health Personnel (ICP HMD 013) Bangkok 9-13 December National Mental Health Teaching Seminar on Traditional Healing (IN0 MNH 001) Jakarta 10-15 December Workshop to Review Curricula for Country Course in Cornunity Health Care Management (ICP PPS 002) Kalutara (Sri Lanka) 11-14 December National Seminar of Heads of the Health Education Department (THA HED 001) Karnj anaburi (Thailand) 11- 20 December 12-13 December Course in Clinical Pharmacology Indonesia Training in Epidemiological Surveillance (IN0 ESD 003) Jakarta Workshop on Nursing Development (IND HMD 013) 17-24 December 17-19 December New Delhi New Delhi Meeting of the Ad hoc Committee for Review of the rift of a Handbook on Child Health Care (IND MCH 003) 18-23 December Inter-country Consultation to Develop a Regional Programe on Diarrhoea1 Diseases Services and Research (ICP RPD 002) Rangoon 20-21 December National Meeting of EPI Officers on Progress of New Delhi EPI in their respective States and Municipalities (IND SPI 001) 20-22 December Workshop on the Improvement and Development of the National Health Systems and the role of Primary Health Care for Long-Term Objectives in the Henlth Sector (IN0 SPM 001) Jakarta Colombo Workshop on Integration of Mental Health Concepts in the Curriculum for Nuraes (SRL PTR 002) SEA/RC33/2 Page 197 Annex 4 27-28 December Seminar on Industrial Estate Planning (IND CEP 006) Jaipur (India) 27 December 1979- 5 January 1980 Workshop on Orientation of Teaching and Implemen- tation of the Midwifery Programme for Matrons, Ward Sisters and Staff Nurses (SRL PTR 002) Colombo Regional Meeting on Immunization (ICP SPI 003) December December Jakarta Rangoon Training Course on Immu~fluorescence Techniques (BUR HMD 005) Research Development Workshop (THA HMD 003) Bangkok December December (2 days) Training Course on Nutrition Surveillance (THA NUT 003) Suphanburi (Thailand) 26 November- 7 December 1979 Inter-country Course in Clinical Bacteriology Dacca 18-21 December Meeting of Directors of Medical Research Councils and Analogous Bodies Colombo 1980 - 14-25 January Seminar on the Promotion of Mental Health in Nursing Practice (ICP PTR 003) Thailand 16 January Workshop-cum-Consultation Meeting to Review Health Education Curriculum for Medical Undergraduates (SRL HED 001) Colombo New Pelhi 30 January- 6 February Inter-country Consultative Meeting on Country Health Programning and Use of TCDC in Health Planning and Management (ICP PPS 002) 4-15 February 19-22 February Seminar on the Promotion of Mental Health in Nursing Practice (ICP PTR 003) Thailand BangLr.k National Seminar on Prevention and Control of Cardiovascular Diseases (THA CVD 001) 26-29 February National Conference on Status of Health Education Services in India (IND HED 005) New Delhi 3-15 March Inter-country Training Course for Training of Mid- Level Management Personnel in EPI (ICP EPI 001) 10-14 March Meeting on Research in Viral Haemorrhagic Fevers of the Eastern Mediterranean, South-East Asian and Western Pacific Regions New Delhi 10-15 March Second National and Regional Conference on Drug Abuse (IND MNH 002) New Delhi 17-19 March National Seminar on Programme to train Ophthalmic Health Care Manpower Development in Sri Lanka (SRL PBL 001) Sri Lanka 17-21 March National Workshop on Mental Health (THA MNH 001) Chiang Mai (Thailand) SEA/RC33/2 Page 198 Annex 4 24-28 March Short Course on the Integration of Mental Health Nursing Principles in Basic Nursing (ICP PTR 003) Indonesia 1-4 April SF+. Regional Advisory Committee on Medical Research: Sixth Session New Delhi 14-18 April Short Course on Community Mental Health Nursing (IND EDS 003) New Oelhi 14-26 April Inter-country Training Course for Instructors for the Training of Mid-Level Management Personnel in EPI (ICP EPI 001) Calcutta 21-29 April 28-29 April Short Course in Neuro Nursing (IND EDS 003) Bangalore New Delhi Inter-personal Skills and Effective Nurse-Patient Relationships (IND EDS 003) 28 April - 2 May Joint ICMR/WHO Scientific Group Meeting on Vaccine Against Tuberculosis New Delhi 21-25 April National MCH Workshop for State-level MCH Officers (IND MCH 003) New Delhi 2-7 June Inter-country Consultative Meeting on Leprosy Research and Control (ICP RPO 002) New Delhi 9-13 June Bi-Regional Workshop on Developing Primary Health Care System (ICP PHC 002) Chiang Mai (Thailand) 10-17 June Training Course for Technicians involved in Vector Control (ICP MPD 001) New Delhi & Bombay 24-30 June Follow-up Meeting on Health for A11/2000 with special emphasis to Community Participation/ Multi-sectoral Approach in PHC (ICP PHC 002) New Delhi National Meeting on Health Legislation Indonesia June June-August Travelling Seminar for Health Education Faculty of Universities offering Post-graduate Training in Health Education - 6 weeks (ICP HED 003) Several countries Course for Providing Administrative Training to Middle-level Workers at the Divisional Level (ICP SPM 003) Sri Lanka June SEA/RC33/2 Page 199 Annex 5 CONFERENCES AND MEETINGS IN THE SOUTH-EAST ASIA REGION CALLED BY GOVERNMENTS/OTHER ORGANIZATIONS AT WHICH WHO WAS REPRESENTED (1 July 1979 - 30 June 1980) 1979 - 2-6 July FAO: Firat Session of the Governing Council of the Centre on Integrated Rural Development for Asia and the Pacific Bangkok 3-6 July ESCAP: Round Table Meeting on Participation of Women and Their Emancipation Through the Application of Science and Technology to Development Bangalore (India) 16-21 July FAO: Third Session of the Regional Animal Production and Health Commission for Asia, the Far East and the South-Weat Pacific Bangkok 31 July - 6 August ESCAP: Expert Working Group Meeting on Water-use Data Bangkok 3-4 August Government of India: Seminar on Drinking Water Resources Management in Rajasthan Jaipur (India) Delhi 3-5 Auguat Government of India: All-India Malaria and Filaria Workers' Conference 7-11 August Government of Thailand: National Seminar on Drug Dependence Pattaya (Thailand), New Delhi' 16-17 Auguat Government of India: National Committee on Zoonoaes: Second Meeting 20 August Indian Association for Radiation Protection: Workshop on Biological Hazards of Microwaves and Protection Aspects New Delhi 22 Auguat Government of India: Fourth Meeting of the Central Co-ordination Committee on Prevention of Visual Impairment and Control of Blindness New Delhi 22-24 Auguat United Nations Asian and Pacific Development Institute: Consultative Meeting on Monitoring and Evaluation of Comunity-focused Projects Bangkok 28 August - 1 Septdmber 4-7 September UNFPA: International Conference of Parliamentarians on Population and Development Colombo Bangkok Bangkok Bangkok Bangkok ESCAP: Inter-governmental Meeting on Human Settlements ESCAP: Inter-governmental (Ad hoc) Meeting on Strategies for the Eighties 10-14 September 17-28 September ESCAP: Meeting on Population Information Clearing House and Network System Expert Group 3-4 October Government of ThailandIILO: Symposium on the Working Child SEAlR~3312 Page 200 Annex 5 7 October Association of Obstetricians 6 Gynaecologists of India: Third Annual Conference of Obstetricians and Gynaecologists New Delhi 11-14 October Government of NepalISasakawa Memorial Health Foundation/WHO: Second International Seminar on Leprosy Control in Asia Kathmandu 12 October ESCAP: Inter-agency Committee Meeting on Water Development Bangkok Dacca Bangkok e Bangkok 16-18 October Government of Bangladesh: National Seminar on Health Laboratory Services 22-23 October ESCAP: Preparatory Meeting of Senior Officials for I11 General Conference of UNIDO 29 October - 2 November Government of Thailand: Fourth National Conference on Medical Education "Medical Education Towards Health for A11 by the Year 2000" 30 October - 5 November ESCAP: Sixth Session of the Committee on National Resources Bangkok New Delhi 5-9 November ESCAP: Regional Preparatory Conference for the World Conference of the United Nations Decade for Women 12-16 November UNESCO: Committee of Experts to Define the Outline of a Preliminary Draft Convention on the Recognition of Studies, Diplomas and Degrees in Higher Education in Asia and Oceania Bangkok 18-20 November Government of IndiaIWHO: Workshop on Research and Development for the IDWSS Decade Nagpur (India) Bangkok 19-23 November Association of Paediatric Societies of the South- East Asia Region: Third Asian Congress of Paediatrics 20 November Indian Council of Medical Research: Task Force Meeting on Rheumatic Heart Diseases New Delhi Jakarta 26-27 November Association of South-East Asian Nations: Meeting on Technical Co-operation Among the ASEAN Countries on Drug Legislation, Evaluation and Quality Assurances 27 November - 4 December ESCAP: Twenty-second Session of the Committee on Trade Bangkok Bangkok New Delhi Bangkok Bangkok Bangkok 28 November - 4 December South-East Asia Medical Information Centre: Seminar on Diarrhoea1 Diseases 4 December IAEA: Twenty-third Regular Session of the General Conference 4 December ESCAP: Sixth Meeting of Inter-agency Task Force on LMCSTD FAOIDANIDA: Workshop on Water-lifting Devices in Asia and the Near East 4-14 December 12-14 December FAO: Workshop on Monitoring & Evaluation SEA/RC33/2 Page 201 Annex 5 17-19 January Government of India: XIX Annual Conference of the Indian Association for the Advancement of Medical Education Trivandrum (India) Institute of Post-graduate Medical Education and Research, Calcutta: International Symposium - Hundred Years of Malaria Research Calcutta 17-19 January 21 January - 8 February United Nations Industrial Development Organization: I11 General Conference New Delhi Cox's Bazaar (Bangladesh) New Delhi 26-27 January Bangladesh Association for Voluntary Sterilization: First Annual Medical Workshop 27-29 January Commonwealth Medical Association: Regional Academic Seminar on Preventive Paediatrics in Developing Countries Bangkok 28 January - 1 February FAO: Inter-governmental Meeting on Agriculture Towards 2000 4-8 February International Centre for Diarrhoea1 Diseases Research: Board of Trustees Meeting Dacca 5-7 February Government of India: National Seminar on Health Science Libraries in India Bangalore (India) Jakarta 6-12 February South-East Asia Medical Information Centre: Seventh Workehop on Information on Functions of Health Centre in Primary Health Care in the Context of Its Implementation New rielhi New Delhi New Delhi 11-12 February 12-13 February 18 February 18 February Government of India: National Meeting on Health for All by the Year 2000 Indian Council of Medical Research: Meeting of Scientific Advisory Codttee on Cancer Research Centre for Development of Instructional Technology: ISIS User Seminar World BankIUNDP: International Seminar on Low-Cost Techniques for Disposal of Human Wastes in Urban Communities Calcutta 21-25 February 25-29 February World Federation of Associations of Paediatric Surgeons: World Congress of Paediatric Surgery Bombay New Delhi ESCAP: Consultative Meeting on Priorities and Operational Modes of the Regional Exchange Programmes in Social Welfare and Social Development ESCAP: Meeting of Task Force on Integrated Rural Development Bangkok 25 February 4-8 March 5-13 March UNESCO: Sub-Regional Consultation for Identifying Training Needs in the Least Developed Asian Countries Kathmandu New Delhi FAO: Fifteenth Regional Conference for Asia and the Pacific SEA/RC33/2 Page 202 Annex 5 17-28 March Government of IndialUNESCO: Seminar on Improvement of Housing for the Lowest Income Families in Asia New Delhi 18-20 March Free Church, New Delhi: National Counselling Conference on Indian Family Life Education New Delhi 18-27 March 25-26 March ESCAP: Thirty-sixth Session Bangkok New Delhi Government of India: National Committee on Zoonoses: Third Meeting 31 March - 3 April World Federation of Medical Education: Planning Committee on Inter-regional Invitational Conference on Education and Health Care, 1981 New Delhi 9-14 April UNESCO: Inter-governmental Advisory Committee on Regional Cooperation in Education in Rsia and the Oceania Bangkok 21-23 April Indian Council of Medical Research: Symposium on Evaluation of Primary Health Care Programmes New Delhi Jakarta 21-29 April UNDPIUNIDO: Inter-governmental Meeting on the Production and Control of Pesticides in Asia and the Far East 6-9 May UNESCO: Meeting of Experts from South-East Asia on Follow-up of UNCTAD Recommendation for Develop- ment of National and Regional Programme and Projects in Science and Technology Colombo 8-12 May 22-24 May 26-28 May World Tourism Organization: Integrated Planning for Development of Tourism Colombo Government of IndiaIWHO: Conference of State Chief Public Health Engineers on IDWSS Decade Ootacamund (India) Government of Indonesia: Symposium on Smoking and Health Jakarta SEA/RC33/2 Page 203 Annex b LIST OF TECHNICAL REPORTS ISSUED BY THE REGIONAL OFFICE (1 July 1979 - 31 May 1980) r Document SEA/Accidentsll SEAIACMRl5 SEA/ACHR/6 SEAICancerl36 SEAICancerl37 SEA/Cancer/ 38 SEAlCancer139 SEA/CVD/~~ SEA/CVD/26 Title Accidents Report on the proceedings of a seminar on prevention and control of accidents, New Delhi (ICP HSD 003), 6-10 August 1979 Advisory Committee on Medical Research Regional Advisory Committee on Medical Research - Report to the Regional Director on the fifth session, Pattaya, Thailand (ICP RPD 001), 2-5 April 1979 Regional Advisory Committee on Hedical Research - Report on the sixth seesion, New Delhi, 1-4 April 1980 Cancer Assignment report on cancer control and research in India (preparatory assistance) (IND CAN 007). 18 June - 15 July 1979 Assignment report on cancer control in Indonesia (IN0 CAN 001), 3 September - 15 October 1979 Assignment report on prevention and control of cancer, Thailand (THA CAN 001), 8 October - 21 December 1979 Assignment report on cancer prevention and control in Bangladesh (BAN CAN 001), 29 November 1979 - 16 January 1980 Cardiovascular Disebsea Assignment report on cardiovascular diseases prevention and control activities, Bangladesh (BAN CVD 001), 4-24 November 1979 Report of an inter-country seminar on prevention and control of pulmonary hypertension, New Delhi (ICP CM 001), 15-19 October 1979 Author Regional Office Regional Office Regional Office Dr Alton 1.Sutnick Dr Yuri L. Puchkov Prof. Folke Edsmyr Dr John A. Pinkston Dr Henry T. Lynch Dr Jiri Hurych Regional Office SEA/RC33/2 Page 204 Annex 6 Document SEAlCVDl27 SEAlCholeral31 SEA/CD/78 SEAlCDl79 and Corr.1 SEA/CD/80 SEAlCDl81 SEAICholeral31 SEA/Epid/91 SEAIDDIB SEA/DD/9 sFA/~rugs/30 Title Aaaignment report on cardiovrmcular , diseamea in the Democratic People'a Republic of Korea (KRD CVD 001), 9 October - 13 Novembar 1979 Cholmra Sea SEAICDl81 Comunicable Dimurea Report on an inter-regionel meting on Japanese encephalitis, New Delhi (ICP BVD 004). 19-24 March 1979 WHO technical guideline8 on Japaneae encephalitis (formulated at an inter- regional meeting on Japanese encephalitis held in New Delhi (ICP BVD 004), 19-24 March 1979 Assignment report on research in the ecology of communicable dimeaaea in Indone~ia (IN0 ESD 002), 1 February 1976- 31 October 1979 Assignment report on the epidemiology, surveillance and control of cholera in Indonesia (ICP BVD 001). 15 July - 21 September 1979 Diarrhoea1 Diseaaem Report on a WHO inter-country consulta- tion to develop a regionel ptograme on diarrhoea1 diseases services and research, New Delhi (ICP RPD 002), 18-23 June 1979 Assignment report on the prevention and control of diarrhoea1 dimeases of children in India (ICP BVD 001). 8 November - 12 December 1979 Assignment report on drug policiem and management, Indonesia (IN0 PM 0011, 3 February - 3 April 1979 Author Dr J. btta Regional Office Regional Office Mr Paul Hedrick Dr R.C. McIntyra Regional Offica Dr John R. Murphy Dr G. Panerei SEAlRC3312 Page 205 , Annex 6 Assignment report on food and drug quality control in Burma (WHO Project No. BUR LAB 002 - UNDP No. BUR/74/027), 29 March - 28 June 1979 I Doc~mant Assignment report on quality control and drugs management in Ulan Bator (MOG PHA 001), 2 March - 1 May 1979 Drug policies, including traditional medicine, in the context of primary health care - Report and workinglinforma- tion papers of the technical discussions held during the thirty-second session of the WHO Regional Committee for South- East Asia, New Delhi, 18-24 September 1979 Title Quality control of drugs and biologicals in Mongolia, assignment report (MOG PHA 001), January-February 1980 Author 1 Education Assignment report on training of health personnel (including community health workers) for primary haelth care in Indonesia (ICP HMD 013), 1-24 February 1979 See ~EA/Epid/89 Assignment report on training of health personnel (including community health workers) for primary health care, Nepal (ICP HMD 013), 16 December 1978 - 11 January 1979 Assignment report on National Institute of Health Sciences, Kalutara, Sri Lanka (SRL PTR 004), 9 June - 31 August 1979 Environmental Health Assignment report on environmental quality management in Mongolia (MOG SES 001), 3 February - 1 May 1979 Assignment report on the feasibility of using the deep shaft proceaa for waste- water treatment in Delhi and Calcutta (IND CEP 006), 23 April - 11 May 1979 Mr P.S. Ramachandran Dr K. Gerecke Regional Office Dr D. Zhelyazkov Dr Vijay Kumar Dr Kiti Tayakkanonta Dr A. Manoharan Mr J. Palaty Mr John M. Sidwick SWL/RC33/2 Page 206 Annex 6 Document SEAiEHl232 SEA/EH/233 SEA/EX/234 SEA/EH/235 SEA/EH/236 SEA/EH/237 SEA/EH/238 SEA/EH/239 %w%4 SEA/Epld/90 SEA/Epid/91 Title Report on a mission on Madras Mctropoli- tan Water Supply and Severage Board (IND PIP 001). June - July 1979 Assignment report on assistance to the National Environmental Engineering Research Institute, Nagpur (cost engineering and process optimization research) (IND SES 001), 28 July - 2 Septembar 1979 Report on a regional consultation on International Drinking Water Supply and Sanitation Decade (ICP BSM 001) Report of a regional seminar on environ- mental impact assessment, New Delhi (ICP CEP 002). 8-12 October 1980 Assignment report on water supply and sanitation, Bangladesh (ITNDPIWHO inter- regional cooperation project) (IRP BSM 0431, 5-21 November 1979 Report on a Government of India/WHO seminar on financing and management of water supply and sewerage, Bangalore (India) (IND BSM OOS), 11-14 June 1979 Assignment report on air pollution training programes and methodology for estimating air pollution levels in urban areas in India (IND CEP 006), 12 November - 19 Decembar 1979 Assignment report on training in sanitary engineering at the Institute of Techno- logy, Bandung, Indonesia (IN0 EHP 001), 29 December 1979 - 28 February 1980 Epidemio1og)l Assignment report on teaching of epidemiology in Mongolia (MOG HMD 003), 14 March - 11 May 1979 Assignment report on epidemiology and disease control in Bangladesh (BAN ESD 002). October 1977 - October 1979 See SEAICD181 Author Mr P.R. Jeffcoate Prof. P.M. Berthouex Regional Office Regional Office Mr C.D. Spangler Regional Office Mr Robert G. Connelly Dr E.A.R. Ouano Dr C. Kalmybva Dr V.P. Lykov SEA/RC33/2 Page 207 Annex 6 Author Mr CarlD.Hasselblad Mr Keith Heldenbrand Dr E. Marc Laforce Dr J.S. Weisfeld Mr M. Santarelli Dr Michel Rey Dr L.M. Wertheim Dr V. Eedenev Dr Ranjit Sen Regional Office Document SEA/EPI/B SEA/EPI/9 SEA/EPI/~O SEA/EPI/ll SEA/EPI/12 SEA/EPI/13 SEA/EPI/14 SEA/EPI/15 SEA/EPI/16 SEA/EPI/17 SEA/EPI/lB SEA/Ei1/20 Title Expanded Program on Immunization (EPI) Assignment report on expanded programme on immunization, Thailand (ICP SPI 002), 6 January 1979 - 20 June 1979 Assignment report on expanded programme on immunization in Indonesia (ICP SPI 002). 26 December 1978 - 25 June 1979 Assignment report on expanded programme on immunization in Karnataka and Gujarat (India) (IND SPI 002). 1-27 May 1979 Assignment report on expanded programme on immunization, India (ICP SPI 002), 15 June - 17 July 1979 Assignment report on immunization services in Indonesia (ICP SPI 003), February 1978 - August 1979 Assignment report on meaales and measles vaccination in India (IND SPI 001), 10-29 September 1979 Assignment report on development of the expanded programme on immunization in the integrated health services in Nepal (NEP HSD 001). February 1977 - August1979 Assignment report on expanded programme on immunization in the states of Orissa and West Bengal, India (IND SPI 001), 25 June - 8 August 1979 See SEA/HEPAT/l Assignment report on expanded programme on immunization (phase I areas), Sri Lanka (ICP SPI 003), 15-31 October 1979 Report on WHO regional meeting on manage- ment of the expanded prograrmne on immunization, New Delhi (ICP SPI 002), 7-9 November 1979 Filariasis See SEA/RES/26 SEA/RC33/2 Page 208 Annex 2 Author Mr Arthur B. Banford Prof. D.J. Gublar Dr S.B. &latead Dr Suchitra Nimmannitya Dr G. Obeyeaekera Prof. H.J. Weddle Dr Jerome Grossman Prof. Kenneth R.Cox Thomas H. Gray Dr George Foatar r I Document I Title I I I ' Food Hygiene SEAIFood. Hyg. /4 Assignment report on development of food I safety and hygiene in Indonesia (IN0 EHP ! 0011, 13 November 1979 - 12 February 1980 I I Haemorrhagic Fever SEA/Haem.Fever/33 1 Assignment report on dengue haemorrhagic L I fever surveillance in Sri Lanka (SRL VBC 002), 23 June - 20 July 1979 I SEA/Haem.Fever/34 SEA/HLM/158 Assignment report on the strengthening of arbovirus laboratory services epidemio- logy and control of DHF in Thailand (ICP RPD 002). 28 November - 25 December 1979 SEA/Haem,Fever/35 Assignment report on dengue fever/DHF I surveillance and control in Maldives (ICP ESD 001), 1-14 January 1980 Health Education SEA/HE/103 I Assignment report on social ncience SEAIRES120 research on medicine in the South-East Asia Region (ICP RPD 002), January - April 1979 SEAIHEIlOL Assignment report on health education in family health in Sri Lanka (SRL HED 002). 12 July - 25 August 1979 SEA/HE/lOS Assignment report on review of curriculum for Master of Science in Public Health (Health Education) and proposals for further development (THA HMD 003) June- August 1979 SEA/HE/106 Assignment report on health education in Sri Lanka (SRL BED 001), 15 December 1 1979 - 24 January 1980 SEA/HE/107 Assignment report on health education SEA/HE/lOB training and primary health care development in Bangladesh (BAN HED 002). 14 April 1978 - 31 December 1979 Assignment report on health behaviour, health education and community participa- tion (ICP HED 003). 8 October - 20 December 1979 SEA/RC33/2 Page 209 Annex 6 Author Dr Ivan lvanov Dr Andrew P. Kenny Dr K.B. Shsrma Dr A.P. Kenny Dr Ivan Ivanov Mr Y . S . Nimbkar M/s. S.C. Dhir 6 S.K. Anand Regional Office Dr V.N. Rao Dr V.N. Rao Document SEA/HLM/157 SEA/HLM/158 SEA/HLM/159 SEA/HLH/160 SEA/HLM/161 SEA/ HLM/ 162 SEA/HLM/163 SEA/HLT/ 7 SEA/HLT/~ SEA/HSD/ 7 SEA/HSD/B Title Health Laboratory Methods Assignment report on health laboratory promotion and health laboratory techno- logy in Rajasthan, India (IND LAB 0021, 1 April - 30 September 1979 See SEA/Haern,Fever/34 Assignment report on laboratory quality control and standardization in Indonesia (IN0 LAB 001), 22 October - 25 November 1979 Assingment report on strengthening of laboratory services in Indonesia (INO LAB 001), 29 August - 12 November 19 79 Assignment report on laboratory quality control and standardization in India (IND LAB 003), October - November 1979 (2 weeks) Assignment report on laboratory promo- tion and health laboratory technology in Andhra Pradesh, India, 1 October - 31 December 1979 Assignment report on public health administration in Maldives (MAV HSD 001), 6-29 December 1979 Health Literature Directory of health science libraries in South-East Asia, June 1979 Establishment of a regional network of health literature, library and informa- tion services (HELLIS) - report of an inter-country consultative meeting. New Delhi.(ICP HLT 001), 27-31 August 1979 Health Services Development Assignment report onmulti-professional team training for primary health care (ICP HMD 0131, 27 December 1978 - 26 April 1979 Assignment report on training of health team for primary health care (ICP HMD 013), 24 March - 11 April 1979 SEAlRC3312 Page 210 Annex 6 Assignment report on health planning in South-Eaat Asia Region (ICP HSD 008), 5 February - 4 May 1979 Document Outlines of a regional programme on formulating strategies for health for all by the year 2000 Report on the Meeting on Financing of Primary Health Care Programmes in Asia, New Delhi, 9-13 July 1979 I I Title See SEAIRES121 Author Report of the Joint UNICEFIWHO Regional Meeting on Formulating Strategies for Achieving Health for All by the Year 2000, with Primary Health Care as the Key Approach, New Delhi, 1-6 December 1979 Report on formulating national strategies for health for all by the year 2000 Report of the inter-country consultation on country health programming and the use of TCDC inhealth planning and management, New Delhi (ICP PPS 002), 30 January - 6 February 1980 Assignment report on the strengthening of national health services in Indonesia, 17 December 1979 - 23 January 1980 (IN0 SPM 002) Mr C.R. Krimhnamurthi Regional Office Regional Off ice Regional Of £ice Regional Office Regional Office Ms Teresa Miller Hepatitis 1 Assignment report on prevention and control of serum hepatitis in the context of the immunization programme in Mongolia (ICP SPI 003). 10 September - 5 October 1979 Leprosy I Asaignment report on "Utilization of Government Leprosy Scheme by Hospitals in India, Evaluation Study" (IND BVD 001) 28 December 1978 - 28 June 1979 Assignment report on study of leprosy control programmes in India (IN0 BW 001). 19 November 1978 - 15 May 1979 Dr A.J. Selvapandian Dr C. Vellut Document 7 I 1 Liver Diseases I Assignment report on control of myco- bacterial diseases in Bangladesh (BAN BVD 001). July 1974 - December 1979 Title Dr V.K. Sham SEA/Liver Dis. /4 Assignment report on progress of research Dr Ian R. Mackay SEA/RES/19 on chronic liver diseases including liver Author SEA/Liver Dis. 13 SEA/RES/18 6 Corr .l cancer in Thailand (ICP RPD 002), 22 June 1979 - 5 July 1979 Assignment report on progress of research on chronic liver diseases including liver cancer in Indonesia (ICP RPD 0021, 22 June 1979 - 5 July 1979 Dr Ian R. Mackay SEAILiver Dis.15 Assignment report on research on chronic SEA/RES/22 liver diseases including liver cancer in Sri Lank (ICP RPD 002), 11-13 October 11979 I / Malaria I Dr Ian R. Mackay SEAILiver Dis ./6 SEA/RES/23 I Maternal and Child Health I Assignment report on research on chronic liver diseases including liver cancer in Burma (ICP RPD 002). 15-18 October 1979 SEA/Ma1/123 SEAIRESI24 Dr Ian R. Mackay Report of a meeting of research workers in the Regional Collaborative Studies on Plamodiwn Falcipanmt Resistance to 4-Ami~quinolines, Chiang Mai, Thailand (ICP RPD 002), 8-13 October 1979 Assignment report on development o£ family and child health services in Bangladesh (BAN MCH 001), October 1978 - April 1979 Assignment report on strengthening of Dr S. Sulahn maternal and child health Dronramme in Dr R.T. Collins Prof. Tin U Assignment report on strengthening of maternal and child health services, Indonesia (IN0 HSD 001), 17 December 1978 - 16 February 1979 Dr J.N. Pohovalla SEAlRC3312 Pa~e 212 Annex 6 Documant SEAlMCHl134 SEAlMCHl135 sE~fMCHl136 SEAlMCHlFPl75 SEAIMCHIFPI~~ SEAIMed.Educ.1361 SEAIMed. Educ. 1362 SEA/Med.Educ./334 Add.1 SEA/Med. ~duc.1334 Add.2 Title Report on the meeting on delivery of health care to the pre-school child in the context of primary health care, Bangkok (ICP MCH 003), 12-16 November 11979 Assignment report on epidemiological surveys of maternal and child health problems in Mongolia (MOG MCH 003), 10 October 1979 - 18 January 1980 Report on the Meeting of the Ad hoc Committee on Paediatric Education and Training in Child Health to consider the draft of the Handbook on Child Health Care, New Delhi (IND MCH 003), 17-19 December 1979 Maternal and Child Health and Family Planning Assignment report on strengthening of family health services in Nepal (NEP MCH 002), June - August 1979 Assignment report on family health in Sri Lank (SRL MCH 002), 20 May - 19 August 1979 Medical Education Assignment report on medical education in Sri Lanka (SRL HMD 0011, 5 February - 31 March 1979 Agency terminal report on assistance to the State Medical Institute, Mongolia, project findings and recommendations (WHO Project MM: HMD 003 - UWDP Project MONG 72/004), September 1975 - June 1979 lbeignment report on development of national poet-graduate training centre#, Bangladesh (ICP HMD 010), 20-29 March 1978 Assignment report on davelopment of national post-graduate training centres, ~urma (ICP HMD 010), 6-17 March 1978 Author Dr H. Wallace Dr C. Gopalan Dr M.M. Varentaov Regional Of fice Dr W. Burgesa Dr V. Omathanondh Dr T.V. Telder Dr E.N. Avilov Dr K.N. Saneviratne -do- SEAlRC3312 Page 213 Annex 6 Document S~AIMed.Educ.1334 Add.3 I I I Title SEAIMed.Educ.1334 Add.4 I Author Assignment report on development of national post-graduate training centres, Indonesia (ICP HMD 010), 12-30 April 1978 SEAIMed.Educ.1363 Dr K.N. Seneviratne Assignment report on development of national post-graduate training centres, Thailand (ICP HMD OlO), 1-19 May 1978 SEAIMed.Educ.1364 -do- Assignment report on "Assistance to the State Medical Institute, Ulan Batar" (Pharmacology) (MOG HMD 0031, April-June 1979 SEAIMed.Educ.1365 Dr A.N. Kudrin Report of a conference on regional cooperation in the WHO fellowship programme, New Delhi (ICP HMD 013), 26-29 September 1979 SEAIMed.Educ.1366 Regional Office I ! Assignment report on Faculty of Public Health, Mahidol University, Bangkok, Thailand (THA HMD 003), 17 October 1978 - 17 August 1979 Report on consultation on coordinated Prof. P.N. Wahi health services and manpower development, New Delhi (ICP HMD 006), 20-24 August 1979 SEA/Med.Educ.1367 ~SEA/~ed.~duc.1369 Report on an inter-country seminar on the reorientation of medical education towards I Dr James D. Shepperd SEAIMed.Educ.1368 community needs, Surabaya, Indonesia (ICP HMD 003), 25-29 June 1979 I Assignment report on post-graduate medical education in Sri Lanka (SRL HMD 001), 24 September - 23 October 1979 Dr J.F. Stokes Assignment report on training of health manpower in Nepal (NEP HHD 001), 20 December 1978 - 19 November 1979 Dr Shamanna Ramaswamy SEA/Med.Educ.1370 SEA/Med.Educ./371 Report on the Eighth Meeting of Directors or Representatives of Schools of Public Health in the African,Eastern Mediterra- nean,South-East Asian and Western Pacific Regions, Bangkok, Thailand (ICP HMD 003). 6-12 March 1979 SEA/Med.Educ./372 Regional Office Assignment report on training of health manpower in Nepal (NEP HHD 001), 15-30 December 1979 Prof. Harold Ellis Assignment report on assistance to the State Medical Institute, Ulan Bator (MOG HMD 003), July - November 1979 Prof. V.P. Pomerantsev SEAlRC3312 Page 214 Annex 6 Document SEA Mad.Educ.1373 SEAIMed.Educ.1374 SEAIMed.Educ.1375 SEA/Med.Educ. 1376 SEA/~ed,Educ./377 SEAl~adllO8 SEA/Ment/57 SEAjMent158 md. 113 SEAlNurs1300 SEA/Nurs/301 Title A/aignment report on poat-greduate teach- ing in occupational health, Sri Lank (SRL HMD 0081, 14 October - 15 November 19 79 Assignment report on post-graduate medical education in Sri Lank (SRL PTR 003) , 12-26 January 1980 b8ignment report on National Institute of Preventive and Social Medicine, Dacca, Bangladesh (BAN HMD 0041, 17 July - 17 December 1979 Assignment report on post-graduate education in public health, Indonesia (IN0 HND 0031, 1 January 1978 - 31 December 1979 Assignment report on radiology training in Burma (education and training for health manpower programme) (BUR HMD 005), 5 November - 17 December 1979 Mental Health Report of a meeting of the Regional Advisory Group on Mental Health, New Delhi (ICP MNH 003), 5-9 March 1979 Assignment report on mental health services in Bangladesh, with special reference to in-aervice training (BAN MNH 001), 24-27 September 1979 Assignment report on mental health teaching seminar on traditional healing Indonesia (IN0 KNH 001). 30 November - 20 December 1979 Nur.inp Assignment report on orthopaedic nursing in Indonesia (ICP HMD 011). 26 April - 14 June 1979 Assignment report on registration of nurses and nursing manpower data in Indoneeia (IN0 PTR 002). 29 December 1979 - 26 February 1980 Author Prof. R.S.F. Schilling Prof. I.D.A. Johnaton Dr 2. Bencic Mr P.J. Blizard Dr William M. Park Regional Off ice Dr W.E.S. Kiernan Dr A. Kleinman Dr T. Maretzki Dr J.S. Neki Mles Mary Powell Mr Edgar A. Turner SEA/RC33/? Page 215 Annex 6 Occupational Health Title -- - Author I I Report of a workshop on comprehensive research-cum-action programme in nutrition for the South-East Asia Region, New Delhi (ICP RPD 001), 11-15 June 1979 Regional Of rice An Action Research Programme in Nutrition for Developing Countries (ICP RPD 001). October 1979 Regional 0i:ice Assignment report on nutrition monitoring, evaluation, planning and surveillance in Indonesia (IN0 NUT 003), 27 December 1979 - 24 February 1980 Assignment report on occupational health Dr G. Anderson and industrial hygiene, Sri Lanka (SRL HWF' 001). 21 February - 20 May 1979 Dr D. Schwefel Assignment report on the design of clima- tic chamber facilities for Indonesia (IN0 HWF' 001), 8 April - 7 May 1979 Mr G.W. Crockford 1 See SEA/Med.Educ./373 I Assignment report on some aspects of education and training in occupational health and safety in Sri Lanka (SRL HWP 001), 4 June - 2 September 1979 Dr R.E. Simson Assignment report on prevention of blind- ness in Thailand (ICP PBL 002), August - October 1979 Dr A. Colenbrander Aesignment report on prevention of blind- ness in Sri Lanka (ICP PBL 002), 3-19 I October 1979 I Prof. P.K. Khosla Assignment report on Indian national plan for the prevention of visual impairment and control of blindness - An information system for monitoring (IND PBL 001). 7 November - 5 December 1979 Dr William H. Hart Assignment report on epidemiological research opportunities in glaucoma and cataract, India (ICP PBL 001), November - December 1979 Dr T.R. Cullinan SEAlRC3312 Page 216 Annex 6 Document SEAIOphthall24 SEA/Ophthal/25 SEA/Ophthal/26 SEAlOphthall27 SEA/Ophthal/ZB SEA/Trach./34 SEA/Ophthal/29 SEA/Ophthal/30 SEA/Ophthal/31 SEA/Polio/8 SEA/Rad/l04 SEA/Rad/l05 Title Assignment report on prevention end control of blindness in Nepal (ICP PBL 0021, 5-18 October 1979 Assignment report on prevention of visual impairment and blindness in Sri Lanka (ICP PBL 002), 17 September - 23 November 19 79 Assignment report on prevention of visual impairment and control of blindness in India (ICP PBL 001), 30 December 1979 - 25 January 1980 Assignment report on prevention of blind- ness in Nepal (ICP PBL 002), 31 October - 6 November 1979 Assignment report on trachoma control and prevention of blindness in Burma (ICP PBL 002), 24 November - 13 December 1979 Assignment report on prevention of blind- ness and visual impairment in Indonesia (ICP PBL 001), November-December 1979 Assignment report on prevention of blind- ness and visual impairment in Nepal (ICP PBL 0011, November-December 1979 Assignment report on prevention of blind- ness and visual impairment in Thailand (ICP PBL 001). November-December 1979 Poliomyelitis Assignment report on the epidemiology of poliomyelitis in Burma (BUR ESD 003), 3-24 November 1979 Radiation Assignment report on radiation health, Sri Lanka (SRL RAD 001), 1-14 May 1979 Assignment report on strengthening of radiological protection services in Mongolia (MOG RAD 001). August - October 1979 Author Dr J.J.M. Sautar Prof. Celbert I. Phillip Dr Carl Kupfer Dr L.P. Aggawal Dr S. Darougar Dr T.R. Cullinan -do- -do- Dr L.B. Schonberger Mr V.G. Ram Subramenian Dr Jerzy Jenkowski SEAlRC3312 Page 217 Annex 6 Document SEA/Rad/l06 SEAlRadll07 SEA/Rad/lO8 SEAlRehabl35 SEA/RES/18 SEA/RES/19 SEA/RES/20 SealRES121 SEAlHSD112 SEAIRES122 SEA/RES/23 SEA/RES/24 SEA/RES/25 SEA/RES/26 SEAlFill20 SEA/RES/27 Title Assignment report on radiotherapy and radiation protection in Indonesia (IN0 RAD 001). 8 November 1979 - 5 February 1980 Assignment report on quality control in nuclear medicine imaging in India (IND RAD 002). 27 November - 18 December 1979 See SEAIMed.Educ.1377 Rehabilitation Assignment report on medical rehabilita- tion specialization course for physicians in Mongolia (MOG HSD 002), 22 October - 21 December 1979 Research Study - ResearchITraining, etc. See SEA/Liver/Diseases/3 See SEAILiver Diseaseslh See SEAlHEl103 Report on the consultation on research programme in financing of health care delivery, New Delhi (ICP RPD 0021, 2-6 July 1979 See SEAILiver Diseaaes/S See SEAILiver Diseases16 See SEAlMa1123 Report on the meeting of the directors of medical research councila or analogous bodies and concerned research foci in the relevant ministries, Colombo, Sri Lank, 18-21 December 1979 Report on the meeting of the bi-regional research study group on bancroftian f ilariasis, New Delhi (ICP RPD 001). 19-23 November 1979 Report of the meeting on development of health services research, New Delhi (ICP RPD 002), 28-30 November 1979 Author Dr Bo Johansson Dr Knud Kristensen Dr Ryszard Kinalski Regional Office Regional Office Regional Office Regional Office A SEAlRC3312 Page 218 Annex 6 Document SEAITrach. I34 SEA/'lrad.Med. 16 SEAlTrad.Med.17 SEAlTrad.Med.18 SE~ITrad.Med.19 SEA/Trad.Med./lO SEAlTrad.Med.111 SE~/Trad.Med.I12 SEAlTrad.Med.113 SEA/TB/152 SEA/TB/153 SEAITBI154 Title Trachoma See SEAlOphthall28 Traditional Medicine Assignment report on traditional medicine in Bhutan (BHU HSD 0011, 1 March - 14 May 1979 Report of the regional meeting on the development of programmes in traditional medicine in South-East Asia, New Delhi (ICP HSD 005). 16-20 April 1979 Assignment report on traditional medicine in Burma (ICP HSD 005). 12-22 May 1979 Assignment report on traditional medicine in Bangladesh (ICP HSD 005),4-11May 1979 Assignment report on traditional medicine in Thailand (ICP HSD 005), 3-13 July 1979 Assignment report on traditional medicine in Indonesia (ICP HSD 0051, 21 June - 2 July 1979 Assignment report on traditional medicine in India (ICP HSD 005) See SEAlMentl59 Tuberculosis Agency Terminal report on tuberculosis control progralmne, Burma - Project find- ings and recommendat ions (WHO Project BUR BW 001 - UNDP Project ~UR/68/018), 1964 - 1978 Assignment report on Tuberculo8ie Research Centre, Madras (IND BW 005), 31 December 1979 - 25 January 1980 Assignment report on control of myco- bacterial diseases in Bangladesh (BAN BW 001), July 1974 - December 1979 Author Dr S. Darougar Dr Bhagwan Dash Dr P.N.V. Kurup -do- -do- Dr K.N. Udupa -do- Dr P.N.V. Kurup Regional Office Prof. Wallace Pox Dr V.K. Sharma - SEAIRC3312 Page 219 Annex 6 Document SEAIVaccinel98 SEAIVBCIS SEAlVBCl6 SEAIVPHl28 SEAlVHSl164 SEAlVHSl165 Titla Vaccine Assignment report on production and control of freeze-dried BCG vaccine in India (IND BLG 002), 23 December 1979 - 17 January 1980 Vector-Borne Disease Control Assignment report on epidemiology and disease control in Bangladesh (BAN ESD 002), July 1977 - December 1979 Assignment report on the proposals for control pf Aodoa mosquitoes in Maldives (ICP ESD 001), 10-31 January 1980 Veterinary Public Health Report on an inter-country seminar for the planning of national and regional programmes for surveillance, prevention and control of zoonosas, held at the National Institute of Communicable Diseases, Delhi (ICP VPH 001). 12-16 November 19 79 Vital Health Statistics Report on a longitudinal survey on natality and mortality in rural Bangladesh (BAN PPS 001). 1976 - 1977 Bulletin of Health Statistical Informa- tion in South-East Asia Author Dr T. Hashimoto Mr G.P. Joshi Mr Jay E. Graham Regional Office Dr Michael Chia Regional Office SEA/RC33/2 Page 220 Annex 7 STATEMENT SHOWING THE IMPLEMENTATION OF 1979 PROGRAEClES LTDER THE REGULAR BUDCET IN THE SOUTH-EAST ASIA REGION Major Progrme/Program 1.1 Organizational Meetings I 1.1.3 Regional Committee 1 2.1 Executive Management 2.2 Coordination I 2.2.2 Coordination with other Organizations 2.3 General Programe Development I 2.3.2 Research Promotion and Development 2.3.4 Director-General'e and Regional Directors' Development Program 3.1 General Health Services 3.1.1 Programe Planning and General Activities I 3.1.2 Health Services Development 3.1.3 Primary Health Care and Rural Development 3.2 Family Health 3.2.2 Maternal and Child Health 3.2.4 Nutrition 3.2.5 Health Education 4.1 Health Manpower Development SW/RC33/2 Page 221 Annex 7 I 5.1 Communicable Dieeaae Prevention and Control I 5.1.2 Epidemiological Surveillance I 5.1.3 Malaria and Other Parasitic Diseases 5.1.4 Smallpox Eradication and Expanded Programs on Imunization I 5.1.5 Bacterial and Virus Diseases I 5.1.6 Veterinary Public Health I 5.1.7 Vector Biology and Control 5.1.9 Prevention of Blindness 5.2 Non-Comunicable Disease Prevention and Control I 5.2.1 Programme Planning and General Activities 1 5.2.3 Cardiovascular Diseases I 5.2.4 Other Chronic Non- communicable Diseases I 5.2,s Oral Health 1 5.2.6 Mental Health I 5.2.7 Biomedical Aspects of Radiation 1 5.2.9 Immunology 5.2.10 Health of Working Populations SEAlRC3312 Page 222 Annex 7 Major Progreomu/Progracam 5.3 Prophylactic, Diagnostic and Therapeutic Substances 5.3.2 Drug Policy and Management 5.3.3 Pharmaceuticals 5.3.4 Biologicals 5.3.5 Health Laboratory Technology 6.1 Promotion of Environmental Health 6.1.1 Program Planning and General Activities 6.1.2 Provision of Basic Sanitary Measures 6.1.3 Pre-investment Planning for Basic Sanitary Services 6.1.4 Control of Environmental Pollution and Hazards 6.1.5 Establishment and Streng- thening of Environmental Health Services and Institutions 6.1.6 Food Safety Progr- 7.1 Haalth Statistics 7.1.4 Development of Health Statistical Services 7.2 with and ~iomodical Information 7.2.2 Health Literature Services 7.2.3 mO Publications 7.2.4 Health Information of the Public Revised Budget asper document EB61/6 20 000 172 400 101 300 674 700 968 400 151 700 968 100 50 000 266 100 123 000 95 000 1 603 900 205 300 78 700 81 200 64 300 224 200 Obligations incurred 8 914 200 050 155 394 675 977 1 040 335 138 568 916 461 86 683 186 158 129 572 102 514 1 559 956 176 020 92 134 86 969 38 918 218 021 Obligations as e percentage of revised budget 107.4 97.3 85.7 97.2 SEA/RC33/2 Page 223 Annex 7 (Ezpreeeed in US DoZ larsl %jar Programe/Programme 9.1 Regional Programe Planning and General Activities 9.2 Assistance to Country Programmes 9.3 Regional General Support Services 9.: Regional Common Services GRAND TOTAL Rnvised Budget as per document EB61/6 401 200 928 500 839 400 446 500 19 053 600 Obligation' incurred 361 501 Obligations as a percentage of revised budget 90.1 952 934 846 139 395 163 19 376 754 102.6 100.8 88.5 101.7
SEA/RC33/2 Page 220 Annex 7 STATEMENT SHOWING THE IMPLEMENTATION OF 1979 PROGRAEClES LTDER THE REGULAR BUDCET IN THE SOUTH-EAST ASIA REGION Major Progrme/Program 1.1 Organizational Meetings I 1.1.3 Regional Committee 1 2.1 Executive Management 2.2 Coordination I 2.2.2 Coordination with other Organizations 2.3 General Programe Development I 2.3.2 Research Promotion and Development 2.3.4 Director-General'e and Regional Directors' Development Program 3.1 General Health Services 3.1.1 Programe Planning and General Activities I 3.1.2 Health Services Development 3.1.3 Primary Health Care and Rural Development 3.2 Family Health 3.2.2 Maternal and Child Health 3.2.4 Nutrition 3.2.5 Health Education 4.1 Health Manpower Development SW/RC33/2 Page 221 Annex 7 I 5.1 Communicable Dieeaae Prevention and Control I 5.1.2 Epidemiological Surveillance I 5.1.3 Malaria and Other Parasitic Diseases 5.1.4 Smallpox Eradication and Expanded Programs on Imunization I 5.1.5 Bacterial and Virus Diseases I 5.1.6 Veterinary Public Health I 5.1.7 Vector Biology and Control 5.1.9 Prevention of Blindness 5.2 Non-Comunicable Disease Prevention and Control I 5.2.1 Programme Planning and General Activities 1 5.2.3 Cardiovascular Diseases I 5.2.4 Other Chronic Non- communicable Diseases I 5.2,s Oral Health 1 5.2.6 Mental Health I 5.2.7 Biomedical Aspects of Radiation 1 5.2.9 Immunology 5.2.10 Health of Working Populations SEAlRC3312 Page 222 Annex 7 Major Progreomu/Progracam 5.3 Prophylactic, Diagnostic and Therapeutic Substances 5.3.2 Drug Policy and Management 5.3.3 Pharmaceuticals 5.3.4 Biologicals 5.3.5 Health Laboratory Technology 6.1 Promotion of Environmental Health 6.1.1 Program Planning and General Activities 6.1.2 Provision of Basic Sanitary Measures 6.1.3 Pre-investment Planning for Basic Sanitary Services 6.1.4 Control of Environmental Pollution and Hazards 6.1.5 Establishment and Streng- thening of Environmental Health Services and Institutions 6.1.6 Food Safety Progr- 7.1 Haalth Statistics 7.1.4 Development of Health Statistical Services 7.2 with and ~iomodical Information 7.2.2 Health Literature Services 7.2.3 mO Publications 7.2.4 Health Information of the Public Revised Budget asper document EB61/6 20 000 172 400 101 300 674 700 968 400 151 700 968 100 50 000 266 100 123 000 95 000 1 603 900 205 300 78 700 81 200 64 300 224 200 Obligations incurred 8 914 200 050 155 394 675 977 1 040 335 138 568 916 461 86 683 186 158 129 572 102 514 1 559 956 176 020 92 134 86 969 38 918 218 021 Obligations as e percentage of revised budget 107.4 97.3 85.7 97.2 SEA/RC33/2 Page 223 Annex 7 (Ezpreeeed in US DoZ larsl %jar Programe/Programme 9.1 Regional Programe Planning and General Activities 9.2 Assistance to Country Programmes 9.3 Regional General Support Services 9.: Regional Common Services GRAND TOTAL Rnvised Budget as per document EB61/6 401 200 928 500 839 400 446 500 19 053 600 Obligation' incurred 361 501 Obligations as a percentage of revised budget 90.1 952 934 846 139 395 163 19 376 754 102.6 100.8 88.5 101.7
SEA/RC33/2 Page 203 Annex b LIST OF TECHNICAL REPORTS ISSUED BY THE REGIONAL OFFICE (1 July 1979 - 31 May 1980) r Document SEA/Accidentsll SEAIACMRl5 SEA/ACHR/6 SEAICancerl36 SEAICancerl37 SEA/Cancer/ 38 SEAlCancer139 SEA/CVD/~~ SEA/CVD/26 Title Accidents Report on the proceedings of a seminar on prevention and control of accidents, New Delhi (ICP HSD 003), 6-10 August 1979 Advisory Committee on Medical Research Regional Advisory Committee on Medical Research - Report to the Regional Director on the fifth session, Pattaya, Thailand (ICP RPD 001), 2-5 April 1979 Regional Advisory Committee on Hedical Research - Report on the sixth seesion, New Delhi, 1-4 April 1980 Cancer Assignment report on cancer control and research in India (preparatory assistance) (IND CAN 007). 18 June - 15 July 1979 Assignment report on cancer control in Indonesia (IN0 CAN 001), 3 September - 15 October 1979 Assignment report on prevention and control of cancer, Thailand (THA CAN 001), 8 October - 21 December 1979 Assignment report on cancer prevention and control in Bangladesh (BAN CAN 001), 29 November 1979 - 16 January 1980 Cardiovascular Disebsea Assignment report on cardiovascular diseases prevention and control activities, Bangladesh (BAN CVD 001), 4-24 November 1979 Report of an inter-country seminar on prevention and control of pulmonary hypertension, New Delhi (ICP CM 001), 15-19 October 1979 Author Regional Office Regional Office Regional Office Dr Alton 1.Sutnick Dr Yuri L. Puchkov Prof. Folke Edsmyr Dr John A. Pinkston Dr Henry T. Lynch Dr Jiri Hurych Regional Office SEA/RC33/2 Page 204 Annex 6 Document SEAlCVDl27 SEAlCholeral31 SEA/CD/78 SEAlCDl79 and Corr.1 SEA/CD/80 SEAlCDl81 SEAICholeral31 SEA/Epid/91 SEAIDDIB SEA/DD/9 sFA/~rugs/30 Title Aaaignment report on cardiovrmcular , diseamea in the Democratic People'a Republic of Korea (KRD CVD 001), 9 October - 13 Novembar 1979 Cholmra Sea SEAICDl81 Comunicable Dimurea Report on an inter-regionel meting on Japanese encephalitis, New Delhi (ICP BVD 004). 19-24 March 1979 WHO technical guideline8 on Japaneae encephalitis (formulated at an inter- regional meeting on Japanese encephalitis held in New Delhi (ICP BVD 004), 19-24 March 1979 Assignment report on research in the ecology of communicable dimeaaea in Indone~ia (IN0 ESD 002), 1 February 1976- 31 October 1979 Assignment report on the epidemiology, surveillance and control of cholera in Indonesia (ICP BVD 001). 15 July - 21 September 1979 Diarrhoea1 Diseaaem Report on a WHO inter-country consulta- tion to develop a regionel ptograme on diarrhoea1 diseases services and research, New Delhi (ICP RPD 002), 18-23 June 1979 Assignment report on the prevention and control of diarrhoea1 dimeases of children in India (ICP BVD 001). 8 November - 12 December 1979 Assignment report on drug policiem and management, Indonesia (IN0 PM 0011, 3 February - 3 April 1979 Author Dr J. btta Regional Office Regional Office Mr Paul Hedrick Dr R.C. McIntyra Regional Offica Dr John R. Murphy Dr G. Panerei SEAlRC3312 Page 205 , Annex 6 Assignment report on food and drug quality control in Burma (WHO Project No. BUR LAB 002 - UNDP No. BUR/74/027), 29 March - 28 June 1979 I Doc~mant Assignment report on quality control and drugs management in Ulan Bator (MOG PHA 001), 2 March - 1 May 1979 Drug policies, including traditional medicine, in the context of primary health care - Report and workinglinforma- tion papers of the technical discussions held during the thirty-second session of the WHO Regional Committee for South- East Asia, New Delhi, 18-24 September 1979 Title Quality control of drugs and biologicals in Mongolia, assignment report (MOG PHA 001), January-February 1980 Author 1 Education Assignment report on training of health personnel (including community health workers) for primary haelth care in Indonesia (ICP HMD 013), 1-24 February 1979 See ~EA/Epid/89 Assignment report on training of health personnel (including community health workers) for primary health care, Nepal (ICP HMD 013), 16 December 1978 - 11 January 1979 Assignment report on National Institute of Health Sciences, Kalutara, Sri Lanka (SRL PTR 004), 9 June - 31 August 1979 Environmental Health Assignment report on environmental quality management in Mongolia (MOG SES 001), 3 February - 1 May 1979 Assignment report on the feasibility of using the deep shaft proceaa for waste- water treatment in Delhi and Calcutta (IND CEP 006), 23 April - 11 May 1979 Mr P.S. Ramachandran Dr K. Gerecke Regional Office Dr D. Zhelyazkov Dr Vijay Kumar Dr Kiti Tayakkanonta Dr A. Manoharan Mr J. Palaty Mr John M. Sidwick SWL/RC33/2 Page 206 Annex 6 Document SEAiEHl232 SEA/EH/233 SEA/EX/234 SEA/EH/235 SEA/EH/236 SEA/EH/237 SEA/EH/238 SEA/EH/239 %w%4 SEA/Epld/90 SEA/Epid/91 Title Report on a mission on Madras Mctropoli- tan Water Supply and Severage Board (IND PIP 001). June - July 1979 Assignment report on assistance to the National Environmental Engineering Research Institute, Nagpur (cost engineering and process optimization research) (IND SES 001), 28 July - 2 Septembar 1979 Report on a regional consultation on International Drinking Water Supply and Sanitation Decade (ICP BSM 001) Report of a regional seminar on environ- mental impact assessment, New Delhi (ICP CEP 002). 8-12 October 1980 Assignment report on water supply and sanitation, Bangladesh (ITNDPIWHO inter- regional cooperation project) (IRP BSM 0431, 5-21 November 1979 Report on a Government of India/WHO seminar on financing and management of water supply and sewerage, Bangalore (India) (IND BSM OOS), 11-14 June 1979 Assignment report on air pollution training programes and methodology for estimating air pollution levels in urban areas in India (IND CEP 006), 12 November - 19 Decembar 1979 Assignment report on training in sanitary engineering at the Institute of Techno- logy, Bandung, Indonesia (IN0 EHP 001), 29 December 1979 - 28 February 1980 Epidemio1og)l Assignment report on teaching of epidemiology in Mongolia (MOG HMD 003), 14 March - 11 May 1979 Assignment report on epidemiology and disease control in Bangladesh (BAN ESD 002). October 1977 - October 1979 See SEAICD181 Author Mr P.R. Jeffcoate Prof. P.M. Berthouex Regional Office Regional Office Mr C.D. Spangler Regional Office Mr Robert G. Connelly Dr E.A.R. Ouano Dr C. Kalmybva Dr V.P. Lykov SEA/RC33/2 Page 207 Annex 6 Author Mr CarlD.Hasselblad Mr Keith Heldenbrand Dr E. Marc Laforce Dr J.S. Weisfeld Mr M. Santarelli Dr Michel Rey Dr L.M. Wertheim Dr V. Eedenev Dr Ranjit Sen Regional Office Document SEA/EPI/B SEA/EPI/9 SEA/EPI/~O SEA/EPI/ll SEA/EPI/12 SEA/EPI/13 SEA/EPI/14 SEA/EPI/15 SEA/EPI/16 SEA/EPI/17 SEA/EPI/lB SEA/Ei1/20 Title Expanded Program on Immunization (EPI) Assignment report on expanded programme on immunization, Thailand (ICP SPI 002), 6 January 1979 - 20 June 1979 Assignment report on expanded programme on immunization in Indonesia (ICP SPI 002). 26 December 1978 - 25 June 1979 Assignment report on expanded programme on immunization in Karnataka and Gujarat (India) (IND SPI 002). 1-27 May 1979 Assignment report on expanded programme on immunization, India (ICP SPI 002), 15 June - 17 July 1979 Assignment report on immunization services in Indonesia (ICP SPI 003), February 1978 - August 1979 Assignment report on meaales and measles vaccination in India (IND SPI 001), 10-29 September 1979 Assignment report on development of the expanded programme on immunization in the integrated health services in Nepal (NEP HSD 001). February 1977 - August1979 Assignment report on expanded programme on immunization in the states of Orissa and West Bengal, India (IND SPI 001), 25 June - 8 August 1979 See SEA/HEPAT/l Assignment report on expanded programme on immunization (phase I areas), Sri Lanka (ICP SPI 003), 15-31 October 1979 Report on WHO regional meeting on manage- ment of the expanded prograrmne on immunization, New Delhi (ICP SPI 002), 7-9 November 1979 Filariasis See SEA/RES/26 SEA/RC33/2 Page 208 Annex 2 Author Mr Arthur B. Banford Prof. D.J. Gublar Dr S.B. &latead Dr Suchitra Nimmannitya Dr G. Obeyeaekera Prof. H.J. Weddle Dr Jerome Grossman Prof. Kenneth R.Cox Thomas H. Gray Dr George Foatar r I Document I Title I I I ' Food Hygiene SEAIFood. Hyg. /4 Assignment report on development of food I safety and hygiene in Indonesia (IN0 EHP ! 0011, 13 November 1979 - 12 February 1980 I I Haemorrhagic Fever SEA/Haem.Fever/33 1 Assignment report on dengue haemorrhagic L I fever surveillance in Sri Lanka (SRL VBC 002), 23 June - 20 July 1979 I SEA/Haem.Fever/34 SEA/HLM/158 Assignment report on the strengthening of arbovirus laboratory services epidemio- logy and control of DHF in Thailand (ICP RPD 002). 28 November - 25 December 1979 SEA/Haem,Fever/35 Assignment report on dengue fever/DHF I surveillance and control in Maldives (ICP ESD 001), 1-14 January 1980 Health Education SEA/HE/103 I Assignment report on social ncience SEAIRES120 research on medicine in the South-East Asia Region (ICP RPD 002), January - April 1979 SEAIHEIlOL Assignment report on health education in family health in Sri Lanka (SRL HED 002). 12 July - 25 August 1979 SEA/HE/lOS Assignment report on review of curriculum for Master of Science in Public Health (Health Education) and proposals for further development (THA HMD 003) June- August 1979 SEA/HE/106 Assignment report on health education in Sri Lanka (SRL BED 001), 15 December 1 1979 - 24 January 1980 SEA/HE/107 Assignment report on health education SEA/HE/lOB training and primary health care development in Bangladesh (BAN HED 002). 14 April 1978 - 31 December 1979 Assignment report on health behaviour, health education and community participa- tion (ICP HED 003). 8 October - 20 December 1979 SEA/RC33/2 Page 209 Annex 6 Author Dr Ivan lvanov Dr Andrew P. Kenny Dr K.B. Shsrma Dr A.P. Kenny Dr Ivan Ivanov Mr Y . S . Nimbkar M/s. S.C. Dhir 6 S.K. Anand Regional Office Dr V.N. Rao Dr V.N. Rao Document SEA/HLM/157 SEA/HLM/158 SEA/HLM/159 SEA/HLH/160 SEA/HLM/161 SEA/ HLM/ 162 SEA/HLM/163 SEA/HLT/ 7 SEA/HLT/~ SEA/HSD/ 7 SEA/HSD/B Title Health Laboratory Methods Assignment report on health laboratory promotion and health laboratory techno- logy in Rajasthan, India (IND LAB 0021, 1 April - 30 September 1979 See SEA/Haern,Fever/34 Assignment report on laboratory quality control and standardization in Indonesia (IN0 LAB 001), 22 October - 25 November 1979 Assingment report on strengthening of laboratory services in Indonesia (INO LAB 001), 29 August - 12 November 19 79 Assignment report on laboratory quality control and standardization in India (IND LAB 003), October - November 1979 (2 weeks) Assignment report on laboratory promo- tion and health laboratory technology in Andhra Pradesh, India, 1 October - 31 December 1979 Assignment report on public health administration in Maldives (MAV HSD 001), 6-29 December 1979 Health Literature Directory of health science libraries in South-East Asia, June 1979 Establishment of a regional network of health literature, library and informa- tion services (HELLIS) - report of an inter-country consultative meeting. New Delhi.(ICP HLT 001), 27-31 August 1979 Health Services Development Assignment report onmulti-professional team training for primary health care (ICP HMD 0131, 27 December 1978 - 26 April 1979 Assignment report on training of health team for primary health care (ICP HMD 013), 24 March - 11 April 1979 SEAlRC3312 Page 210 Annex 6 Assignment report on health planning in South-Eaat Asia Region (ICP HSD 008), 5 February - 4 May 1979 Document Outlines of a regional programme on formulating strategies for health for all by the year 2000 Report on the Meeting on Financing of Primary Health Care Programmes in Asia, New Delhi, 9-13 July 1979 I I Title See SEAIRES121 Author Report of the Joint UNICEFIWHO Regional Meeting on Formulating Strategies for Achieving Health for All by the Year 2000, with Primary Health Care as the Key Approach, New Delhi, 1-6 December 1979 Report on formulating national strategies for health for all by the year 2000 Report of the inter-country consultation on country health programming and the use of TCDC inhealth planning and management, New Delhi (ICP PPS 002), 30 January - 6 February 1980 Assignment report on the strengthening of national health services in Indonesia, 17 December 1979 - 23 January 1980 (IN0 SPM 002) Mr C.R. Krimhnamurthi Regional Office Regional Off ice Regional Of £ice Regional Office Regional Office Ms Teresa Miller Hepatitis 1 Assignment report on prevention and control of serum hepatitis in the context of the immunization programme in Mongolia (ICP SPI 003). 10 September - 5 October 1979 Leprosy I Asaignment report on "Utilization of Government Leprosy Scheme by Hospitals in India, Evaluation Study" (IND BVD 001) 28 December 1978 - 28 June 1979 Assignment report on study of leprosy control programmes in India (IN0 BW 001). 19 November 1978 - 15 May 1979 Dr A.J. Selvapandian Dr C. Vellut Document 7 I 1 Liver Diseases I Assignment report on control of myco- bacterial diseases in Bangladesh (BAN BVD 001). July 1974 - December 1979 Title Dr V.K. Sham SEA/Liver Dis. /4 Assignment report on progress of research Dr Ian R. Mackay SEA/RES/19 on chronic liver diseases including liver Author SEA/Liver Dis. 13 SEA/RES/18 6 Corr .l cancer in Thailand (ICP RPD 002), 22 June 1979 - 5 July 1979 Assignment report on progress of research on chronic liver diseases including liver cancer in Indonesia (ICP RPD 0021, 22 June 1979 - 5 July 1979 Dr Ian R. Mackay SEAILiver Dis.15 Assignment report on research on chronic SEA/RES/22 liver diseases including liver cancer in Sri Lank (ICP RPD 002), 11-13 October 11979 I / Malaria I Dr Ian R. Mackay SEAILiver Dis ./6 SEA/RES/23 I Maternal and Child Health I Assignment report on research on chronic liver diseases including liver cancer in Burma (ICP RPD 002). 15-18 October 1979 SEA/Ma1/123 SEAIRESI24 Dr Ian R. Mackay Report of a meeting of research workers in the Regional Collaborative Studies on Plamodiwn Falcipanmt Resistance to 4-Ami~quinolines, Chiang Mai, Thailand (ICP RPD 002), 8-13 October 1979 Assignment report on development o£ family and child health services in Bangladesh (BAN MCH 001), October 1978 - April 1979 Assignment report on strengthening of Dr S. Sulahn maternal and child health Dronramme in Dr R.T. Collins Prof. Tin U Assignment report on strengthening of maternal and child health services, Indonesia (IN0 HSD 001), 17 December 1978 - 16 February 1979 Dr J.N. Pohovalla SEAlRC3312 Pa~e 212 Annex 6 Documant SEAlMCHl134 SEAlMCHl135 sE~fMCHl136 SEAlMCHlFPl75 SEAIMCHIFPI~~ SEAIMed.Educ.1361 SEAIMed. Educ. 1362 SEA/Med.Educ./334 Add.1 SEA/Med. ~duc.1334 Add.2 Title Report on the meeting on delivery of health care to the pre-school child in the context of primary health care, Bangkok (ICP MCH 003), 12-16 November 11979 Assignment report on epidemiological surveys of maternal and child health problems in Mongolia (MOG MCH 003), 10 October 1979 - 18 January 1980 Report on the Meeting of the Ad hoc Committee on Paediatric Education and Training in Child Health to consider the draft of the Handbook on Child Health Care, New Delhi (IND MCH 003), 17-19 December 1979 Maternal and Child Health and Family Planning Assignment report on strengthening of family health services in Nepal (NEP MCH 002), June - August 1979 Assignment report on family health in Sri Lank (SRL MCH 002), 20 May - 19 August 1979 Medical Education Assignment report on medical education in Sri Lanka (SRL HMD 0011, 5 February - 31 March 1979 Agency terminal report on assistance to the State Medical Institute, Mongolia, project findings and recommendations (WHO Project MM: HMD 003 - UWDP Project MONG 72/004), September 1975 - June 1979 lbeignment report on development of national poet-graduate training centre#, Bangladesh (ICP HMD 010), 20-29 March 1978 Assignment report on davelopment of national post-graduate training centres, ~urma (ICP HMD 010), 6-17 March 1978 Author Dr H. Wallace Dr C. Gopalan Dr M.M. Varentaov Regional Of fice Dr W. Burgesa Dr V. Omathanondh Dr T.V. Telder Dr E.N. Avilov Dr K.N. Saneviratne -do- SEAlRC3312 Page 213 Annex 6 Document S~AIMed.Educ.1334 Add.3 I I I Title SEAIMed.Educ.1334 Add.4 I Author Assignment report on development of national post-graduate training centres, Indonesia (ICP HMD 010), 12-30 April 1978 SEAIMed.Educ.1363 Dr K.N. Seneviratne Assignment report on development of national post-graduate training centres, Thailand (ICP HMD OlO), 1-19 May 1978 SEAIMed.Educ.1364 -do- Assignment report on "Assistance to the State Medical Institute, Ulan Batar" (Pharmacology) (MOG HMD 0031, April-June 1979 SEAIMed.Educ.1365 Dr A.N. Kudrin Report of a conference on regional cooperation in the WHO fellowship programme, New Delhi (ICP HMD 013), 26-29 September 1979 SEAIMed.Educ.1366 Regional Office I ! Assignment report on Faculty of Public Health, Mahidol University, Bangkok, Thailand (THA HMD 003), 17 October 1978 - 17 August 1979 Report on consultation on coordinated Prof. P.N. Wahi health services and manpower development, New Delhi (ICP HMD 006), 20-24 August 1979 SEA/Med.Educ.1367 ~SEA/~ed.~duc.1369 Report on an inter-country seminar on the reorientation of medical education towards I Dr James D. Shepperd SEAIMed.Educ.1368 community needs, Surabaya, Indonesia (ICP HMD 003), 25-29 June 1979 I Assignment report on post-graduate medical education in Sri Lanka (SRL HMD 001), 24 September - 23 October 1979 Dr J.F. Stokes Assignment report on training of health manpower in Nepal (NEP HHD 001), 20 December 1978 - 19 November 1979 Dr Shamanna Ramaswamy SEA/Med.Educ.1370 SEA/Med.Educ./371 Report on the Eighth Meeting of Directors or Representatives of Schools of Public Health in the African,Eastern Mediterra- nean,South-East Asian and Western Pacific Regions, Bangkok, Thailand (ICP HMD 003). 6-12 March 1979 SEA/Med.Educ./372 Regional Office Assignment report on training of health manpower in Nepal (NEP HHD 001), 15-30 December 1979 Prof. Harold Ellis Assignment report on assistance to the State Medical Institute, Ulan Bator (MOG HMD 003), July - November 1979 Prof. V.P. Pomerantsev SEAlRC3312 Page 214 Annex 6 Document SEA Mad.Educ.1373 SEAIMed.Educ.1374 SEAIMed.Educ.1375 SEA/Med.Educ. 1376 SEA/~ed,Educ./377 SEAl~adllO8 SEA/Ment/57 SEAjMent158 md. 113 SEAlNurs1300 SEA/Nurs/301 Title A/aignment report on poat-greduate teach- ing in occupational health, Sri Lank (SRL HMD 0081, 14 October - 15 November 19 79 Assignment report on post-graduate medical education in Sri Lank (SRL PTR 003) , 12-26 January 1980 b8ignment report on National Institute of Preventive and Social Medicine, Dacca, Bangladesh (BAN HMD 0041, 17 July - 17 December 1979 Assignment report on post-graduate education in public health, Indonesia (IN0 HND 0031, 1 January 1978 - 31 December 1979 Assignment report on radiology training in Burma (education and training for health manpower programme) (BUR HMD 005), 5 November - 17 December 1979 Mental Health Report of a meeting of the Regional Advisory Group on Mental Health, New Delhi (ICP MNH 003), 5-9 March 1979 Assignment report on mental health services in Bangladesh, with special reference to in-aervice training (BAN MNH 001), 24-27 September 1979 Assignment report on mental health teaching seminar on traditional healing Indonesia (IN0 KNH 001). 30 November - 20 December 1979 Nur.inp Assignment report on orthopaedic nursing in Indonesia (ICP HMD 011). 26 April - 14 June 1979 Assignment report on registration of nurses and nursing manpower data in Indoneeia (IN0 PTR 002). 29 December 1979 - 26 February 1980 Author Prof. R.S.F. Schilling Prof. I.D.A. Johnaton Dr 2. Bencic Mr P.J. Blizard Dr William M. Park Regional Off ice Dr W.E.S. Kiernan Dr A. Kleinman Dr T. Maretzki Dr J.S. Neki Mles Mary Powell Mr Edgar A. Turner SEA/RC33/? Page 215 Annex 6 Occupational Health Title -- - Author I I Report of a workshop on comprehensive research-cum-action programme in nutrition for the South-East Asia Region, New Delhi (ICP RPD 001), 11-15 June 1979 Regional Of rice An Action Research Programme in Nutrition for Developing Countries (ICP RPD 001). October 1979 Regional 0i:ice Assignment report on nutrition monitoring, evaluation, planning and surveillance in Indonesia (IN0 NUT 003), 27 December 1979 - 24 February 1980 Assignment report on occupational health Dr G. Anderson and industrial hygiene, Sri Lanka (SRL HWF' 001). 21 February - 20 May 1979 Dr D. Schwefel Assignment report on the design of clima- tic chamber facilities for Indonesia (IN0 HWF' 001), 8 April - 7 May 1979 Mr G.W. Crockford 1 See SEA/Med.Educ./373 I Assignment report on some aspects of education and training in occupational health and safety in Sri Lanka (SRL HWP 001), 4 June - 2 September 1979 Dr R.E. Simson Assignment report on prevention of blind- ness in Thailand (ICP PBL 002), August - October 1979 Dr A. Colenbrander Aesignment report on prevention of blind- ness in Sri Lanka (ICP PBL 002), 3-19 I October 1979 I Prof. P.K. Khosla Assignment report on Indian national plan for the prevention of visual impairment and control of blindness - An information system for monitoring (IND PBL 001). 7 November - 5 December 1979 Dr William H. Hart Assignment report on epidemiological research opportunities in glaucoma and cataract, India (ICP PBL 001), November - December 1979 Dr T.R. Cullinan SEAlRC3312 Page 216 Annex 6 Document SEAIOphthall24 SEA/Ophthal/25 SEA/Ophthal/26 SEAlOphthall27 SEA/Ophthal/ZB SEA/Trach./34 SEA/Ophthal/29 SEA/Ophthal/30 SEA/Ophthal/31 SEA/Polio/8 SEA/Rad/l04 SEA/Rad/l05 Title Assignment report on prevention end control of blindness in Nepal (ICP PBL 0021, 5-18 October 1979 Assignment report on prevention of visual impairment and blindness in Sri Lanka (ICP PBL 002), 17 September - 23 November 19 79 Assignment report on prevention of visual impairment and control of blindness in India (ICP PBL 001), 30 December 1979 - 25 January 1980 Assignment report on prevention of blind- ness in Nepal (ICP PBL 002), 31 October - 6 November 1979 Assignment report on trachoma control and prevention of blindness in Burma (ICP PBL 002), 24 November - 13 December 1979 Assignment report on prevention of blind- ness and visual impairment in Indonesia (ICP PBL 001), November-December 1979 Assignment report on prevention of blind- ness and visual impairment in Nepal (ICP PBL 0011, November-December 1979 Assignment report on prevention of blind- ness and visual impairment in Thailand (ICP PBL 001). November-December 1979 Poliomyelitis Assignment report on the epidemiology of poliomyelitis in Burma (BUR ESD 003), 3-24 November 1979 Radiation Assignment report on radiation health, Sri Lanka (SRL RAD 001), 1-14 May 1979 Assignment report on strengthening of radiological protection services in Mongolia (MOG RAD 001). August - October 1979 Author Dr J.J.M. Sautar Prof. Celbert I. Phillip Dr Carl Kupfer Dr L.P. Aggawal Dr S. Darougar Dr T.R. Cullinan -do- -do- Dr L.B. Schonberger Mr V.G. Ram Subramenian Dr Jerzy Jenkowski SEAlRC3312 Page 217 Annex 6 Document SEA/Rad/l06 SEAlRadll07 SEA/Rad/lO8 SEAlRehabl35 SEA/RES/18 SEA/RES/19 SEA/RES/20 SealRES121 SEAlHSD112 SEAIRES122 SEA/RES/23 SEA/RES/24 SEA/RES/25 SEA/RES/26 SEAlFill20 SEA/RES/27 Title Assignment report on radiotherapy and radiation protection in Indonesia (IN0 RAD 001). 8 November 1979 - 5 February 1980 Assignment report on quality control in nuclear medicine imaging in India (IND RAD 002). 27 November - 18 December 1979 See SEAIMed.Educ.1377 Rehabilitation Assignment report on medical rehabilita- tion specialization course for physicians in Mongolia (MOG HSD 002), 22 October - 21 December 1979 Research Study - ResearchITraining, etc. See SEA/Liver/Diseases/3 See SEAILiver Diseaseslh See SEAlHEl103 Report on the consultation on research programme in financing of health care delivery, New Delhi (ICP RPD 0021, 2-6 July 1979 See SEAILiver Diseaaes/S See SEAILiver Diseases16 See SEAlMa1123 Report on the meeting of the directors of medical research councila or analogous bodies and concerned research foci in the relevant ministries, Colombo, Sri Lank, 18-21 December 1979 Report on the meeting of the bi-regional research study group on bancroftian f ilariasis, New Delhi (ICP RPD 001). 19-23 November 1979 Report of the meeting on development of health services research, New Delhi (ICP RPD 002), 28-30 November 1979 Author Dr Bo Johansson Dr Knud Kristensen Dr Ryszard Kinalski Regional Office Regional Office Regional Office Regional Office A SEAlRC3312 Page 218 Annex 6 Document SEAITrach. I34 SEA/'lrad.Med. 16 SEAlTrad.Med.17 SEAlTrad.Med.18 SE~ITrad.Med.19 SEA/Trad.Med./lO SEAlTrad.Med.111 SE~/Trad.Med.I12 SEAlTrad.Med.113 SEA/TB/152 SEA/TB/153 SEAITBI154 Title Trachoma See SEAlOphthall28 Traditional Medicine Assignment report on traditional medicine in Bhutan (BHU HSD 0011, 1 March - 14 May 1979 Report of the regional meeting on the development of programmes in traditional medicine in South-East Asia, New Delhi (ICP HSD 005). 16-20 April 1979 Assignment report on traditional medicine in Burma (ICP HSD 005). 12-22 May 1979 Assignment report on traditional medicine in Bangladesh (ICP HSD 005),4-11May 1979 Assignment report on traditional medicine in Thailand (ICP HSD 005), 3-13 July 1979 Assignment report on traditional medicine in Indonesia (ICP HSD 0051, 21 June - 2 July 1979 Assignment report on traditional medicine in India (ICP HSD 005) See SEAlMentl59 Tuberculosis Agency Terminal report on tuberculosis control progralmne, Burma - Project find- ings and recommendat ions (WHO Project BUR BW 001 - UNDP Project ~UR/68/018), 1964 - 1978 Assignment report on Tuberculo8ie Research Centre, Madras (IND BW 005), 31 December 1979 - 25 January 1980 Assignment report on control of myco- bacterial diseases in Bangladesh (BAN BW 001), July 1974 - December 1979 Author Dr S. Darougar Dr Bhagwan Dash Dr P.N.V. Kurup -do- -do- Dr K.N. Udupa -do- Dr P.N.V. Kurup Regional Office Prof. Wallace Pox Dr V.K. Sharma - SEAIRC3312 Page 219 Annex 6 Document SEAIVaccinel98 SEAIVBCIS SEAlVBCl6 SEAIVPHl28 SEAlVHSl164 SEAlVHSl165 Titla Vaccine Assignment report on production and control of freeze-dried BCG vaccine in India (IND BLG 002), 23 December 1979 - 17 January 1980 Vector-Borne Disease Control Assignment report on epidemiology and disease control in Bangladesh (BAN ESD 002), July 1977 - December 1979 Assignment report on the proposals for control pf Aodoa mosquitoes in Maldives (ICP ESD 001), 10-31 January 1980 Veterinary Public Health Report on an inter-country seminar for the planning of national and regional programmes for surveillance, prevention and control of zoonosas, held at the National Institute of Communicable Diseases, Delhi (ICP VPH 001). 12-16 November 19 79 Vital Health Statistics Report on a longitudinal survey on natality and mortality in rural Bangladesh (BAN PPS 001). 1976 - 1977 Bulletin of Health Statistical Informa- tion in South-East Asia Author Dr T. Hashimoto Mr G.P. Joshi Mr Jay E. Graham Regional Office Dr Michael Chia Regional Office
SEA/RC33/2 Page 199 Annex 5 CONFERENCES AND MEETINGS IN THE SOUTH-EAST ASIA REGION CALLED BY GOVERNMENTS/OTHER ORGANIZATIONS AT WHICH WHO WAS REPRESENTED (1 July 1979 - 30 June 1980) 1979 - 2-6 July FAO: Firat Session of the Governing Council of the Centre on Integrated Rural Development for Asia and the Pacific Bangkok 3-6 July ESCAP: Round Table Meeting on Participation of Women and Their Emancipation Through the Application of Science and Technology to Development Bangalore (India) 16-21 July FAO: Third Session of the Regional Animal Production and Health Commission for Asia, the Far East and the South-Weat Pacific Bangkok 31 July - 6 August ESCAP: Expert Working Group Meeting on Water-use Data Bangkok 3-4 August Government of India: Seminar on Drinking Water Resources Management in Rajasthan Jaipur (India) Delhi 3-5 Auguat Government of India: All-India Malaria and Filaria Workers' Conference 7-11 August Government of Thailand: National Seminar on Drug Dependence Pattaya (Thailand), New Delhi' 16-17 Auguat Government of India: National Committee on Zoonoaes: Second Meeting 20 August Indian Association for Radiation Protection: Workshop on Biological Hazards of Microwaves and Protection Aspects New Delhi 22 Auguat Government of India: Fourth Meeting of the Central Co-ordination Committee on Prevention of Visual Impairment and Control of Blindness New Delhi 22-24 Auguat United Nations Asian and Pacific Development Institute: Consultative Meeting on Monitoring and Evaluation of Comunity-focused Projects Bangkok 28 August - 1 Septdmber 4-7 September UNFPA: International Conference of Parliamentarians on Population and Development Colombo Bangkok Bangkok Bangkok Bangkok ESCAP: Inter-governmental Meeting on Human Settlements ESCAP: Inter-governmental (Ad hoc) Meeting on Strategies for the Eighties 10-14 September 17-28 September ESCAP: Meeting on Population Information Clearing House and Network System Expert Group 3-4 October Government of ThailandIILO: Symposium on the Working Child SEAlR~3312 Page 200 Annex 5 7 October Association of Obstetricians 6 Gynaecologists of India: Third Annual Conference of Obstetricians and Gynaecologists New Delhi 11-14 October Government of NepalISasakawa Memorial Health Foundation/WHO: Second International Seminar on Leprosy Control in Asia Kathmandu 12 October ESCAP: Inter-agency Committee Meeting on Water Development Bangkok Dacca Bangkok e Bangkok 16-18 October Government of Bangladesh: National Seminar on Health Laboratory Services 22-23 October ESCAP: Preparatory Meeting of Senior Officials for I11 General Conference of UNIDO 29 October - 2 November Government of Thailand: Fourth National Conference on Medical Education "Medical Education Towards Health for A11 by the Year 2000" 30 October - 5 November ESCAP: Sixth Session of the Committee on National Resources Bangkok New Delhi 5-9 November ESCAP: Regional Preparatory Conference for the World Conference of the United Nations Decade for Women 12-16 November UNESCO: Committee of Experts to Define the Outline of a Preliminary Draft Convention on the Recognition of Studies, Diplomas and Degrees in Higher Education in Asia and Oceania Bangkok 18-20 November Government of IndiaIWHO: Workshop on Research and Development for the IDWSS Decade Nagpur (India) Bangkok 19-23 November Association of Paediatric Societies of the South- East Asia Region: Third Asian Congress of Paediatrics 20 November Indian Council of Medical Research: Task Force Meeting on Rheumatic Heart Diseases New Delhi Jakarta 26-27 November Association of South-East Asian Nations: Meeting on Technical Co-operation Among the ASEAN Countries on Drug Legislation, Evaluation and Quality Assurances 27 November - 4 December ESCAP: Twenty-second Session of the Committee on Trade Bangkok Bangkok New Delhi Bangkok Bangkok Bangkok 28 November - 4 December South-East Asia Medical Information Centre: Seminar on Diarrhoea1 Diseases 4 December IAEA: Twenty-third Regular Session of the General Conference 4 December ESCAP: Sixth Meeting of Inter-agency Task Force on LMCSTD FAOIDANIDA: Workshop on Water-lifting Devices in Asia and the Near East 4-14 December 12-14 December FAO: Workshop on Monitoring & Evaluation SEA/RC33/2 Page 201 Annex 5 17-19 January Government of India: XIX Annual Conference of the Indian Association for the Advancement of Medical Education Trivandrum (India) Institute of Post-graduate Medical Education and Research, Calcutta: International Symposium - Hundred Years of Malaria Research Calcutta 17-19 January 21 January - 8 February United Nations Industrial Development Organization: I11 General Conference New Delhi Cox's Bazaar (Bangladesh) New Delhi 26-27 January Bangladesh Association for Voluntary Sterilization: First Annual Medical Workshop 27-29 January Commonwealth Medical Association: Regional Academic Seminar on Preventive Paediatrics in Developing Countries Bangkok 28 January - 1 February FAO: Inter-governmental Meeting on Agriculture Towards 2000 4-8 February International Centre for Diarrhoea1 Diseases Research: Board of Trustees Meeting Dacca 5-7 February Government of India: National Seminar on Health Science Libraries in India Bangalore (India) Jakarta 6-12 February South-East Asia Medical Information Centre: Seventh Workehop on Information on Functions of Health Centre in Primary Health Care in the Context of Its Implementation New rielhi New Delhi New Delhi 11-12 February 12-13 February 18 February 18 February Government of India: National Meeting on Health for All by the Year 2000 Indian Council of Medical Research: Meeting of Scientific Advisory Codttee on Cancer Research Centre for Development of Instructional Technology: ISIS User Seminar World BankIUNDP: International Seminar on Low-Cost Techniques for Disposal of Human Wastes in Urban Communities Calcutta 21-25 February 25-29 February World Federation of Associations of Paediatric Surgeons: World Congress of Paediatric Surgery Bombay New Delhi ESCAP: Consultative Meeting on Priorities and Operational Modes of the Regional Exchange Programmes in Social Welfare and Social Development ESCAP: Meeting of Task Force on Integrated Rural Development Bangkok 25 February 4-8 March 5-13 March UNESCO: Sub-Regional Consultation for Identifying Training Needs in the Least Developed Asian Countries Kathmandu New Delhi FAO: Fifteenth Regional Conference for Asia and the Pacific SEA/RC33/2 Page 202 Annex 5 17-28 March Government of IndialUNESCO: Seminar on Improvement of Housing for the Lowest Income Families in Asia New Delhi 18-20 March Free Church, New Delhi: National Counselling Conference on Indian Family Life Education New Delhi 18-27 March 25-26 March ESCAP: Thirty-sixth Session Bangkok New Delhi Government of India: National Committee on Zoonoses: Third Meeting 31 March - 3 April World Federation of Medical Education: Planning Committee on Inter-regional Invitational Conference on Education and Health Care, 1981 New Delhi 9-14 April UNESCO: Inter-governmental Advisory Committee on Regional Cooperation in Education in Rsia and the Oceania Bangkok 21-23 April Indian Council of Medical Research: Symposium on Evaluation of Primary Health Care Programmes New Delhi Jakarta 21-29 April UNDPIUNIDO: Inter-governmental Meeting on the Production and Control of Pesticides in Asia and the Far East 6-9 May UNESCO: Meeting of Experts from South-East Asia on Follow-up of UNCTAD Recommendation for Develop- ment of National and Regional Programme and Projects in Science and Technology Colombo 8-12 May 22-24 May 26-28 May World Tourism Organization: Integrated Planning for Development of Tourism Colombo Government of IndiaIWHO: Conference of State Chief Public Health Engineers on IDWSS Decade Ootacamund (India) Government of Indonesia: Symposium on Smoking and Health Jakarta
sEA/~C33/2 Page 192 Annex 4 MEETINGS AND COURSES ORGANIZED OR ASSISTED BY WHO AND HELD IN THE SOUTH-EAST ASIA REGION (1 JULY 1979 - 30 JUNE 1980) 19 79 - 2-6 July Consultation on Research Programme on Financing of Health Care Delivery (ICP RPD 002) New Delhi 9-13 July Meeting on the Financing of Primary Health Care Programmes in Asia New Delhi 16-20 July Annual Practitioner Preceptor Training Programme (THA HMD 003) Bang Sen (Thailand) Bangkok 16 July - 4 August Inter-regional Training Course on EPI Planning and Management (ICP SPI 002) 17-21 July National Seminar on Teaching of Human Reproduction, Family Planning and Population Dynamics (SRL HMD 007) Peradeniya (Sri Lanka) Dacca 23 July - 17 August Clinical Teaching in Nursing (ICP HMD 011) 25-27 July Workshop I1 on Food and Nutrition for Multi- sectoral Officers (nutritionists, scientists and physicians) (THA NUT 003) Kanjanaburi (Thailand) 30 July - 4 August Workshop on Low-cost Material Production and Use of Audio-visual Equipment for Health Educators and Faculties in Training Institutions (SRL HED 002) Colombo Country Course in Health Planning and Management (ICP PPS 002) Colombo 30 July - 9 August Training Course for Medical Officers of Referral Institutions in Leprosy Control (BAN BVD 001) Dacca July 6-8 August Follow-up Workshop on Educational Science (BUR PHC 001) Rangoon 6-10 August Inter-contry Seminar on Prevention and Control of Accidents (ICP HSD 003) New Delhi 6-10 August National Seminar on Drug Dependence, Treatment and Rehabilitation (IRP MNH 018) Cholburi (Thailand) Bangkok 6-18 August Inter-country Cold Chain Training Course for Logistical Cadre (ICP SPI 002) 12-25 August Second National Workshop on Educational Science for Teachers of Health Personnel for Primary Health Care (BUR PHC 001) Rangoon Curriculum Workshop, National Institute of Health Sciences (SRL PTR 004) Kalutara (Sri Lanka) 14-15 August ConsultationonCoordinated Health Services and Manpower Development (ICP HMD 006) New Delhi 20-24 August Short Course on Evaluation of Student Performance (ICP HMD 011) Bangalore 20-31 August SEA/RC33/2 Page 193 Annex 4 Medical Education Conference (IND HMD 014) New Delhi Kathmandu 25-28 August 26 August - 7 September EPI Seminar for Senior Supervisors and Refresher Training for District and Assistant Supervisors (ICP SPI 003) 27-30 August National Medical and Health Education Conference (IND HMD 014) New Delhi 27-31 August Consultative Meeting for the Establishment of a Regional Network of Health Literature, Library and Information Services (ICP HLT 001) New Delhi National Seminar on Post-graduate Training in Mental Health (IND MNH 002) Bangalore August- September Seminar on Neuro-Oncology (IND MNH 002) Bangalore August- September National Seminar for Clinical Psychologists (IND MNH 002) Inter-country Course on DPT Vaccine (ICP LAB 004) Clinical Teaching in Nursing (ICP HMD 011) Bangalore August- September 3-15 September 3-28 September Jakarta Bangladesh 19-28 September Sixth National Course on Educational Science for Teachers of Health Professionals (IND HMD 014) Pondicherry (India) 24-28 September Workshop on Health Economics and Management Planning (IND PPS 001) New Delhi 26-29 September Conference on Regional Cooperation in the New Delhi Implementation of the WHO kellowships Programme (ICP HMD 013) Research Study Group Meeting on Nutrition in Primary Health Care (ICP RPD 001) New Delhi 3-8 October Course on Operating Theatre Techniques and Management (BAN EDS 001) 4-27 October Dacca 8-9 October EPI Refresher Workshop in Phase I Areas in Colombo (ICP SPI 003) Colombo 8-12 October Regional Seminar on Environmental Impact Assessment (ICP CEP 002) New Delhi 8-12 October 8-13 October Workshop on Neonatology (IND MCH 003) New Delhi Meeting of Research Workers in Regional Collabora- tive Studies on P.faLcipm Resistance to 4-aminoquinolines (ICP RPD 002) Chiang Mai (Thailand) 11-14 October Second International Workshop on Leprosy Control in Asia (ICP BVD 001) Kathmandu 15-19 October Inter-country Seminar on Prevention and Control of Pulmonary Hypertension (ICP CVD 001) New Delhi 15 October (for 36 days) Workshop on the Immunochemistry of Parasitic Diseases (IND ESD 001) New Delhi SEA/RC33/2 Page 194 Annex 4 New Delhi 22-26 October Consultation on the Development of a Regional Teacher Training Programme in Maternal and Child Health (ICP MCH 013) 22-27 October National Mental Health Workshop No. 1 for Senior Medical Administrators (BAN MNH 001) Dacca 22 October- 2 November Regional Training Course on Water Quality Monitoring (ICP CEP 004) Nagpur (India) 22 October- 21 November Health Planning and Management Course (ICP PPS OOZIIND PPS 001) Shillong (India) 24 October- 9 November Workshop on the Epidemiology and Control of Leprosy (IND BVD 001) Calcutta 25-29 October Workshop on Neonatology (IND MCH 003) Trivandrua (India) New Delhi October Country Course in Health Planning and Health Systems and Management (ICP PPS 002) 1-30 November Workshop on Nursing Development (IND HMD 013) Pondicherry (India) 3-30 November 5-9 November Second Workshop on Medical Mycology (IND ESD 001) New Delhi Seminar on the Role of Education and Communication in Primary Health Care for Integrated Rural Develop- ment (IRP HED 002) Kanchanburi (Thailand) 5-10 November 5-17 November 7-9 November 8-11 November 9-22 November WHO Inter-Regional Workshop I1 on Prevention and Treatment of Drug Dependence (IRP MNH 018) Bangkok Course on Operating Theatre Techniques and Management (BAN ESD 001) Chittagong (Banglade&) New Delhi WHO Regional Meeting on Management of the Expanded Programme on Immunization (ICP SPI 002) Workshop on Urban Health Administration Planning and Supervision (TEA HSD 001) Bangkok National Mental Health Workshop No. 2 for Junior Medical Officers, Nurse Tutors and Teachers of Medical Assistants (BAN MNH 001) Dacca Inter-country Seminar for Planning of National and Regional Programme for Surveillance, Prevention and Control of Zoonoses (ICP VPH 001) New Delhi 12-16 November New Delhi Meeting of the Global Advisory Group, Expanded Programme on Immunization (IRP SPI 024) 12-16 November 12-16 November Chiang Ma1 hailan and) WHO Workshop on Epidemiological and Intervention Programme for Rural Opium-using Populations (IRP MNH 018) New Delhi National Seminar on Mental Health (Identification, Treatment and Community-oriented Mental Health Services, particularly with reference to the Mentally Retarded Child) (IND MNH 002) 12-17 November SEAlRC3312 Page 195 Annu 4 > 12-17 November Meeting on Delivery of Child Care to Pre-school Children in the Context of Primary Health Care (ICP MCH 003) Bangkok 12-30 November Workshop on Teaching Methodology (BAN HMD 003) Dacca Indonesia 12 November- 1 December National Training Courses on International Classification of Diseases (3 courses - each of 6 days' duration) (ICP HSD 007) 13-15 November MNHIHQ Project Meeting of Investigators in the Study of Psychotropic Drug Effects in Different Populations Bombay 17 November National Meeting of Principal Investigators of the Measles Immunization Feasibility Study (ICP SPI 003) New Delhi 18-20 November Workshop on Leprosy Control (NEP BVD 001) Biratnagar (Nepal) 19-23 November Meeting of the Bi-Regional Research Study Group on Bancroftian Filariasis (ICP RPD 001) New Delhi 19 November- 1 December Inter country Training Course for Instructors of Mid-level Personnel for EPI (ICP SPI 002) Bangalore 19 November- 6 December Workshop on Quality Control of Vaccine Kasauli (India) 20-22 November National Workshop on Research and Development Needs for Drinking Water Supply and Sanitation Decade (IND SES 001) Nagpur (Indta) 20-24 November National Workshop on Family HealthIBetter Family Living through Communication and Education for Integrated Rural Development (IRP HED 002) Dacca 21-23 November Inter-regional Meeting on the Community Control of Rheumatic Fever and Rheumatic Heart Diseases (ICP CVD 001) New Delhi 26-28 November Regional Consultation on Activities for the International Drinking Water Supply and Sanitation Decade (1981-1990) (ICP BSM 001) New Delhi 26-28 November National Seminar on the Role of Health Sector in Nutrition Activities (BAN NUT 002) Mohakhali (Bangladesh) Bangkok 26-29 November Workshop on Health Administration and Planning (THA HSD 001) 26-30 November Seminar on Histopathological Diagnosis of Tumours (ICY CAN 001) Bangkok 26 November- 15 December Training Course in Microbiology Dacca 28-30 November Meeting on Development of Health Services Research (ICP RPD 002) New Delhi SEA/RC33/2 Page 196 Annex 4 November Training Course for Family Welfare Workers in Leprosy Control (BAN BVD 001) All Thana HQs in Bangladesh November National Workshop on Mental Health (MOG OCD 001) Ulan Bator November 1979- January 1980 Three-month Certificate Course in Health Education (SRL HED 002) Colombo 1-6 December Joint UNICEFIWHO Regional Meeting on Formulation of Strategies for Health for All bv the Year 2000 New Delhi with primary Health Care as the KG Approach (ICP PHC 002) 3-13 December 3-27 December Seminar on Anti-Malaria Operations with Special Reference to Applied Field Research (ICP RPD 002) Bangkok Training in the Coding of Data according to the International Classification of Diseases (THA PPS 001) Thailand 4-8 December National Seminar on Appropriate Educational Technology for the Training of Comunity-oriented Health Personnel (ICP HMD 013) Bangkok 9-13 December National Mental Health Teaching Seminar on Traditional Healing (IN0 MNH 001) Jakarta 10-15 December Workshop to Review Curricula for Country Course in Cornunity Health Care Management (ICP PPS 002) Kalutara (Sri Lanka) 11-14 December National Seminar of Heads of the Health Education Department (THA HED 001) Karnj anaburi (Thailand) 11- 20 December 12-13 December Course in Clinical Pharmacology Indonesia Training in Epidemiological Surveillance (IN0 ESD 003) Jakarta Workshop on Nursing Development (IND HMD 013) 17-24 December 17-19 December New Delhi New Delhi Meeting of the Ad hoc Committee for Review of the rift of a Handbook on Child Health Care (IND MCH 003) 18-23 December Inter-country Consultation to Develop a Regional Programe on Diarrhoea1 Diseases Services and Research (ICP RPD 002) Rangoon 20-21 December National Meeting of EPI Officers on Progress of New Delhi EPI in their respective States and Municipalities (IND SPI 001) 20-22 December Workshop on the Improvement and Development of the National Health Systems and the role of Primary Health Care for Long-Term Objectives in the Henlth Sector (IN0 SPM 001) Jakarta Colombo Workshop on Integration of Mental Health Concepts in the Curriculum for Nuraes (SRL PTR 002) SEA/RC33/2 Page 197 Annex 4 27-28 December Seminar on Industrial Estate Planning (IND CEP 006) Jaipur (India) 27 December 1979- 5 January 1980 Workshop on Orientation of Teaching and Implemen- tation of the Midwifery Programme for Matrons, Ward Sisters and Staff Nurses (SRL PTR 002) Colombo Regional Meeting on Immunization (ICP SPI 003) December December Jakarta Rangoon Training Course on Immu~fluorescence Techniques (BUR HMD 005) Research Development Workshop (THA HMD 003) Bangkok December December (2 days) Training Course on Nutrition Surveillance (THA NUT 003) Suphanburi (Thailand) 26 November- 7 December 1979 Inter-country Course in Clinical Bacteriology Dacca 18-21 December Meeting of Directors of Medical Research Councils and Analogous Bodies Colombo 1980 - 14-25 January Seminar on the Promotion of Mental Health in Nursing Practice (ICP PTR 003) Thailand 16 January Workshop-cum-Consultation Meeting to Review Health Education Curriculum for Medical Undergraduates (SRL HED 001) Colombo New Pelhi 30 January- 6 February Inter-country Consultative Meeting on Country Health Programning and Use of TCDC in Health Planning and Management (ICP PPS 002) 4-15 February 19-22 February Seminar on the Promotion of Mental Health in Nursing Practice (ICP PTR 003) Thailand BangLr.k National Seminar on Prevention and Control of Cardiovascular Diseases (THA CVD 001) 26-29 February National Conference on Status of Health Education Services in India (IND HED 005) New Delhi 3-15 March Inter-country Training Course for Training of Mid- Level Management Personnel in EPI (ICP EPI 001) 10-14 March Meeting on Research in Viral Haemorrhagic Fevers of the Eastern Mediterranean, South-East Asian and Western Pacific Regions New Delhi 10-15 March Second National and Regional Conference on Drug Abuse (IND MNH 002) New Delhi 17-19 March National Seminar on Programme to train Ophthalmic Health Care Manpower Development in Sri Lanka (SRL PBL 001) Sri Lanka 17-21 March National Workshop on Mental Health (THA MNH 001) Chiang Mai (Thailand) SEA/RC33/2 Page 198 Annex 4 24-28 March Short Course on the Integration of Mental Health Nursing Principles in Basic Nursing (ICP PTR 003) Indonesia 1-4 April SF+. Regional Advisory Committee on Medical Research: Sixth Session New Delhi 14-18 April Short Course on Community Mental Health Nursing (IND EDS 003) New Oelhi 14-26 April Inter-country Training Course for Instructors for the Training of Mid-Level Management Personnel in EPI (ICP EPI 001) Calcutta 21-29 April 28-29 April Short Course in Neuro Nursing (IND EDS 003) Bangalore New Delhi Inter-personal Skills and Effective Nurse-Patient Relationships (IND EDS 003) 28 April - 2 May Joint ICMR/WHO Scientific Group Meeting on Vaccine Against Tuberculosis New Delhi 21-25 April National MCH Workshop for State-level MCH Officers (IND MCH 003) New Delhi 2-7 June Inter-country Consultative Meeting on Leprosy Research and Control (ICP RPO 002) New Delhi 9-13 June Bi-Regional Workshop on Developing Primary Health Care System (ICP PHC 002) Chiang Mai (Thailand) 10-17 June Training Course for Technicians involved in Vector Control (ICP MPD 001) New Delhi & Bombay 24-30 June Follow-up Meeting on Health for A11/2000 with special emphasis to Community Participation/ Multi-sectoral Approach in PHC (ICP PHC 002) New Delhi National Meeting on Health Legislation Indonesia June June-August Travelling Seminar for Health Education Faculty of Universities offering Post-graduate Training in Health Education - 6 weeks (ICP HED 003) Several countries Course for Providing Administrative Training to Middle-level Workers at the Divisional Level (ICP SPM 003) Sri Lanka June