Organisation mondiale de la santé (OMS) · Technical Documents

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

31 décembre 1980 Organisation mondiale de la santé

Texte intégral

BRIF;F REPORTS RECEIVED l"ROH aOVERNf·{ENTS ON THE PROGRESS OF THEIR HEALTH ACTIVITIES

American Samoa Australia China Fiji Guam Japan l.falaysia "*

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Democratic Kampuchea

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French Polynesia ** Hong Kong

New Caledonia and Dependencies ** New Zealand * Papua 1'1ew Guinea Republic of Korea Singapore * Socialist Republic of Viet flam ** l!-

Trust Territory of the Pacific Islands \"lallis and Futuna

"**

* **

Issues in English only Issued in French only

ENGLISH ONLY

AMERICAN SAMOA GOVERNMENT PAGO PAGO, AMERICAN SAMOA 96799

LBJ TROPICAL MEDICAL CENTER DIRECTOR'S OFFICE

MED-A

August 27, 1980

Health System in American Samoa American Samoa has a State Health Planning and Resources Agency funded by a Federal Grant. On May 6, 1976 the Governor of American Samoa appointed a State Health Coordinating Council which has review and approval authority over state plans and statewide project applications, and advises the State Agency generally in the performance of it's various functions. Members of the State Health Coordinating Council consist of Laymen, Physicians, Dentists, Nurses and Educators and provides the State Agency with input from both users and providers of the Health System. In 1978 after many months of hard work gathering information and data and assessing the efficiency of the existing Health System, the State Health Planning Agency compiled and published an American Samoa Plan for Health 1978-1983. (This Plan for Health has recently been revised and updated). In most respects the American Samoa Plan for Health is analogous to World Health Organization's strategies and plans of action to achieve the goal of an acceptable level of health for all by the year 2000. Programs that are now in effect and are: 1. 2. 3. 4. 5. 6. 7. 8. be~ng

pursued with vigor

Primary Medical Care Maternal Child Health and Crippled Children Control of Diarrheal Diseases Contagious and Communicable Diseases Detection and treatment of Hypertension Family Planning Immunization Mosquito and Vector control

Health System in American Samoa Page -2Aguust 27, 1980

9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19.

Sani tat ion Safe Drinking water for all Health Education Collection of data and statistics Mental Health, Alcoholism, Child Abuse Filariasis and Leprosy, Detection and Treatment Development of Medical Manpower Continuing education for Medical Personnel Rehabilitation Preventative and therapeutic dentistry Evaluation of all programs

A Renal Dialysis Unit was activated at the LBJ Tropical Medical Center in June 1980. Steps have been taken to improve and expand regional intercountry programs for the control of diseases prevalent in the region. Our plans for the years 1984-1989 are to expand and improve our present on going programs. To monitor and evaluate existing programs, and to establish new programs if there is a demonstrated need for them. The World Health Organization has for many years provided great assistance to the Government of American Samoa and it's Department of Health. We look forward to continued cooperation from WHO in the areas of Manpower development, further education of our Medical Personnel, on site consultation by Specialists and the provision of pertinent useful printed information.

j(/l,~V-L (y, )~~/ hi·V

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JAMES P. TURNER, M.D. Deputy Director Department of Health Services JPT/jon

ORIGINAL:

ENGLISH

AUSTRALIA - NATIONAL HEALTH ACTIVITIES DURING 1979-1980 1

This report outlines some new initiatives undertaken during the past year. 1. National Health Promotion Programme

This programme, which is aimed at improving the general level of health in Australia, was developed and tested. It was directed principally towards developing a national media campaign to persuade the community to adopt a number of simple rules for good health. Evalu4tion of the programme, pilot-tested in three cities, showed favourable results, and a strategy for a national campaign is being developed. 2.

Nutrition

During the year, there has been a g~owing recognition by both Government and the community in Australia of the importance of nutrition to health. One major initiative has been the drawing up and adoption of a food and nutrition policy, recommending a set of dietary guidelines for Australians. There is a growing acceptance of these guidelines by nutrition professionals, the food industry and the community in general. 3. Alcohol and tobacco

The Government has adopted a broad long-term health-oriented national strategy on drug abuse. As part of this strategy, the Government has adopted a specific policy on alcohol and alcohol abuse and will apply preventive and curative measures to combat alcohol abuse. The Government has also determined as national policy a commitment to a decrease in the per capita consumption of tobacco.

Aboriginal health

The Government has a commitment to improve the health status of Aboriginals to a standard equivalent to that of their fellow Australians. Accordingly special programmes have been instituted and continued during 1979-1980. During the past decade such programmes have been supported to the extent of approximately $20m per annum. While the normal indicators of health status, such as the infant mortality rate, hospital morbidity, have shown that the health standards of Aboriginals are improving, much still remains to be achieved before the Government's aims are realized. It is recognized that not only must the environmental and socioeconomie conditions be improved but health services provided for Aboriginals must be able to relate to their cultural understandings of health and at the same time increase their awareness of the benefits of good health.

~ lSubmitted by the Director-General of Health, Department of Health, Australia.

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. A special report on Aboriginal health, commissioned by the Government, called for the greater involvement of Aboriginals in the health care delivery services. Aboriginal medical services are continuing to develop. The recently conducted National Trachoma and Eye Health Programme also found that Aboriginal involvement was a key element in their success. 5. WHO Western Pacific Regional Teacher Training Centre for Health Personnel

There has been a further increase in the number of enrolments and in the number of countries sending fellows. A doctoral programme in health personnel education has been introduced. Centre personnel were involved in a medical education workshop conducted in China following the signing of the Memorandum of Understanding between WHO and the Government of China. The primary health care area has been further developed in the Centre's programmes. 6. Study of transcultural medical problems

The Migrant Health Unit has developed its investigational functions into the diseases found in migrants. particularly with regard to Indo-Chinese refugees. Many transcultural medico-social problems have been defined and examined with a view to finding solutions to these. As approximately half of Australia's postwar population increase is due to new migrants from many cuI tures, a number of new fields requiring study have emerged. 7. Study of utilization of health and medical services by migrants

As migrants do not generally arrive in Australia with a knowledge of Australian health and medical services, there is reason to believe they underutilize existing services. Recommendations are being made to overcome in time this underutilization of services. Measures involving the production of numerous health topic multi-lingual publications to assist in counselling. together with ethnic radio short segment announcements and subsequently films and video tapes, are being developed.

Community health programme

Funding has been provided for the provts10n of increasing numbers of ethnic health workers, interpreters and translators. 9. Family planning

In 1979-1980 the Commonwealth Government continued to support, under the Family Planning Programme, family planning education, information and training activities throughout Australia. Grants for new initiatives were made to rural family planning extension projects and to a factory-based family planning education project primarily for migrant women.

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10.

Evaluation of new technologies in medical practice

The National Health Technology Assessment Advisory Panel has been established to advise on new and existing medical technologies and related services and to monitor their impact on health services. 11. National Perinatal Statistics Unit

This unit was established at the Commonwealth Institute of Health and is responsible for the analysis and interpretation of perinatal health data and research on perinatal epidemiology. 12. Medical and dental manpower

Because of the projected oversupply of doctors, medical immigration has been restricted. A review of the adequacy of existing and projected supply levels of dentists is being undertaken. 13. National Survey of Nursing Personnel

A report of the National Survey of Nursing Personnel was published in November 1979. The Survey collected data from approximately 136 000 respondents, including responses from health institutions, professional (registered) nurses, enrolled nurses, students and nursing aides in training. The data formed a base line for determining the supply, characteristics, distribution and uti! ization of nurs ing personnel in Australia. The results of the Survey will be of major importance to governments and health service administrators in determining future policies in the delivery of nursing care to the community. 14. National Nursing Manpower Task Force

Following on the National Survey of Nursing Personnel, it was decided to establish a National Nursing Manpower Task Force to estimate and monitor future nursing manpower requirements in Australia. 15. Quarantine

New human quarantine arrangements are being made which involve the progressive closure of all human quarantine stations. A high security isolation unit is under construction at the Fairfield Hospital in Melbourne and mobile isolators are located in all capital cities to transfer highly infectious cases of diseases such as viral haemorrhagic fevers to the Fairfield Unit. 16. Health Facilities Planning and Information System

The Australian Departments of Health and of Housing and Construction jointly continued development of a Health Facilities Planning and Information System, to provide a logical and methodical approach to decision-making during the planning, design, construction and commissioning of hospitals and other health facilities. The System will relate to both construction of new facilities and refurbishment or replacement of existing ones. Introduction of a rational system of decision-making, having regard to all available relevant information, is expected to result in substantial savings in both capital and operating costs of health facilities.

ENGLISH ONLY

SOME MAJOR POINTS IN THE HEALTH WORK OF THE PEOPLE'S REPUBLIC OF CHINA SINCE LAST YEAR

Since the thirtieth session of the WHO Regional Committee·for the Western Pacific, China has further implemented the policy of "readjusting, restructuring, consolidating and improving" the national economy and made great achievements in various fields. The Central Committee of the Communist Party of China and the State Council have put it explicitly that culture, education and health work should be taken as one of the priorities in the process of the readjustment of national economy so as to make considerable progress in these fields within a relatively short time. After several years' readjustment, the health services in China have been restored to a normal order and are moving steadily towards modernization· with new advances being made constantly in disease prevention and treatment, scientific research, medical education, etc •• By the end of 1979, there were, in the whole country, 65 009 hospitals and 1.932 million hospital beds, 1066 specialized prevention and treatment centres, 3047 health and epidemic prevention stations, 2559 maternal and child health centres. and 295 research institutions of medical sciences. The number of professional health workers totalled 2.642 million. On the average, every tho\,lsand population has 1 •. 99 hospital beds and 0.67 medical doctors (including both western medicine and traditional Chinese medicine). The national conference of directors of health bureaux was held late 1979, which addressed itself to the implementation of the policy of readjusting, restructuring, consolidating and improving the national economy in the light of the actual situation in health sector. It was decided at the conference that the major tasks for health in 1980 would be: to further build up health services in rural areas; to strengthen health and epidemic prevention work and carry out patriotic health campaigns on a large scale; to inherit and carry forward medical heritages of the motherland and facilitate the integration of western medicine and tr adi tiona1 Chinese medicine; and to go in for fami 1y planning conscientiously. In the meantime, effective measures should be taken to. enhance our Party's leadership over health work, to train health technical personnel .and administrative staff energetically, to strengthen scientific management and to do a good job in pharmaceutical production and supply so as to guarantee the accomplishment of above-mentioned tasks. Some new progress has been made in various fields following the principles and tasks defined by the conference. The buildup of health services ~n rural areas is a priority in our health work. The provinces, municipalities and autonomous regions in this country .are making arrangements for the implementation of requirements for the successful building up,first and foremost, of health institutions

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in about one-third of the counties. Up to now, China has 2300 county hospitals with each having about 130 beds on the average and 55 000 conunune health centres, each averaging about 14 beds. Apart from these, each production brigade has a few barefoot doctors and each production team has health aids and birth attendants. Taking into account the new economic situation prevailing in our rural areas, we are considering how to improve the cooperative medical service and the contingent of barefoot doctors better suited to the present status of rural collective economy for the purpose of continuous consolidation and better management of cooperative medical service, stabilizing and upgrading of barefoot doctors and of increasing the capabilitv of grass-root level of health institutions in disease prevention and treatment. The national meeting on health and epidemic prevention work and that of the directors of general offices of provincial, municipal and autonomous regional conunittees in charge of patriotic health campaigns defined the tasks for the new historical period, namely, to continue to follow the principle of putting prevention first and integrating health work with mass movement and to do a good job in disease prevention and treatment and in carrying out patriotic health campaigns. The supervision and monitoring of environmental sanitation, workers health, food and school hygiene have been reinforced in various localities; certain standards, rules and regulations as well as legislation have been worked out since last year. At present, China is pulling its forces together in formulating its first health act. Thanks to the importance shown by the local Party conunittees and governments, headway has been made in the patriotic health campaigns. In the urban areas, environmental sanitation has been improved with garbage removed and sewage drained and the density of vectors such as flies, rats, mosquitos and bedbugs has been reduced. In the rural areas, large-scale health capital construction, for example, "two proper controls and five reformations" (proper controls of water and excreta, reformations of wells, latrines, animal enclosures, kitchen stoves and environmental sanitation), has continued. The health conditions in both urban and rural areas continue to change for the better, and .efforts are being made to create a clean, beautiful and civilized working and living environment for the broad masses of people. This year, this country has summarized its experiences and lessons in our work in the field of traditional Chinese medicine and the integration with western medicine, considered principles, policies and measures which should be taken for future action, and formulated the principle of energetic development of traditional Chinese medicine, western medicine and the integration of the two schools of medicine and their Joint existence on a long-term basis. All these will have positive effects on the development of new medicine and pharmacology bearing national characteristics of our own and the promotion of modernization in our medical sciences. The natural increase rate of population in China has been lowere(l to 11.7 per thousand in 1979 with eight provinces and municipalities well below 10 per thousand. It is planned to control the total popul<ltion of our country within 1.2 billion by the end of this century. In ordl't" -~

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to accomplish this arduous task, our Par,ty and government have advocated one chi ld for each couple andcrewardto those with one child. The local governments have also taken a number of effective measures to encourage' e~erycouple to have one child. ,In addition to .family planning education carried out in an active manner in collaboration with other governmental departments, the health departments at various levels have also done a lot of work in giving technical advice in family planning, conducting scientific research and providing better maternal and child health services. The infant mortality in this country has dropped remarkably; for instance, in the urban areas of Beijing, infant mortality has lowered to about 12 per thousand and maternal mortality 1.3 per ten thousand in 1979. With a view to train more qualified personnel to meet the needs of the four modernizations, we have reinforced, in a planned way, continuous education for the existing medical and health staff, taking into consideration the present status of our medical and health workers. Training courses in various forms have been organized for different categories of technical and administrative personnel by the provinces, municipalities and autonomous regions. Since the beginning of this year, there have been altogether 4000 professional technical personnel and senior teaching staff trained in the courses directly sponsored by the Ministry of Public Health. Various forms of training activities have been adopted, such as spare-time courses, TV university and correspondence education. We have actively promoted technical cooperation and exchanges with foreign countries, have sent study missions and post-graduates abroad and invited foreign experts to give lectures in China. The national meeting on higher medical education held this year summed up our experiences in the last 30 years, had intensive discussions on how to develop higher medical education in conformity with the actual conditions and is determined to elevate, in the 1980's, higher medical education to a new level in terms of both quantity and quality.

",--

Some progress has been made in 1980 in medical research on such priority subjects as cancer, cardiovascular diseases and endemic and occupational diseases. On the basis of a retrospective investigation on the mortality of malignant tumours in the 1970's, this country carried out an analytic study on fairly complete statistical data gathered from among a population of 850 million from 1973-1975. As a result, the distribution of malignant tumours in this country has been clarified r "Maps on the Distribution of Malignant Tumours in the People' s Republic of China" and "Investigative Study on the Mortality of Malignant Tumours in China" have been prepared, which are of great importance to the formulation of national anti-cancer programmes for the protection of people's health. Fourteen research institutions of medical sciences have been designated as WHO collaborating centres in accordance with the Memorandum Between the Ministry of Public Health of the People's Republic of China and the World Health Organization Governing Technical Cooperation in Health Activities.

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The modernization of medical and health sciences is an important component of the four modernizations in our country, which is apparently a long-term arduous task. At present, we are faced with a number of difficulties, and much remains to be done. We shall continue to follow the line and principle laid down by the Central Committee of the Communist Party of China, unite and work hard to make greater efforts in raising the health standard of our people and speeding up the process of four modernizations.

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LA :3AN':rE

EN FRANCAIS SEULEMENT

SITUATIOB 3AliITAIRI AU KAl';PUCHEA llB1100RATIQUE DE

1975-1980

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Nous avons ramis en valeur la madecine traditionnelle en se servant de matie-res r·remieres existant .~s Ie payee Parallelement des eftorts ont ~te entrepr~i~~n"~at d~ tonctionnement de!.usines pharmace~tiques fa~riquant de~ u(edicamenta modernes a partir des matieres premieres import6es. Nous avons, pour cela, torm& le personnel necessaire au tonctioDnement de ces usines. Un ·lab.:)ratoire de recherche et de contrOle de la gualit~ at de 1'etticaci~ des medicaments a ~t' institu' pour les tester avant de les mettre a la disposition de la population. Pour taire face aux nouveaux besoins, nous avons egalement importe beaucoup de medicaments mQdernes de l'~tranger en particulier des antibiotiques, des medicaments antipaludiques et d'autrea produita que noua n'avona pas encore ~aDriqu' dans 1e pays .Par ailleura. l' Insti tut Pasteur a Obro~ ObaDgYa a ite ~galement remi~ ~~.~oDCtionnementet produisant des vaccins co __ tre la variol~" "8ffncho1"riqueset~ des vaccina pd!t- lutter coatre la ~aladie des animaux. Nous avons pu tormer des personnels qualifi"6s pour ripondre a cette nouvelle tache. Dans 1e domaine de la sante de la mere at de 1'enfant, des etforts ont faits poar donner des soins a la mere pendant la periode pre et post-natale. NOU8 encourageons les meres • al1idter leurs enfants au seine Nous nous sommes preoccuPes .ussi de la sante de l'enfant. C'est pouquoi la mortalite intantile dim1nue d'une fa~on app~ciab1e. .

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Des resu1tats speetaculaires ont ete obtenus dans 1. domaine de la lutte contre Ie paludisme. En 1978, avant l'invasion des troupes ~trangeres dans notre pays, le paludisme est eradique a95~ dans tout 1e territoire national. Pour atteindre de tols resultats, nous avons dU mener une campagne. e7stematique avec la participation de toute la population atin de lutter coytre cett.e maladie. Pour cela nous commen~ons par ouvri. una ecole de formation des cadres de for:nation sani tiire po.r mettre sur pied un reseau de personnes chargees d'ettectuer des mesures prophylactiques et t~rapeutiques i travers tout le pays. Des prodults insecticides tela que le DDT importe en rande quantil(e pouretre utili.e dana cette camp~ne. La popuation elle-meme participe aveo enthouaia.me a cette campagDe en assainissant 1es lieux propices au deve10ppement des mouatiques. Des malades atteints le paludisme. oat 801gn's at trait6s jusqu'a complete ~uerison. Noue avons mene une campagne de prelevement de sang i travers tout le p~ pour d'tecterle cas de paludisme et fait des traitements adequats. Ctest ainsi que dans lea regions reputees comme endemiques tels que Paili n dans 1a province de Battambang, Aural dans la province de Ko. . POng. chhnangA_Ratanakiri et Kompong 30m port, 1e paludisme est eradiqu6de ~;b.

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En ce qui concerne les maladies diarrh'iques ~~enterie bacterienne et amibienne), notre 11inistere de la Sante a pris

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- 3 certaines mesu.ren prophylactiques • .Du point de vue sanitaire, nous avons ~duque la population concernant l'hygiine des eaux de boisson notamment en faisant boiillir l'eau et concernant l'a1imentation g~~rale. Grace aces mesures, 1a friquence de cette maladie a diminu&. En plua des midicaments modernes, nous avons eu recour~ au:x: medicaruelJ.ts traditionnels. D,~ maladies parasitaires ont ~t. egalement sensiblement diminuaes par des mesures prophylactiques et par 1'utilisation des meiicamenta traditionnels.

En co qui concarne les maladies epidemiques comme le cho18ra, neus avons mene une campar.:ne de vaccination systematique ii travers tout 1e pays at obtenu un resultat satisfaisant. C'est ainsi que, dep~is 1975 jusqu'a l'invasion de notre pays par des troupes~trangeres 1e 25 ~ecembre 1978, nous ntavons pas des cas de cholera. Ainsi durant trois annees depuis 1975-1978, des efforts -enormes ont ete deploy6s par 1e Gouvernement du Kampuchea Democratique an vue d'ameliorer la sante de la population et d'augmanter son bien.... tre. Des resu1tats importants oat ete obtenus dans oe domaine. Des temoigna;;es des j09Z'nalistes tela que j,Judman at Elisabet;h Becker qui ont visi te notre pays au mois de .Decembre 1972. prouvent que l'btat de sante de notre I::opulatio n stes~ coasiderab1ement ameliore. Malheureusement tous ces efforts 2nt et! aneantis par l'invasion de notre pays par des troupes etrangeres le 25 Decembre 19?8. II) ~~~2~_~I~!!!~§_A£_~~~~~£ll~_~~Q2S!!!J~~~UtS LE.~2

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son invasion 1e 25 Decembre 1978, l'ennemi a~resseur~ vise non seulement a occuper notre territoire national pour realiser sQn ambition expansioniste mais Bussi a exterminer notre race par l'utilisation non .eula.ent d.es &rIDe. conventioJmelle. et des armes de 18 famine mais aussi plus criminel1ement encore des gaz et des prodults chlmiques toxiques. ~lus de deux millions d'habitants de notre pays ont ~~e massacr's par 1'ennemi. De cette faQon plusieurs millions d'8utres sont entrain de souftrir du fait de ls ~uerre dtagression actuelle. La presence de 250.000 de troupes etrangeres dans notre pays ne tscilite en rien les mesures en vue de sauver la vie de 1s population du Kampuchea. 11 est majntenant certain 9ue la situation sanitair~ ~ 1 'beur. actuelle au KSr:lpucbea Democratique est d.e plus deplorable. Des images montrees i travers toute 1a presse in~ernat1o-

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nsle montran'C des rei·uf':ies chasses de notre pays par les troupes d'occupation 'Cemoignent 'Coute l'horreur dee crimes commie par l' ennemi a 1 'egard de la population civile innocente. ~ dcOW plusieurs centaines de rnilliers d'autres qui restent actuellement a l'in1:8rieur du pays continuent de mourir <1e maladie, de ramine et p-ar les srmes conventionnelies et chimiques de l'ennemi. Les deplacements perpetueis de is popula'Cion pro voqu's P4r I'ennemi. l'exode de cette population vers les zones insalubren te1s que 1es f'orets et les re~ions mon'&agneuses amenent la recrudescence de toutes sortes de maladies tels que Ie paludisme. la diarrhee. la malnutrition et l'infe~tion microbienne et virale. Ces mnlaClies atteignent particulierement les enfallts~ les rueres et les personnes ag6es qui sont les plus faib1es. face a ce nouveau environnement hostile. Ralgre toutes sortes de dif'.ricult-es. notre lWlinistere de 18 sante a fait de tres gros efforts pour fairs race a cette nou~e~le situation. Des centres hospitaliers ae 1uO a !)OO lits ont ete Mis en place pou~ r~ponare aux besoins urgent.. ~es centres medicaux ant -eta crees avec des personnels adequats pour rapoDdre a 1a demande croiss8n'Ce de 1a p~ula'Cion. Du fait de 1a guerre, nous avona eu recours aus medicaments traditionnels pour lut~~~.contre Ie paluaisme. 1a diarrh8e. ~777~' s. abua uti1isO~Qes medicaments modernes a eet et"f'et mus nous ne disposons qu·en quanti~e 1imitee. ~ar ailleurs. des Organisations liumanitaires sont touJours les bienvenues. Nous nous perme'Ctons lei de lancer un appel pressant au Comit~ R6gional de l'Organisation r:ondiale a.e 1a Sant~ au l:'aei.fique uccidental de bien vouloir se pencher sur 1e cas de 1. population au Kampuchea Democratique qui est entrain de sourrrir et de lui en aide sous toutes les formes possibles en vue d'alle3er cette sourfranee. J'avance, 1e Gouvernement du Kampuchea Democratique 8e permet de lui ad.resser ses chaleureuses remerciements. Nous sommes eonvaincus que 1a ai liuation sani taire de notre pOfJular.ion ue peut ·ti'"tre resolue que par 1e ratrait total at incondi~ionnel des troupes d'agression de notre· pa;iS du l ..ampuchea J)emocratique. Aprea oe retrai t Is popula'Cion aura trouve una situation stable ~ l'in'C~rieur de chaque villa':e, (le chaqua vii :.0. de chaque di.Gtric'C permettant ainsi de mener a bonne fin l'am61iorat~on de la saD'&e de tout. ls population. I.e retrai t des troupes '8trangeres de notre P838 permet a 1a population de wener son 'Cravail de production et de x-epondre 8J.SSl aux be,;oin:, HliIl1entaire:J qui a son in.f1uence sur son etat de sante. Le peuple du Kampuchea a 1e droit de ~cider ~e ,on propre destin en toute ind:9pendance de souverainete, saris 1Dz.erence exterieure.

ENGLISH ONLY COUNTRY REPORT - FIJIl 1. INTRODUCTION

This report covers the progress of health activities 1n Fiji up to 1980, the last year of the seventh development plan. The Ministry of Health's objectives, as set out 1n the seventh development plan, are as follows: (a) (b) (c) to promote the physical, mental and social wellbeing of the people of Fiji; to protect the young and the old from illness; to provide adequate clinical facilities and staff to satisfy the medical and dental needs of the rural and the urban population; to promote a better standard of living through reducing the birth rate.

Because sufficient coverage of the country by the basic health services was achieved during the sixth development plan period (1971-1975), most of the objectives of the seventh development plan (1976-1980) were attained during the development plan period.

PROGRESS IN THE SEVENTH DEVELOPMENT PLAN PROGRAMMES

2.1

Strategy

The main objectives of the Ministry of Health in the seventh development plan, as shown above, were implemented through various programmes and projects. However, the strategy was based on the principl~s of primary health care. Emphasis was placed on the following components: (a) nutrition; safe drinking water; environmental sanitation~

it) (c)

sanitary disposal of human waste; minimal environmental pollution and hazards; industrial and environmental health;

ISubmitted by the Permanent Secretary for Health, Fiji.

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(d)

control of communicable/chronic diseases: immunization; vaccination;

(e) (f) (g) (h) 2.2

appropriate health care; family planning; health education; essential drugs. i~volvemen~

Community

The Ministry of Health shifted the emphasis towards health programmes which have their roots in the community, based on the cultural, political, socioeconomic and educational situation, and also fully utilized community involvement in the various health programmes. 2.3 Nutrition

The National Food and Nutrition Committee (NFNC) has been set up to formulate national policies on nutrition throughout the country. It has also tackled policies on local food production and its equitable distribution, especially to the disadvantaged groups, slum dwellers, destitutes, the elderly, the unemployed urban dwellers and others. Projects to deal with malnutrition have included nutrition education of the mother in maternal and child health clinics, antenatal and post-natal clinics as well as home visits of district nurses. 2.4 World Food Programme

The World Food Programme (1977-1982) distributed dried powdered milk to pregnant and nursing mothers, infants, pre-school and primary school children, and in the treatment and surveillance of malnourished children. 2.5 Maternal and child health services

Maternal and child health services have been improved during the plan period. Adequate care in the antenatal, delivery and post-natal periods has been provided to mothers and infants. There has been increased provision of preventive health care and immunization for infants, those in early childhood and those in the school age groups. The maternal mortality rate has been reduced by 45% from 156/100 000 live births in 1970 to 86/100 000 live births in 1978 because of improved services. The immunization programme has improved to such an extent that by 1978, 88% of all infants given the prescribed dosages returned for the second and 75% returned for the third dosages. Whooping cough, diphtheria, tetanus, poliomyelitis and tuberculosis (in the under-IS years age group) have not been notified in the last 10 years in Fiji.

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2.6

Family planning

Since it was Government's intention to reduce the birth rate and thus promote a better standard of living, a birth rate of 22 per thousand was targeted by 1980 compared with that of 29 per thousand in 1975. However, this has failed to be realized, and despite an increased family planning protection rate of 28% in 1978 (only 24% in 1975), the birth rate has remained high at 32 per thousand in 1978.

2.7

Drinking-water and sanitation

Availability and accessibility of safe water at an affordable cost by all people in Fiji has remained one of the main objectives in the development plan period. To this end a target of safe drinking water for all the population in all communities and schools has been set. Progress so far has been very encouraging, and 70% of the villages and 55% of the rural settlements in the whole country have obtained safe water supplies. Similarly, 100% of the population is targeted to have sanitary latrines and reasonable waste disposal and drainage facilities. Again, progress has been extremely satisfactory for all urban areas and 70% of the villages and rural settlements in the whole country have been adequately covered.

2.8

Environment

The overall improvement of the environment 1S an important target of the national objective to provide a code on water, noise and atmospheric pollution and its corresponding enforcement. To this end enforcing laws and regulations is just as important as educating the people to realize the urgent need to protect the environment, which faces a continuous challenge from the rapid changes brought about by development in the urban and the rural areas. Several national targets have been laid down, including the following; (a) (b) (c) Cd) the establishment of the environmental protection council of Fiji; the prevention of pollution of communal water supplies, lakes, rivers, streams and coastal waters; the establishment of the national environmental and industrial health centre; and the increase in the regular inspection of all food process1ng establishments, markets, etc.

These targets have been set to adequately meet the national objectives, which aim at ensuring that all developments are undertaken in accordance with ecological principles; the promotion and extension of all aspects of industrial and environmental health and the need to ensure that industrial wastes are rendered harmless before being discharged into rivers, streams or the sea.

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2.9

Chronic diseases

Progress in the control and surveillance of non-communicable but preventable chronic diseases has been somewhat slow. The national targets have been set to reduce to specified levels the following: (a) (b) (c) (d) (e) (f) (g) rheumatic heart diseases; degenerative cardiovascular diseases 1n the under-50 age groups; pulmonary emphysema; peptic ulcer; cirrhosis of the liver; medical control of all diabetics and hypertensives; and control of gout.

The recent WHO-sponsored survey on hypertension and diabetes mellitus in Fiji has been the latest activity undertaken. However the ongoing programme on the medical control of hypertension and diabetes mellitus has been firmly established throughout the country. The control of smoking together with the reduction of alcohol-related problems, control of drug dependency and the prevention and control of accidents are progressing slowly, through governmental and nongovernmental agencies. 2.10 Health care

Appropriate health care throughout the country has progressed well under these three main objectives; (a) (b) (c) access by everyone to appropriate health care; an adequately functioning health service network accessible to all to meet demands for outpatient and inpatient care; provision by the network of comprehensive health care, covering health promotion, prevention, treatment and rehabilitation.

To attain these objectives, Government has continued to replace or extend existing medical centres and also constructed new centres in areas it deemed to be in immediate need of such services. Major capital projects undertaken in the period were the completion in early 1980 of the new lIS-bed Labasa Hospital, which had been built in phases, and the new 100-bed maternity annex at Colonial War Memorial Hospital. Also completed in the seventh development plan period were 36 nursing stations and 5 health centres, while another 11 new nursing stations, plus 3 existing ones to be upgraded to health centres have yet to be completed.

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2.11

Health manpower

The provision of facilities for appropriate health care, as discussed in (10) above, has been paralleled by the training of health manpower. The national objectives have been to provide the necessary manpower with appropriate expertise and competence to meet the service needs in the Ministry of Health and, secondly, to expand and improve the quality of health manpower by strengthening the Fiji School of Medicine and the Fiji School of Nursing. Both these training institutions have continued to produce health manpower not only for Fiji but also for other countries in the South Pacific.

NEW PROJECT

No other new project in Fiji in the plan period deserves higher priority at present than the national bulk purchasing of essential drugs. This phased project under WHO sponsorship has been set up with these ob ject i ves : (a) (b) (c) (d) to give the popUlation in Fiji the opportunity to purchase the most needed drugs at a reasonable price; to purchase drugs of established quality at the best possible prices; to reach the largest possible number of the population with the most needed drugs through realistic distribution; and to make available the most needed drugs selected in sufficient quantities at all times.

Although the project is planned to be operational by the early part of the eighth development plan (1981-1985) in two phases, several essential activities have yet to be implemented. These include the following: (a) formulation and implementation of drug policies on: selection of essential drugs; legislation; procurement; distribution; pricing; drug information for health workers; education of the public; (b) (c) (d) collective purchases of drugs for government and private sectors; prescribing and dispensing; distribution through all possible appropriate outlets in government and private sectors.

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HEALTH STATUS OF THE COUNTRY

4.1

Health care

Notwithstanding a low health budget averaging 6.79% of the total national operating budget in the years 1970-1975 and 6.45% in the years 1976-1980, an adequate and efficient health care system was maintained. Apart from the low budget, the other two factors responsible for this efficient health care were the dedication of the staff and the most welcome community involvement of the people of this country in the health programmes. 4.2 Common diseases

The standard of health of the people is generally good. The most common illnesses are influenza, dengue fever, infantile diarrhoea, measles and chickenpox. There is some evidence of tuberculosis in the older age groups and a rapid increase in the incidence of sexually transmitted diseases (STD) in the younger age groups. 4.3 Population

The population of Fiji has shown a steady increase: 401 018 in 1960, 590 439 in 1976, 601 491 in 1977, 612 046 in 1978 and 628 472 in 1979. The crude birth rate dropped from 39.3 per thousand in 1960 to 28 per thousand in 1976. It rose to 30.6 per thousand in 1977, then to 32.1 per thousand in 1978 and reached 32.2 per thousand in 1979. The annual rate of natural increase of the population fell from 3.3% in 1960 to 2.4% in 1976, remained somewhat static at 2.5% in 1977 and 2.6% in 1978 but rose again to 3.1% in 1979. 4.4 Age distribution

The age distribution showed that in 1960 43.7% of the population were under 15 years of age with a minimal decline to 41.6% in 1976. The population over 65 years of age was 3.2% in 1960 and 2.4% in 1976 and this pattern of age distribution had shown no significant variation. 4.5 Death rate

The crude death rate has fallen from 6.5 per thousand in 1960 to 4.4 per thousand in 1976 and thence increased slightly to 5.S per thousand in 1978 and 5.7 per thousand in 1979. The main causes of death in Fiji are the same as those seen in the more developed countries. These ate diseases of the heart or circulatory system, cerebrovascular diseases, metabolic diseases such as diabetes mellitus and the various deficiency states, complication of old age, diseases of the newborn, disease of the lungs or the respiratory system, and various forms of cancer.

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4.6

Life expectancy

Despite this, the average life expectancy at birth for the country as a whole has generally increased. For males of all races, this has increased from 57.96 years in 1956 to 63.3 years in 1976, while for females of all races this has increased from 58.22 years in 1956 to 69.68 years in 1976. 4.7 Areas of concern

The main areas of concern, which will require close monitoring by the Ministry of Health in the coming years, are the pro~lems of malnutrition affecting young children and mothers in pregnancy and the accompanying complications of anaemia in pregnant mothers giving rise to babies of low birth weight; a high infant mortality and increased predisposition to maternal mortality; the mosquito-borne diseases such as filariasis, dengue haemorrhagic fever, measles, the increasing incidence of sexually transmitted diseases, road transport accidents and ~lcohol-related disorders •

EN FRANCAIS SEULEMENT

Mars 1980 1 LE SERVICE DE SANTE PVBLIQUE EN POLYNESIE FRANCAISE

~-~-~---~------~----------------~---~~-------~----. L ··HBRITAGE Le Service de Sante s'.at imp1ante dans le Territoire avec la presence f'ran.;aise et dans 1e mhe temps que .'insta11ait l'Aalira1 BRUAT. Des 185", on peut trouver la trace d'une infirmerie mi1itaire pres de la Papeava, plus tard en 1857 deja, une inf'irmerie de garnison dans le quartier Vaiami, a 1aquel1e succede en 188% et sur le m3me emplaCeMent un h6pital.

Cet h&pital sans cesse agrandt et modernise, pendant pres de 90 ans, etait encore en 1970 l'h6pital genetal de PAPEETE. Devenu depuis lors f'ormation annexe abritant 1es services de neuro-psychiatrie et de pbtisio10gie, il a laisse la place au.nouvel h&pital de Hamao qui f'onctionne a la fois comme formation bospitaliere municipale pour Papeete et comme f'ormetion de recueil des malades grave. evacues de l'lle de TAIIITI et des diver. arcbipels. 70~ de la population est ra •• emble dans le groupe central des lIes du Vent - Tahiti et Moorea, dont 9/10. pour la seule lIe de Tahiti et 50" dans la seule agslomeration de PAPEETE.

Cette physionomie sinsuliere, cet amiettement geograpbique, cet eparpilleDlent at ce desequili:bre demographique ainsi que le8 servitudes qui en decoulent, conditionnent l'organisation et Ie mode d'action des services administratif's et techniques. A la concentration delDOgraphique de ltarchipel des lIes du Vent correspond a Papeete un noyau sanitaire fortement structure ou sont centralises tous les organismes repondant aax diverses activites normales d'un service de sante. A la dispersion des populations inaulaires des autree archipe1s repond un reseau d'inf'irmeries ou de dispensaires dissemines sur 1es lIe. lea plus importantes parf'ois double ou remplace par un service medical itinerant qui supervise une organisation primaire de type communeutaire. A l'eloignement .et i l'isolement des archipels peripheriques est apporte le correctif d'ane certaine volonte de decentralisation bospitaliereet de relative autono.ie de f'onctionnement. L'h6pital Mamao dispose des moyens de diagnostic et de trait.ment les plus modernes, et un personnel medical et paramedical bautement qualif'ie. Cet h&pital a obtenu en 1978 une part d'autono.ie de gestion admin~8trative sous la f'orme dIan budaet annexe. Paral1elament a son installation au chef' lieu, le Service de la Sante Publique s'est peu a peu 6tendu aux di.vers archipels pour atteindr. l'orcanisation actuell.e, avec lea f'orwaationsnecessiteiGs tant par lea iaaperatif's adaainistratif's sanitaires et demographiques. 1 Presente par laDitection de 1a Sante pub1ique de 1a Polynesie fran~aise. d

1 ,

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LE PRESENT L'organisation actuelle de la Sante Publique en Polynesie Frana pour reference l'arrate 526/I.ADM du ) FeYrier 1975 portant reorganisation du service territorial et I . loi de ju11let 1977 portant statut du Territoire pla9ant la Sante PUbl!que sous la competence du Territoire. ~aise

Cette organisation a ete conditionnee par la configuration geograpbique et la repartition demographique - 11' lles distribuees en cinq archipels, representent 1t.000km2 de terres emersees sur 1t.000.000 km2 de surface oceanique et comptent environ 1~0.000 habitants tres inegalement repartis. I - LES ORGANISMES CENTRAUX

1 - Organisme de Directton La Direction du Service de Sante Publique de Polynesie Fran~ai

se qui assure : - l'animation, la coordination et le contrale des activites de sante pub1ique - le recueil des statistiques sanitaires et les relations avec les organismes internationaux - la planification sanitaire et la preparation d'une legislation - la preparation du budget et la gestion des credits et l'administration generale des moyens materiels et bAtiments - la gestion des personnels, l'orientation/\\ contrale de la formation des personnels 2 - Formation d'approvisionnement Le service pbarmaceutique pour l'approvisionnement des formations du Territoire ,.-....

L'Inspection des pharmacies

1 il ~

J - La Formation Une Ecole-Territoriale d'infirmiers/ieres agreee pour la preparation du dipl&me d'Etat comportant un cycle A, tandis que Ie cycle B de cette mame ecole assure la preparation d'un dipl&me territorial d'adjoint de soins, de niveau un peu superieur aux aides sOignants de Metropole, ou certains agents specialises - bygiene generale, hygiene dentaire, aide-laborantins etc •••

i " "

II II

II - ORGANISMES DE MEDECINE PREVENTIVE 1 - Centre de protection infantile, situe non loin de la Direction, confi' , trois midecins, deux pu'ricultrices, une assistante soeiale, du personnel infirmier. Son £ichier comprend 7.000 dossiers. Actuellement, pres de 2.000 nouveaux entants y sont inscrits chaque annie. Cependant, la vocation initiale de cet itablissement pour la prevention et l'education des meres est surclasse par 18 demande de 80ins et le centre tonctionne essentiellement comme dispensaire intantile.

II II .~

...

. .. / ....

:3 2 - Le Service d'hYliine territorial de salubrite pub11que et des guarantaines Ce service conjugue Ie contrale epidemiolog1que territorial, le contrale sanitaire aux f'rontieres, les enquetes et contrales au niveau d'une agglomeration de certaine importance. Place sous la responsabilite d'un medecin contractuel, assiste d'un adjoint, doit Caire l'objet d'une decentralisation vers les di££erents archipels sous reserve de ren£orcer qualitativement et quantitativement ses ef'f'ectiCs. :} .. Le service d' hygiene ,s091air,! installe dans Ie 9uartier Hamao, mobilisant quatre m6decins retenus essentiellement par des activites curatives au detriment de la vocation essentielle du service. Au niveau des archipels, les activites de medecine scolaire sont assumees par Ie medecin en place. Service a decentraliser et a soulager par la creation de dis. pensaires municipaux secondaires dans l'agglomeration de Papeete.

4 - Le service d'hYliene dentaire charge de l'application des mesures dthygi~ne et de prophylaxie dentaire en milieu scolaire, des traitements conservateurs precoces de la carie dentaire, grAoe a un f'ichier tenu selon les methodes modernes de l'in~ormatique. 5 - un service d'hYliene mentale annexe au service de neuro. psychiatrie de Vaiami. 6) une section d'Education Sanitaire chargee de dirtger, pro. grammer, coordonner les actions d'&ducatlon de la sante avec l'aide d'un comite territorial regroupant des personnalites politiques conCessionnelles et les animateurs de jeunesse. 7) Une section des handicapes chargee de coordonner, animer, aider les activit6s entreprises sur Ie territoire dans le domaine des handicapes physiques 0'1 psychiques et d'etudier la prevention des de£icits. 8) un service territorial de trans~usion sanluine destine a evoluer 6ventuellement en centre territorial de trans~usion sanguine. Certaines activites du domaine de la Sante Publique assumees par Ie-Service d'Etat des Endemies (dissous en tin 1979) pour la lutte contre la tuberculose, les maladies respiratoires, la maladie de Hansen, les maladies transmises par voies sexuelles sont encore assumees sous Ie contr&le de l'Institut de Recherches Medieales Louis Malarde parallelement aux autres activites assumees par cette institution territoriale dans Ie domaine de la recherche.

....

III - ORGANISMES DE MEDECINE DE SOINS Ils assurent les actes de diagnostic et de traitement 8uivant un f'onc.ionnement pyramidal en l secteurs primaire secondaire et tertiaire (communal) (circonscriptions (territorial) medicales)

... / ...

4.. 1 - les :formations territoriales (secteur tertiaire) Elles re90ivent los malades de tout leTerritoire soit directe~ ment sur certi:ficat medical des medecins de Papeete et Tahiti, soit par evacuations sanitaires des archipels. Elles comprennent : a -hopi tal terr.i torial de Mamao

405 lits acti:fs

services de medecine generale pediatrie chirurgie generale chirurgie specialisee maternite

ophtalmologie otorhinolaryngologie

service d'electroradiologie et radiotherapie service de kinesitherapie laboratoire de microbiologie chimie medicale une pharmacie consultation de atomatologie b _ ~. ~aeita1 de soins specia1is!~ (Vaiami) de 113 1its

..;.

service de neuro-psychiatrie service de phtisiologie

ave~

psychiatr1e ouverte t'ermee

cJ. qn ce?tre d'accuei1 pour personnes 4,ees (CAPA) de 90 lits a Taravao d - un centre de sell a Orof'ara inCirmerie neuve. 2 - Le secteur secondaire comprend • • lies du Vent a Tahiti ,GO#'

mal.4d.Le- de. Ban. village et d'~

Papeete : les centres specialises des services de prew vention accordant leurs soins en tant que centre de sante urbain centre de protection maternelle centre de protection infantile centre medico scolaire dispensaire central de Mamao Faaa Taravao la circonscription medicale de Tahiti Nui (Nord) et ses centres communaux lacirconscription medicale de Tahiti Iti (Sud) avec l'h&pital secondaire de Taravao de 90 lits at les centres communaux

11 II II II

JI II

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5 b - Moorel'l La circonscription medicale de Moorea avec un centre medical de 20 lits a ACnreaitu et 2 centres de sante annexes Dans les archipels a - lIes sous le vent La circonscription medicale des lIes aous Ie vent avec l'h&pital secondaire d'Uturoa (RAIATEA) 80 lits et centres de sante annexes par iles (5) b - Aux lIes Marquises lits Une circonscription medicale avec un h&pital secondaire de 40 a Taiohae (NUKU-HIVA) Un centre medical de 20 lits Des centres de sante annexes c - Aux Tuamotu-Gambier Un dispensaire centre de coordination Un centre medical a Rangiroa Des infirmeries

Atuona (HIVA-OA)

Papeete

Nakemo Anaa Rikitea Tiputl\ Une inCirmerie h8pital a Hao (Service de Sante des Armees) d - Aux Australes

Un centre medical de 20 lits a Tubuai Des centres annexes par iles (4)

J - Le secteur primaire 11 s'agit des centres de sante communaux repartis dans 1es di£ferentes circonscriptions medicales et places sous la responsabilite soit d'un inCirmier/iere ou d'un adjoint/te de soins_ Le Conseil de Gouvernement du Territoire at en son temps, donne son approbation pour Ie principe de l'installation d'au moins un centre de sante par commune, ce qui nlest pas encore realise partout. Cependant, tenant compte des repartitions particulieres de la population polynesienne sur les atolls et dans les vallees encaissees des tles Marquises, une evolution du developpement des soins primaires a ete engagee pour l'installation de' centres de sante primaires confies a des agents communau •• ires de sante a formation elementaire. Experience en cours de realisation aux Tuamotu Gambier les collectivites varient de 20 a ,0 individus sur les atolls •

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6 AU TOTAL : Secteur tertiaire territorial 1 hopital principal Mamao 1 hopita1 so ins specialises Vaiami 1 village hansenien 1 centre pour personnes agees Secteur secondair~

405 115 40 90

1its 1its 1its 1its

6 hopitaux secondaires ou centres medicaux avec cabinets dentaires Secteur primair,! 12 centres de sante communau*~.certains medica1isas par la presence de medecins VAT ou non : Moerai (RURUTU) Patio (TAHAA) Fare (HUAHINE) Vaitape (BORA-BORA) Avato'ru (RANGIROA) Hakahau (UA-POU) 22 centres de sante primaires 15 postes de secours IV - DEPENSES ENGAGEES POUR LA SANTE Ces depenses sont financees par deux sources distinctes de credits (en francs CFP) Budget du Territoire Sante Publique et Hopital de Mamao Institut de Recherches Medica1es Louis Malarde Fonds d'Etat Fransais personnel ........ 0 •••••••••••

4 centres de consultations specialisees

I J

1978 1.072.500.000 48.500.000

1979 1.)07.482.000 58.225.000

I I

Service des Endemies •••••••• To tal Glmeral Budget du Territoire •••••••• Fonds d'Etat fran~ais.......

862.250.000 107.120.000

599.098.000 126.040.000

1.121.00Q.000 969.)70.000

1.)65.101.000 725.1)8.000

PERSONNEL SANTE PUBLIQUE - Personnel medical

L'action medicale entreprise sur Ie Territoire au titre de la Sante Publique a toujours pour support majeur Ie personnel de tache du Service de Sante des Armees effecte du fait de ses competences tant dans 1es formations hospita~ieres que dans 1es circonscriptions medica1es de l'ile principa1e Tahiti et des archipels peripheriques •

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7 Les postes de direction du service comme de l'h6pita1 Mamao sont conCies du personnel des Armees detache.

En 1979, ce personnel comprend : • Medecins des armees .•.•..•....•..•.•..•••••...••••.• )0 pharmaciens chimistes ••••••••••••••••••••••••••••••• ) o£Ciciers d·administration •••••••••••••••••••••••••• J vo1ontaires de l'assistance techniqu••••••.••••••••• 15 (dont 5 chirurgiens-dentistes)

Personnels contractuels .. medee ins .. - pharmac i en •• d 0 0 • 0 • 0 ••• 0 0 •••••••• 0 • • • • • • • • • • • • • • • • • • • ••

16 1 10

III

•••••••••••

•••••

••••

•••

o.•••••••• • • • • • • • • •

-0

•

... dentistes .. ~

••••

0.,

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

•

••

soit en ce qui concerne 1es medecins de sante pub1ique un medaein pour 2.500 habitants. 11 convient d'associer a la couverture medica1e de la population l'action entreprise sur Ie territoire par Ie secteur des armees luim'me (CEP) et par Ie secteur prive. Le taux de couverture est a10rs de 1 medecin pour 1.000 habitants Le personnel para-medical Ce personnel ne comporte qu'un Caible renCorcement par du personnel des armees, un poste a 1a Direction et trois postes a l'h&pital Mamao, l'essentiel de ce personnel est compose de cadres de l'Etat pour la Polynesie Fran~aise ou de contractuels du Territoire - techniciens scientiCiques •••••••••••••••••••••••••••• 6 infirmiers/ieres •...••••...••.••....••••••••••••••••• 260 adjo.ints/tes de soins •••••••••••••••••••••••••••••••• 120 - techniciens agents •.......•..•..•.•...••.•..•.....••• 60 - administratiCs ....•.....••.•••..••..•.••••.••••••.•.• 90 ~ VI~-

LES ACTIVITES ENREGISTREES

Taux moyen pour une annee Medecine de soins Nombre d'hospitalises ••••••••••••••••••••••• 16.000 hospitalisations ••••••••••••••••••••••••••• 2JO.OOO consultants •••••••••••••••••••••••••••••••• 250.000 consultations •••••••••••••••••••••••••••••• 450.000 Medecine preventive examens pratiques (Centre de Protection InCantile) contr&le des ecoles (Hygiene scolaire) •••••••••••• hygiene dentaire - soins systematiques - •••••••••• Hombre de naissances enregistrees dans les £ormations de Sante Pub1ique par an •••••••••••••••••••••••••• 65.000 10.000 51.590 2.000

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L'AVENIR La priorite qui a ete durant de nombreuses annees accordee a la medecine curative avec Ie succes certain qu'e11e a connu doit etre maintenant reconsideree et reamenagee. En e££et, Ie ren£orcement inevitable de structures centrales, lee besoins nouveaux qui se sont individualises ont constitue un £acteur supplementaire de concentration au niveau du che£-lieu aux depens d'une deserti£ication progressive des archipels peripheriques mais egalement d'une pauperisation croissante du milieu urbain. A£in de £aire £ace a la situation actuelle sur Ie Territoire, dans Ie domnine sanitaire et social la Direction se doit de renr~rcer ses moyens, de rede£inir sa vocation. En tenant compte des transformations engendrees par Ie statut du Territoire, les autorites politiques doivent disposer d'un conseil superieur territorial de Sante Publique. Toute la legislation sanitaire est dans Ie domaine des structures.

reprendre et actualiser 4

En ce qui concerne la medecine de soins, la specialisation renforcee de Mamao, meme si elle doit necessairement etre contr8lee pour ne pas desequilibrer l'action d'ensemble, ne peut etre negligee tenant compte de l'evolution rapide des techniques et de l'isolement de la Polynesie FranQaise dans Ie Paci£ique. Un nouvel hopital meres et en£ante doit permettre de decongestionner l'hopital Namao at de grouper toute l'action d'education de prevention de soins pour cet important secteur. Un nouvel hopital psychiatrique doit etre cree a£in de liberer Ie quartier devenu central de Vaiami. Mais surtout de veritables formations secondaires de qualite doivent jtre installees au niveau peripherique pour satisfaire au mieux possible des principaux problemes des archipels. Dans Ie domaine de la prevention et de l'education, de grands efforts sont a consentir dans la decentralisation de tous les services qui doivent etre representes dans chacune des circonscriptions medicales • Le pivot du developpement sanitaire repose sur la formation des personnels dont il apparait souhaitable qu'elle puisse se taire au niveau du territoire par un institut des carrieres paramedicales en limitant au maximum l'expatriation. Pour son developpement sanitaire et Ie contr6le de ses structures Ie Territoire bene£icierait d'un soutien technique par une universite metropolitaine.

ENGLISH ONLY GUAM HEALTH STATUS REPORT FOR THE 31ST WHO REGIONAL COMMITTEE FOR WESTERN PACIFIC SEPTEMBER 1980 WITH LAST YEAR'S REPORT AS A POINT OF REFERENCE, GUAM REPORTS THE FOLLO\'HNG CHANGES: A. ADVANCES HAVE BEEN MADE IN TUBERCULOSIS CONTROL WHICH REFLECT A CONTINUING DOWNWARD TREND FOR THE PAST DECADE. CASE RATE PER 100,000 POPULATION IS DOWN TO 54.4 FROM A HIGH OF 180 IN 1970. ALTHOUGH GUAM'S CASE RATE IS STILL THE HIGHEST IN THE U.S. INCLUDING ALL ITS POSSESSIONS, THE NUMBER OF CASES RESISTANT TO FIRST LINE ANTI-TB DRUGS, REMAINS MINIMAL. IMMUNIZATION LEVELS AMONG THE SCHOOL-AGE POPULATION AGAINST ALL IMMUNIZABLE DISEASES APPROACHES 90%. FOR THE PAST TWO YEARS, NOT A SINGLE CASE OF POLIO, DIPHTHERIA, PERTUSSIS AND TETANUS WAS REPORTED. SINCE JULY 1979, THERE HAVE BEEN NO CASES OF INDIGENOUS MEASLES. A NEW PROGRAM FOR SCREENING AND TRACKING HYPERTENSIVE INDIVIDUALS HAS RECENTLY BEEN ESTABLISHED. WE ENVISION A DRAMATIC EXPANSION OF THIS PROGRAM BOTH IN THE PUBLIC AND PRIVATE SECTORS IN THE NEXT THREE YEARS. GUAM REMAINS RABIES FREE ALTHOUGH THE PROBLEM OF FERAL DOG CONTROL PERSISTS. MODEST GAINS HAVE BEEN ACHIEVED IN DEVELOPING A HEALTH INFORMATION SYSTEM FOR OUR TRADITIONAL PUBLIC HEALTH PROGRAMS. SERIOUS ATTEMPTS ARE BEING MADE TO DEVELOP A MANAGEMENT INFORMATION AND A PROGRAM EVALUATION SYSTEM. A REVITALIZED MATERNAL AND CHILD HEALTH/FAMILY PLANNING COMPONENT OF THE PUBLIC HEALTH DEPARTMENT CONTINUES TO DECREASE BOTH INFANT MORTALITY RATE (15.8/1,000 LIVE BIRTHS) AND LIVE BIRTH RATE (24.9/1,000 POPULATION) • 'l'HERE IS A CONTINUED INCREASE AND EXPANSION OF ACTIVITIES IN THE AREA OF CORRECTIVE AND REHABILITATIVE SERVICES FOR MENTAL RETARDATION AND OTHER CRIPPLING CONDITIONS THROUGH THE COOPERATIVE EFFORTS OF SEVERAL GOVGUAM AGENCIES. INTERMITTENT GENETIC COUNSELING SERVICES FROM OFF-ISLAND SOURCES HAVE ALSO BEEN MADE AVAILABLE. SPEECH AND HEARING DEFECTS ARE BEING SCREENED, DETECTED AND CORRECTED EARLIER. HEALTH EDUCATION, NUTRITION COUNSELING, ACCIDENT PREVENTION AND HEALTH RISK-REDUCTION PROGRAMS MADE MODEST INROADS. THE PUBLIC HEALTH DEPARTMENT CONTINUES TO PROVIDE THE LARGEST PUBLIC DENTAL PRACTICE IN THE AREA FREE OF CHARGE TO ALL CHILDREN 16 YEARS OF AGE AND UNDER. PLANNING HAS BEEN INITIATED TO FLUORIDATE THE WATER SUPPLY AS A MORE COST-BENEFICIAL ALTERNATIVE.

.G.

"\ ...

A PILOT PROGRAM AIMED AT DEV.L:LOPING A PREVENTIVE SCREENING WITH REFERRAL AND FOLLOW-UP COMPONENTS TO A TARGET GROUP OF INDIVIDUALS AGED 55 AND OLDER HAS RECENTLY STARTED. DATA FROM THIS PROJECT WILL BE USED TO DEVELOP FUTURE HEALTH MAINTENANCE PROGRAMS. VENEREAL DISEASE INCIDENCE CONTINUES TO BE IN THE UPSWING WITH AN ALARMING INCREASE IN THE NUMBER OF PENICILLIN-RESISTANT GONORRHEAL CASES. GASTROENTERITIS, DIARRHEA AND RELATED COMPLAINTS ARE INCREASING. TOGETHER THESE PROBLEMS WERE THE CAUSE OF 2,171 OR 6.7% OF ALL PATIENT VISITS TO GUAM'S ONLY CIVILIAN HOSPITAL. THE MOST FREQUENT ETIOLOGIC AGENT IS SALMONELLA AND GAINED FOR GUAM THE NOTORIETY OF HAVING THE HIGHEST INCIDENCE (85 PER 100,000 POPULATION) IN THE ENTIRE U.S. AND ITS POSSESSIONS. AS OF THE 23RD REPORTING WEEK OF 1980, SALMONELLA CASES WERE RUNNING 48% AHEAD OF THE 1979 RATE. MAJORITY OF CASES WERE IN INFANTS UNDER 1 YEAR. A. CASE/CONTROL STUDY OF GUAM'S EPIDEMIC SALMONELLA BIOTYPE S. WAYCROSS IS CURRENTLY IN PROGRESS. VIBRIO PARAHEMOLYTICUS IS THE NEXT MOST COMMONLY IDENTIFIED PATHOGEN CAUSING DIARRHEA-GASTROENTERITIS IN ADULTS. THIS IS A RELATIVELY NEW PATHOGEN ISOLATED ON GUAM JUST A FEW YEARS AGO DURING THE COURSE OF A CHOLERA OUTBREAK INVESTIGATION. CIGUATERA FISH POISONING AND SHIGELLOSIS HAVE LOW-LEVEL MORBIDITIES ON GUAM BUT SEEM TO BE INEXORABLY GAINING GROUND. VIRAL INFECTIONS OF THE GASTROF.NTF.RITIS TRACT MAYBE A SIGNIFICANT CAUSE OF GASTROENTERITIS ON GUAM BUT DUE TO THE LACK OF A VIRUS LABORATORY ON THE ISLAND, THE TRUE INCIDENCE OF SUCH INFECTIONS IS NOT KNOWN. THE GUAM DEPARTMENT OF PUBLIC HEALTH AND SOCIAL SERVICES IS COMMITTED TO THE U.S.'S TWIN NATIONAL GOALS OF HEALTH PROMOTION AND DISEASE PREVENTION. WE ARE ALSO COMMITTED TO WHO'S GOAL OF PROVISION OF PRIMARY HEALTH CARE FOR ALL BY THE YEAR 2000. GUAM'S HEALTH PLAN AMBITIOUSLY CALLS FOR OUR ENTIRE POPULATION'S ACCESS TO ESSENTIAL PRIMARY CARE SERVICES BY 1983! GUAM'S HEALTH DEPARTMENT HAS 4 DIVISIONS, ONE OF WHICH IS THE PUBLIC HEALTH DIVISION. THIS DIVISION HAS A PROPOSED BUDGET OF $3.5 MILLION FOR Fy'81 WHICH REPRESENTS ONLY 2.5% OF THE ENTIRE GOVERNMENT OF GUAM BUDGET. IT PROPOSES TO SPEND $33.00 PER CAPITA TO REHIBILITATE, CURE, PREVENT DISEASE AND PROMOTE THE WELL-BEING OF GUAM'S PEOPLE. ABOUT 47% OF THIS BUDGET IS ALLOCTED FOR Hl~ALTH PROMOTION AND DISEASE PREVENTION OF WHICH 53% IS FOR CURATIVE AND REHABILITATIVE SERVICES. 20.5% OF THIS BUDGET COMES FROM FEDERAL GRANTS AND CONTRACTS AND THE BALANCE GRiI'1fI~B J\NQ COt,TRACTS AflD THE 131dtlmCE COM!!! FROM LOCAL RECOURCES.

ENGLISH ONLY Brief Report on Progress of Health Activities in Hong Kong - 1979 1 Introduction The population of Hong Kong increased by 6.3% from 4.7 million in 1978 to 5 million in 1979. The general standard of health

is comparable with most advanced countries as exemplified by the low infant mortality rate and the absence of common childhood communicable diseases such as diphtheria and poliomyelitis. the problem of an influx of refugees and illegal In 1979 Hong Kong faced immigran~s.

However, meas~es

due to the energetic applications of preventive and control

no introduction of quarantinable diseases or epidermics of other communicable diseases were reported.

Vital Statistics The crude birth rate was 16.8 per thousand population, as compared with 17.2 in 1978. The infant mortality rate was 13.3 per

thousand live births, and the maternal mortality rate was 0.08 per thousand total births which was very low in comparison with other countries in this region. population. The crude death rate was 5.3 per thousand

Health of the Community Total notifications of notifiable communicable diseases numbered at 12,997 in 1979. total. Tuberculosis cO~9rised

60.8% of the

Four cases of cholera were notified and transmission of the Thirty-nine

disease was prevented by effective control measures. im~orted

cases of malaria and one case of congenital malaria were No indigenous case was recorded. tmm~ni~ation

notified. cases.

There were 1929 measles

Free measles

for children aged 9 months to 5 years Septe~ber

continued throughout the year.

Since

1978 rubella vacGination /was •...•••.•

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

was offered to girls aged 11 to 14 and to women of child-bearing age. A register for congenital rubella syndrome was set up for long term evaluation of this new immunization programme. The main causes of death in Hong Kong in 1979 were malignant neoplasm, heart diseases and cerebrovascular diseases.

/Health Services ••••••

Health Services Tuberculosis and Chest Services The notification rate and death rate of tuberculosis were 161.4 and 10.7 per 100,000 population respectively. Over 98% of all

newborn were vaccinated with BCG - perhaps the highest rate in the world. As a result tuberculosis is now rare among those under 15.

Territory wide publicity programmes have been intensified in the past two years in order to tackle the main sources of infection.

Social Hygiene Service Of the total 5388 cases of venereal diseases notified the number of gonorrhoea, syphilis and non-specific urethritis cases were 2761 (51%) 1130 (21%) and 974 (18%) respectively. cases occurred in the teenage group (below 15 About 3.9% of the While free

year~).

treatment are given at social hygiene clinics, energetic control measures are directed at interrupting the chain of transmission.

Family Health Service The Family Health Service operates a total of 38 maternal and child health centres and 41 family planning centres. In 1979.,

91% of new borns were taken to a centre for attention and advice on at least one occasion. More than 50,000 children have benefitted

from a comprehensive observation scheme introduced in April 1978 to screen, detect and assess early developmental abnormalities so that early remedial actions can be taken to eliminate or minimise disabilities.

Health Education . ~

The Central Health Education Unit, established in 1978, has commissioned several projects, including campaigns on cholera prevention, health of the elderly and eye care. The broad ai'ms of the unit are to

educate the public on health care, to act us

ro:;ource unit providing

health educational materials and techniques for other services, to co-ordinate health educational activities and to disseminate health information.

/Hospi tal. •••••

Hospital and Out-yatient Services

At the end,of 1979 there were totally 20,606 in Hong Kong.

hos~ital

beds

This gives a ratio of 4.2 beds per thousand

~opulation.

There were 52 Government out-patient and specialist clinics, a number of which held evening out-patient sessions, Sunday and public holiday sessions to cope with the increasing demand partioularly in the more densely populated areas. ~.

The School Dental Care Service began operating on a trial basis in November 1979. Its objective is to prevent dental decay in The

.....

school children by regular examinations and simple treatment ~

programme has started in Primary I students and its phaseddevelppment will eventually cover all primary school children. dental clinics are planned for the 1980s. Six other school

/Medical •••••• •

Medical Development

Following the regionalisation of the medical and health services in 1911 the bed-occu~ancy

in various district hospitals

has increased significantly while pressure on the regional hospitals has been considerably relieved. The territory is being divided into

four regions, and the East New Territories will become the fifth region when the new 1400-bed Sha Tin Hospital begins operating in early 198).

The South Kwai Chung Hospital, a new l)OO-bed mental hospital,is to be completed in 1980. Also scheduled for completion in 19801s

the Dental Teaching Hospital which will provide clinical training facilities for the dental school being established at the University of ~ong

Kong. A second medical school, to be~tablished

at the Chinese

University of Hong Kong, will have its first intake of pre-clinical students in 1981. year. The school will eventually produce 100 doctors a

Two more nurse training schools are also planned over the next

five years. After a two-year community nursing pilot scheme in 1919, the service has now become an integral part of· the medical and health services. This service provides domicilIary nursing care for the It also offers ~

elderly and physically and mentally handicapped.

post-hospitalisation care, rehabilitation assistance and advice to patients and their families on personal care and prevention of accidents.

OR IC IleAL:

,-"Cl.lS H

REPORT ON THE PROGRESS OF HEALTH ACTIVITIES IN JAPANl (1979)

. 'The . h~arth situation in Japan has gre~tly improved recently alonl vith its' si»cialand~conomi,c development. In tJtw. report, 80_ basic health. statiaticsw1libe presented to show the health situation, while recent tople~' ,i'ti " the field of heal th and medic~l s~rvices vi 11 be :hiahliptecJ •. l

Vital statistic. (Table 1) (a) Population

The total population of Japan, as of 1. O«:tober 1979, vas estiuted at 116 13'0 OQo. The population has doubled since 1920 when the flaure of 55 96Q 000 ,was recorded in the first national census. - The last national census in 1975 in,dicated.a total JH)pulation of, III 939 600, showing an annual average increase of 11 co.,.red vith the.' above figures. This increase vas equivalent to the one recorded during the period 1960-1965, but showed a decline compa~ed vith the rate recorded dQrUi, 'tb~ p~riod 1970-1975,. which was 1.41. ' .\ f . " '. : '( .::~.

. the higher rate recorded during the period 1970-1975 can be attributed to the second wave of the so-called "baby boa.", the women born during the period of the first "baby b90Dl", i.e. 19477"1949 reaching child-bearing aie.. Th'~ phenomenon 'see~ to have ended in 1976. In ter. . of age composition of the popUlation in 1979, the y~nler age Iroup (o-I4yeata) accounted' for 23.8%, "'e wor~ing age group (15-64 years) 67i.31 and the older' ~&e'8rOup(65 years or .,re) 8.91. ,! ," .'.

~/\"",'

(b)

Live birth rate

The live birth rate stayed at a level of around 30 per thousand population through the Meiji Bra (1868-1912) and the Tai8ho: Bra <1912-1926) uj( t& die' pos t-war period around 1949, placinl Japan in the:. Category of counities'with a, high live birt,h r,ate at that time. Since then, the rate has continued to decrease sh,arp1y, re.achina, a low of 16.9 in 1961 which is atmOst' low as that the European countd.. ~. In 1962, the rate showed a slight upturn as a result of the "second baby boo."; however, since 1974, it has . f; started to decrease and the decline continues •

as ';.t

•

(c)

~a~!l rate (Table 2)'

The nUliber of deaths in '1979 was 689 659.; the death rate .vas 6 per thousand"' pOpulation" The" chief causes of. de.athvere cerebrovuculer 4iseii~e8, malignant neoptas., and heart ~li.e••'ee .in that o~cler. Tuber~ul~os is' ~as. already dis~ppeared fra. a . . . the Jeadinl c.uaes of death and tHe emphasis of ~"~~Q~.l he.lt" activities is n~ on,cbrOllic disea •• s.

lSubudtted by the Director, International Affairs Division, Minister'. Secretariat, Ministry of Health and Welfare, Japan.

- 2 -

(d)

Infant mortality rate

The infant mortality rate of Japan stayed at a level of more than 150 per 1000 births until the end of Taisho Era (1912-1926). It started to drop thereafter, and was less than 100 in 1940. The rate further decreased to 13.1 in 1970, and reached a record low rate of 7.9 in 1979. This was much higher than the rates of European countries before the second World-War, but it decreased very sharply after the war at a speed never attained by other countries. Japan is now ranked as having one of the lowest infant mortality rates in the world. 2. Life ex~~ctanEl

(Table 3)

According to the first life expectancy table covering the period 1891-1898, the average life expectancy at birth was 42.8 years for males and 44.3 years for females. Since then, the average life expectancy at birth has improved very much in 1 ine with the overall development of medical and public health activities. The life expectancy was 50 years in 1947, (50.06 for males and 53.96 for females) and reached 60 years for females in 1950 and for males in 1951. The rate of increase was unprecedented in the world~ the average annual increase was 1.69 years for males and 1.72 years for females during the period 1945-1955, and subsequently 0.41 years for males and 0.52 years for females. In 1979, average life expectancy was 73.46 years for males and 78.89 years for females. Thus the average life expectancy at birth for both males and females has overtaken the levels of the Western developed countries and even attained the levels of some Scandinavian countries. This rapid improvement is largely due to the decrease in infant mortality rates and youth mortality rates by tuberculosis. 3. Measures for healt~~omotion

Cerebro-cardiovascu1ar diseases and other degenerative diseases have become one of the major national health problems in Japan as in Western countries. To prevent these diseases and to promote health, health promotion centres have been established in the regions as local centres to carry out health promotion measures since 1972. I f heal th is to be maintained and promoted, da il y activi ties must provide for a proper balance of physical exercise, nutrition and rest. It is di fficult for most people, however. to judge corrt'ct1y whether their individual daily lives are satisfactory or not from the viewpoint of health maintenance and promotion. The work of the health promotion centres is to provide expert advice to individuals, by teams, on how to live 24 hours a day. The centres have the following three functions: (l)·examination and judgement of health aspects of individual lives, (2) prescriptions on changing lifestyles, and (3) provision of actual guidance.

.. 4. Degenerative disease control (a)

1 -

Cerebro-cardiovascular disease control

To prevent cerebro-cardiovascular diseases, continuous control is indispensable in accordance with the results of medical examination. Mass medical examinations for cerebro-cardiovascular diseases are carried out throughout the country to prevent apoplexy and heart diseases. To strengthen the programme, the National Cardiovascular Disease Centre was established in Osaka in July 1977. The centre is expected to educate and give training to experts on diagnosis, treatment and epidemiology of cardiovascular diseases, playing the role of a national headquarters for cardiovascular disease measures. (b) Cancer control

The number of deaths by cancer accounted for 21.6% of total deaths in 1978. In terms of sites of cancer, both male and female suffer mainly from stomach cancer, which is characteristic of this disease in Japan. Cancer control measures consist of (1) health education, (2) medical e.xamination, (3) completion of medical institutions specializing in cancer, (4) training ~f cancer experts and (5) development of research. There is one national cancer centre in Tokyo and nine regional cancer centres in nine areas, which serve the entire country. These regional centres. function as centres ~or cancer diagnosis and treatment in the respective region. Through mass medical examination, cancer cases are often detected and treated in their early stage. 5. Communicable disease control

Fairly extensive preventive vaccination programmes have been carried out in Japan under the requirements of the Preventive Vaccination Law including regular vaccinatiort for diphtheria, Whooping cough, poliomyelitis, rubella and emergent ones for influenza, Japanese encephalitis, and Weil's disease. However, the Government has recently been confronted with serious problems because of accidents or heal th hazards due to ser ious side-e ffects from vaccinations which, although very rare, have presented grave social problems. To cope with these problems, the special aid system for vaccination-induced accidents was introduced in February 1977. The incidence of tuberculosis has been decreasing year by year. The total number of newly registered tuberculosis cases during the year 1979 was 76 455 (morbidity was 65.8 per 100 000 population, which was less than one third the morbidity rate in 1968). The main emphasis has been on preventive measures, and extensive mass health examinations have been maintained. to

__________________________-J"

·4-

Maternal and child health

Pregnancy and births are required to be registered at local health authorities by the Maternal and Child Health Law, and maternal and child health programmes are focused upon the care and protection of these pregnant women and infants. Since the maternal death rate is still relatively high, although some improvements are being made, the problem of expectant mothers is a serious one. In dealing with this problem, the Government is g1v1ng priority to the following programmes: (l) improvement of the ratio of those taking advantage of the free twice-yearly health examination provided for pregnant women, which has been carried out since 1969; (2) strengthening of the manpower, both in quantity and quality, at community level required for maternal and child health promotion, which has been carried out since 1968. 7.

Environmental health (a) Food sanitation

There are 6509 food sanitation inspectors, as of 31 December 1979, mainly stationed at health centres, who carry out food sanitation inspection. In order to improve the efficiency of the inspection programme aimed at assuring the safety of food, an active training programme has been conducted for these inspectors. In addition, food sanitation inspectors stationed at 13 major ports and 3 airports engage in the sanitary control of food imports; the reevaluation of the safety of food additives and insecticide residues in food has been maintained since 1974 and 1964 respectively. This was done for 30 kinds of food additives and insecticide residues in 53 agricultural products during the year 1979.

The population served with water supply systems as of 31 March 1979 was approximately 104 250 000, equivalent to 90.3% of the total population. About 13 000 million m3 of water was supplied during the year 1976, which will be increased to about 21 000 million m3 or more by 1985. 8. Health_manpower_and medical facilities (Table 4)

The number of physicians, who form the core of the health manpower, was estimated at about 142 984 as of the end of 1978 (124.1 per 100 000 population). The number of medical schools is 76 at present and the total number of students admitted to those schools was about 7960 in 1979. The physician-population ratio is estimated at 157 per 100 000 in 1985. The number of dentists, pharmacists, public health nurses, midwives, and clinical nurses has increased over the previous year. The increase in the number of clinical nurses has been particularly remarkable.

·-

.. ,,-<,

• v Table 1.

)

.,.

)

1/ <.

VITAL STATISTICS AND OTHER STATISTICS

1978 Number Popul ation (estim ated) Live birth s (per 1000 popul ation) Death s (per 1000 popul ation) Natur al increa se (per 1000 popul ation) Mater nal deaths (per 10 000 birth s) Infan t death s (per 1000 live birth s) Neona tal deaths (per 1000 live birth s) Still birth s (per 1000 births > Perin atal deaths (per 1000 live birth s) Marri age (per 1000 popul ation) Divor ce (per 1000 popul ation) Rate

1979 Number Rate

114 511 000 1 708 645 695 838 1 012 807 367 14 329 9 629 87 462 22 207 793 257 132 147 14.9 6.1 8.8 2.1 8.4 5.6 48.7 13.0 6.9 1.15

115 465 000 1 642 582 689 659 952 923 14.2 6.0 8.3

12 923 8590 82 319 20 496 788 50S 135 250

7.9 5.2 VI

47.7

12.5 6.8 1.17

Tab le 2.

DEATHS BY LEADING CAUSES

1977 Number 1.

1978 Rat e Number Rat e (pe r 100 000 pop ula tio n) 158 964 156 584 111 912 32 849 28 941 29 402 20 810 16 143 16 377 8 045 137 .7 135 .6 97. 2 28. 5 25. 1

Ce reb rov asc ula r dis eas es Ma lign ant neoplasms He art dis eas es Pneumonia and bro nch itis Ac cid ent s Se nil ity wit hou t me ntio n of psy cho sis Sui cid e Hy per ten siv e dis eas es Cir rho sis of the liv er Dia bet es me llit us

(pe r 100 000 pop ula tio n) 170 029 145 772 103 564 32 430 30 352 28 381 20 269 19 333 15 453 9 509 149 .8 128 .4 91. 2 28. 6 26. 7 25. 0 17. 9 17. 0 13. 6 8.4

3. 4. 5.

6. 7. 8.

25. 5 a-

18. 0 14. 0 14. 2 7.0

9. 10.

·r "

.\-

) t

)

7 -

Table 3.

AVERAGE LIFE EXPECTANCY AT BIRTH

Sex Year Male Female Year Male

Sex Female

1891 - 1898* 1899 - 1903* 1909 - 1913* 1921 - 1925* 1926 - 1930* 1935 - 1936* 1945 46 47* 48 1949 1950 - 1952* ~

42.8 43.97 44.25 44.06 44.82 46.92 23.9 42.6 50.06 55.6 56.2 59.57 58.0 60.8 61.9 61.9 63.41 63.60 63.88 63.59 63.24 64.98

44.3 44.85 44.73 43.20 46.54 49.63 37.5 51.1 53.96 59.4 59.8 62.97 61.5 64.9 65.5 65.7 67.69 67.75 68.41 67.54 67.60 69.61

1959 69* 1960 61 62 63 64 1965* 66 67 68 69 1970* 71 72

65.21 65.32 65.37 66.03 66.23 67.21 67.67 67.74 68.35 68.91 69.05 69.18 69.31 70.17 70.50 70.70 71 .16 71.76 72.15 72.69 72.97 73.46

69.88 70.19 70.26 70.79 71.16 72.34 72 .87 72.92 73.61 74.15 74.30 74.67 74.66 75.58 75.94 76.02 76.31 76.95 77 .35 77.95 78.33 78.89

1950 51 52 53 54 55* 1955 56 57 58

74 75 76 77 78 79

*Complete life tables

- 8 -

Table 4.

NUMBER OF MEDICAL CARE PERSONNEL

1978 Total number

Rate (per 100 000 population)

Physician Dentist Pharmacist Public health nurse Midwife Clinical nurse

142 984 48 731 104 693 17 016

124.1 42.3 90.9 14.8 23.0 375.0

26 493 431 911

ON THE PROGRESS . 0,.

l£ALTH

ACTl1}i:r.r.n;S-

....•.....

.1,\'

••

IN HA~;3IA

WORLD lEAL'DH ORGANIZA!fION' REGIONAL COl!MITTE.F.: FOR THE THIRTY-F~RST WES~N

PACIFIC

S$SSION' MANILA, . 9-15 SE~Q.· '980 .

...... .... ... ~

DIVISION OF 'PUNNING"AN& D&VEWReNT· MINISm OF .~. "l.u.A!'SI~

',' '.

Kuala Lwnpur, 5th.

S~~ember t

1980.

",.

COm:TRY 1.1. HALWSIA is A federation of 13 states and a Federtll Territory. Elevtln cU' ~. St.ates and the Federal Territory Bre in Peninsular Mal~¥sia and the remaining two 3btes - sab~h and SarOlwak\ Ue in the Island of Borneo. T~e Total land ar~~ is127,5\~1 sq.mil~s <330, It 84 Km. ) • Peninsular M;al!'Jysia is 50,806 sq .miles (131,58BKm 2 ) and the Ebtes of Sab!:.lh and Snrnwak CO"nr an ,'lrf:8 of 76,775 sq.miles (198,896Km 2 ). The annual ninf::lll is between 60 and 160 inches. 'rhe daily 0 o a ver~: ge temperuture v:~ries from 70 F to 90 P. He 1a ti Va humidity in everywhere generally high but the night temper,sture is compnr:ltively coo~.

PO?JLU'ION

2.1.

The estimated population Hnd population :Ire 8::; follows :-

den~ity

Penaity/

Sq.Km Penin~;ular ~1alaysia

Sabah

Sarawak

HALAYSIA ~'. 7,

.. ..

•• • /If

"11.°5

84 1c -).

0.98 1.22

•• ••

10 /40

13.25

HEALTH STATES

3.1.

The general health status of the population continues to impro:v:e and the various mortality indic:~tors are continuously an the decline.

19~7 (Ye3.r of I nde f'e nde,nc~}

1978 (Latest Available) ,

% Decline

Crude Death Rate Neonatn 1 Rate Hort~li ty

12.40

30.00 75.49

17.1

43.00 62.73

Inf:mt Hortali ty Rate Toddler Rate ~lortality

28.1

11.00

2.3 16.2

still-Birth Rate Maternal Mortality Rate ~.2.

24.00 (1959)

2.8a

70.21

The Proportion~l Dea:ti;l. ;"from 32.8% in, 1~7t& 58.8LI%in deaths are now oecurling in the

_Ie

(50+ years) has incre;j~~ More than kif of the 9,l:~r age-group.

tm.

3.3.

The life expectancy at b~r.'h for t,l1Eit.~_ f~a,lc , population Which, was 56 and 58 ~a'f's raape<G:t1.'"~;~n, 19110/' ll.:ls ~incret'sed to 64.9 llnd (ic).9 years in 1977. . The Crude Birth Rate was JO.1 in 1978 as c'Ql!I!.paredto 46.0 in 1957. The Rate of N~ltu~l Increase h33 tllelf"efore 'declined from 33'.7 in 1957 to 24.2 in 1978.

3. 4 •

HSALTH BUOOET

4.1.

The Henlth Budget for 1980 is r~S 835.7 mdllion (MS 69"'.6 million fo·%' Operating Expenditure and M$ 1}6.1 million for Development Expenditure). The OpeNiting Expenditure is 6.43% of the total country appropriation: for the 'Opera ting Budget whilst the Devel,.pment Expendit,ure is 1.3R7~ of the Totol Developmeljlt or c:aplit.!ll Invest'i1ent a\ppropriation. , US$ 27.lf5. The per capita health expenditure in NJ 6.3.00 or Both the Operllting and CapitOll Investment BudCetG are funded out of the Current AccCl)unt.

4.2.

:.:.: .....

'. 3

.... ;:.:

: ..

'.'

':-

.......... :

'.~

'. Pe.v~lopn~mt .or :Capi t:l1 . . . Investment EXp~itUre . • ~.:: .'.

... qC!,n~ra}..< . A?:Ti~i·S.~~?!i6n·· •• '> :.16'927130>:' 2.0, Public .Health .•.• .168 207 610 '~;'20':13"" """~'~""><~' ••" ... ' •• ..;

Ope lfl.ti.ng Expenditure . • " , .?'.

,. t

•

'•

'.'

;

. ..'

.. ':.:

.',

":':' (:' '~...~

;;"

....

'. Patient care . . . /' " i. ' i .•

... . . ,~

!t.' . ·.

471 252: ~O:.. ~;~,a. :.. ~, 17'. ciao' .·5~17·' "·1I:~~.. 1}~+';:1'l':~·{ l

..'

. ' '.,

:~:c~!.i~;.!':.?:!,~"'tJ\!,·i;1~h.;:; ;

:.. ~';':.. _'___ :"~~',.:' : ..:.~~.... , . ~~~l1(.·~'~~~~;:."ji;;~i·~·" "

:-;.

'.'

" 835718 . 08le:100~'oP-: . '.=:;==.=~~~.::~=~=':::~~ ~ . ' • i . ~ .

,'" . ~. ,. . . .. :.,~.

M ...

,,;.~

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... ..'.:'.' ;'. .

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. ~

('.~.

~'~'. ': .,;. :;t···i.#.:,:.:·'.;' ~ ...

"t ..f

JEVEU>91ENT:

5.1.

,fH!RD MALUS!A PLAN

<'~5). (19.76~~~~:

." ,·.,.(1916~.1;~). ;'. 'l'h~: ~r~!i$io·n. ot_.'iJft~i?t~.~· and:.e.xJ~~~~'."'r...·· 3. health, services h'~e. c·OIltri·Du\.d tt- 't*.tter hea).:ttl " '" . ..' '~'" .''':'''Ji~ "1'': . ' : . " '.: .;' t" ; .. ; . "';.".:.'. . ' .{ . ";. . '.'

'. . .... 1989

mar~s. ~he

,nd. of

t}\li

'JAtird . Malay·si~ Plan' 'i"'-:"

'improy.~. ql\~J.j.~,:.r, l~t_f .and iaC~d 'p~o~~<f~1-v~t.1,f~.~~·seAre ,r.e~lec~~d. i~._ ;'~~iA,c~a.~n~ in~c,~"s .01' .or}!!ll.t"l~~t:t.5l.~·~·: '. . :. mQr.,1d~.tJ '-lnd. increaai~~ .' GrOQs ...tional Pr,,~du¢t: tdNl"'j}:" .' .' .'. . : •. : : • ' ......

.,.'.

~!, .~'. ~ ~

."#"

~ ~. •••

•

......

<~'.'"

L.· :., ,..'

...

:"'~':.

~""·f~.~~ :' ;' \.'!'~'" .,,:~ ~~': :.

_~.1.,1.~;.capiull-. ·:tnve&~m~n~; t~M~'Per: '( . .'. .... ~" ••

. '.' . :': i;::.J'.·; :~:~:;~;' for th" ~.:-

. varipus .health sectors",,' tis tollows"::. ..:··::\h .. ;.::.:. :.. '. •

Th",

~Pcapitalln,~.stment lev~l ::;...... ... . .• ~. . ,.

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5.1.2. "~I

Achievemen.t in Physical Terms:

--P~in;~ii;------l-------;:~~------l!----~:;:~:~-----l

•Sectors

-; 4.)

~~i ~jl--;J.4'::ri~

8 --~--~

p..~

1I1;:S;:S::l

~ ~

SIP Ori P.

4.)

0 8

:lrl .6

J.4s:l ...... s:l II1fl;l;l p.. IZof

-,-j -;-Cn;~-] SIP Ori 0 Po 8

+'IH~.ri~E~

Preventive Curative

1150 97 1053 732 113 517 66 451 313 55

--12 I 101 4

rs.. rs.

111 ,2 ,p......

----

~ ....

::SEo0'-'

---

85 42

72 41

25 47 40 5 36 29

~;~=:~~~~_~;;:~~ 2~~_=:;~ =:~=_:~I::~~ :;L~_:;; ";, Governme-n.t· s I-lew Economic Poliey (NEP) and the In pls'nning the FMP cognisance has been \aken of ne~d to provide basic ~ealth 'care for the total population. In supporting the NEP the-Ministry of Health (MOR) would COncern itself with improvingtlle health standard Of the individual and thus the community. TheMOHwill accord higheat priority to populationgroup5 living in economically dep~essed areas as .ell as areas which are unserved or underserved by essential health serviceo.

The app;;oach to health planning in the FY.P has been based on he,'llth problem identification and health programmes t.or~.s,o.lve them rather than on mere project listiQg. Overall _o.bJ~ctives :lS well as programme objecti ves have been clearly defined andapp:ropriate strategies identified in Qrder to achieve )heseo?,Jecti ves_. Objective of the MOH: The Objective of the MOR, in li~e with the New Economic Policy. is to fad l i tate th-e attainment and main'tensnce by the individual of a standard of health 'which will' en.ablehim to lead an ecoriomic,glly and socially productive life_ Based on this Objective, the t-10H had identified problem prioritiesal1d adopted certain brO'Jd strategies as well sa spectific strategies after examinine various options and applying the followin~ criteria in the choice :

n vn:ilabi.lity I feasibi 1 ity ,~nd effectiveness 0f technology

cost factor manpower problems, eiXteint a ~,ehll\di9&Y can be u~d b~ l<'r ~:a1H~'gOry li?~ant,l; and be widely i apj):lied .. impli<;:ati~

m\jJ;lti~le effe'c1):s~;

a nu.mber ef

h~alt.b

.stl'ateg&~§ :lft l~iAe!1f:

" i..

Seme spei¢i fic Istrat.,s.;(l,dQ,ptced' 8l"e eir!:phasis cn i~.'~l't:i~ied targe:ti pOpU'la~1en ,'mel areas through '" • • &equitable r$OlJ,rce ai,loe'lrt i en ;

~GM;jH<P'1l 0' f "Ff!'.'JIW a·ncr r~h:~ bi ~·t~:t,,'i v~ ~v'l:~e4; whiCR tl"~ 'aplW'O~Fiate, .ceani tile; e:£'f'e't!l·tH·e and , "etf;i~'ie1l1t ' .,. }.' '

use ~r tJPl'l'p~~::tec'hnQ,l:Q1!i~5 ,¥ie;i: c'1nl<>c' \i/4;dely 8:pplld,.,• •: .ich ¢'an S(l),l~~'alnumber ai health and h~·l~,.,.f,;elated probl~s

maxi·mum utilfsatiof,l ef cemmuni tY,resoura-tU; , '

, C!invironplent

e,o-ordina'U~' ef' _lti-ar"ency ef(fol",ts to i"Tnprove: And I!)~ill't;a.n a healthy U vihg ,,~,

f~proveiment 0,,( m~np,geJl\!ent ef he;~tth$erviees tl1rough bette, maii'ilJ.gement te'¢hnit.~st studies .~d ini10rmatitm ~jstcm c,om~tency-b.<'~. ~ t.~$~~r:~~:ntEff t'r;-;'~ininc~tq

H:GlU~\P liealth ,~~:~alth-rela:ted t>'~r:$mlnel with ~he l'leciessarl ~'it~ge, skill afid a~t:i,tur:ie ,$0 t.hat they cail,bj!~.r re:UAt.e thei~ ,f~ct~Q~S to the needs an/ll' e~~htien6 of t\llJ! cEtmml$:fty

cullabot'1.l tiull I'll th other ilb'",')IlCietl ano JJro~:i')tc inter-lJgency co-ordination ill he·3lth-relat,!d i t5sue 5 'promotion of biomedical, clinic3l and hea lth service rese',lrch. Health nervice rese:lrch is of particular importamce because it concerns itself with. management issues

strengthen administ~ative and supporltive services to health snd health-related acti vi tics, and' provision of appro~iate

career development of

he,91th and health":related personnel.

5.3.

HE:AITH PROBLEMS: Malaysia is at the cross-roads of health problems where diseases com:1on in developing countries, viz., ; communicable diseases and disea,ses aSSOciated with poor environments lcondi ti ons, are rapidly declining and dire;~sec prevalent in developed countries, such aa, orgr~nic di~;;orderc, indufitrinl and motor accidents and occuplltion:11 di30:l~;C;; :I~'(: , emerging. Sitch a situation c:o)11s for an ord~rl.Y chanGe in emphasiu ilnd technology so that the residual effects of commUI i08ble diseases enn be controlled or eradic',tt!d and ;~ppropri:ltc , f:lcilities developed to cope wit,h the increasing problcr:i13 of industrial and occupational haz\ards, org'Jnic di$order:~, changing life· Gtyles, etc _.

This therefore calla fGr the syrotematic traininG ,1;'1.t1 re-trllining of medic1.l1 and allie'd personnel to enable them to effectively de,,1 with the changing problems.

5.4. , HEALTH

PI{OOR!'.MMES:

'l'he word progr.3mme is used here to me:)n a group of related activities delivered by a set of specific reGOUrC0~; for the achievement of defined objectives. zach progrnm~e has its mm programme objective(s) , stNtegy/strategies and

activity/activities. Cperational constraints of the progr3mmes have been identified and appropriate eteps will be t~ken to minimise or n~move them in the course of implement:l tion. 'l'he:.lcti vi ties of tb.~MOll in the Fr1P hawe been org,lnised along 22 programm~·s axi.el are grouped into three sectors, viz_, preventive, curative and supportive.

Highlights of' Gome of the programr:nes arJ.l -

5.4.1.

Family Health

~ogra~:

The creation of this programme is in the context of a comprehet\sive service aimed at the family'ss a unit. .I:outin~

A.part from providing the

maternal and ~hildhealth service, the scope.haS,been widen to include out-:of-school children, adolescents. youths, women dur~ng the child-bel'lring intervals aa well as the father in the family. Family counselling on emotional and school, truancy, teenage promiscuity, drug adrtiction,

mental developnent will be given empb,.asis with particular . reference to such community. problems a:; cigarette smoking andalooholism. Environmental I

Sanit~tion

Programme:

This prosramme will be further intensified as the coverage of the rural pOImlat:i..'i:mis stili far from satisfactory.

Food Quality Control Programme: Whi 1st efforts will be further intensi fied in the hygiene of food preparation and hand1Lnc an~ of foo~ premises, the. inspection of food for 'luali ty will be strengthened throu~h the establisrunent of Food tabora tory Servi:ees.

5.4.4. . '. \

Vector-bQrne Disease

Contl\~lProgr')mme:

There are three major vector-borne dil:'>C'I$'2S in. the country. They are malaria, filariasis and dengue/dengue haemorrhagia fever. All at-e borne by mosquitoes, though of different species. The intention is to group the control of these Clnd other vector-borne diseases by phases under one programr.ie as many of the steps in. atld resources needed for interven;tion are similar. Under Phase I, the inten-

tion is .to transfer fn~laria c()ntrol eer-nces current] under the gener:;ll public llea'lth service ~o the l-bl:.trii Eradication Programme (ME.P). In Phase 11, filariacii and dengue/dengue harmorrhagic fever control \'lill be transferred to MEP which .ill be re-named Vector-borr~ Diseases Contro.l Pr9gr.~. The re-stI'~cturinls ",ill bQcompleted wp-en thl.s pr&gra.!ri!l1e, .takes also control .; of ticks, mites, fleas anti flies'.' Re'::groupine of

:th~,~e l·a.c:tivit.i~,1? ~s ~eme~ ,

rationa~'approach. • # '

t.. :,

5.4.5 •. :' CQlllml,1ni.c~ble.

Di~eas.~s Prevention and' Controler0E7'~rm

~, 'Th~ incid~nce ofcommu~icdb'i~ disease::; with effecti ve vaccines for prevention had been consider-a' reduced. Vaccination and other control activiti':!c ',:

. /1 ~

bf' intunai Hed.

Mellsles Vtlccination will be

introduced..

5.4.6.

Heill th EducCltion Programme:

Among all the strategies, he 3 1th education has been identified as dne of those which r:.lnks Vf~ry high, because the tee-hnolo!;), is relatively cheap, can be widely applied, and will benefit ~.an.y he·')lth problems when carried out effectively. iVith more health education oifticet's being trained at the Public Health Institute. and the establishment of Audio~visual Production Centre with World Bank 1.03n, health education is expected to race! ve added im?ct~lG. There is a greater need for closer collabor[~tion Wi"!;jl the t-linistry of J~ducation for he-~lth edUC:.ltion in schools and the training of school te<Jcher:::. in he ,.J.t;l education. Within the MOH system, it is propoGcd to hring health educ:ltion into hospi tal~ as well ..

In-patient Care Programme: The proposals in l1tP are: equity in the distribution of bedb among 3re8D 'o\' constructing neW hospitals or expanding existin;; ones

ba1ance in the distribution of beds among disciplines to further develop facilities/services curr~ntly deficient ego milk kitchen t PBU. CSS», lCU/CCU laboratory t pharmacy and supplies, physiotherapy

to establish a cardio-thoracic surgical unit to establish medical audit mechanism to improve hospital management to improve training fucilitiec and proGrammes and libraries.

Qut-patient Care Programme: Out-patient services are provided by hospital-based out-patient departments, urban l'olyc linics, health centres and mobile teams. On the average 2.2 persons/1.000 population/day attend hospital out-patient departments. 6.9 million nttended OPD in 1977 compared with 5.7 million in 1970. 30% of OPD worklOlld are referred to Gpecialists. About 3~ are seen after office hou:·~.

·...

In the FMP further emphasis will be 81 Ven to improve the OPDs. Arnone the str:ltcgies that will be adopted are: to limit OPU sizes to cater to not more th3n 400 patients per day to improve the m~nase.nt of the OPD by placing it under til Mntor experienced officer, and posting well ...tr<lii._d and suit.:lbl.~ staff to OPD. to impro~ radiologic~l and laboratorY services. It is pro}>osed to install x-ray faeili ties in the ~igger

health centres

to provide better aMbulance services with adequate resuscitative facilities to improve accessibil..,lity of OPD services through decentrlllisution to post medical officers to many mOre he1'llth cent.res through the present exercise of up-gradin::; sub-health centres. The MOl! recognises the fuct tha't in m"lny c·,.:;c::; the OPD is the first point of contact of the sick patient with the health service. An effect! ve OP!) service which can diagnose illness e3rly and provide effective ambulant treatment will not only shorten suffering but also minimise hospit~l admission.

5.4.9.

Laboratory Support Programme: Radiological Support Programme: In order to C()p(~ with increase and v::lriety of demand, under the FMP further improvement to these progrummes is necessary.

5. /1 .10. PeN;onal Dental Care Programme: With the expansion of the Dent3l Tr:dninc School in Penang undertaken in TI'~P, more dent'~l nurses will be taken tor training in FNP. Hore dent~ 1 officers will be. sent abr09 d for 6peci~list tr,'lininr;~ It is proposed to inct"ea·se the scope of dent·:::l c~lro tel adult population which ~rently is re$tricted to treHtment of emergencies only. There 'fIill be a m.()re organised and systEtmat.:L,c· approach to pJ'e-school children through kinde~aarten, etc •• i

5. 11 .11.

Freventive DenVll Care Proc;ramme: Prevention of continue. dent~l

cnries through the

fluorid:ltion of public Vilter oupplies will

5.4.12.

Health l'!anpower Planning and Tra inin5 Programme: j

Shortnp;e ot he.rJlth manpower of VilrlOur:': types affect the runnirlg of health progr~mme~;. There ~6 a la6 time of ;1-6 ye.:lrs in manpower production. Unless there is a proper manpower planning link~d to facility development and programme structures, there is likely to be underproduction, over-prQQuction or production of the \IIrong type of personnel. Activities in relation to health manpower planning wi 11 be further emphasiseda On the productioncide, the emphasis ','lill be on making it more effective and efficient effective from the point of appropriaten~6s and relevance of curricula and. educati onal methodolo-:J', nnd efficient from the point of resource utilistltLm. The following main strategies will be strengthen linkage between health manpower development and health service development establish and develop smore reliable inform.'ltion system on health manpower project health manpowe~ demands usingapprQpriote variables ag. population chanGes, changes in health problems, health technologies, etc. interact with agencies dealing with socia-economic development and general of specific manpower iDSUOS. adopt~d!

On the production of training side among the following 6tra~egies will be adopted: I

otll::!:::'!J

to emphasis "quality" training by using COOlpctc~Cy based curricula,·. and~pgrading ability of tet;\chinC statf to emphasise and diversify post-basic and contin:.<i:.1C education to emphasise management training for m3naijers and. supervisors

to l1lt'lko Upd:ltint: and up-grading tr!1ininC ncti vi ties where fensi ble the resl)Onn:i. hili t:r of line ml1Mgern at ctate, district and institution level to emphasise human relations and related subjects in all training programmes so that health staff Ciln relate more effectively to patients' needs, cultures and values emphasise the training ~nd career development of general duty medical officers to establish a teacher training centre for teachers of health and allied personnel

5.4.13. Pharmacy and Supplies PrO$ramme: The areas of concern of this programme are logistics, drug quality and safety, and research. Activities relating to logistics will be improved by providing better physic.:ll f'acili ties, and udo)t,i ol1 of moreeffecti ve procedures and pr~tctices. A standard drug list will be developed, and drug information centres will be established in hospit~lc. Local production of quality pharmaceutical preparation will be increased. A.part from strengtheninc the enforcement of current drug and pharmacy laws, imported and locally manufactured drugs will be te.:;tcJ, registered and licensed. Local pharmaceutical factories and manufacturers of traditional medicines will be licensed.

5. 4 .14. Biomedical Research Progz;amme: Health Service Research Programme: The Institute for Medical Re5e"1~'Ch, alone or in collaboration with other agencies undertook many re6e~rch activities, apart from carrying out hieh level labor[ltory investigation and training of laborntory personnel. Many of these research subjects are biomedical or clinical in nature. In the FMP, biomcdic::ll research programme ae on~ of the supportive tool~ for health programme development, will co-ordinate its activities with health programme development und alii;n itself with general guidelines and priorities which will established.

, Health service research Will be intensified in the FMP and the Public Health Institute will be the focus of such activities, though there may be many collaborating centres. The programme will look into such issues as manpower, organisation, resource utilisation, service utilisatiOll t problem identification, quality of care t cost issues, information, need and demand, communi ty :response, and various other maaagerial subjects. It is felt health service research cart improve the effecti veness and efficiency of health programmes,. q1lEllity of decisions and the planning process. , One of the main .econcerns in the FMP would be the re-cycling of reaea~ch findings into development effort ..

5.4.1,.

:;ngineering Programme: The Environmental Health and Engineering Uni t currently provides expertise in environmental quality contro~, urban engineering and radiation protection. It is necessary to d.evelop further engineering capability within the MOH and esta blisn appropriate structures for it. The programme Will: provide effective and efficient engineering support to ensure maximum functioning of plants and e.quipment pr,ovide engineering cOIlsultuncy services reduce radiation hazards provide proper waste collection, treatment and di:sposal systems in hospitals. The programme eavisages the esta<blishment of different levels or workshops at hospi tale, some or which will se"e specific: zones in addition to catering for local Beede. Manpower for these workshops will have to be developed. It is proposed to establish a training celltre for them under the FHP.

PLANNING & DEV£LOPM~NT DIVISION, NINISTRY OF HEALTH, MALAYSIA,

KUAlA LUMPUR. 6.9.1980. KS/lJM/cs1~

18 nAII:AIS SIULEMEtrl'

REPU'BLIQUE FRANCAIS! ---~----------------

:0-2 S U C C INC T SUR

/7 77

-----------------------------~---------------------~-----------

1 •• ACTIVITES SANITAIRES dalia 1,. TEAAITOIAE de

1. NOUVELLE-CALEOONIE " DEPENDANCES

1 9 ., 9

. Pr ••• nt. par

DESTIMTII!' , 1. Olract.ur du Bur.au ~ "'Iional de 1· Orgeni •• tien . "ondl.1. d. 1. '.1 ant • . P.O. I •• 1931 .

- "e.

fl. CHARP'I Chlrurll.n d•• Hlplt.uK d•• Ar•••• Olracteur d. 1. Sent • • t d. l'MY91'na Pub11qu.

L. ".decln G.n.ral

en Nou".lle-Cal.donl. . ,

- --;,

".IIL", -

,M'''''''''I

...

-1 1 - 0 [ JIll 0 G R A P H I I;

1979 138.800 3.688 6,8 26,6 19,8 93

population moyenna nombrs de neissance. vivantes taux de mortalit' (pour 1000 hab.) taux de natalit~ (pour 1000 heb.) - .ccroisselllent naturel (pour 1000 hab. ) nOllbra de d~cr:.8 de moins d'1 an . 1Il_.

................. ...... '

.!:t.ll 134.500 3.902 7,8 29,0 21,2 135 DE 5 ANT E

.!211! 137.500 3.639 6,6 26,4 19,80 109

2 - ACT I V I T E 5

S E R V ICE

1 1 !---------------I--------------I----------------I----------------1-----------------1 1977 ! 116 871 t 267 460 1 12.940 t 278.032 ! !---------------I--------------!----------------!----------------1-----------------1 , 1978 ! 126.322 1 279.737 1 14.144 r 273.520 ! Journ~es

Ann~9s

Consultants 1 Consultations 0 0

H08plteli8~a

d'hospo

I---------------!--------------I----------------I----------------!-----------------! , 1979*! 124.508 1 249.862 1 130465 1 265.506 1 , 1 ! , I *Les statistiques m~dicales sont informatis~es depu1s Ie 1er Janvier 1979 •. ces chiffres ne sont pes comparables avec ceux des ann~es pr~c~dentes POUR LA

cons~quence

3 - 0 E PEN 5 E 5 a) I -

5 ANT E (1) de fonctionnement

D~pBnses

1°} - en valeur (F.CFP) ! t ' ! DIFFERENCE 1 t Nature d~penses t 1978 1979 1 (en + ou 1 ! ______________________________ ! ________________ I ________________ 1-----~~-:2-------1 1

r A - Budget Territoire t B - Budget 5ant~ (1) - Personnel - Autres d~penses

1 12.571.120.000 1 14.014.350.000 1+ 1.443.230.000 1 1----------------1----------------1-----------------1 1 1 I· ! t

, 1.269.060.000 t 380 0 020.000 1 I

t 1.429.265.000 1+ 420.265.000 1+ I 1.849.530.000:+

160.205.000 40.245.000 200.450.000

1 1

r :

1.649.080.000 t

(1) En application d'une convention Etat fran~ais_Territoire, l'Etat f~an~aie e particip' ~ ces d'psnsss pour un montent de 189.090.909 f.CfP en 1978 et de 209.090.909 f.CfP an 1979. 28 ) -

9n pourcentega

:__________ ~~~~~~~~~~~~ ____________ :-----~~~~---:--- __ ~~~~ ____ :-----i~;~~~:~~~~-:l-: I Rudg.' S.nt. / 8udQ.t T.rritolr. I I D'p.n ••• P.r.onnel r d. tonotionne.enl 1:1,11 ~ I I

1J,19 ~

+ 0,08 ~

I I

D'p.n...

I I

76,95 ~

I I

71,27 ~

r f

+ 0,32 ~

1 I

.../ ...

•

- 2 -

II - OdpenS8S dt~guipement (op~ration8 nouvelles seule.ent) -f.CfP 1978 1979 - ftnencement Budget Territoire ••• ., ••••• 3.000.000 - f.I.O.E.S .. (ftnancement Etat fr8n~8i8). 7 .. 000.,000 16.500.000 - finance_Bnt par emprunta du Terrltoire 7.000.000 143 .. 802.271 26.500.000 (1) Taux du dollar US = 76,00 b) - Budget dtEtat francais s (f.I"OoE.S.": fonde dtlnvestissement de d'veloppement Econo.ique et Social) Tranche 1978 • • • 0 • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Tranche 1979 ••••••••••••••••••••••••••••••••••• c) - Total des d~penses pour Ie Sentd I

150.802.271

16.500 0 000 7 .. 000.000 ~ 1,,849.530.000 150.802.271

1978 1.649 .. 080.000 26.500.000 1.675.580.000 + 324.752.271 12.411 f .. CfP

fonctionnement ••••••••••••••••••••• [qulpement . 0 • • • • • • • • • • • • • • • • • • • • • • 0

TOTAL •••••••••••••••• O~pense8

2.000.332.271

Progression des cr~dit8 1978 / 1979 par Habitant ~ 1978 ••••••••

~ 1979 •••••••• 4 -

14.600 f.CfP

PER SON N [ L 5

e) - du Service de Santd [ffBctif PERSONNELS pr~8ent

1 - 1977 - 1 I I 1------------------------------1--------------1---------------1--------------1 f Docteurs en mddecina 1 59 1 6. 1 65 I

Effectif prdsent 1978 -

Effect!f prdsent 1979 -

r I ~

t------------------------------I--------------I---------------1--------------1 r Pharmaciens r:5! 4 I • , 1------------------------------1--------------1---------------I-~------------I f Oentistes 6 t 6 6 1------------------------------1--------------1---------------1--------------1 t Auxiliaires Mddlc8ux t t t r I (Assistantas socieles, Seges-t I feM.sa - Assistants - Infir- t I .lera) " r

398

r r r

424

r r f

441

1------------------------------1--------------1---------------1--------------1 r EI.v •• (Assistants - AidasIntir.iare) t 51 t 53 t •• 1 1------------------------------1--------------1---------------1--------------1 1 [Illploy'. d. 8ur.au - Pareonr I n.l. d'.xploitatlon - trana- I I t J I ports 1 431 t 469 t 469 1 r I I I I I Soignant. -

• I

"EDECINS "ilitalres •••••••••• B Salari'a •••••••••••• 10 Llbdraux •••••••••••• 75 - 0 R G A N I SAT ION OIR~CTION DE LA SANTE (T DE L'HYGIENEPUBLIQUE , I

DENTISTES 15 23

PHAR"ACIENS 2 1 33

"[D(C!NE OE SOINS 18 Clrcon8orlptlo". PMdlcnlnll

[ICHntru I'h1dlc.1 (Plddflcln . t O.. ntlet. Itlnlirftnt

I:1ventuelle.ent) Inflrmeris (eoina par mddecin ou inrirmiar Itlndrant) oispensalre (Infir.i~re) Thermalisme (La Crouen) 156 lit •

l 31

1 t

.-.H8pital Territorial- ( G. BOURRET) (Service + Banque du Sang)fft

~Centra ~

Raoul fOLLEREAU (Hanadniena) Centre Hoepitalier Spdciall.'

Psychiatrie (226 lita) Gdriatrie (73 lits) ---Sanatorium du Col de La Pirogue (30 lits) "EoECINE DE DIAGNOSTIC ET DE PREVENTION '.18 Clrconacriptiona "l:1dlcalea .Dlv1810n d'Hygi~n8 SocIal.

IL-

Lo18P8nsalra Anti-tuberculeux LDlepanaaira Anti-vl:1n6rien oispensaire Anti-hansdnien oispensaire d'Hygi~na "antale , Service dentaire ~Service d'Education Sanitaire _ _ Bureeu de Stetistiquee Oncologiquea

~l i

dea fonctionneirea et Aasiet's Sociaux de Protection ~eternella at Inr.ntile ~Inepection "6dico-Scolaira ___ Bureau de Surveillance Senitaire ____ Sarvice "6dical da la Jeunesea at dee Sporta ~Diepen8eira ~Centra

___ ~EDECINE DE RECHERCHE ET DE DIAGNOSTIC BIOLOGI UE I L- I natltut PASTEUR L--H8pital Gaston BOURRET _ ~___

PHARfiACIE O'APPROVISIONNE"ENT INSPECTION DES PHAR"ACIES ECOLE O'INfIRflIERS!ERES

DES "EOECINs

RELATIONS AVEC bE CONSEIL Ot L'ORORE ------ DES PHAR"ACIENS ---- OES OENTISTES RELATIONS AVEC LES ORGANIS"ES PARe-PUBLICS RELATIONS AVEC LES ORGANIS"ES INTERNftTIONAUX

.•. 1..•

-. 6 - L U T T E CONTRE LE5

LEA U X

SOC I A U X

a) - LEPRE - an 1979, 520 ldpreux sont racensda (539 en 1978) d~nt 20 nouveaux ca. (20 en 1978 dgalement) avec 8 ldpromataux. b) - TUBERCULOSE ~ 91 n-ouv'e~ux cae ddpietde en 1979 (119 an 1978), dont 76 tuberculoses pulmonairaa. • vaccinations B.C.G ••• ~ •••••••••••••••••••••• o testa tubarculiniqua. post-vaccinaux ••••••••• • rdactiona po.itive ••• o • • • o • • • • • • • • o • • ~ • • • • • • • exam.n. radiologiques pulmonairea systdmatiquo. • ••••••"•••••••••••••••••••••••••••••••••

13.383 9.225 3.826 7.920

(41,41 ~)

c) - ~ALAOIES VENERIENNES • syphilis •••••••••••••••••••••••••• • gonococcies ••••••••••••••••••••••• 629 331 441 278 459 413

d) - HYGIENE ~ENTALE - Oispensaire charg' de la prdventlon, du ddpistage, de la post-cure des maladia • • antalea. II participe dgalemant ~ la lutte contra l'a1coolisme, 1a toxicomania et 1a ddlinquanca juvdnila. a) - TU~EURS ~ALIGNES - 192 tumaurs ma1ignas ont dtd ddpistdas an 1979, dont 47 chaz 1ae autochtones et 145 chaz das non autochtones. II s'agit easentiel1ement de tumeurs dpithdlia1sa. Una bombe au cobalt ronctlonna dan. une cllnlqua prlvda d~ NOU~EA. 7 ~

0 R TAL I T E - la8 princlpales causas an sont •

• 1es maladies cardio-vasculairas • lee cancere • le8 traumatismes 8 - ~ 0 RBI 0 I T E - non spdciriquamant tropicals - beaucoup d'attactions bronchopulmonairas, cutan'ae, digestive8, da parasitos •• et d. traumatisllas. 205 • orai11ons ••••••••••••••••• 426 I, • varicella ••••••••••••••••• • dengua •••••••••••••••••••• 66 /I nombreux ca. da malnutrition, de cariea denteires, surtout chez lee enfante.

9 - 0 R lEN TAT ION S la. dv~na.ant.

ACT U E L L E 5

Au p1ftn de 1a Sant. Pub11que de Nouve1la-Calddoni. at Odpandance., marquant. et durable. 8urvanu. en 1979 sont Assentia11e.ant I

1·) - Le suppression de 1. gratuitd dane lee for.etlon • • anltaira. d. 1. Santd Pub1ique intarvenua au 1ar sept •• br. 1979 avac 1a . i •• en plae. si.ultan'. d'un rdgi •• d'Aida ~ddieal •• Bian que 1. taritication soit netta.ant int.rieure au prix de ravient r'.l. catt. prs.i'r • • tap. conduit d'sor •• ia lee organisms. dit. d. ·eouvertur. soc!ale- • un. participation plua large au. d'pen •• e d. sant. du T.rritoir • • 1".0-· 1ution vere un Centre Ho.piteli.r Territorial .uppo •• que l'on doit progre •• iv ••• n' attaindra una v'rit. da. pri. et 1. eurv!. d'un •• ct.ur m'dieal lib'ral .n .ara rendu. po •• ibl •• Pour l'in.tant, 1. aouci d. lui 'vitar la concurrance . . . na dan. 1. conjcnctur. 'eono.iqu. actuall • • un. surcharg. de. service. d'urgence d. l'H&pital Ca.ton BOURRET.

••• 1•••

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- 5 -

"ai. la eouvar'ure sociale de l'enaa.ble de Ie populatloft du Terrltolre allorctte leiss·e sntier Ie probl'-II. d ·un. solution globala , 91.000 parsonne. sont partiellemsnt priess an charge par 1a CAFAT, una vttritable aida mttdicale na davrait concerner que ceux qui sont INCAPABLES de cotlser an tout ou partie dans una vttritabla caisse de e4curitd sociala , 1 _ da la population fran~aise rel'-ve da l'Aida ~ttdice1a, et 35 " da Ie population cal~d:onienne I Hl se si tue l' effort social souhaitable. 2 0 ) - L'avenir prochain devra d~terminer la nature dea relations entra lea formations de la Santtt Publiqus et 1es ~tab1issement~ privtts et se_ipublics. En fonction de la demande, fluctuanta, de ces derniers, Ie choix devra se faire entre une participation d'tttablissements priv.s ~ but non lucratif ~ l'ex~cution du service public hospitalier ou Ie concession de Service Public hospitalier, avec alors poasibilittt de leur aa~Dciation au fonctionnement du service public hospitalier et crttation d'un syndicat interhospitalier de l'agglomttretion de NOU~EA. On pourra alors parler d'une POLITIqUE DE SANTE, dquilibrde, donnant enfin-~ la popUlation calddonienne Ie LIBRE CHOIX de son h8pital I ~ l'ttpoque o~ nous vivons, il fautcomprendre que l'ttquipe hospitali~re a remplactt Ie mttdecin traitant. 11 semble que l'on s'oriente actuellement vere des concessions de service public avec lea cliniques, ce qu! aurait l'avantagede donner un ballon d'oxyg~ne au secteur privd, fort utile dans la conjoncture ~conomique actuelle. Pour leur part, Ie Ce~trj Hospitalier Spdcialiatt de Nouville et peut.etre l'h&pital de KOU~AC vont dvoluer dans les anndes prochaines vers une autonomie de gestion, seul moyen de sauvegarder la fiabilitd dea h8pitaux modernes. . 3 D )_ Le "d~collagen de l'Inetitut Pasteur de NOUMEA qui, grace' l'aide du

F.I.D.E.S., du Territoire et de l'O.~.S. peut, ~ c&td de sea activitds de routine hospitali~re, se lancer vers 1a recherche: disposant d'un laboratoire pr3t pour une ~quipe aupp1~mentaire de chercheurs, ayant fait tout saul sa place dane Ie concert scientifique de la Commission du Pacifique Sud, cet Institut privd de Santd Publique est pr3t ~ jouer dans 1es anndes 1980 un r81e international , 4 D )_ Le Dispensaire enticancdreux, prdvu dans 1a Ddlibdration crdant la division d 'HygHme Sociale, n' avai t j amais dtd mis en place. Un Bureau de statistigues Onco10gigues rdunissant des mddecins publiea, parapublics et privds 'onetionne depuia 1979, et son fichier dtab1i ~ partir du 1er Janvier 1977 comporte d'j~ p1usieurscentaines de dossiera J 1a recherche des documents de l'annde 1976 est en cours. A partir de eette masse d'informations maintenant disponible a dtd mende ~ bien une premi~re recherche ~piddmiologiqu8 sur les tumeurs malignes de l'utdrus, qui fait suite aux travaux de 1a C.P.S. sur Ie caQcer du poumon en 1975 ••

5 0 ) - L'intormatisation des donndes statistigues da 1, Sant. Publique au 1er Janvier 1979. Fondda sur la nomenclature O.~.S.,un certain no.bra d'indicateurs sont pria en compte at, apr~. une pdriode de r8dage qui le rendra fiable, cette inforMatisation doit permettre d. d.tarmin.r .t d. eonduir. l.a. action. da sant. appropridee. 11 .eet • noter un. i.portant. difficult. qu1 a'est fait jour ~ l'oceaaion d. eatte infor.atisation, , savoir l'abaanca dee numdros d'ldantitication individu.ll. type INSEE, qui l1111t. le champ d'action dea enquatas pratiqudaa (pri~ d. revient notamment) d~nt on pourrait tirer d'utilea indication ••

.•.1•••

- 6 L'ann~e 1979 peut 3tre conBld~r~a comme una ann~e de transition. C'est en arret an 1979 qu'a d~but~ Ie racuell :nrormstlB~' das statlstiqua8 m~dicaI9a, que Ie. vlgiles de sant~ se Bont mis en place sur l'ensembla du Tarritolre, qu'un programme de recherche Bclentlfiqu8 propra est entrepria, at enfin qua l'Alde M~dlca1e a ~td lnstaur~a parsll~lament ~ Is suppressIon de Is gratuitd o

~ j

Cee ~l~montB. qui vont s'Arflrmar au coure des ann~e. ~ venire parmettront una meilloure prdvention au sana large et alderon~ sans doute ~ una r~organl9ation g~n~rale de. rapports des trois secteurs publics, para-public et priv~ dans l'agglomdration de NOU~EAo

II, <

ENGLISH ONLY

NEW ZEALAND BRIEF REPORT ON THE PROGRESS OF HEALTH ACTIVITIESI 1979-1980

GENERAL

Proposals for a reorganization of health services in New Zealand are currently being tested in two pilot areas, one urban, and one predominantly rural. The proposals involve greater regional responsibility and a restructuring of services. to: promote a coordinated team approach to planning the delivery of health services and evaluation; encourage the development of a flexible structure responsive to changing social needs; increase local control in the determining of health service pr iorities; promote community involvement in assessing health needs; allow planning to be organized on service lines; preserve the balance between the public, private and voluntary sectors of the health services;

. 1n

ensure a balance between preventive and community-based services, and institutional-based treatment services. The Government expects to review the success of the first pilot scheme 1981.

HEALTH PROMOTIONAL ACTIVITIES

(1)

Family health

The voluntary organization concerned with child health supervision (the Plunket Society) has continued to expand its services under the South Auckland contract with the central Government. Its nurses now provide all surveillance services for the under-S year age group in this region, freeing public health nurses for greater involvement in school, adolescent health and other activities. The society has increased its family support units and there are now 15 (8 fixed and 7 mobile) operating in various parts of the country.

lSubmitted by the New Zealand Embassy in Manila.

- 2 -

Many of the problems of child health in New Zealand relate to deficiencies in parental care and ignorance. In order to help overcome this, an improved educational programme is being implemented. This includes the appointment of a national coordinator to coordinate and expand parenthood education and the production of a series of films on child health. These films are designed to have popular appeal for the target groups and highlight health problems, prevention and services available. Each film covers a definite age group. So far two films have been completed~ one in the antenatal period and the other from birth to 1 year. The other four films all cover the 1-6 year age group. Notification of congenital defects diagnosed before the baby is discharged from hospital so as to allow for closer surveillance of such infants, but also to detect clustering of defects which may be suggestive of an ehvironmental teratogen, has proceeded satis factorily ... There is over 90% compliance and clusters can be investigated at an early stage. To date clusters of spina bifida, cleft palate and Downs syndrome have not revealed any common environmental cause. A national post neonatal mortality survey was completed during the year and the results will be available soon. This revealed a high incidence of "cot deaths". Further studies into this problem are planned. (2) Disease control 1

-. I 1

While dengue fever and Ross River disease has spread to many countries in the Pacific basin, New Zealand has been very fortunate in this respect. There were a number of tourists who returned from Fiji last year with Ross River fever but no secondary cases have been detected. A of the out on insect mosquito mosquito aircraft vectors, survey completed in 1979 demonstrated the continued absence Aedes aegypti. Present disinsection procedures, carried from overseas, will, it is hoped, keep this and other not already in New Zealand, out.

il jl

The possibility of the introduction of other serious virus diseases such as lassa fever, marburg, etc. has been considered and a comprehensive but simple control programme promulgated. This relates largely to professional awareness of the possibility and an upgrading of hospital isolation and barrier nursing techniques and training. There was a significant reduction in tuberculosis to well under 60P cases in 1979. An undue proportion of cases occur in Polynesians living in or visiting New Zealand. This and other communicable diseases have been found in refugees from south-east Asia, who are given a medical examination and orientation programme on arrival. There has been an increase in the number of cases of travellers contracting malaria while overseas. Efforts are being made to ensure that travellers to malarial areas do know of the need for prophylaxis.

-. I "

- 3 -

Immunization levels have improved over previous years and the "eradicate measles epidemics by the year 1983" programme is progressing. In the noncommunicable disease field, a new and more comprehensive agreement restricting cigarette advertising and requiring warning notices came into force. Cigarette companies have succeeded in reducing tar content of most brands of cigarettes over the years. (3)

Health protection activities \

The Toxic Substances Bill to control the importation, manufacture, distribution and handling of toxic substances, refer.red to last year, was enacted late in 1979. Under this a Toxic Substances Boa~d has been established and is considering proposed reg·ulations. The proposed regis ter is expected to be established this year,. A new Food Bill is being. introduced into Parliament this year and progreu is be~ng made to al~gn the regulations with Codex Alimentarius Standards. Certification of exported food and supervision of imported food has greatly increased this year. Legislation was passed to require the importer to provide any required certi fication to the medical officer of health. Initially this requirement has been limited to imported prawns. In the occupational health field, emphasis has been placed on an extensive farm worker survey seeking to identi fy the heal th problems in that industry. Lead, including lead in canned food, continues to be an important issue. In the occupational area a major review of the Lead Proc~ss Regulations is being undertaken in cooperation with employers and union representatives. The subsidy scheme to support water and sewerage schemes undertaken by local territorial authorities has been in operation for 10 years and has made a significant contribution to environmental health services. A review of the scheme has resulted in some modifications, including the removal of a basic cost factor of per head of popUlation. The removal of this plus a new subsidy for fluoridation of $1 for $1 should encourage fluoridation schemes independent of major water supply scheme •

-"-

. 4. CLINICAL SERVICES (1)

Expenditure on pharmaceutical benefits The three workin'g groups set up by the Minister to examine expenditure now reported.

h~ve

Group I was the Educational Working Party and considered four areas: the teaching of prescribing to medical students, prescribing in hospitals, prescribing for the community (doctors' prescribing patterns), and the educa t ion 0 f the pub lic •

- 4 -

Progress in the fourth area is limited by the economic climate; but the measures developed in the other three areas have been c~mmunicated to the relevant authorities. Group II examined the effects of promotion and dhtribution costs and concluded that there was no evidence of excessive cost. Group III was concerned with the information systems and again, implementation is limited at present by cost considerations. Expenditure on pharmaceutical benefits has risen by 14.54%. in the 1979-1980 year, a very favourable figure when reviewed in the international inflationary context. (2) Medicines (a) In 1979 a decision was made to reduce the consumption of minor tranquillizers by restricting the free supply toone month. ,The preparations affected are: Chlordiazepoxide Diazepam Lorazepam Oxazepam (Librium) (Valium) (Ativan) (Serepax) ~,

Returns over an eight-month period show a drop in consumption of about 20%. At 12 months a more accurate assessment may prompt further action. (b) The successful restriction of the amount of heroin entering New Zealand has meant that addicts have turned more to prescription poisons. Tighter control of barbiturates is currently one of our problems. (c) The last year has seen the entry of computers into retail pharmacy. Several pharmacies have tex:minals, and the trial ,has reached the point where the department will accept computer ,printouts as a basis for payment.

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" ". ii

•

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II ., I,

(3)

Control of cosmetics

Inspections of pharmaceutical manufacturers continues. The standard is the department IS "Code of Good Practice for the Manufacture and Distribution of Medicines" (which is based on the WHO Code). A scientist has been appointed to extend this concept into the manufacture of cosmetics. Inspections of, manufacturing premises are being made, with the object of getting a picture of the present position of the indus try; while making recommendations for upgrading.

" " "

I •

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- 5 -

The question of a code has also been discussed with the industry federation; it seems clear that an official departmental code will need to be developed. This will enable comparable controls to be exercised over food pharmaceuticals and cosmetics. (4) Practice nurse scbeme

This scheme had its inception 1n 1970, as an incentive to doctors to work in rural ,areas, and has now spread to include urban practices. In essence, the scheme seeks to improve primary heal th care by subsidizing the employment of registered nurses in general practice. What started as a 50% subsidy for about 100 rural district nurses, has been extended to a 100% subsidy, which currently enables 875 doctors 'to employ 836 nurses. Only 39 nurses are currently employed under the 50% scheme. This expansion has resulted in a fairly considerable annual expenditure. Problems have inevitably arisen; some nurses may be doing non-nursing tasks; there are fears of overlap with the areas of district and public heal th nur,se,s; home vis itin'g by the nurses has not increased as IIIlch as was hoped. These and other d'ifficulties have resulted in an interdeparbllentaLcommittee being set up to look at all areas of the ·scheme. There has been such acceptance of the positive features of 'the scheme that it is to be hoped that problems can be resolved to a degree where the scheme can <,continue to function.

5. ....

HOSPITAL

S~RVICES

! A major scheme for the rationalization and limitation of high-cost technology has been approved by the Government. This includes the provision of an additional CT head scanner, a body CT scanner and provision over the next three years for expansion of radiotherapy and oncology services in the six main centres. There has been no increase in the number of superspecialist units, e.g. cardiac surgery, since last year. Emphasis in general is being placed on community care, and the expansion of renal dialysis, for example, has been in the area of training for home dialysis. The increasing costs of hospital services have been held in real terms by strict financial control on the part of hospital boards. The construction of new hospital buildings is largely limited to replacement of sub-standard accommodation, except in Auckland where there is still some shortage of acute beds. Increasing emphasis is being laid on the restriction of future operating costs in new or replacement butldings.

\ - 6 -

DENTAL HEALTH

During the year the results of the 1976 .urvey of adult oral health were received. The result. of this New Zealand-wide .urv~y confirmed the indications from previous local surveys that: (1)

Young adults have heavily filled dentitions, litt;:le untreated dental caries, and few mis.ing teeth. The percentage of adults wearing full artificial denture.ri.e. markedly with age~ 5% in age group 20-24 28% in age group 35-44 77% in age group 65+

(2)

A change for the better is, however, t,king place. There is a~rked reduction in the prevalence of dental caries in childrep and adole'.cent •• Since 1965 there has been a steady decline in the treatment;: need. of children. In 1979 children and adolescents. r,equir,d ab,out 60% less dental treatment than in 1965. This decline. in treatment needs is the re.ult of fluoridation and other deilta1 health promotion mea8ure8. The future young adul ts will have much le88 heavily filled dentition., Which i8 a prerequisite if the objective of natural teeth for life i8 to be achieved.

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. ,

ENGLISH ONLY

BRIEF COUNTRY'S REPORT ON HEP.LTH SERVICES IN P.N.G. TO M.H.n, 31ST REGIONAL C~ITTEE MEETING AT MANILA BY OR A. TARUTIA, SECr~ETrr.y FOR HEALTH PAPUA NE~ GUINEA PORT MORESBY SIR JULIUS CHAN, C.B.E., K.B.E. 462,840 SQ. !<M. 3,045,000 13.1% 86.9%

COUNTRY CAPITAL CITY PRIME MINISTER LAND AnEA POPULATION (1979) URBAN POPULATION RURAL POPULATION NATURAL INCREASE ADMINISTRATIVE DIVISIONS Resources "

2.8% PER YEAR 19 PROVINCES

...

Hospitals Health Centres Health Sub Centres Aid Posts

19 161

209 1,!H6

Papua New Guinea attained har independence five (5) years af)('. A major chanl}e in the political and acministrative structure of the country since that time has been the introduction of decentral1sat1~n and the establishments of 19 Provincial Governments. The ropulation of Pa~ua New Guinea 1s predOOlinantly a rural one. LinGuistics --. The people of Papua New Guinea are Melanesians with s'lile mixtures of Micronesian stock in the north western islands. There ar0. morPo than 70n language grcups. The ma,~or l1nlJua-franca is P1df'Jin Ennlish. liiri t10tu 15 spoken along the coast of Papua. EngHsh is the main laf19uarte of Qovernment, education and education. Social Organisation Social organisation is based on the clan or kinship ~roups. It tends to be egalitarian with status beina acquired rather than inherited. Acquired wealth such as aarden rroduce. rigs and ceremonial objects is closely linked with leadership. Land is owned by clans and kinship ~roups. Food

Subsistence farming ~rovides main staples such as sweet r~tat0. yams. taro and bananas whilst hunting of small animals and hirds provides nccasi~nal protein. In coastal areas fish is eaten and in some areas $a~o r31m is a staple. ../2.

- 2 -

Beliefs ...

Traditional belief in magic, taboos and practices influencing attitudes t~ards health, illness and death are still of fundament~l importance to many societies. The influence of missions, SOCi0-cconomic change,education and health servfces have affected some chan~es. Missions Mission influence has been present since the nineteenth ~entury. Their work was primarily evangelical though it include educJti(,n .'li1d h~alth work. Literacy Rates, Education Opportunities The adult literacy rate is estimated to be abcut 30%. In 1976, 58% of 7 12 years old were enrolled in primary schools and 12.6% of the 13 - 1~ years of aqe ~roup was enrolled in secnndary school. There are 94 Pr0vincial Hi~h Schools and 4 National Senior Hiqh Schools, which provide Grade 11 ~nd 12 education and 9 Technical Colleqes. Vocatinnal centrus i>rovi('e CfPortunities outside of the fonnal education system for adolescent school leavers f'Jr , . basic t~aining in practical skills leading to wa!Jc 0r self-emnloymcnt or general coonmity improvement. .

.,.'

...

The present health service delivery system is a pyrrunid of hospitals, health centres, health sub-centres, aid posts and special disease units. Th(~ Departmental policy is now mov1n1 towards systemic appr08ch of ~o1n~ into the community for ·the purpose of stimulat1n~ and mobilizin~ commu"i~y ~articipa tion in the· promotion of its health (see"attachment). It, is .realised that in most places such an undertakin~l is beset ""ith many problems. such as customs, tradition beliefs, superstiticn and communication difficulties. Because the barriers are bin, one sector cannot 10 much. But joining the resources of all sectors would make a cons~derable difference especially if the relevant staff were to be ry1ven skills in c0I1AJnicat1on, community organisation and develo~ent. '-

;

... /3. ,~ ,',

;.:'

TOTl\L OEf.'J\p.Tr.'JENT nF HEALTH BUOOET

1970 • ~ .11'..

• ' ..

Appropriation :17, 111 ~50a

Fstirnatad Ex?enditlJre 32.5sr.f'56

31,722,479

ESTIMATED OF GROSS OC)1ESTIC PROOtlCT PER HEAD (K

= t l $$1.40) C.O.P. PER CAPITA K3R2

YEAR 1976 1977 1978 -.; \..

B.o.P. I~058

POPULATION I'

million Kina II II II

1.289 1,334

2,793,800 2,874,500 2,958.500

1(447 K451

The Health Budqet and medical J'I'lanpower are concentrated on urbiin areas - 1n part a response to the more vocAl demands of the urban ~lit~. With ~;r.tit2d finance, priorities must be made and services provided that give the best value to the most-num~cr of peoole. Service~ ~as to be ari~p ted to local needs, customs and available resources. As Papua New Guinea has a shortage of capitAl and an oversupply of unsk1lbd labour, the need is to adapt tcchnoloqy to the advant~90 of th~ larqo supply of labour and to minimise the requirement for cnpita1.

.-,

Papua New Guinea Government is cOP.lllitted to the conc':~t of Primary Care, which has longed been practicp.d with limited ~COP(;.

~.ealth

The concept of Decentralisation further pr~otes e~ual distrihution of resources and bring dechion-m'!king policy to mu;t the "srir~tion of the peoplo/ in rur~l sector • Fiscal pol h.~ hn:> t.hus been "d'rt~ctl:d towards the setting of sust,lin;tblt! '~Jt·uwl.h trends in pu"lic expenditure after adjustment for inf1.~ti()n. Measures to raise revenue and allocate expenditur~ are aimed at r~ising a higher proportion of revenue from internal sources and ensurinq t~~t fynds are spent in line with National qC'als. ~!ithin thf! exp~1nt~itul"c target set e(lch year» the H.P.O. titke the viewpoint that distinctbns bnt"itlcn "rocurrent" and "development" expenditure are an inappropriate t:-:ol f')r !1rf'!'I'~r fi!;c(1l manaqcroont. In many developinq countries this over~Hl1lphasis "n Ild(;vl~l"r'I" ment budgets has led to the under financing ('If recurrent developmf::nt costs" • •

. . /1.

- 4-

In the period following sel f~·governf'1ent, Papua New Guinea has been faced with the problem of developinq a management framework that allows the country to develop its economic and social infrastructure while reducing dependence on Australian aid. a) National Public Expenditure Pl.an (NPEP) - the NPEP is a rol1inQ four ye~r plan ~hich allocates government exponditure in line with the priorities ('If the National Development Strateq.v. The pl~n is based on an expenditure target ~'hich isjjudged t'" be sustainable ever a f0ur year period. 1\11 development nrojects included in the NPEP have recurrent costs included in their capital crsts. The aggreqrate ex~enditure tarqet includes new and on"oing NPEP projects as well as the recurr~nt budC'let. b) Foreiqn Aid Manat:1ement - Papufi Ne',., Guinea directs all external aid into the NPEP. Infact, the expenditure tarqet is set based on estimates ("If 1ike1.V future aid fl()ws frnm all sources. This policy ensures that aid does not distort the fiscal priorities (If . the NPEP by fundinQ :1rojects C'utshfe the rlan. Mech,misms have been developed for accepting fltied fl grants in \~ "ray thnt ~ives Papua New Guinea best value for money and doe~ not distort national rrioritios.

" : ,

- 5 -

HEALTH PROBLEMS Disease Problems A list of health problems in Papua Ne~ Guinea rated in order of ~ricrity by takinSl into account morbidity. PK"rtality, f'lreventabflfty aftdsociAl and economic loss is: 1. Res~iratory

diseases includin" nartussis

)..

2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

Malaria Gastro-intestinnl diseases Malnutrition Tuberculosis Accidents and Injuries Pre{JOancy and its com~lkations Leprosy Skin Conditions Sexua l1.v TransmHted Di seases Psycho-social Oisorders Dental Diseases Ne00lastic & Oenenerative Dise~ses

Ccmmon c!iseases seen at health contro are skin diseases. diarrhnaal disease, malaria, malnutrition, pneumonia, bronchitis, ntitis media. conjunctivitis and also some cases of leprnsy,. tuberculosb and sexually transmitted diseases. Incidence of the Notifiable causes of 100,000 Populati~n)

Mor~idity

in P.N.G. (1979) (rer Rate 100,ono 4,288

Disease Malaria Diarrhoeal (O-5 yrs) Influenza (ionorrhC'ea Measles Syphilis Tuberculosis Pertussis Leprosy Pi~bel

Cases 130,575 46.343 34~321

10.383 9,3Q·1 4.818 2,232 1~942

1,522 1,127 341 309

l5R 73 64

I ....

772 ~?'3

24 21 2 1.5 0.1

Policmyelitis Tetanus Dirhtheria

66 47 4

- 6 Malaria The Dep.artment of Health recoqnises Malaria as one of the bi~~est Public Hea lthProb 1ansi n the country rmd ranki t as sec("\n r ! h??l 1th Dr; 0ri ty . The , pre.Sef\\t 1M;1tU~'ia; sttuati on st11l·ne.eds' financial reS0urces an~ continues review of the methods used in c('ntrnl1in~ malaria. J\lth("\uf1h, the r,\"vernment has already allocated K4 l"1i1lion to cl')ntrol M~larii'\ in Pa!"\u~ He,,' Guinea this y~ar and for the: next 3 years, this \.,111 n()t he f!d~ou:~te (lnl~ will cover cnly 60% of the oopulation. \"£1 hore that Vie C'lth!-?r '}0% nf the porulaticn will be covered by anti-malaria dru1s availablp. ~t t~~ h~~lth instituticns. The fi')ht against Malaria is a continu'llJs rne. Fl"c,'!l srrainq with D.D.T. is advisable. Develo~ent of resistanc~ to chlcr~ouin commonly used anti-malaria dru1s have arlded new dimension t~ the rrobl0ms. Tuberculosis Control Prooralmte In 1~77 the Department of Health clnsed all speciDlise~ hosritals fer Tuberculosis rind Lerros.y patients ~n(~ int(~"rated the T .B. Con t r("l 1 rr("l~ramme to nasic he~lth servic~s. ~1icrcscoric examinations is ~nc0ura1e~ tr. ~etect new cases and treat ,"it the i1id rost after treatment hi'l,S ':'een stah1ised. B.C.G. v:lccinatir·n ;;olic_~,f tr) all new horn, sch(!(tt entry and schoc1 leavers are heirin enc0uraqc1.

;:liTI979" epider.1inlC'~tcal 'ricture revf.':nled thC'lt

trt?l ('f r,~07f. ~.'!tients were prrv~n tuberculosis infect1rn an~ underonin'; tr;,:;;''ltl'l'1p.nt. This fi'1ure represent an infection rC\te ()f 1.29 cases tuf:\ercu10sh cas~;s ier 1,OnO .. p~;:uratl(ln~ -It is muthlo\Aler ;in the 'm(")untain ~rnvinc"':$ thcm the cOi1st(\l fjrovinces. :1 ')

!&m:P~~~~~.!'.fl_Lrro~~e

Leprosy is rnted sixth in the he~lth !')riority. In 10 79 reCjistered cases of leprosy was 8,484~ which rerresant a rrevalenCt~ Y'f\te equivalent t(' 2.9 c~ses·per 1000 porulation. Inte~ratod health care services is ~&in1 encouraqed at all levols. Immunisation Pro(,)ramme I'm lrrrnunisatinn (foP .1.) a'1ainst the frllrMin~ communicable diseases continue throuqh maternal and child health clinics and SOOl€ special me l )ica1 patrClls. l\ !~orld Health Or'vmisation Technical Officer is working very closely with ~r National count~r-part whr co-nrdi· nate all E.P.I. activities. Ex~anded

../7.

- 7 " Whoor'i nil Couflh (Fertuss is)

Tetanus Oirhtheria f'oliomyelitis Pigbel Tuberculosis Further ilTl;"lrf)Vement of E. r . I. was achi eyed, through the i ntrf"ductbn of sclar power frid']cs, ttrhich imrr0ved the cold chain system~ thus 1r.tprt'.'ve th,# storage and preservatinn of vaccines l"Iotency in the rurAl and "emotH ~reas. Emphasi s is ~laced on ch11dren a1e 'lrou 0 -5 vears. It is estimated that 1982~ 80% of all children under five .Years shoc.t! receive the 2nd and 3rd doses of each vaccine.

MI\TERNAL/CHILO HEALTH SERVICES COVERAGE 1977 PROVINCE 1 YEAR ~festern

1-5 YEARS 1~3 .1

I)ERCEtJT C()YEREO AfM~!;~.fA[ . SUPERVISEO BIRTHS CARE '14.1 25,(

I I

,.-..

Gulf Milne Bay Northern Southern Highlands Western Highlands Chimbu Eastern Highlands Morobe ~hdang

53.8 73.9 61.5 51.7 37.9 tl8.3

26.1 38.9 51.4 21.2 37.0 30.l1

36.2 29.0 46.4 25.3

ZO.3* 52.8

_\:

fast Serik '''est Seri k Manus Ne\'! Ireland \~rest New Brita 1n East New Britain National Capital Enga AVERl\GE ~

44.7 40.5 41.9 41.(; 45.0 63.2 48.5 59.7 61.1

21.5 21.6 39.0 36.8 39.6 37.1 67.3 4q.2

26.9 24.5 26.8 33.1 31.5 38.6 92.4 52.6 51.1 5.1.9

13.5 19.2 23.3 17.0 !t.2 l~.O

1-9.0

13.9 9.15

29.9 t;3.2

70.1 6!'.9

54.3 53.2

52.2 42.9 50.5 37.8

85.8 108.0 30.0 {~3.3

35.8 70.3 11.9 23.6

* includes National Capital

,8 Famll y t4ea 1th

Health Car~ in Papu(! New Guinea is rrevided ~,v the G"'v~rnmentJ t'ly various church IJrou:)s and by [lrivate practi tioners. The ~overnment rrnvictes the largest ~r~portinn rf health serv~es, hut in many rural areas, church health centre!; make ft major c~,ntrihuti('n to health care'approximatelySO% (\f the maternrtl and chilrl heaHh services in rural ,urea'is,carried cut hy church grours. Church Health S':::rvic€:s ~r~ hi·~hly '(subsidised by thf: Government to nrnvidQ services "'S ~<li.~l1~s trainin,.., ':.:Nurse '/\ides. Malnutrition It has been est;"'(!te~ that the ni\t1'mal flOpu11ti(:n is rmly cp.ttinn 80% of'its rec~nded food enerqy requirements. Malnutritir.n is .ry Major ;,"(Ac:t.P~jnthe hi-'lh rrf)~ortion r:f infant ~nc! chi1r! ck?(\tns an'~ the 1~~~~ learni'n~:'capacity "f marlY $Chf.'01 children. In adt'~itiQn !!'le.ny C1ilr!ren reQuire 10n,: h()srit~l treatment for :.1iseases mc1'1e m0re s~!V':~rt;: "y melnutriti~n. w~o ciluld othenlise be tr(!~t~d at home or require 0n1,: n j1nrt steW" in hos!1ital. 'r ".;," . ,. ", . , .~.

....

,~.

,"~-

FamilY f-'1anninq Only 2 • 6% of the child bearing i'l!1C practice f~mi1.y :·)l~nnin~;. i;~l0 femi'll ed~catir,n pro~ramme must be enc('lura,)ed ::it ~11 lev~~ls. t. ~Ul.(l. Consultant is attached t!i the ;:>ro!)r(!tmle. Fin"ncial 1'!'.d from UI'IE'pr, is received fc)r F.,mily Plannin!; Frrgramme. Environmental Health It is estimated that 80% of the rur~l pn'1ul!ltil"ln ("Ir at-c'ut 2 millirn r'·,,=crh~. lack of i'!"'equ~te ",'ater ::1nn t;a~;c s1'mit~tior. f(lciliti,~r... t,'ith th:\ ~o:;sisti'mce ('If' ~".H.O. S"'nit~ry En'linear, ('l; pelic.v dOCUMp.nt hi'lS htcn t1r"lwn u:' f0r the next four years. Two ~!ational Officers with Civi 1 ~n1in~erinl'" qu:\l ific~·" tic.~ns have heen recrui terl to undert(!ke this :")r')ject (lncl (!nsurc.! that im~le mentation starts nn schedule. Cnr.l1'unity wi'lter su!"~,ly rro,ject ;s hein(1 encouraqed in some Hi~hland Provinces.

.. I .. ~

rr6"inC~s

Research Projects 1) 2)

Piqbel vaccines has !Jeen st?\rted 1n the H1f1hl?\nd M(ll"rii'~ Parollsites resistance tr. chloroquin;

Research into thb indicates that they ~re st111 sensitiv~ to rther "ntimalaria drur;s such as Funs l1a' ana Ouinint:. ~oth the~,c tw('" dru~s are very costly.

3) ~,)

Research Vaccine as~i$ted by H.H'.n. and th~ Institute "f ~'p.dicC!l Research. Co!Mtunity r<lrticipatil'ln researttl trial in ("I"'':: of the Provinces (Northern) V;tla':1~~S are enc~ura"e1 tC' self hel;" in srrl'!yin(1 o'1eratit)n and vi11aq€ council is -,sket1 tfl ",on1tN' ~u~ervHi~n ron tri~l' basis. Pneumcni~

l"iTTj;::Hr~G!T' ... .,;;, TN1L: ,<,,;: PEfM-<It£.iT OF i-fAi.:ni AND CHIBr.H RURAL EAG!LIIIEe; 1';ITH mP1Hit"!~l PATTO;; 'flY PROYH!CE;. HEALTH . _,~ HEl\L TH TOTAL ,..= .~. "'" TOT!\L ;'Rub.t "•' " CENTRES SUB CENTRES CENTR.ES I1ID'tClSrS,;':" FACILlTI~S . ...'i.e_ .' ,~( ~ '<0., ','

1r.:r': ~"

rOP-PER FACILITY

PlOY I NCE ~!E;TER"

D"Y 4 ,t

CHS 3 3 2 1

TOT

DOH 1

CHS

TOT

DOH

CHS

TOT

DOHCH_S~ .. JOT r'

t::J.,!.

,,~4

::.: DOH

CHS,· TOT

GULF

7 7 '7 9

12 8 17 20

1 8

7 .9

5 5

14 10 11

19 15

36 52 74

CEURfIL NArIO~~l

13 9

211 29

.: 3t1;; 9'; ." ,

-; 70

'to

<;.

680 1000

61 79 92

.:. 57 87

~.,

76 103

CA?ITAl 8 3 5 6

16 99 35 ., t6"

1220 1060 8·10

MILNE B:W NO~THERN

8 3 · 9,

12b

1 , 2 3 '5 .1

SO:.JTHERN HIGHLAND II EN~ri

4 13 8 11 7 7

1 5 1 3 5

4 14 3 5 3

4 14 8 6 6

3 12 10 7 9

5 16 6 10 4 10

8 28 16 17

67. 4 13119

71 150 1<)6 1,31

70~9

7rf'

143 116 133

178 122

1390 1-ao 1€6C

106 126 106 5

WESTEm~ HIGHLf~~:D

S['4!>,U

EASTERt! HIGHLAND MOROSE MADi\NG

EAST SEPIK

7 14 11 7

4 5 1

18 16 8

7 2 .,

10 1 6 16

15 8 8 20

12 21 13 11

13 22

5 11 17

WEST SEPIK MANUS NEH IRELWD

8 3 6

.2 1 ,5 2

10 1 8 8

17 1 1

2 3 9

17 2 4 1~

e 19 4 7

3 8 11

26 24 28 27 3 12 In

140 192 137

5 3

111 143'

115

15 1,18 9 ' 124.

11 12 2

150

203 149 152 l~O

97 56 61 37

3 1 3

57 61 40

152 213 150 161 105 56 65 ~./'.

13 16 23 19

165 229 173 180·

l40e 1670

1160 1060

1080

22 4 S 14

127 60 73 58 77 0

860 560 950 l€~O

£:'\5T NfJN BRITAIN UEST NP~ B~ITAIN

6 3 117 3

9::0

6 3 15 18 6 18 24 77 3 80 83 21 lQ4 1000 ~4 161 (4 165 209 161 2"9 370 1788 128' l~t6 194~ 337 2286 1190 T:UriL N1TES: 1. An insi~'lific~nt proportinn of urban clinics ar2 include'1; 2., DOH = De;->artl'1ent of Health; 3. CHS Church Health Servic;s All National Capital District faci1i'~"'~;s are regarded (\s urtan and not included here although they ~re availablt:; tc S~~ rural residents,

N)RTE

SOl~ONS

)

..---

INGLISH ONLY REPORT ON PROGRESS OF HEALTH ACTIVITIES REPUBLIC OF KOREA (THE 31ST SESSION OF THE WHO/WPRO REGIONAL COMMITTEE) (MANILA, PHILIPPIBES)

Since the presentation ot the last report at the 30th session of the Regional Committee Meeting in Singapore, signifioant progress has been made in the improvement ot health care activities in the Republic ot Korea. The important achievements are presented as follows:

Medical Aid Programme

Last year, 2,142,000 low income earners reoeived tree medical care under the medioal aid programme which has been implemented with government's financial support since January 1977. In 1981, the government will expand the programme to cover 3,728,000 people or about l~ of total population.

Expansion of Medical Insurance System

The medioal insurance programme, whioh has been implemented since July 1977, originally covered ~,920 thousand persons, workers and their families from enterprises with more than five hundred employees. In 1979, however, the programme was expanded to cover workers at enterprises with more than three hundred employees, government officials and private sohoo1 teachers. Accordingly, 7,980 thousand persons or 21.2% of the total population and 8,858 thousand or 23.6 % were covered by this programme in 1979 and 1980 respectively.

- 2 ~..

This programme will be further extended in 1981 to cover workers from enterprises with more than one hundred employees and 10 million persons or 25.8% of the total population will then be covered.

Health Service in Remote Areas

The government has assigned medical doctors to all health centers, of which there are 214 at the city/county/ku(district) levels. Of the 1,366 health sub-centers at the eup/myon(township) levels, only 335 sub-centers do not have medical doctors in August 1980.

This indicates that the majority of people living in remote areas benefits from health services provided directly by medical doctors.

Improvement of Primary Health Care

In addition to the above-mentioned programmes and services, primary health care has also been strengthened. Progress has been made in providing better health care at low cost through improving the function and facilities of the health centers and sub-centers, health education programmes, maternal and child health care and family planning services through village mothers' clubs, etc. In this connection, it should be noted that a demonstration prOject to utilize Community Health Practitioners in remote areas, conducted by the Korea Health Development Institute (KEDI) since 1976, will be gradually expanded throughout the country. The Community Health Practitioners are trained to promote the primary health care programme and serve in the doctorless remote areas.

•

- 3 -

Oommunicable Diseases SurYeillanoe

Every year, the government provides the public with free preventive inoculation for various communicable diseases such as ?holera, encephal~tis, typhoid, diphtheria, tuberculosis, etc. The prevalence rate of acute communicable diseases was 14.8 per 100,000 persons in 1979. Efforts will be aade by the gDvernaeat to reduce the rate to 12.0 per 100,000 by 1981.

,--.. ......

!fB Oontrol

The government has been implementing tuberculosis control activities as a national procramme. The prevalence rate ot pu1aoDar7 tuberculosis has been lowered from 5.l~ (1,240 thousand patient8) in 1966 to 2.", (780 thousand patients) in 1980. This has resulted Iro. efficient implementation of the national programme through BOG vaccination, early case-finding by X-ray and sputum. eXaJlinatian, and treatment under registration.

G. . Improvement of Environmental Sanitation In January 1980, the government established the Oftice of Environment to deal etfective1y with the increasing environaental pollution problems and to carry out an integrated policy tor environmental preservation. In the field of public water supply, besides the. urban water 8upply projects, the goyernaent has installed a number of water supply systems in rural arE)a8 since 1967. At the end. ot 1979, .' 23,764 villages benefited from simple water supply pro3ects, thus increasil'lg the sate water supply rate to 73 percent ot the total rural population or 6,896 thousand people.

- 4 -

Population Control and Family Planning Programme

Through the strengthening of the family planning programme, the population growth rate was reduced from 2 .. 92 percent in 1962 to 1.6 percent in 1979. It is expected to further reduce the rate to under 1.35 percent by 1991.

Maternal and Child Health now, the MCH programme has had an impact on delivery only. However the government is revising the programme it through the primary health care services. It is planned the safe delivery rate from 52.8 percent in 1979 to 90

Up to assistance to improve to improve percent in

1986.

Drug Production

In May 1977, the Korean Good Manufacturing Practice (KGMP) system was introduced. Since then drug manufacturers have made great progress by replacing outdated facilities and techniques with modern ones. Korea has consequently attained self-sufficiency and high quality of international standard in drug production and is currently increasing the export of pharmaceuticals',to many foreign countries.

Welfare of Aged and Disabled Persons

There are 1,407 thousand persons, or 3.7 percent of the total population, aged 65 years and over. The government is now moving to establish the Aged Persons Welfare Law by the end of this year. As a part of welfare policies for aged persons, the government has, since May 1980 established a scheme that discounts half of health service charges to persons aged 70 years and over.

- 5 -

Mentally and physically disabled persons are an estimated 3.5 percent ot the total population. The government has provided vocational training, construction of facilities, and some subsidies tor their rehabilitation. Referrring to the United Nations Year p£ Disabled Persons, 1981, the government 'will take special steps to promote the welfare of disabled persons. It is planned to ....... "" . .. promulgate the Disabled Persons Weltare Law this year, and a plan of action for the International Year of Disabled Persons is in preparation. ',

The significant improvement of national health in the Republic of Korea is attributed to the successful implementation of four consecutive five-year economic development plans. In ~orea, health and social arfairs are essential parts or our current socio-economic development po11oy. Emphasis is being placed on the provision ot better health care at low cost to the entire population as well as active promotion of so~ial welfare.

ENGLISH ONLY

SINGAPORE 1

Brief Report on the progress of Health Activities in Singapore, 1979

Introduction 1. Singapore is an Island Republic with a total land area The total estimated population is 2,362,700

of 616.3 sq km.

million with a population density of 3833/ sq km. 2. The general health status of the popula'tion continues This is reflected in an infant ,mortality rate of

to improve.

12 per 1000, death rate of 5 per 1000 and life expectancy of 71 years. The Health Budget for 1979 was S$216,750,460 million,

and the per capita health expenditure was S$89.15. II Health Services (A) Primary Health Care Primary Health Care is provided by the Outpatient Services, I

Maternal and Child Health Services and School Health Services.

July 1976, the Primary Health Care Division was formed integrating these services under one administration to provide comprehensive medical care with maximum utilisation of the available resources in manpower, finance and materials and for an intersectorial approach linking preventive and curative health activities at primary health care level. Since this integration, the coverage

has been further extended by the setting up of polyclinics in the new satellite towns in conjunction with redevelopment programmes. These new generation polyclinics provide integrated curative, psychiatric, maternal and chi.ld health, family planning and dental services.

Submitted by the Permanent Secretary (Health)/Director of Medical Services, Singapore.

The Primary Health Care Services provide :a) a comprehensive primary health care programme for women of child-bearing age, infants and pre-school children. -~J)

a preventive and primary health care programme for school Ohildren.

c) d)

an ambulatory, curative service for the public. a home nursing service for the aged, disabled and nonambulant chronic sick. These services are provided through a network of 12

Polyclinics, 18 Maternal and Child Health Clinics, 15 Outpatient Dispensaries and the School Health Services. The Maternal and Child Health Clinics prOVide fami17 planning services, ante-natal and post-natal care, post-partum and post-abortal services for mothers, childhood immunisation against TB, smallpox, diphtheria, pertussis, tetanus, poliom,eli1;ls and measles. Birth registration is compulsory and througt information received from the Registrar of Births, close surveillance health and immunisation status of infants is maintained. The School Health Services, through the prescriptive screenings performed by compQsite health teams of doctors and nurses at selected periods of school attendances, provide free preventive health care to Singapore's half million school children. These

the

screenings include not only an assessment of the general health and nutritional status of pupils but also an assessment of the pupils' mental, emotional and intellectual development.

3 The Outpatient Dispensaries (OPDs) provide ambulatory, therapeutic care for the public. There is a close working relat,onpatien~s

ship between the OPDs and the general hospitals, to which

are referred if hospitalisation or sophisticated investigations needed.

(B)

Medical Care Major improvement programmes continue to be implemented

in the existing hospitals.

The first phase of the redevelopment

of the Sincapore General Hospital is expected to be completed by

... ;..-,

early 1981.

The total number of beds in the 12 Government Hospitals

is 8485, with a bed occupanc;y rate of 76.5%. III Environmental Health (A) Communicable Diseases (i) Cholera In 1979, ten sporadic cases and two carriers of El tor cholera were reported. Seven o~ i

the cases were of There were

Serotype Ogawa and three of Serotype Inaba. no deaths.

Two carriers for El tor cholera, Serotype

Ogawa, Trlere detected during epidemiological investigations.

(ii) Malaria A total of 208 cases of malaria including 1 death from cerebral malaria were notified in 1979. (97.l'fo) were imported, induced. Of these, 202

5 (2.4%) introduced and 1 (0.5%)

75% of the infection we~e caused by Plasmodium

vivax, 22.6% Plasmodium falciparum, 1.4% Plasmodium malariae and 1% Mixed Infection. All age groups were affected with

4 a high morbidity rate in the 15-34 age group (27.07 per 100,000). Cases were reported thrOughout the year with a

peak in July.

Indigenous malaria are no longer in existenoe in Singapore. Maroh 1975. The last known indigenous case was reported in Although Singapore is both w.lnerab le and

receptive to the reintroduction of malaria, we have a we1lestablished vigilance system to prevent secondary trarwmissioll of introduoed oases. (B) Pollution Control Measures The Anti-pollution unit, is responsible for monitoring the pollution levels. For 1979, there were no significant ohances in

the level when oompared to 1978, exoept for dust fallout in industrial areas. The higher levels of dust fallout were attrjbuted to oonstrucThere are nowa1toeather

tion aotivities around the monitoring sites. 19 monitoring stations.

Over the past 3 years, the annual overall

levels for total aoidi ty and smoke in urban, industrial and rural areas had remained fairly oonstant. The exeroise to relooate sawmills from urban area_, where they were a souroe of serious air and water pollution completion. The unit intensified its efforts to oontrol air pollution from stationary souroes. It made 1834 faotory inspections and Eapbasis was plaoed on the ~as

nearing

conducted 699 source emission tests.

observation of smoke emissions from woodworking faotories.

5 Regular inspeotions were oarried out on all the five refineries. Smoke observations were oonducted frequently to Fuel

ensure that the refineries were not emitting blaok smoke.

oil and water affluent samples were also regularly oolleoted and analysed. IV Collo.l us ion With the integration of the Primar.y Health Care Servtces, and the improvements being oarried out in our hospitals, it is Singapore's intention to continue improying the general health status of the popUlation in order to reaoh the MeOtarget Of health for all by the year 2000.

**************

EN FRANCAIS SEULEMENT

RAPP01{T SUCCINT SUR LES ACTIVImS SilliITAIllli;3

DE LAnEPtrnLI:!UE SOCIALISTE DU VIETNAN 1

(de Septembre 1979

a AoUt 1980)

sani~re .,(1976-1980) • Nous nous efforiODS de r6aliser les indice~ de

1980 est l'annee finale du 2e plan quinquennal de developpement

e1aboree dans le plan, po~tant sur les domaines suiva;nts ,: hygiene et ~lax:ie, consulta.tion medioale et traitement, planifioationfamilial.e, gestion san! taira, devel'lPPement des ressouroes looales en matiere premiere pour 18. production des m8d1oam~ts, formatiOlll et reoyolap des cadres, recherche soientifique ••• ' ba.ae

Les resu.l.tats obt~ au" oours des 5 der.nieres 8Z1IU}es ant cree ~gtt:'essivement 1& base mat,riell, et canst! ~tent les premioes ,Pour la realisation de l' objectif preoonise pa.r l' a4S a savoir, lila sante pour taus d I ici l' an 2000" • ' ,, , ,Les :erinoipales &Ojivi tes ,ani taires de Septembre 1979 seront evoquees dans le present rapport •

a AoUt 1980 #

DeVeloppeent des so.i.n! de sante primaires • Realisant la Declaration d'Alma. At&, noua avona deolenche une ca.mpa.ple d'8J!Ulation ,dans 1e'servioe de sante a l'eohelle nationale den~e "oa,.6De d'emulation pour lla.oCjCllllplieeement 5 taches" • que noua CJOIlSiderona,OCllllle prioritaires pour ameUorer dava.ntage les soins de sante primai'r.sl,du n!-V84U dec01llDlUl'1e. de district gusqu1au nivea.u de province'; Les 5 taches a aooomplir sont I " #) ~

....,

. '

1/ 1& oonstruction des 3 ouvrages hygiem.ques (latrine, pui ts,

salle de bain) ; 2/ la realisation des indices de planifioation familiale ; 3/ la re&1.i",tion des indioes de oulture et d'utiliaationdes plant.. m8dioiDales ; 4/ 1a gestion sam. taire pour ohaque habitant ; et 5/ ~ cC?JlSolidation de l'organisa1;.ion des soins de sante prima.ires a l' echelle de oommune et de distriot • .. , Avec oe moov_ent d,emw.a.tion, 1, <Jualite des pr,.tat~ona sanitaires a l' eohelle de cOlDlllUne et de distriot a ete nettement smelloree • En vue de renforoer la oapaci te de presta.tions dana les condi tiona se posent de nombreux probl8mes materiels techniques at de main d'oeuvre ••• nous avons struotu:r:e 1 t ensemble du terri ttoire du p83S en 10 zones san1tairee plaoees S0U8 le oontrole de 10 }2rovinoes ou villes,appelees cer;tres sanitaires • Ces centresont pour tiohe dtaider les provinces plaoees soua leur

, - .'

lRapport soumis par 1a delegation vietnamienne a 1a trente et unieme session du Comite regional de l'OMS pour Ie Pacifique occidental.

- 2 " , responsabilite a res~udre le~ ~roblemes :echnique~ et de,gestio~ • Chaqu~ oentre oomprend W1 hopi tal general, \ttl hopi tal speoialise, une eoole supe, rieure de medeoine, W1 oertain nambre d'instituts ou de filiales d'instituts de recherche relevant du ~s~ere de la Sante et etablis en ~royinoe • ~~ l'avenir, lorsqu'ils auront ete parfaits, ohaque centre sera a meme , , d'integrer les activi tes de prophylarle, de trai tement de la population !- la formation , et le reoyolage des cadres san1taires et la recherche scientifique dans la region • "

" , Au point de vue organisation" l' annee ~see, nous a:.vons etablJ. des .1nstallatians provisoires et restaure l'aotivite de pres de 400 stations sanitaires de oommune, 24 hopitaux de district, 4 hop·it8UX. de province " detrui ts au cours de la guerre d' agres8ion en Fevrier 1979 des provin.oes de 1& frontiere du Nord • Assa.inissement de llenvircmnement et lutte oontre les maladies transmissibles. Afin d'assainir progressivement l'environnement, nous oontinuons de , , pramouvoir dans la population a oanstruire les , installationsnygieniques primordiales savoir la latrine" le iui ts, la salle de bains • Jusqu'ici 149 oommunes",2 distriots ont realise les indioes de oonstruction de cas' ouvragee hygieniques • A,la oampagne, il y a maintenant en mo;renne 1 latrine oonforme awe normes hygienique pour 2 familles, 1 pui ts d I eau saine pour ) familles et 1 salle de bain pour 4 familles • Le programme delu~te antipaludique oansti tue toujours le point important dans les activi tes de lutte " , contre les maladies transmissibles • Au ooura de l'annee ecoulee, l'acoent a ete ms particulierement sur les ~uetes epidem101ogiques et le tra1 tement anti~ud1ques dans lea provinces meridionales, surtout , , , , dans les nouvelles zones eoonomiques • Ia pulverisation au DlY£ a protege environ 15 mill..!0ns de personnes vivant dans les zones impaludees et on a entrepris la therapeutique preyentive a. plus de 6,6 millions d'habitants, abe.issant l'index plasmodique a ',9 p 10.000 dans les provinces septentrionales (4,4 p 10.000 en 1978) et 52 p 10.000 dans les provinces meridionales (18 p 10.000 en 1917)

•

-j I

" Grace , a la vaccination elargie oombinee avec les mesures b,ygieniques et propl)l"laotiques active~, ,les maJ.!1¥es transm18sibles dangereuses oomme le cholera, la peste ont ete encerclees, on ne oompte plus que quelques cas , , dans quelques provinces meridionales • " La , diphterie. la rougeole et la . " _ ooqueluche oh!z l~entant ont tendanoe a r~gresser iar rapport a 1978 • La surveillanoe epidemiologi~u~ dans les ports. lesaerodromes, les noeuds des voies de ~~cation & ete l'objet d'1p1e,ttent1on plus vigilante, oontribuant a arreter la transmission des epid8m1ea • •

I • I,

Ii !: I' 11

'Planitioatian familiale Dans la,planif1catian faun.liale, nous cantinuons a benefioier de l' aide des differents ~s et organisations internat1oualea. Is. mawre majElQre oonsiste persuader les femmes se faire poeer des clisposi tits

Ii ... .

II II 11

II ·11

j -

intra-,Uterine • (DIU) Fin 1979~ d~s 5404 communes, 143 distrigt~ et !o provinces, Ie nombre de femmes a l'age de reproduction ayant benefioie de la pose de DIU equivant a. 5/~ de la population. Copne resultat de la realisation active du programme de planification familiale, Ie taux de croissance demographique a abaisse de 3~; en 1976 a. 2,33;; dans !e pay~ entier fin , 1979 • Dans des communes, districts et provinces qui ont , reussi " .a realiser l'indice de pose de DIU aux femmee avec un nombre egal a 5, J de la population, l'indice de oroissance demographique est de 1,5~~ environ. Dans un certain nombre de communes, grace la propagande active de la planifioation familiale, Ie taux de oroissanoe demographique est assez bas (1,2 0,6/~) • Bien <lue Ie taux de naissance dans Ie pays entier sont de ),04 J~ - un taux pas eleve - mais en raison du ~atble taux de mortalite (7,1 p • .~1.000) i1 en resul te que Ie taux de oroissance demographique se si tue toujours dans Ie groupe eleve •

Gestion sanitaire de ohaque habitant. La. gestion sani taire de ohaque habitant oonsti tue un grand objectif que noue nous devons de realiser pour les annees a venir dans Ie cadre de la protection de 1a sante dans notre pays • Les institutions sanitaires de base (communes, arrondissement, bureaux, usines) sont d'etab1ir les , , charg9S " dossiers de sante pour , ohaque habitant dont 1a sante releve de leur , , competenoe, et d'organiser periodiquement des seances de oonsultation medicale p~eventive • Dans Ie mouvement d'emulation pour l'aco9mplissement des 5 taches , fin 1979 , 357 communes, 9 districts ont mene a bonne fin la gestion sanitaire;dans les autres communes Ie travail en est aux differents stades • ~

Le probleme des medicaments au niveau des soins de sante primaires , ' " vue de resoudre l'approvisionnement des,medicaments a la population entiere , surtout au niveau des soins de sante primaires, nous mettons l'ac~ent sur !'inventaire et la oulture des plantes medicinales dans ,les differentes regions du pays, nous encourageons l' auto-suffisance en medicaments pour guerir les maladies courantes au niveau des soins de sante primaires avec los plantes medioinales disponi bles looalement • Dans Ie mouvement d' acconplissement des 5 taches, nous avons as'sisne au ni VGau sanitaire de commune l'indice de 35 especes de plantes medicinales cultiver pour trai ter 7 mal~dies et ou symptomes courants comme la grippe, la fievre, la toux, la diarrhee etc ••• Fin 1979, 2160 communes, 51 districts ont accompli les indices de culture et d'utilisation des plantes medicinales • Do ~neral, la presque totalite des postes sanitaires de commune des provinces septentrionales e~ la p1upart de ceux des provinces meridional~s ont leur j'ardin g.e plantes medicinales et peuvent se suffire pour 20 - )0> des besoins en medicaments courants des,habitants de 1a co~e, 30 a. 5Q~ des ~:1¥adeB au ni veau g.es soins de ,sante primaires sont trai tes par des :plantes medicinales cultives dans la region • ~

,'" -,

- 4Consultation medicale - Traitement - Fbrmation des oadres - Recherche soientifigue , , - En 1979 on a totalise 102.101.559 oonsultations medioales • ~ moyenne, ohaque habitant a ete examine 1,8 fois par an • Le nombre de lits d1hopital a augmente de 3900 par rapport 1978 • La nombre total de malades ayant recu un traitement ambulatoire est de 1.411.142 personnes ; 6.925.562 , , , persannes ont ete hospita1isees •

- Sont sortis de 1 l eoo1e, au cours de l'annee soolaire 1978-1979 : environ 1300 docteurs en m6decine ; 400 pharmaoiens universitaires ; 4000 cadres et teohnioiens seoondaires ; et 6000 oadres primaires de differentes oategories • , - Les travaux de reoherohe soientifique sur la prevent~on et .1a lutte oontre les maladies infeotieuses, les pro, ,. maladies sooi81es, les maladies , fessionnelles~ llintegration de la medeoine trad!tiarugelle a la medeoine moderne, Ie pour la produc, developpement des ressouroes en matiere medio81e , tion des medicaments etc ••• se poursuivent avec suooes • Les travaux d'en~u;t, systematiqu" d'~ormation medioale, de statistique sanitaire ont ete elargia et ameliores •

Hanoi, Ie

Aout 1980

ENGLISH ONLY

1979 COUNTRY HEALTH REPORT FOR THE TRUST TERRI'roRY OF THE PACIFIC ISLANDS

.....

1979 COUNTRY HEALTH REPORT FOR THE TRUST TERRITORY OF THE PACIFIC ISLANDS TABLE OF CONTENTS: Health Servies International Cooperation Board of Medical Licensure • Micronesia Health Coordinating Council • Health Planning and Resources Development Agency • Maternal and Child Health/Crippled Children's Services/Family Planning Headquarters Crippled Children's Services Communicable Disease Control Branch • Planned Activities for FY 1980. • page # 1 1

2 3

4 4 6

7 8

Notifiable Diseases Listed in Rank Order of FY 1979 in the Trust Territory and the Northern Marianas • Environmental Health Branch Mental Health Branch Dental Health Branch Clinical and Public Health Nursing Branch . Medical Supply and Pharmacy Services Vital and Health Stati~tics

10 11

12 13 15 15

and Medical Records • • • • • • • p •

Vital Registration System • • Births Infant Deaths Death of All Ages Leading Causes of Deaths

1.6

.., •

, •

17 17

....

Maternal Deaths •

TABLE OF CONTENS: page 2 page # Personal Health Program Health Education Health Educators Clinical Staff Public Health Clinics • Environmental Health Medical Education and Training Nutrition Research Medical Facilities Number of Hospitals, Dispensaries and Health Department Personnel in the Trust Territory by State, 1979 •.•.••. . • • • Admissions in the Trust Territory and the Northern Marianas Hos9itals by Type of Service, Sex, and Age Group, FY 1979 (October 1978 September 1979) . • • • • • • • • • • . • . • . . • • • • Registered Live Births in the Trust Territory of the Pacific Islands and Northern Marianas by State and Type of Attendant, 1978 •• . . Registered Live Births in the Trust Territory of the Pacific Islands and the Northern Marianas by State and Place of Birth, 1978 • • Number of Discharges from Trust Territory and Northern Marianas Hospitals by Type of Disease, Sex and Age Group, FY 1979 (October 1978 - September 1979) • • • • • • • • • • . • . . . . Number of Patients Treated in Out-Patient Departments of the Trust Territory and Nothern Marianas Hospitals by Disease and State, FY 1979 (October 1978 - September 1979) . • • • • • • • . . • • • • Number of Hospital Discharges in the Trust Territory and Northern Marianas by State and Cause Group, 1978 • • • . . • • . . • . . • . Number of Registered Deaths in the Trust Territory and Northern Marianas by State and Cause of Death, 1978. (Ordered by major causes) • • • • • . • • • • • • • • • • • • • • • • • • • 18 19 19

20 20 20 20 22

22 22

1979 COUNTRY HEALTH REPORT FOR THE TRUST TERRITORY OF THE PACIFIC ISLANDS HEALTH SERVICES The programs of the Bureau of Health Services are designed to improve health, environmental and sanitary conditions, minimize communicable diseases, establish standards of medical and dental care, encourage scientific investigations in the field of health, provide paramedical and auxiliary services such as nutrition and health education, and supervise and administer all government operated hospitals, clinics, dispensaries, and other medical and dental facilities. The Bureau of Health Services at the Territorial level includes personnel in the fields of medicine with public health backgrounds and with skills in nursing, dentistry, pharmacy, medical records, vital statistics, hospital administration, accounting, health education, mental health, environmental health, health planning, maternal and child health, professional development and training. This team provides services and gives direction for the implementation of public health and medical care programs. No comprehensive health services exist outside the government, although religious missions provide varying amounts of medication and care for their own personnel and students, and occasionally donate medicines to government hospitals. Private practice of dentistry exists in Ponape and the Northern Marianas. INTERNATIONAL COOPERATION The Territory is affiliated with the World Health Organization (WHO), Western Pacific Region. The Territory actively supports and subscribes to the International Sanitary Regulations, and makes epidemiologic reports to WHO. The WHO and the Health Section of the South Pacific Commission (SPC) provide technical assistance upon request. The U.S. Public Health Services (US PHS) and the Environmental Protection Agency cooperate with the Territory in providing some laboratory services, special grant assistance, and environmental and epidemiologic consultation. During the reporting year, a number of consultants have been furnished by the US PHS, Energy Resources Development Agency, World Health Organization, South Pacific Commission, TripIer Army Medical Center, Naval Regional Medical Center on Guam, School of Public Health of the University of Hawaii, and other universities in the United States. These organizations also offer training opportunities through fellowships and in-service training seminars. BOARD OF MEDICAL LICENSURE The Trust Territory Code requires that all physicians, dentists, and other related health professions who treat patients in the Trust Territory must be licensed to practice their specialties and healing arts.

TRUST TERRITORY HEALTH REPORT, 1979

The Code of Public Regulations, Release No. 3-72, established a Trust Territory Health Services Board of Licensure, whose function includes examining candidates, and reviewing credentials of applicants for license to practice in the Trust Territory and making recommendations to the Director, Bureau of Health Services, for the issuance of such licenses. The and The the Trust Territory Bureau of Health Services Board of Licensure was organized held its first meeting in Saipan on April 16, 1974, and annually thereafter. Board consists of seven members representing the various specialties in field of health and medicine.

During FY 1979 the Board issued licenses to: Fifteen physicians (including permanent and consultant physicians), 29 nurses, 5 dental officers and 2 sanitarians. MICRONESIA HEALTH COORDINATING COUNCIL One of the legislative mandates under u.S. PL 93-641 (Section 1524) is the establishment of a "Statewide Health Coordinating Council". In the Trust Territory, the Council is called the Micronesia Health Coordinating Council. The Council is composed of representatives of consumers and providers of health care. Consumers' representation consists of two consumers from the Government of the Marshall Islands, two from the District of Palau, and five from the Government of the Federated States of Micronesia, who are selected from the membership of bona fide community-based organizations. Representation of providers is entirely on a District baSiS, one from the Government of the Marshall Islands, one from the District of Palau, and five from the Federated States of M1cronesia. The current division if seven consumer representatives and nine provider representatives.

The prime functions of the Council are as follows: 1. Review annually and approve a Territorial Five-Year Comprehensive Health Plan and/or its revisions. 2. Conduct public hearings on the Territorial Health Plan or its revisions. 3. Review and comment each year on the Annual Implementation Plan for the Territory which will indicate the activities during the year to be undertaken to achieve the goals of the five-year plan. 4. Advise the Territory Health Planning and Development Agency generally on the performance of its functions. 5. Review annually and approve or disapprove any program application (often called State Plan) for programs specified in PL 93-641 as coming under the review authority of the Council. 6. Review annually and approve or disapprove as consistent with the Territorial Health Plan, the Medical Facilities Plan mandated by Public Law 93-641 which will indicate new medical facilities to be constructed or proposed renovations in existing facilities.

TRUST TERRITORY HEALTH REPORT, 1979 7. Review annually the budget of the Territorial Health Planning and Development Agency.

8. Review and approve or disapprove any programs or projects for proposed use of Federal funds. HEALTH PLANNING AND RESOURCES DEVELOPMENT AGENCY The Bureau of Health Services was designated by the High Commissioner and the Secretary of Health, Education and Welfare as the Territorial Health Planning and Development Agency eligible for funding under U.S. Public Law 93-641. The Office of Health Planning within the Bureau of Health Services was delegated primary responsibility for the development of the required health plans and for implementing the resources development functions specified in PL 93-641. The Territory Health Planning and Development Agency became fully designated by DHEW on July 1, 1979. The primary functions of the Office are as follows: . ..;: 1. Conduct the health planning activities of the Trust Territory of Health Services. 2. Prepare all plans required under Public Law 93-641. Bure~u

3. Carry out all health resources development activities mandated under Public Law 93-641. 4. Provide staff services to the Micronesia Health Coordinating Council and a,ssist the Council in its review of the various plans submitted to it. 5. Review on a periodic basis (~t least annually) all institutional health services being offered in the Trust Territory of the Pacific Islands. The Office has been assigned the task of coordinating the planning of all health programs or health,-related programs in the Trust Territory of the Pa,cific Islands in order that planning and programs are coordinated at various levels. To accomplish its official duties, the Office of Health Planning during the past year participated in the following activities: 1. Expanded staffing of the Office of Health Planning (establishment of District Health Planning activities in all jurisdictions except the Marshall Islands).

2. Coordination of efforts with the Government of the Northern Mariana lslands so that the GNMI can obtain a separate Health Planning capacity. 3. Establishment and training of the members of the Micronesia, Health Coordinating CounCil, including the provision of manpower and technical assistance during the Council's quarterly meetings, the revision of Council by-laws into compliance with the newly-structured l6-member body, drafting of Council resolutions, and other duties as requested by the Council.

TRUST TERRITORY HEALTH REPORT, 1979

Funding of a project to revise the Territory's Health Data System.

s. Development and passage of Certificate of Need legislation in the Government of the Marshall Islands, the Federated States of Micronesia and the District of Palau. 6. Preparation of an Agency Full Desgination Refunding Application for continued funding for Health Planning activities. 7. Completion of District Comprehensive Health Plans for Palau, Yap, Truk, Ponape, Kosrae, and the Marshall Islands. 8. Completion of District Annual Implementation Plans, based on District Health Plans, for Ponape, the Marshalls, Truk, and Kosrae. Yap and Palau AlP's are in various stages of completion. 9. Completion of Preliminary Territorial Health Plan and Medical Facilities Plan. 10. Provision of technical assistance to other divisions, offices and activities in the Bureau of Health Services upon request. 11. Assistance in the development of a Staff and Council Training Program by consultants. 12. Completion of the State Health Education Plan.

13. Continued production of Health Planning NEWSLETTER for public information about Health Planning activities in the Territory. 14. Provide assistance for the development of the grant applications for National Health Service Corps and United Nations Fund for Population Activities. 15. Completion of all requirements for full designation as the Territorial Health Planning and Development Agency. MATERNAL AND CHILD HEALTH/CRIPPLED CHILDREN'S SERVICES/FAMILY PLANNING Fiscal Year 1979 was the sixth full year of Department of Health and Human Services COHHS) funding for the Trust Territory of the Pacific Islands. Funds have been used for the hiring of professional staff, individual staff training, a Trust Territory-wide Maternal and Child Health (MCH) workshop on "Infant Care and the Problems of Young Parents", and essential equipment and supplies for state/district use to the general end of strengthening the entire program on behalf of children and women of childbearing age in the Trust Territory of the Pacific Islands. HEADQUARTERS , -~

The Maternal and Child Health/Crippled Children's Services/Family Planning (MCH/CCS/FP) Branch of the Trust Territory Bureau of Health Services is staffed at Headquarters level by a pediatrician as Chief, a Public Health Staff Nurse

TRUST TERRITORY HEALTH REPORT, 1979

and an Administrative Assistant. Throughout the year Headquarters staff provided assistance, consultation, and supervision to the Federated States of Micronesia, Marshalls, and Palau in their efforts to improve the health status of the mothers and children of Micronesia via: 1. Increasing the accessibility and quality of those MCH programs and services which necessarily have to be provided at the state/district hospitals (e.g., clinical laboratory treatment services, newborn intensive care, specialized diagnostic, treatment and referral and specialized restorative dentistry). 2. Programs of nutrition, education, dental health education and general health education directed at both professional staff and the public •. 3. Improvement of MCH programs and services to the remote areas including the outer islands. 4. The various programs on projects: a. :L

b. c. d.

Intensive Infant Care (Palau) Dental Health for Children (Truk and Ponape) Maternal and Infant Care (Ponape) Children and Youth (Marshall Islands) Family Planning Title X (Truk and Palau)

As in previous yea~s, the Headquarters staff of the MCH/CCS/FP Branch worked actively with the state/district in implementing and improving programs through on-site consultation and supervisory visits, correspondence, dissemination of educational materials, telephone conversations, teletype dispatches, communication satellite conferences, and workshops. When at mid-year the pediatrician-chief. was added to the staff, consultation to the state/district about individual medical cases became an added service. High costs of travel and limited travel budget combined to keep Headquarters staff on-site contacts with the state/district well below the optimal; nevertheless, each state/district was visited at least once during the course of the year. A TT-wide MCR workshop was held on Saipan with 30 MCH personnel including nurses and health educators from all states/districts in attendance and four participants from the Northern Mariana Islands. Headquarters Bureau of Health Services staff members attended the three-day annual Association of State and Territorial MCH and CCS Directors meeting held at New Orleans, Louisiana in April 1979, sponsored and funded by DHHS Region IX.

I , I

I , t... ...

A public health nurse from Kosrae attended the Bi-Regional Institute for MCH and CCS Programs on "Newer Concepts of Prevention in MCH and CCS" held for Region VIII and IX DHRS in San Francisco, California, in April 1979. One representative from Headquarters Bureau of Health Services was invited as speaker during this seminar. This training was sponsored by the University of California in San Francisco and DHHS Region IX MCR grant and staff. It was funded by DHHS Region IX.

TRUST TERRITORY HEALTH REPORT, 1979

TT-wide child abuse and neglect prevention, nutrition and immunization plans were developed and submitted for approval. Headquarters staff contributions were made toward the development of a TT-wide health manpower retraining program to be centered at Ponape Hospital. Certain primary goals were defined by Headquarters staff during the year: 1. Reduce the Trust Territory infant mortality rate from the present 30/1,000 live births by at least 20 percent in the coming year via: a. b. c. d. e. f. improvement of prenatal care; encouragement of breastfeeding; nutritional education for both professional staff and public; improvement of the technical quality and capabilities of the clinical laboratory facilities in the state/district hospitals; improved quality of pediatric care both as to prevention and as to care of the sick infant; and improved technical quality of the treatment of nutritional disorders.

t \ .-

2. To achieve a level of at least 90 percent complete immunization for Trust Territory children ages 0-2~ by year's end via: a. b. c. public health teams to outer villages and to main island schools; increased emphasis on immunizations in well child clinics; and public education campaigns.

I I

3. Reduce the incidence of nutritional deficiency illness and mortality rate amongst Trust Territory infants, children and women of childbearing age at least 50 percent as pertains to illness of sufficient severity as to necessitate admission to hospital via: a. improvement of nutrition services through the addition of a qualified public health nutritionist for each state/district hospital and sub-hospital at Ebeye. ~

I [

CRIPPLED CHILDREN'S SERVICES Crippled Children's Services provided the vehicle in Territory-wide efforts to prevent diseases and disabilities that cripple children and to locate, diagnose, treat, and provide followup services for children who suffer from crippling conditions or who suffer from conditions which threaten to lead to crippling. Coordination of the total program including central record keeping is provided by Headquarters. The Chief and the staff of Maternal and Child Health/Crippled Children's Services (MCH/CCS) screens each child candidate referred into the CCS programs and arranges the scheduling of specialist consultation visits to state/district hospitals. The Chief of MCH/CCS also provides on-site consultation within his speciality (pediatrics) during his visits to the states/districts. Each state/district has a designated CCS physician who is responsible for case finding and followup. The prO$r~ also provides funds to maintain a CCS Patient Coordinator based i~ ~o~ulu -~-

TRUST TERRITORY HEALTH REPORT, 1979

whose responsibility is to assist CCS clients and their families during referral stays in the Honolulu area. Since the specialties of orthopedics, neurology, otorhinolaryngology, opthalmology, urology, cardiology, plastic surgery, and endocrinology are currently not represented in the Trust Territory hospitals, CCS clients whose problems fall into one or more of these areas must be seen by a visiting consultant or referred to facilities outside the Trust Territory for consultation. Since it is in general more effective to bring the outside consultant to the Trust Territory, this is done wherever possible rather than in preference to sending the child to an outside facility. Expenses of visiting consultants cOllDDonly are borne from general Trust Territory funds, while CCS funds have been used to defray the larger costs of outside facility referrals. These latter funds made possible the referral of 19 children to Letterman Army Medical Center (California); 12 to Shriners Hospital for Crippled Children (Hawaii); six to TripIer Army Medical Center (Hawaii); and one to U.S. Naval Regional Medical Center (Guam) for specialized surgical and/or diagnostic procedures. Two who suffered from severe cardiac abnormalities expired before . the referral could be completed and four children cardiac patients did not survive the operation procedure. Pediatric cardiology consultation has been provided on a remote basis by the staff of the Pediatric Cardiology Section of TripIer Army Medical Center-clinical data and consultative reports being exchanged by mail between the Chief, MCH/CCS, and the Army Medical Center staff--and this very valuable service to the Trust Territory has been provided this past year without charge except for the cost of the mailings. On-site consultation visits by Colonel Donald B. Roberts, Chief of Pediatric Cardiology, TripIer Army Medical Center, to all of our state/district hospitals will have been made by the end of Fiscal Year 1979. This consultation tour will be funded by CCS. Children who suffer from crippling orthopedic problems are afforded needed orthopedic surgery and rehabilitative treatment through Shriners Hospital for Crippled Children in Honolulu. This institution makes no charge to the Trust Territory for these valuable services, although CCS customarily funds the costs of transportation to and from Honolulu. COMMUNICABLE DISEASE CONTROL BRANCH ~~

,__

The COllDDunicable Disease Control (CDC) Branch is responsible for surveillance, identification and control of all communicable diseases for which effective preventive and control measures are available. The staff includes an Acting Public Health Advisor who is a Registered Nurse and a clerk-typist. During Fiscal Year 1979 the chief has been a physician epidemiologist detailed from the Center for Disease Control, U.S. Public Health Services. Beginning FY 1980 the Trust Territory will no longer receive direct assistance for an epidemiologist and Public Health Advisor from DHHS. However, the Public Health Advisor being assigned to Guam will provide assistance to the TTPl. The Branch receives federal funding for venereal disease and childhood illUDunization grants.

TRUST TERRITORY HEALTH REPORT, 1979

The following activities occurred during FY 1979: 1. In late October 1978, an Immunization Task Force was formed at the Bureau of Health Services which consisted of Dr. Cam McIntyre, then Chief of CDC Branch; Mrs. Augusta Salii, R.N., Acting Public Health Advisor; and Mrs. Christina Rubasch, Medical Records Specialist. The Task Force members travelled to each district/state in the Trust Territory and the Northern Mariana Islands to plan, organize, and implement a Mass Immunization Campaign which began January-August 1979 in order to reach the national goal of 90 percent by October 1979. The Task Force provided assistance and consultation to each district/state in preparation for their immunization plan to serve as a guide for the districts/states and the Northern Marianas to conduct activities in reaching the following objectives of the TTPI Mass Immunization Campaign: a. Immunize all children under 17 years of age who have incomplete immunizations and to raise the level of immunization in the TTPI and the Northern Marianas to no less than 90 percent by August 1979. Improve our immunization program so that the TTPI and the Northern Marianas immunization levels will continue to remain above 90 percent in the future.

2. An Immunization Survey was conducted in August 1979 for two-year-olds, six-year-01ds, and eighth graders (school year 1978-1979). The survey results show the immunization levels have reached approximately 77 percent. 3. Venereal Disease Control programs continue to be maintained. There was no significant change in cases of syphilis reported in calendar year 1978. Reported cases of gonorrhea totaled 422 (excluding the Northern Marianas) versus 448 during 1978. 4. Diarrheal diseases remain the major communicable disease problem in the Trust Territory. The main age group affected are the infants. PLANNED ACTIVITIES FOR FY 1980 1. The major activity of the Communicable Disease Control Branch is to continue to raise the TTPI immunization level to 90 percent by the end of Fiscal Year 1980.

jl "

, II

2. 1980.

A possible one-week Venereal Disease Workshop is planned for March All states/districts and the Northern Marianas participants will attend.

3. The Communicable Disease Branch still plans to investigate further the causes of diarrheal diseases and work together with the Environmental Health and Maternal and Child Health Branches in implementing control measures. New cases of Notifiable Diseases Reported in the Federated States of Micronesia, Marshall Islands, and the District of Palau in Fiscal Year 1978 and 1979.

TRUST TERRITORY HEALTH REPORT, 1979

(Listed in rank order of cases in FY 1979.) Diseases Influenza Amebiasis Gonoccal Chicken pox Strep throat and scarlet fever Fish poisoning Hepatitis, infectious Measles Filariasis Dysentery, bacillary Dysentery, unspecified type Tuberculosis, all forms Mumps Meningitis, other (except tuberculosis) Leprosy Pertusis (whopping cough) German measles (Rubella) Meningitis, Meningococcal Syphilis Tetanus Source: Monthly morbidity epidemiological tables in the Office of Health Statistics, Trust Territory Headquarters. New Cases of Notifiable Diseases Reported in the Northern Marianas in Fiscal Years 1978 and 1979. (Listed in rank order of cases FY 1979.) Diseases Influenza Chicken pox Gonoccocca1 infectious Dysentery, unspecified type Fish poisoning 12 1978 74 2

1978 9,172 3,370

1979 8,359 852

448 377

422 323 238 172

249 295 132 1,218 158 282 219 47

82 52 49 48 38 36

35 11 10 4 1 1

25 8

1 1

1979 3,015

3,272

24 57

47 ~3

TRUST TEHHITORY HEALTH REPORT, 1979

Diseases, continued Mumps Strep throat and scarlet fever Hepatitis, infectious Rheumatic fever Amebiasis Tuberculosis, all forms Leprosy German measles (Rubella) Measles

1978 90 54 5

1979 18 17 5 5 4

3 123 5 2

2 1 1 1

Source: Monthly morbidity epidemiological tables in the Health Statistics Office, Trust Territory Headquarters. ENVIRONMENTAL HEALTH BRANCH The staff of the Envir0nmental Health Branch numbers 50 people. The Headquarters staff consists of the Chief of Environmental Health, a Sanitary Engineer, two Area Sanitarians, one responsible for the Western Carolines and stationed in Palau, and the other responsible for the Eastern Carolines and the Marshalls and stationed in Ponape. The local personnel includes a Chief Sanitarian in each state/district and 37 staff for all states/districts. The Headquarters staff of the Environmental Health Branch perform dual functions in that they also serve as the staff of the TT Environmental Protection Board (~PB). Similarly, state/district Environmental Health personnel serve as the staff of the state/district Environmental Protection Advisory Board (EPAB). The nine-member EPB is composed of one representative from each of the six entities in addition to the Director of the Bureau of Health Services (Chairman), the Director of the Bureau of Public Works, and the Director of the Bureau of Resources. The EPAB's which serve as agents of the EPB at the local level, are composed of seven members each, one of whom is also a member of the EPB. To date, EPAB's have been established in all states/districts except the Marshalls. The EPB is responsible for overall program planning in air, land, and water pollution control, solid waste collection and disposal standards, hazardous waste material disposal, pesticides, and environmental education. The basic program responsibilities of the Environmental Health Branch are to prevent disease and environmental degredation and to achieve and maintain the environmental quality necessary to promote public health. Accomplishments of the EPB during FY 1979 include: 1. Promulgation of revised regulations governing the sale, use and disposal of pesticides. The regulations also established a certification system to keep hazardous pesticides out of the hands of unqualified users. The EPB sponsored a workshop to train state/district personnel in enforcement ~

II I!

TRUST TERRITORY HEALTH REPORT, 1979 of the new regulations.

2. Establishment of Marine and Fresh Water Quality Standards. Water quality is being monitored in district/state laboratories, and the public is being informed of those areas where the water is below standard. Laboratory personnel received training from Headquarters and U.S. EPA staff at an EPBfunded workshop. 3. Promulgation of Solid Waste Regulations which set standards for storage and collection of solid waste, solid waste disposal facilities, and hazardous waste disposal. 4. Development of a hous-sewer connection program to improve sanitation by connecting individual houses and buildings to the sewer systems in the government centers. S. Providing start-up funds for a demonstration aluminum can recycling project in Truk. If successful, this program will serve as a model to the other states/districts in Micronesia • The Environmental Health Branch, with the assistance of WHO, is in the process of identifying the nature and prevalence of vector-borne diseases in the Trust Uerritory, especially those transmitted by mosquitos. Training in fundamental principles of vector control, survey techniques, and identification of the genera of mosquitos of public health important in the Pacific was given to state/district staff, and two WHO fellowships for in-depth training in vector control have been awarded for 1980. The TT Health Services Regulations on Mosquito and Fly Control were amended to require disinfection of aircraft landing in the TTPI in order to prevent the introduction of vectors, especially malaria. MENTAL HEALTH BRANCH The Branch of Mental Health is responsible for: 1. 2. 3. Alcohol and Drug Abuse programming; Mental Health programming for adults and children; Mental Health Training;

.r-..,

4. A cooperative program for special training in psychiatry for Micronesian Medical Officers has been established at the Department of Psychiatry in the University of Hawaii School of Medicine;

..-

S. A case registry has been established of all known cases of alcoholism, drug abuse, and mental illness in the Trust Territory; 6. A medical officer in charge of mental health for the State of has been appointed; ~osrae

7. Support was given to an Alcohol Outreach Program in the State of Yap. mis program was directed by a Maryknoll Sister; 8. An Alcoholics Anonymous Group has been started in Yap. Leadership training for an Alcoholics Anonymous Group in the Marshalls has been ~tafted; and 9. The Mental Health Branch continued to be heavily involved in direct patient care, spending approximately one-fourth of its time in tlii, activity. A staff member visits each of the six areas about once every three months.

TRUST TERRITORY HEALTH REPORT, 1979

DENTAL HEALTH BRANCH The Dental Health Branch is charged with the task of planning, developing, and implementing comprehensive dental health programs aimed at reducing the prevalence of dental caries and to control the occurrence of gum diseases, to the lowest possible rate for all the citizens of Micronesia. Emphasis is placed on dental health education, specifically toward the awareness of good oral hygiene and the importance of dental health in conjunction with general health. There are 19 dentists, 44 dental nurses, and about 30 dental auxilIary personnel providing dental health care in the Trust Territory. In addition, one private dentist is practicing in Ponape State. Six central dental clinics are located in each of the six administrative centers Additionally, there are sub-dental clinics at Ebeye in the Marshalls and Ulithi in Yap State, which are supplied with modern equipment to provide operative surgical, prosthetic and dental public health services. Dental services to the outer islanders are provided when field trip ships visit these islands with dental personnel. Services are often limited to emergency care due to time limitation. The overall dental operation of each political entity, the Marshalls, Federated States of Micronesia, and Palau, is headed by their Chiefs of Dental Services who formulate and implement dental programs in their respective jurisdiction. School dental health programs are one of the division'S main concerns, and one of the top items of priority. The program covers pre-school and grade school aged children. In addition, the Maternal and Child Health (MCH) funds supplement existing programming in providing additional dental health services to expectant mothers. Good oral hygiene is emphasized to mothers, as well as their role in dental health for children. The Sodium Flouride Mouth Rinse Program is also a priority and is conducted on weekly intervals throughout each school year. The program is being instituted in all elementary schools. Additionally, each school child received examinations, proplylaxis, and all other necessary treatment in the school dental health services when dental teams visit the schools. A~cientific study has proven the effectiveness of the Sodium Flouride program showing a 20-50 percent caries reduction There were 20,250 school children who received the treatment in 1977 and 65,123 in 1978. Manpower development for professional staff will remain as a great concern to the Division. The School of Dental Nursing in Palau continues to turn out more dental nurses who are trained to perform simple extraction, filling, ~nd carry out dental health education and other dental services for school children as the primary area of their responsibility. In order to keep up with the rapid changes in modern dentistry, a one-week seminar is conducted every year for all dental officers and dental nurses during the annual conference/seminar. During such seminars, administrative matters and business for both the Microneisan Dental Association and the Micronesian Dental Nurse Association are discussed.

TRUST TERRITORY HEALTH REPORT 1979

Consultants are obtained from the South Pacific Commission, WHO, the U.S. Naval Regional Dental Center in Guam, DHEW, Region IX, San Francisco, and from some interested private practitioners from Guam and Hawaii. Dental Nurses and Dental Officers are awarded WHO Fellowships each year for advanced training abroad. The fields of study in most cases, are selected according to dental care needs in Micronesia. The Chief, Dental Health Services Branch continued to give support from his office and travels to the Federated States of Micronesia, the Marshalls, and Palau from time to time to consult and give advice on ongoing programs and other activities in the three entitities. CLINICAL AND PUBLIC HEALTH NURSING BRANCH With the completion of new hospitals in Kosrae, Ponape,and Yap, nurse staffing patterns need to be considered due to increased number of beds and larger physicial facilities. Continuing education for nurses, a program funded by a federal grant, is active in the District of Palau, the Marshall Islands, the Federated States of Micronesia consisting of Kosrae, Ponape, Truk, and Yap, as well as the Northern Marianas.hospitals. Learning resource centers are being developed for nurses in all areas. A one-week seminar of supervisors of nursing, both public health and clinical was conducted focusing on the importance of quality care through supervision. The seminar was conducted in the new Ponape Hospital, and was attended by 23 nursing supervisors from all areas including the Northern Marianas. The Health Manpower Development contract allows for the Chief Nurses of the District of Palau, the Marshall Islands, and the States of Ponape, Kosrae, Truk, Tap, and the Northern Marianas to attend the nursing administration segment. However, through MCH funds, supervision also from these areas were able to participate in this course which was presented by the Ponape Hospital in conjunction with the University of Hawaii School of Nursing. Twenty-five participants qualified for University of Hawaii certificates in Nursing Administration. Standards of Nursing Administration for the Trust Territory have been written by Chief Nurses and Supervisors. Increased positions for graduate nurses will be needed to meet the standard of adequate graduate nurse supervision of the practical nurses. Two Trust Territory graduate nurses, one in Yap and one in Truk, successfully completed a six-month intensive course in nurse midwifery in Suva, Fiji made possible through WHO Fellowships. The increasing trend of mothers coming to the hospital for delivery as well as nurses assuming more responsibility for delivery makes this a most important development for obstetrical and public health nurses. The Micronesian Nurses Association's constitution and by-laws have been developed. It is felt by the Professional Nurses of the Trust Territory that an annual meeting for the purpose of setting and maintaining standards, as well as the socialization of graduate nurses, should be estbalished particularly at this time with the development of the separate governments.

L.-

TRUST TERRITORY HEALTH REPORT, 1979

The nurses need to maintain an avenue of communication among all the islands in the Pacific. The American-Pacific nurse leaders' third annual conference was chaired by a Trust Territory nurse, Francisca Bismark from Palau, Western Caroline Islands. The membership of this conference includes American Samoa, California, Hawaii, Guam, the Trust Territory, and the Northern Marianas. The purpose of this conference is to look at the problems of island nursing and to correlate nursing resources available from the United States both for nursing education and nursing service. A pilot project for the basic education of practical nurses has been ongoing this year at the Community College of Micronesia in conjunction with the Ponape Hospital. Selected experienced practical nurses have attended four to six months of class at the college with supervised clinical experience at the hospital. It is hoped that through the extension program of the college this course can be offered in all areas.

15 TRUST TEruU'l'ORY m:l\L'l'Il

REPORT, 1979

MEDICAL SUPPLY AND PHARMACY SERVICES The Medical Supply is a support activity in the Bureau of Health Services which provides logistics support to all Headquarters health programs and all Bureaus of Health Services in the procurement and supply of pharmaceuticals, medical supplies, and equipment. The Medical Supply Service is headed by the Medical Supply Officer, and is officially, with the Procurement and Supply Division under the general supervision of the Directc of Finance. The medical supply function within each of the four new separate governments of Micronesia is carried out as directed by the chief executive of the government concerned. The pharmacy service is supervised by the Chief Pharmacist in the Bureau of Health Services under direct supervision of the Director, Bureau of Health Services. The Chief Pharmacist serves in an advisory capacity to the Headquarters Medical Supply Officer and the state/district medical supply officers, and the pharmacies in the various areas to insure that drugs are properly stored, compounded, and issued. The Chief Pharmacist plans, organizes, trains personnel, supervises activities in all hospital pharmacies according to hospital policies, establishes standard procedures for dispensing drugs, and establishes standard state and federal practices of the profession. The Chief Pharmacist, under the Director of the Bureau of Health Services, monitors the quarterly narcotic inventories for all areas' warehouses, dispensaries, nursing stations and pharmacies in the Trust Territory of the Pacific Islands. VITAL AND HEALTH STATISTICS AND MEDICAL RECORDS The Vital and Health Statistics and Medical Records Branch, Office of Health Planning and Vital Statistics and Medical Records at the Headquarters level, Bureau of Health Services, is one of the supportive branches to the Trust Territory Headquarters Government, serving the Northern Mariana Islands, and the emerging governments throughout the Territory. under the general direction of the Director of the Bureau of Health Services, and under the immediate supervision of the Public Health Statistician, assisted by a Statistics Specialist and other resource personnel, this Branch is responsible for developing and implementing the vital registration system and medical records of activities in the District of Palau, the Marshall Islands Government, the Federated States of Micronesia, and the Northern Islands, until these new governments can develop their own offices of Vital and Health Statistics and Medical Records. In addition, this Branch assists in coordinating in-service training activities and workshops for improving the skills and performance of Health Statistics and Medical Records personnel in the four new separate governments of Micronesia, as well as the personnel in the Trust Territory Headquarters Governments. The Branch collects, compiles, analyzes and presents vital statistics and other health statistics data needed to evaluate trends of diseases and epidemics, and also evaluates program progress and monitors and controls confidential information. The users of the Trust Territory Health Statistics include individuals

~~.

TRUST TERRITORY IIEAL'I'H REPORT, 1979 studying Trust Territory health programs and problems, Trust Territory Health Planners, Health Administrators, and other Trust Territory program administrators at both national and local government levels, the South Pacific Commission, the World Health Organization, the United Nations, and various united states federal agencies. VITAL REGISTRATION SYSTEM Registration of births, deaths and fetal deaths throughout the Territory is a joint function of the state/district and headquarters Bureaus of Health Services. The system is authorized by Section 624 of the Trust Territory Code and Public Health Regulations, Chapter 1, Vital Statistics. The system depends on the conscientious efforts of State/District Directors of Health Services, physicians, vital statistics personnel, local reporting agents, and other State/District health personnel. Each state/district is divided into local reporting areas with a local reporting agent who collects reports of births, deaths, and fetal deaths in the area and forwards them to the State/District Director of Health Services. The State/ District Director of Health Services is responsible for seeing that a completed certificate is filed in the Office of the Clerk of Courts for each event that occurs in his state/district. The Clerk of Courts in each state/district is responsible for indexing, filing and preserving the original certificates, preparing certified copies on request, and collecting payment of a fee where required. A copy of each certificate is sent to the Vital and Health Statistics and Medical Records Branch, Headquarters Bureau of Health Services, for statistics and various administrative purposes. The Branch of Health Statistics and Medical Records of the Headquarters Bureau of Health Services prepares certificates and other forms used in vital registration, handbooks and instructions, and gives in-service training and supervision to. state/district vital statistics personnel. Headquarters Bureau of Health Services gives leadership in establishing uniform practices and in improving completeness of coverage and quality of certification. BIRTHS A provisional total of 2,534 live births was recorded during the calendar year 1978 from the Federated States of Micronesia, the District of Palau, and the Government of the Marshall Islands. This is 25.8 percent lower than the 3,415 live births recorded for the same area in 1977. The total 1978 provisional crude birth rates for the Federated States of Micronesia, the Marshall Islands, and the District of Palau is 22.3 per 1,000 estimated population for the same period and place, which is lower than the 31.0 crude birth rate of 1977. A total of 562 live births in 1978 from the Northern Marianas Isl~nds. ~his is 2.1 percent lower than the 574 live births recorded in 1977. The 1978 provisional crude birth rate for the Commonwealth of the Northern Marianas is 37.8 per 1,000 estimated population for the same year, and less than the 40.0 provisional crude birth rate for 1977. Registration of births is almost 100 percent completed in the Northern MAri~na

-. "-

TRUST TERRITORY HEALTH REPORT,1979 Islands and in the Palau District where almost all births occur in hospitals. The exact percentages of completeness of birth registrations are not known in the Federated States of Micronesia (Kosrae, Ponape, Truk and Yap). The Marshall Islands reported very few births this year. Cultural factors, geographic distances and other administrative problems make it difficult in all cases to obtain a complete registration of vital events. This is true in the eastern states, where most births occur outside the hospital. Efforts to improve registration of vital events by educating the public through radio announcements about the basic value and uses of the certificates have been continued in all states by the State Vital Registration staff with technical assistance from the Vital and Health Statistics and Medical Records branch at Headquarters. The Northern Mariana Islands is reporting the highest provisional crude birth rate in the Territory this year, with 37.8 live births per 1,000 estimated population, followed by the State of Ponape, with 36.8, the State of Yap wi.th 31.2, the District of Palau with 19.8, the State of Truk with 17.7, the Marshall Islands with 16.7, and 16.6 for the State of Kosrae. INFANT DEATHS The provisional Trust Territory of the Pacific Islands infant mortality rate of 28.0 per 1,000 live births for 1978 was based on 71 infant deaths reported to this office from the governments of Palau, the Marshalls, and the Federated States. The compara:ble rate was 34.8 per 1,000 live births based on 126 infant deaths for 1977. The Marshall Islands infant mortality rate of 57.9 was recorded as the highest in the Territory, followed by 40.3 for the State of Yap, 32.7 for the District of Palau, 22.5 for the State of ponape, 13.0 for the State of Kosrae, and 9.3 for the state of Truk. Diarrheal and intestinal diseases and prematurity continue to be the first and second most frequently reported causes of infant deaths in the Territory, which constitute 45.1 percent of the total reported infant deaths in 1978. A provisional total of eight infant deaths was registered in the Northern Marianas during 1978. The provisional infant mortality rate for the same year was 14.2 per 1,000 live births. The comparable provisional rate was 32.5 per 1,000 live births based on 20 infant deaths registered in 1977. Of the total (8) infant deaths, four were classified dead under prematurity, two under certain causes of mortality of early infancy and one each under influenza and pneumonia and all other causes. DEATH OF ALL AGES A provisional total of 393 deaths was registered in the Federated States of Micronesia, the Marshall Islands, and the District of Palau for 1978, compared to the provisional total of 570 in 1977. The total crude death rate for 1978 was 3.4 per 1,000 estimated population. The comparable crude death rate was 5. 2~,for 1977. The State of Yap continues to report the highest crude death rate of this year, with 8.3 deaths per 1,000 estimated population, followed by the State of Ponape with 6.2, the District of Palau with 3.4, the Marshall Islands with 2.9, the State of Kosrae with 1.7, and the State of Truk with 1.3.

•

TRUST TERRITORY HEALTH REPORT, 1979 Of the 393 total deaths, 221 deaths, or 56.2 percent, were medically attended by physicians in the Trust Territory. Individuals who died in the fifty and over age group accounted for 46.3 percent of the total deaths reported during the year, followed by infant deaths (under one year of age) with 18.1 percent, and age group one to four years with. 13.7 percent. The remaining 21.9 percent accounted for the remaining age groups 5-9 through 45-59. LEADING CAUSES OF DEATHS For the leading cause of deaths in the Territory, exclusive of the Northern Marianas, the malignant neoplasm, including neoplasm of lymphatic and hematopotic tissue, diseases of heart and diarrheal and intestinal diseases were in the first, second, and third ranks respectively, and accounted for 13.2 percent of the total deaths reported in calendar year 1978. Influenza and pneumonia, bronchitis, emphysema and asthma, accidents of all types, cerebrovascular diseases, prematurity, nutritional deficiences, meningitis, were in the fourth through tenth ranks respectively, while suicide, conginital anomalies, cirrhosis of liver were tied in rank eleven. Certain causes of mortality of early infancy were in rank twelve, homicide and tuberculosis, all types, were in rank thirteen, diabetes mellitus, nephritis and nephrosis were in rank fourteen, measles and peptic ulcers were in rank fifteen, maternal deaths and meningoccal infections were in ranks sixteen and seventeen, respec.ti vely. The accidents, all types, as cause of death changed position from fifth rank in 1977 to first rank in 1978. Fifty percent of all deaths classified under accident were due to motor vehicle accidents. The diseases of heat and malignant neoplasms including neoplasms of lymphatic and hematopotic tissues were in the second and third ranks. Influenza and pneumonia and prematurity were in fourth and fifth, while pronchitis, emphysema and asthma and diabetes mellitus were tied in the sixth ranking position. Also, diarrheal and intestinal diseases, cerebrovascular diseases, cirrhosis of liver, certain causes of mortality of early infancy and homicide were tied in seventh ranking position. Nutritional deficiency, meningitis and tuberculosis, all forms, were in the eighth rank in the Northern Marianas. MATERNAL DEATHS The 1978 provisional maternal mortality rate for the Territory was 7.9 per 10,000 live births based on two deaths due directly to maternal causes. The maternal deaths were reported as one each from the Marshall Islands and the St~te of ponape. PERSONAL HEALTH PROGRAMS Under the direct administration and general supervision of the Di~eQtQr, Bureau of Health Services, the office of Federal Programs coordinates special DH~W health programs supported by the federal grant funds and other so~ces for the Trust Territory excluding the Northern Marianas. Coordination at Headquarters and each state/district includes tecnnical leadership and guidance on federal laws and regulations, research development

19 TRUS'l' 'l'ERRITORY HEALTH REPORT, 1979

implementation, evaluation and reporting requirements of federal program and reporting requirements of federal program and alignment of available federal aid with state/district health program needs. The Federal Health Programs Office coordinates the following programs: General Public Health, Hypertension, Feasibility Study and Planning for Emergency Medical Services, Health Assistant Retraining Program, State Health Planning, Prevention and Control of Communicable Diseases, Water Pollution, Family Planning, Maternal and Child Health, Nursing Continuing Education, and Health Manpower Development and Training. Public Health grants provide funds for general administrative services at the Headquarters level, as well as funds for implementation of public health programs in the state/district, mainly to improve, modernize, or expand services which are not generally available through regular Territory funds. Federal grant funds supplement funding of programs in the areas of environmental health, general public health, tuberculosis control, filariasis control, Venereal disease control, dental health, health education and training of staff and immunization program. Professional services contracts from the University of Hawaii and other institutions were coordinated through this office. In addition, training programs for state/district personnel under the sponsorship of the World Health Organization, South Pacific Commission, Department of Health, Education, and Welfare were also coordinated by this office. HEALTH EDUCATION The goal of health education as provided through the state/district Department of Health Services is "to help people achieve health through their own actions and efforts." This goal is to be achieved through (a) change in individual, or community knowledge, attitude, and behavior or reinforcement of existing healthful behavior, and (b) the development in people of a sense of responsibility for their own health. The state/district Departments of Health Services provide health education through utilization of state/district health education through patient education provided by the clinical staff through public health clinics, and through the home visits performed by state/district sanitation staff. HEALTH EDUCATORS Each state/district Department of Health Services in the Trust Territory employs one or more health educators. Health educator activities vary from state/district to state/district, but generally include: - Radio broadcast of health education messages: - Production of teaching aids for use by Health Services clinical staff; - Provision of lectures to villages and village groups during field trips to intermediate and outlying areas; Work in conjunction with the Head Start Program each year to develop and implement instruction of Head Start staff, students and parent in topics pertaining to health. - Technical assistance to other Health Services Divisions and other agencies in the community who provide health education service; - Coordination of health education messages provided in the state/district.

TRUST TERRITORY HEALTH REPORT, 1979 CLINICAL STAFF Each primary care practitioner (physicians, MEDEX, health assistant), when providing services to patients, incorporates into the patient examination/ treatment session information regarding the etiology of the present complaint, its treatment and methods for preventing recurrence. In the inpatient wards, nurses occasionally provide informal health education, while in some states/districts, education is routinely incorporated into the care of selected patients. In some states/districts mothers of pediatric patients receive routine health education services; in others postpartum women are given health education messages regarding child care, nutrition, and family planning. Dental staff also are instructed to provide dental education during the course of the examination/treatment service. PUBLIC HEALTH CLINICS Public Health Clinics represent one of the most vigorous forces of health education in the Territory. Public Health staff, working in conjunction with the health educators, provide lectures/demonstrations to groups of patients (particularly mothers receiving services under Maternal and Child Health Programs) both in the state/district centers and in the outlying villages where field clinics· are held. Instruction is also given women by staff members on individual basis during the course of treatment. This instruction includes topics pertaining to prenatal care, nutrition, infant and child care, family planning, immunizations, oral health, and environmental health. Public health staff also provide health education services to schools and other community groups upon request. ENVIRONMENTAL HEALTH State/district sanitarians provide the following types of health education: - Radio messages pertaining to Environmental Health Division activities and to sanitary measures; - Instruction to food handlers (this is a formal educatiqn course mandated by Trust Territory law offered annually by the state/district sanitarians in conjunction with Public Health staff); - Instruction to private citizens regarding proper sanitation dur~ng vi~lqge sanitary inspections which are held regularly in all states/dis~riot$1 and - Other instruction to citizens and community groups upon request. MEDICAL EDUCATION AND TRAINING During FY 1979, TTPI health services unified training and continuing eduoation activities conducted under the auspices of WHO, UN, SPC, and speqiql p~Oirams funded by the U.S. Government. The result of this effort will en~~f~ th~t TTPI health services personnel receive adequate continuingeduqati~n AnQ that manpower is recruited and trained in areas of needed services. The World Health Organization provided 18 fellowships during FY l~79. These included fellowships for training in technology, public health n~~sing, c~inical

TRUST 'rERRITORY HEALTH REPORT, 1979 nursing, pharmacy, public health dentistry, dental nursing, statistics, medical equipment repairs, clinical laboratory medicine, nutrition, anesthesiology, and clinical dentistry. WHO also provided special seminars and workshops, which included the Ministers' Conference on Centralized PHarmaceutical Supplies in Manila. This conference was attended by the Director of Health Services, Saipan, the Special Consultant for the Governor of the Northern Marianas, the State Director of Health Services, Ponape, and the District Director of Health Services, Palau. Other seminars focused on family planning, radiation protection, laboratory technology, and nursing midwifery. During the year, WHO provided a health manpower development consultant from the Regional Office in Manila. This consultant attended the Advisory Board Meeting for the Health Manpower Development Program (HMDP) now ongoing in Ponape. The HMDP is a multifaceted manpower development and training program funded by the DHEW, Washington. Goals of the program include providing retraining 'sessions varying from two weeks to two months for medical care providers, dental care providers, nursing care providers, and support staff. All states, districts, and the Northern Marianas are participating in the training opportunities. Phase II, which is the implementation phase, began June 30, 1979, and will continue through 1981. The HMDP also must focus on health manpower recruitment; and to this end it is establishing a Health Careers Opportunity Program to be based in Ponape. Both WHO and DHEW have assisted the HMDP in identifying and recruiting qualified physician-instructors for the Program. With such recruitment, Ponape Hospital will become a central training site for Micronesia. WHO has also expressed its interest in maintaining close collaborative efforts with the TTPI and the HMDP in Ponape, since WHO foresees that if the HMDP is successful it may well serve as a training site for other South Pacific countries. Other federal programs which have established links with the HMDP include the Health Assistant Retraining Program. This Program began in 1975 and ended late in 1979. It retrained 95 percent of the outer island Health Assistants in the Trust Territory. The Program Coordinator provided assistance to the HMDP in curriculum development and evaluation techniques for the Health Assistant preceptor component of the HMDP. The Continuing Education for Nurses Program assisted in conducting an HMDP Nursing Administration seminar in Ponape. The Continuing Education for Nurses Program is ongoing through 1980 throughout the Territory. It has the primary responsibility of establishing a structure for and system of continuing education for nurses throughout Micronesia that can be assumed and supported by the various health services systems now developing in Micronesia. Other programs which have conducted activites with the HMDP in Ponape are the Environmental Protection Branch of the Bureau of Health services, the Communicable Disease Branch, and the Maternal and Child Health Branch of the Bureau. In the future, other federally funded training programs, such as the Paraprofessional Training Program for Mental Health Workers in Micronesia, will conduct or assist in conducting training programs through the HMD~. Micronesian Health Services face a manpower shortage in the future, not only because of natural attrition, but because of lack of a consolidated effort to recruit and train future health services personnel. WHO, as well as tne UN, SPC, DHEW, and the HMDP, has recognized this problem. With the efforts now being made to consolidate continuing education and training prog~~s and the recruitment program which will soon begin, TTPI Health Services hopes to avert the problem.

. -,

22 TRUST TERRITORY HEALTH REPORT, 1979 NUTRITION The goals of the Nutrition section of the government are: To determine the extend to which nutrition is a problem and to define the factors responsible for any existing problems; to develop nutrition programs in relation to defined programs; to work cooperatively with related agencies such as Education, Agriculture, and Community Development in coordinating nutrition activities; to promote the training of nutrition personnel for states/districts in Micronesia. A nutrition survey was conducted in May 1973 in all of the states/districts. The report has been completed and is available for public use. Implementation of the Nutritional Survey's recommendations is being fOllowed up by the Bureau of Health Services. Nutritional conditions in children such as malnutrition, anemia, parasitism, diarrhea, including a few kwashiorkor cases, are found in some state/district hospitals. Obesity, diabetes and gout are seen among some adults in the states/ districts. RESEARCH Medical research is carried out mainly through special projects sponsored by outside agencies. A team of Energy Resources Development Agency scientists, including medical specialists, continued their long-range follow-up work on the effects of the 1954 radiation fallout on the residents of Rongelap and Utirik in the Marshall Islands. An educational booklet in question and answer format on the fffects of radiation on Rongelap and Utirik people was completed and used in the Marshalls general hospital and clinic for the people concerned.

A Trust Territory Fallout Services Act has b-en enacted by the Congress of Micronesia to provide certain care and benefits to the people of Rongelap and Utirik atolls. Funds authorized under this act provide supplemental medical care to Rongelap and Utirik patients. MEDICAL FACILITIES Medical care in the Trust Territory and the Northern Marianas is provided through the state/district hospitals, including a 3~-bed rehabilitation center, three hemodialysis centers-five units in Majuro, six units in Ponape, and .four units in Palau. Construction of the new Yap 50-bed hospital has been completed and occupancy took place November 19, 1979. In addition to the state/district center hospitals, there are facilities called sub-hospitals in Ebeye, the Marshall Islands and Rota in the Northern Mariana Islands. The new 35-bed Kosrae State Hospital was completed in early 1978 with beneficial occupancy taking place in April of that year. These sub-hospital units are serving a population group ranging anywhere from 1,000 to 8,000 people located away from the state/district centers.

23 TRUST TERRITORY HEALTH REPORT, 1979 Other facilities include the 173 dispensaries and medical aide posts, staffed by Health Assistants and scattered throughout the outlying islands in the Territory. Efforts to renovate old facilities as well as build new facilities will continue as funds become available. The above capital improvements are indicative of efforts to modernize and upgrade physical facilities as well as improve medical care. A total of 49,956 people (45% of the total Trust Territory citizen resident population) have direct access to state/district and sub-hospitals. Another 40,247, or 36%, are within one-day access to these facilities, with dispensaries serving the remaining 20,353 people, or 18%, living on the outer islands. The outer islanders receive additional medical or public health services when regular Trust Territory field trip ships visit their islands, or by special trips when emergencies arise. More than 200 small radio stations outside of state/district centers offer two-way communication systems for health workers, thus providing information to state/district centers more readily, especially in medical emergencies. In addition to the acquisition of additional administrative vessels, the state/ district health centers have increased the number of land and sea vehicles for more numerous and more frequent visits to the lagoon and other nearby outer islands.

Table 41.

Number of hospitals, dispensaries and health department personnel in the Trust Territory by sute, State Federated States of Hieronesi. Ttelll kosrae Ponape Truk Yap Tot., 4 1 22 47

197~.

Trust 'larsha 11 Islands ]

p.lau Dhtrict

T. T.P.I. Headquarters

Territory Total 6 I

l!ll.!

Genera' Hospi t.1s Sub-HospH.

Dfspen!lries Dersonnel Phys IClan Phys Ici.n Ass Istant (Kede.' Dentist Other Professional Staff Registered Nurse Graduate llurse /fealth ASSistantl Practic;a I Nurse /fe. ltll Ass is tan t/ Practical Nurse Trainee Denta I Nursel Technicians Othcr Technical Staff Administrative St~ff Clerk/Clerk Typist Other Service I/orkers TOTAl

22 5 10 2 3 2 20

4 94 22 31 9 16

I 2

7 165 42

58 8 14 4 3

2 1

1 2 15 10 t 5 6 1

Ii 7 3 Ii 1 34 CO 5 15 33

8 12 3

.. 2

7 96

17 98 I

10 2 5 ? 1 42 28 8 25

1 I' 2 1

47 19 37

10 166 354 11

147 3 14 29

31 1 12 18

228 10 Ali 86 9 40

11 11 8 11 14 210

65 3 125

1 12

3 Ii 51l

3 17 28

3 8

3 10

1Z 3

32 64

31 1"9'6

10 124

29 111'

118 3S

.-.... \'

297

675

1090

-...II

HEAL TH

Table ,,2.

MN.ssions in the Trust Tcrritoty and the> Northern Mariana fIospitals by ~ of Service, Sex and A9<> croup, " 1979 COctcter 1978 - ScpI:cd>cr 1979) .

state

'!rust IlarshAll ~l

IlXthern

'JWe of

servicel Age group

FecIu..ted states of Hiaonesi..

Palau 'n!rritory llariana District 739 410 329 361 210 151 378 200 178 359 235 124 85 67 18 274 168 106 337 1 336

Sex Both Hale FeMala Both HIlla '--le

lCascae

I'I:Inape

'IhIk

Yap 423 220 203 181 lOB 73 242 112 130 138 84 54 46 27 19 92 57 35 248 1

Islands 1,154 613 541 543 316 227

'lbtal 7,356 3,757 3,599 3,530 2,051 1,479 3,826 1,706 2,120 1,232 727 505 258 176 .82 974 551 .23 2,598 2,595

Islands 553 281 272 218 122 96 335 159 176 259 137 122

Hedicinc TOtal

441 240 201 299 176

1,879 1,018 861 886 522 36.

2,720 1,256 1,.64 1,260 719 541 1,460 537 923 55 38

5,463 2,734 2,729 2,626 1,525 1,101 2,837 1,209 1,628 720 425 295 168 IllS 63 552 320 232 1,667 1 1,666 11 11

Under 15

123 142 6. 78 22 7 15 5

15 and over ~'-

Both Mala Female

"3 .96 497 505 296 209 116 7S 41 389 221 168 581 581

611 297 314 153 67 86 5 4 1 148 63 85 594 1 593 2 2 1

~ TOtal

Both Male Female

17 1 1 54 38 16 741 741 7 7

under 15

Both f'lale Fanale

3 2 17 4

15 and ovar

Both f'lale Fl!III&le F_le PUna1 .. FeoIale Both Male F""",le Both 14&le Female

13 97 97

259 137 122 351 1 350

CIlstetrias TOtal under 15 15 and <Ncr 'J\ilP.rculosis '1\:)tal

247

• • 4 4

. 1 3

14 3 1 1

under 15

1 7 7 11 11 1 1 4 1 3

15 and over

Both Male F""",le

16 13 3

~CM>r ';...,.

Male Both Male 560 247 313 2,965 1,314 1,651 1,002 597 405 1,963 717 1,246

2 813 308 505 228 135 7,863 3,172 4,691 2,795 1,630 1,165 5,068 1,542 3,526 1,903 682 1,221 550 321 229 1,353 361 1,439 646 793 447 277 197 992 369 623

2 ll,20S 4,500 6,705 3,792 2,228 1,564 7,413 2,212 5,141 1,163 .18 745 219 122 97 944 ~6

All Services TOtal

.--le Under 15

3,525 1,303 2,222 1,261 719

Ibth Male FaMle

304 179 125 256 68 188

542

91 585 173 412

15 .. n;!

<NOr

Both Male r-le

2,264 584 1,4180

648

"" ..,. A

HEALTH

Table 43.a.

R@qistered live 8irth~ in the Trust Territory of the Pacific Islands and Northern .'ariaon by S.tat .. and Type of Attendant. 1978. (/lumbers and Percentages) ~edt'rat"d Stotes o~ 'herones.a ~osrae

State

Type of Attendant ~s

POndet' 11

Truk 14

fotal

,larsh. II Islands

p.lau District

Trust '1orthern Territory .~ariana Total Is lon~s 42~

Phys ieia" Ml!dex. Reqi s tered or Grdduate tlurs .. Health Assistant or Practical nurse Cert Hied .11 dWi'fe a) Midwife b) Other TOTAL Percentage Physician Ml!dex. Registered or Graduate Ilurse lfealth Assistant or Practical Nurse Certified tlldWlfe .) Midwife b) Other

'26 85 14 7 3 38 273

232 751 518 8 81 203 1.193

36 III 302 16 466

157 103 6

162

49 12 6 9

446 126 69 89 801

111 366 I 3 67

966 826 8 83 ??r. 2.5J4

?89 0

2 7 7.7!1

2 ~6c

642

1.3 63.6 15.6 7.8 11. 7 100.0

8.9 55.7 15.7 8.6 11.1 100.0

5.3 26.6 57.0 0.2 0.5 10.4 100.0

46.2 31.1 5.1 2.6 1.1 13.9 100.0

12.9 41.9 28.9 0.5 4.5 11.3 100.0

7.7 24.0 64.8 3.4 100.0

57.1 37.5 2.2 0.7

16.8 38.1 32.6 0.3 3.3 &.9 100.0

46.6 51.4 1.6 0.4 100.0 .)

2'.5 100.0

. ) b)

TOTAL

Gradudte nurse "ho has succes~fully complete reco9nized progra .. in midwifery • Traditional village midwives. !!lOst of "hom had trained at general hospitals.

-.. Table 43.b. Registert'd Live Births In the Trus t Terri tory of the Pac i fic Islands and tht' Northt'rn 'larianas by state ,od !)lace of bi rth. 1918. (Numbers and Percentagt's) ~f:aerated ~tates o~ .1tcronesla

StH@

Place "f Illrths Kosrae Numher, CI!nera I hospital field hospital lIispensary Home or other TOTAL rerc~ntan"s

Ponal!e 595 5 201 801

Truk

Yal! 181 20 12

Total 1.278 25 490 1.793

tlarshal1 Islands 249 156 10 Sl 466

p.l~u

Di s t ri ct 160 IS 275

Trust Northern Terri tory .lariana Tot,11 Islands 1.1Al 156 lS SS6 2.S34 ~27

-..-

441 200

11 (,

2 562

642

273

Genera I hosp i ta I Field hospital Dispensary llome or other TOTAL

71.9 22.1 100.0

74.3 0.6 25. I 100.0

68.8 31.2 100.0

66.3 7.3 26.4 100.0

11.3 1.4 27.3 100.0

53.4 33.5 2.1 10.9 100.0

94.S 5.5 100.0

10.5 6.2 1.4 21.9 100.0

93.ft 4.8 1.1 0.4 100.;)

HEALTH 'l'~le

44.a.

IbIt>er of cIisc:ha.rges frail 'l'rust Territory and Ibrthenl Marianas hospitals by type of disease, sex and age 9l"OUP. lY 1"9 (0I;:t.c:tler 1!J18 - Septeftt>er 1919).

iWii of

Senicel Sex

lIge Group

Type of DischarQe

_rae 466 458 2U 243 5 218 215 3 296 295 I

State Federat.ed States of Hicrcnesia 'lbtal 1iUk !'Dna!!! YO!!

Marshall Islands

Palau District.

Trust Ibrthern Territory I' .....i""" 'lbtal Islands

Medicine ,

SUxqery

TOtal

Ibth

Total 1:ru~ed

Death ""'Ie 'lIoUl Treated Deatll

•

2,559 2,424 135 1.423 1,336 87 1,136 1,088 48 1,052 1,010 42 626 601 25 426 409

2,876 2,830 46 1,352 1,326 26 1,524 1,504 20 1,294 1,278 16 739 732 7 555 546 9 1,582 1,552 30 613 594 19 9" 958

643 570 73 344 308 16 299 262 37 248 229 119 148 136

6.544 6,282 262 3,367 3,213 154 3,177 3,069 108 2,890 2,812 78 1,689 1,644 45 1,201 1,168 33 3,654 3,470 184 1,678 1,569 109 1,976 1,901 75 1,687 1,686 1 1 1 1,686 1,685

1,422 1,342 80 745 699 46

1,153 1,107 46 682 654 28 471 453 18

9,U9 8,731 388 4,724 4,566 158 4,325 4,165 160 3,958 3,822 136 2,256 2,249 7 1,632 1,573 59 5,161 .,909 252 2,468 2,317 151 2,693 2,592 101 2,626 2,624 2

923 846 77 419 438 41 444 408 36 242 224 18 137 126

'-1e_l 'freated Death

6n 643 34

IhIer 15

80th

'lIoUl 'l'reated Death

605 559

.6 349

463 451 12 288 281 7 175 170 5 690 656 3. 39. 373 21 296 283

Hale

-I 'l'reat:ai Dutil

176 175 1 120 120 170 163 7 72 U C 9. 95

12 100 93 7 395 341 54 196 172 24 19' 169

324 25 256 235 21

11 105 98 7 681 622 59

....u.~_

JaMl. 'l'Dt.al 'l'reoted Death

17 1,507 1,414 93 797 735 62 710 619 31

15 and

O\IV

10th

Total Treated Death 1bt.a1 Treated DNth Total

817 783 34

Male

396 375 21 421 408

342 312

30 339 310 29 354 354 1 1 353 151

rBMl. ctJstetries 1btal

_ted

Death ~e_l

1 100 100

11 753 753

30 249 249 1 1

13 598 597

13 341 341

'l'reated Deeth tbIc!r 15

585 584 1

1 1 1 597

hn&.le 1I:It.II1 Treated Duth Plfttle Total '!'reate!! DNth Botn

1 3 2,623 2,621 2 48 45 3 29 29 l' 16 1 2 2

15 and over

100 100

585 584 1

753 753

248 248

1 19 18 1 15 15 9 9 7 7 28 27 1 22 22 6

596 1 4 3

340 340

'l\Jberculosis 'l'Dt.al

Total 'lreated Death _1 treated Deeth 'freated

16 1~

I 2 2

1 5 5

'., tbIc!r IS

Hale

r - l e 1I:It.II1 Death 80th

, 1 1

5 1

2 1 1 1 I 1 I

11 10 1 1 1

'lbta1 treated I80th

Kale

_I 'l'reated Death

' - I e 'lbtal 'l'reated Death

I I

1 1 46 4l 1 28 28

15 and over

Ibth

1I:It.IIl 'treated

o..ath

19 18 1 15 15 4 1 1

9 9

28 27

l'II!1e r ..... le A_'

'lbtal 'lrea~ed

, 7 2 2

1 22 22

1 2 1

15 14 1 5 5

Death

'lbtal 'freated 1\-.I4'h

6 5 1

2 1 1

10 9 I

18 15 1

HEALTH

Table 44.a.

n: 1979

IbDer of discharqes fran Trust Territory and Northern (Octcber 1978 - Sept.esri:er 1979). - continued. Sex Type of Disc:harqe Total Treated Death

~\1rianas

hospitals by type of disea ..... sex and aqe group. Northern Trust Territory Mariana Islands Total

Type of Sl!rv1C1!!/ Age Group

State Federated States of Micronesia l<osrae

PoMe!l

Trul<

Yae.

Total 8 8 8 8

.larshaU Islands

Palau District

~ rota!

Both

8 8

Hale

Total Tmated Death 1n!ated Death

• 2 2 2 2

8 8 1 1 2 2 2 2 ~

r - l e Total

In!er 15

80th

Total _ed Death

Male

Total 1n!ated Death '!I:eated

hmale Total Death

15 and OYU

Ibth

Total 'lnated Death Total 'l'reated Death

, 6 6 6

6 6

1 1

Male

6 6

FaIIille Total Treated Death All Sl!rvic:es· Total Both

1 I

Total Treated Death Total Treated Death

566 SS8 8 248 243 5 318 315 3 296 295

3,144 3.008 136 1,42] 1.336 87 1.721 1.672 49

3.656 3.609 47 1.375 1.349 26 2.281 2.260 21 1.299 1.283 16 744

901 828 73 351 315 36 550 513 37 249 230 19 148 136 12 101 94 7 652 598 54 203 179 24 449 419 30

8,267 8.003 264 3,397 3,243 154 4.870 4.760 110 2.896 2.818 78 1,694 1.li49 4S 1,202 1.169 33 5.374 5.188 186 1.706 1,597 109 3.668 3.591 77

2.024 1.942 82 747 701 46 1.277 1.241 36 607 561 46 350 325 25 257 2]6 21 1,411 1.381 36 397 376 21 1.020 1.00S 15

1.510 1.463 47 687 659 28 823 804

11,801 11.408 393 4.831 4.60] 228 6.970 6,805 165 3.968 3.832 136 2.332 2.255 71 1.636 1.577 59 7.836 7,579 257 2.502 2.351 151 5.334 5.228 106

1.279 1.201 78 480 438 42 799 763 36 243 22S 18

Male

Female Total Treated Death In!er IS Both

19 465 453 12 288 281 7

-..~

Xltal treated Death Total '1'reated Death

1 176 175

1.052 1,010 42

Male

GOI

626 2S

737 7 555 546 9

1 120 120

137 126 11 106 99 7 1.0)6 976 60 343 312 31 693 664 29

Fallale'lbtal 'l'reatl'd Death 15 and OYer

426 409 17

177 172 5 1,045 1.010 35 399 378 21 646 632 14

Ibth

Total '1'reated Death Total 'l'reau.i Death

270 263 7 72 68 4 198 195 ]

2.092 1.998 94 797 7J5 62 1.295 1.263 32

2.360 2.329 31 634 615 19 1,726 1.714 12

Male

F..... le Total TrCAted Death

·' A

HEALTH ........,

ftble 44.b.

Ib!iler of patients treated in out-petient departments of and state. rr 1979 (0t::tcbeI: 1978 - SepteI\'ber 1979'.

t\uritory and tbrthern Marianas hospitals by disease

State ~

'l:nlst

Mx'thern

of dUease J(Qarae

Federated States of Micronesia fonape

Marshall 'Ibt.&l

Palau

'l'ettitory Mariana 'n>!:al .

'Iruk 4,352 1,448 1,904 1,185 1,150 685 546 693 737 737 414 417 98 84 12 34 45 5,301 20,442

Yap 1,509 803 948 391 3119 263 184 268 289 150 75 69 22 11 45 65 3 20. 2,141 7,651

III11U1ds 4,204 1,000 680 2,151 359 516 878 448 464 231 295 253 400 44 110 1 1 6,544 18,585

District

Islands

D1sea ...... of the respirataEy systaD n.e.s. Diseases of the skin " sulx:utaneaus ti.ssue Intestinal parasitism Infeetious diseases of the intestinal tract DUuses of the digestive system Diseases of the ear and mastoid precess Asthna " other allergic ccnditions D1saases of the eye Injuries and adverse affects Diseases of the genito-urinary system Diseases of the ci.rculataEy system ~ infections Qr.r.\lnicable ciiseues n. e. s. Diabetes mellitus Gon:x:I:al infections cases and suspects 'l\Jberculosis .,.... and suspects Fil .... iasis Le;roay cases and suspects All other conditions n.e.s.

284 366 185 213 50 57 175 36

6,062 4,103 3,481 1,308 772 1,725 1,613 1,349 481 341 224 218 170 237 64 6 1 3 6,291 28,515

12,207 6,120 6,524 3,103 2,961 2,730 2,518 2,346 1,573 1,236 730 776 513 340 121 106 49 25 14,619 59,181

2,173 1,507 301 383 1,053 399 193 2H 933 351

18,584 9,221 7,511 5,643 4,373 3,645 3,589 3,038 2,970 1,818 1,360 1,190 1,014 394 333 177 .9 21 22,351 81,293

2,909 1,239 294 273 740 313 252 443 125 305 275 10 39 164 6 3 5,193 12,583

17 2 223

• 1

335 171 101 10 102 70 1 l,lS9 9,521

.u- "

2 886 2,579

'nIta1

HEALTH fable 45.

NUrioer of hospital discharges in the Trust "futtita<y and tcn:hern """Unas by st.>te and <:.wse -;rouP. 1978. St.>tII I"ederat.ed states of Micronesia

trust Marshall

Palau District

':'erritory '!bt .. ! Islands

Ibn, ~ _iuis 00..... dysentary

""" 60 418 1.9 13.0 0.3 0.2 0.5 0.2 4.4 0.1 0.2 2.8 0.1 0.5 0.5 O.l

rap

'1btal

Islands

1.1 0.5 0.2 0.7 O.l 2.0

451

13.6

8 59 7 3 10

1.0 7.1 0.1 0.4 1.2 0.5 0.4 0.0 0.1 1.0 0.2 1.9 1.6 0.5 0.5 0.2 0.4

105 928 33 16 '9 21 211 2

1 •• 12.6 0.4 0.2 0.7 0.3 2.9 0.0 0.1 2.2 0.1 0.7 0.7 0.5 .O.B 0.2 0.4 0.3 0.8 0.3 0.5 0.5 0.7 0.5 1.0 0.5 0.3

43 303 3 4 7 3 9

1.9 13.6 0.1 0.2 O.l 0.1 0.4 0.0 0.1 1.4 0.0 0.3

123 15 15 2 21 3

0.0 9.4 1.1 0.0 1.1 0.2 1.6 0.2 0.1 0.0 0.0 1.0 1.4 0.2 0.5 0.2 0.4 0.2 2.1 0.5 0.7 0.4 2.2

14! I •• llH 12.( 51 20 71 26 2'1 5 13

10 132

0.6 7.6 0.5 0.0 0.5 0.2 0.2 0.1 0.0 0.3 0.2 0.2 0.7 0.1 3.2 0.1 0.9 0.9 1.9 0.2 1.1 1.6 1.5 0.5 0.9

Tuberculosis, re5piratcry 1\lberculosi.,. othI!I' forma

11 5 16 I 141 2 , 90 4

15 I

-.:w.osis.

23 9

~ialdi_

Viraldi.5Msea _caldu.~loataniu OtlVlrhe~

• 3

1 63

0.0 1.9 0.2 0.5 0.6 0.6 1.0 0.2 0.4 0.1 0.3 0.3 0.7 0.4 0.5 0.7 1.7 0.3 0.4 0.8 0.8 6.7 4.2

1 8

10 161

:92

0.5 0.2 0.7 0.2 2.2 0.0 0.1 1.8 0.1 0.7 0.8 0.4 0.7 0.2 0.5 0.2 0.8 0.3 0.5 0.7 0.8

9 9

3 4 1

Infective parasitic di.sea5es, n. •• s. ltLlignent neopl_ 8Imi9n necpl_ Macplasne n........ Diabetes melUtua Ot.har erdccrine

5 l 3 12 1 56

16 10 20 7

.u-

0.6 0.2 0.3 0.5 0.9 0.2 0.2 0.6 0.6 0.3 0.4 0.5 0.1 0.7 0.7 1.5 2.E

5 11 19 21 l2 , 13 3 , 11 23 12 16 24 56

2 16 13 4 4

11 53 48 35 56 17

2 1

Motabolic: diseases Blood • blood

Mo:ntal dioonlers non.,....tory d i _ of -.tral nenous aystao ~systaa.u......

.u-

fomin<J to ..

27 19 57 21

23 3 12 3 23 3 6

1.0 0.1 1.0 0.1 0.5 0.1 0.3 0.4

13 18 2 6

12 72 89 .~

3 5

23 55 24 90 1$

1 16 16 33 4

15 29 7 6

19 3

0.1 2.3 0.4 0.6 0.7 ·2.3 0.2 0.1

2 27 , 9

D ••• 5.

5 ,

34 37 55

10 31

0.5 1.4 0.0

20 27 26 9

- . . . . • oonrlltial.s of the eye Diseases of ear • aastoid process ......tic fever. beort Ilypertc:nsiw d i _ Ot.har fonna of heart

19 20

5 29

n !5

,11_

11 12 16 4 23 22 48 8J

2 7 12 6 12 8 5 41

37 75 39 22 60 57 214 269

5 28

0.2 1.3 0.5 0.5 1.6 1.1 4.1 ).1 2.0 5.0 0.4

8 5

0.6 0.4 1.9 0.5

50 Ie! 7~

0.5 1.0 1.7 0.4 0.9 0.9 3.4 4.0 4.0 4.0

16 20 5 6 14 30 45 82 9 B

disaascs Q!ren'oyucular disaoses Circulatory syst6ft d.i..seaso n.e .. 8 .. _ respiratory infections

11 12 25 27 221 139

1.4 0.7 1.4 1.0 0.6 5.7

12 12 35 24 90 68 '5

25 6

1.1 0.3 0.3 0.8 1.7 2.6 4.7 0.5 0.5 0.1 2.2 0.6 l.l

4J 103 999 3£9 .eH (;~

0.8 0.8 ).7 J.?

0·6 18

tIlfluenza JIIbeu:on.i...

IIr:ct>chitus •

enp,ys<ma

264 157 II 4 89 13 7

8.2 4.9 0.6 0.1 2.8 0.4 0.2 0.4 0.5 0.5 0.4 1.2 0.3 0.3 1.1 4.) 4.5 1.0 0.4 0.7 0.2 5.9

51 139 17 IS 286 7 4

1.5 4.2 0.5 0.5 8.6 0.2 0.1 0.2 0.8 0.2 0.3 0.8 0.7

13 11 10 17 5 , 3

1.6 1.3 1.2 2.1 0.6 0.7 0.4 0.4

328 307 45 )6 380 26 14 24 47 28 27 81 35 24 103 461 2H 79 41 H 6 108

4".5 4.2 0.6 0.5 5.2 0.4 0.2 0.3 0.6 0.4 0.4 1 •. 1 0.5 0.3 1.4 6.J 3.7 1.1 0.6 0.5 0.1 4.2

AstI>na

110

4 96 57 23

1.( 0.3 7.3 4.' 1.8 0.2 0.2

lespiratory oysteli

diseases n.o.a. Qr.aJ cavity, salivary 91ands , jaws diseases GasuitiB , d\xJdenitis ~qus,

J 3

!-6

0.5

61 7 13

0.0 2.7 O.l

IS 12 7

1.1 0.9 0.5 0.3

0.4 .:~o - 4.2 4~

1 39 11 22

at.aNlch it --C ••

du:xJconll'ft diseases n.e. II ~1e1t.1.

0.6

34 41

0.3 0.4 0.7 0.5 0.4 1.5 0.4

Hernia ot abcIaRinal C8Vit.y InUstine , pco:it<>neuno

13 17

8 26 5 9 28 22

13 19 14 10 47

0.6 0.9 0.6 0.5 2.1 0.1 12 10

0.( 11 17 5 4' 0.6 1.0 0.3 2.8 0.2

disease. UYU. gallbl_ • pancreas diseases Rep".citis & ~osia II< 1NrY s)'StmI

4 7 4 14 2

0.5 0.8 0.5 1.7 0.2 0.5

0.9 0.8

,I52 41

16 14 39 11 11 35 138 145

4 30

0.3 2.3 O.l

diseases n.f'!.S. Hale genital organs

I!a H .,

diseases _ t o oyary. fallop1an p.r-...etriun _ of utcrull , other qon1tals

'0.3 53 175 92 1.6 5.) 2.8 1.1 0.6 0.1 0.0 " 2.9 23

11 )1 :55 62 19 3 10

0.5 1.4 7.0 2.B o.~

14 31 66 41 II 10 ,

1.1 2.4 5.0 3.1 1.6 0.8 O.S

0.5 1.5 6.J ).5 1.1 0.5 0.5 0.1

0.5 44 150 56 7 2.S 8.6 ).2 ~.,

QrplieaUons of prcqnancy.

15 148 31 10 11 8

1.8 17.9 4.5 1.1 1.3 1.0 0.0 2.8

lB 682 377 119 56 SO

"Uvvy•• pucrpen"" Slt11I , subc:utan.-ous in.!cct:l.ons , oon:1itions Anhr1t1 • • rheunatl!11:1 !cine, Joint" nuscula-

II 13 2)

38 19 1

alccletal di:ieaac. 0'"9"'\1 t.>l ......... lies c:erul.n disoases to f)ooccrw

0.1 0.5 0.1

0.3 0.) 0.1 71

r"("'\o.tY'Irn inf.1ntl'l ot Mn1Uty. and 111-.:!eUn"d d1 ..........

6 181

0.0 60 4.6 5:3

135

6.1

4.1

4.5 65.9

2397

14.6

2459

74.3

'44

17.8

5500

74.9

1581

71.2

893

U.2

797.

73.3

1146

·' .. 31 ~EAlTH 7al::e ';5. 1<Ullt:Jer 0' """"it.1l <!i:od>...-<Jea in the Trust '1'elTitDzy and Northern Mari"""" by st:.at.. and cause ']roup, 1978 . . - oontinucd .

state

'Inlst

ttlrthe."n Mariar.a lslarlds , t)"., ,

Kosrae

~ '::'l" ... -.s;:crt aceidents

51 15 117 3 21 207 550 57 607

Federated states of Micronesia

·Pcnape

Yap tllnl ,

, 1.6 0.5 3.6 0.1

7 26 768

Marshall Islands

Palau District

'l't!rritory 'lbtal tllnI

, 1.0 0.4 3.6 0.1

tllnI

lI=':ent.al poisoning. etc. Nor:t:rUlSpCrt accident CbIIt>l~cat.icns of medical £ S".:gical care 9Uei:e or self-inflicted in:;-.:y Injury pur;x:scly inflicted '::y o~er person Injuries s-.Jb-total CM1 ....:.rt.'I !C%Nl :aliveries spec~oJ. aaussions Clile:ir.:.'1 sub-total ":'otal d.isc!'..rges fbi: l::tiinq r.ewborns I

15 5 94

0.5 0.2 2.8 0.2 0.5 0.5 4.6

7 , 57

0.8 0.7 6.9 0.0

43 32 54

1.9

1.4 2.4 0.4 0.0

28 3 26

2.1 0:2 6.6

144 61 408 20 18 85 736

1.3 0.6 3.8 0.2 0.1 0.8 6.8

54 14 66

3.1 O.S 3.8 0.6

8 15 16 153

11 16 54 448

0.0 1 29 147 0.1 2.2 11.2

0.0 0.7 6.4

0.1 17 88 2.1 10.6

0.2 0.7 6.1

O.C 19 163 0.5 9.4

2 141

0.1 6.3

17.1 I.B 18.9

689 8 697

20.8 0.2 21.1

76 20 96

9.2 2.4 11.6

1315 95 1410

17.9 1.3 19.2

438 62 SOD 2~22

19.7 2.8 22.5 100.0

257 13 270

19.6 1.0 20.6

2000 170 2180

18.S 1.6 20.0

401 30 431

23.0 1.7 24.S

3211 100.0

3309 100.0

828 100.0

7348 100.0

1310 100.0 10880 100.0

1740 100.0

~ Prr.~e

f5 :!>so 8 oz. or lessl PIiIt1:e

42 683 4

36 160 2 198

126 1376 16 1518

55 461 516

29 246 275

210 2083 16 2309 438

(ever 5 lbs. 8 oz. I 1Iir_~.eic;!lt

not stated

533 10 591

IieWbe!n total

Ta!>le 45.a.

tlUrrtler of reqista.'"CId deaths in the 'IhIst Territory and Northern .Marianas by state and cause of death, 1978. ( Cltdered by NJar causesl

state Federated States of Micronesia

Trust

Northern

Ml\rshall 'lbtal

Palau District 5 8

Territory Hariar ... 'lbtal 49 43 42 30 24 18 16 15 12 9 8 8 8 6 5 5 4 4 3 J 2

Jl'alrae .... l~;-....~= neoplasms :Jisea.ses cf heare D1A.~::ea: &nd intestJ..na1 ~sedSeS

Ponape 19 16 15 8 5

Yap 12 9 8

Islands 8 7

Islards 8 15

2 3

36 28

1:-.!: .,,;e:-:za and: pnetJ1lll'\i.a 2:'::-':-..";.:.5, ~yscm.t and AS':."r.. I,:;:"'-.:.s. J":.'!".... ~..: :"<;'''1 C'r:·C'-:::-.·:~,s.culac

6 6

29 16 20 12

12 10 2 4

1 4

2 5

311 types diseases

1 1

~~.;~~~! c·!ficicncy S"'~e':~

11 8 6 4 5 2

4 1

4 2 4 5 2 4

2 2 3

3 17 2 4 1 1

1 3

11 9 8 5 8 2 5

2 4 4 3 5 2 2

1 3

~.,...:t..ll

.1."'D"'.ilies

:~::"'.:d:'s of !1VCt' ':)o.r~..a..;..., ;;"-2;-.a&eS of rDrt.ality

1 1 2 1 2

1 l 2

3 2

""! ... ~ ::' l:-:!a,:v:y ~lT.:.:,;..:c

7"~.::: all typ.,s :::'~·..cs ~ll:.tw.s .~.::.. <;':'5 " :,p-ri'.rosis

-.:".5.

1 3 3

2 2

"\...l,S:cs ,,~:..= :";::--'r .... \.,..:~..,)~ ,~:,'K"a.."'JP.s

3 5 3 3 4

1 1 2

2 1

"-:""-~"'-.l"""X"Cdl L-.!ections :...!~ -......... ~ C'_1~S

1 1 1 27 f201 8

1 2 1 13 (101 15 171 76

1 1 1 10 f21 82 15

1 81 fS2~

::,,,~

56 (371 267

1131

I-! 78

116

EN FRANCAIS SEULEMENT TERRITOIRE FRANCAIS DE WALLIS ET FUTUNA

RAPPORT SUCCINCT SUR L'ACTIVITE SANlTAIRE EN 1979 PRESENTE PAR LE DOCTEua ROLLET, DIRECTEUR DU SERVlCE DE SANTE 12/ -

Infrastructure sanitaire du territoire - Au cbef-lieu MATA-UTU : - un h6pital territorial de 45 lits, plus une extension en construction (ouverture en septambra 1980) • - Dans les districts peripheriques :

•

- a WALLIS - a FUTUNA

: -

) capacite tbeorique : un dispensaire a MUA a BIBIFO) 12 lits un II scolaire a MALAETOLI un " a LAlfO un

.. ..

a SIGAVE - un dispenaaire

- un dispensaire renforce en petit h&pital sa.maire

a ALO

2 2/ - Organisation du service: - 18 Service de Sante du Territoire dispose a MATAUTU d'un organe de direction avec un Medecin-Chef et d'un service d'administration et de geation avec un secretariat.

- 11 coaprend : a) - un service de medecine curativs individuelle sUbdivise en deux circonscriptions medicales : una a VALLIS, 1 'autre a FUTUNA. • b)- un service de medecine preventive : -Ie Service d'Bygi~ne, de Pro~hylaxie et de lutte contre les Grandes Endemies (S.H.P.G.E.) - Le Service de medecine curative dispose de : A) - l'Bapital territor~al : celui-ci comprend - un bloc technique et des services moderne mis disposition en aodt 1975 avec:

- un dispensaire, en realite centre de triage, recevant les malades a leur arrivee et les dirigeant sur le>differents services hospitaliers ou les traitant sur place, suivant la gravite de la maladie. - Ce dispensaire est dirige par un Medecin, son personnel comprend : deuxinfirmiers et una femme de salle •

./ ...

2 ~

....~

- un bloc-chirurgical avec' ; une intirmi~re anea~4.i.t4tet deux aide-aoignaqts (tea). _ un 'bloc-radioav.~e~:'·un man1pu.lateur de"radiologiej,L h

\,!?r .

':;,,~,eBrb;L~t' cltP/~~.i,~;~y,C : - un'

un chliu.rilen

del1ti't.{V~A.T.

labo~at~ir~ ;';ra1;lquant lea ex~ns comple.ntaire. at a.ryi par un :l:nf,~~e~ +~bQrCU!tiJl. par '1W'. ~~-teuuae Wle ,f• • • '~aalle. .

c~~t. tJ:Oi8

;it"!. ~•. ~t.nit~"P1i~~~Q~~~ cU!1:il$4e

.4,4e.,..~~ I,t

aveQ

- le,.' It~c;a~ 'd~ iS~~1c.4'Bygi~ de Prophy1uie et d. lutte contre les Grand.e:Ifd,••:lea. '.. ..... '1""'\

5'~~~I:.,,::,,:~ ':,' r' ,( ~.:~ ~'i1~~A::" J!

,""J

- la phantacie, .,ul'.9Ur~ de ~dicament. du territpi.e (PM depha~~,:.p,11l,y,~e)ay,e~ , ... t .... de salle a8~1Po!l. 1a cli8~ibutlon d.e8.,dica _Jlte. . . .

1',:

<)"1;'

':' .

:)~~~~l~,,\~;'\i:"'~:' /"

'.I

' "

..: dea ..~ices pn'raux : - lea CuiSil'),.'," (~ra.;'i~~;v.. r~',l~ 3) . - 1a buanderi. ( ..'".. .. ...,. .. ,)

~':: :";~'~'h;~,r~d(:-"die, ~t~Jlt.4!-~q'pit.li"atioJJ.et , Q~~q.ant: ·'.;)~ic " . . .,

deIJ ate1:le:r:1!J ,drezit_ti~ vcStustee clat~t de 1~:'~ ,dont le remplaoe_nt ~~tFeV\l .n. 1960 a.fin quo 89it caplete ot acheve'lth8plial territorial, :"l;' . . . .

'0 .:.

:,',!:

,."": UA pl"fil!-9n d '~~spi ~aliaation. m6Uco-chirurgieal de , ,,' j

lits avec 4euxaid.-soignants (tes) et deux f ..... ~ ,

1411 ••:. (, ;,. '.

.~;\~'ft~at"lt~~~:'4'S Uta. - .~ pavillon d'isolemant de 12 lits - un atelier pour "l'entretien general (personnel 'diver..') '':''\Ui'garage (4 cha~ffeur.) groupant :' "',{

- 3 vehicules des services generaux 404 camionnotte : ",,';-' 18s ve~ft~ltH' affect~s au personnel lIed1es1 .tpar....

~; 2 . .bu~~~c~~J7 ~ed~~a+.,

:""

',: ' . .

,. lI.)¥'4LLIS a'8uf~Xl~,(les soilUJ courants

a MUA et a lIIHIFO (2 aide-.~ignants(te8) par formation et une consultation heb40ma4aire par un Xedecin.

./. tt.

.....

.. - a FUTUNA

par contre, Ie dispensaire de SIGAVE est dirig~ en petit h&pital : il comprend : un centre de soins externes, un petit bloc radio-chirurgical, une maternit~, une petite hospitalisation medico-chirurgicale (effectif total = 17). soin~

- a ALO, •

Ie dispensaire comprend : un centre de une hospitalisation medicale, une maternite •

externes,

- La circonscription medicale de FUTUNA dispose de trois vehicules 404 Camionnette. - Les infirmeries scolaires s'adressent plus particulierement, aux eleves des internats (dernier recensement 1.051 eleves). - Le S.H.P.G.i. est implante dans les locaux de l'H&pital territorial. II est dirige par un M~decin, assiste d'une aide-soignante-secretaire, d'un manoeuvre et d'une femme de salle. II dispose d'une section d'information santtaire de base comprenant deux agents sanitaires travaillant en permanence dans les villages. Ses .issions essentielle.ent mobiles sont assur~es a l'aide des trois vehicules legers avec un chauffeur. 3 2/ -

Effectif du personnel par categorie : 18) - Personnel europeen - WALLIS & FUTUNA

- 3 Medecins milltaires en service de tache - 1 Medecin V.A.T. - 1 Dentiste V.A.T. - 1 Sage-femme D.E. - 1 Inflrmiere anesthesiste 22) - Personnel local:

WALLIS: - 12 aide-soignants (tes) 1 Secretaire - 6 Ouvriers - 4 Chauffeurs - 8 Manoeuvres - 9 Femmes de salle, lingeres et blanchisseuses. FUTqNA - 11 aide-soignants (tes) - 2 Ouvriers - 2 Manoeuvres - 2 Femmes de salle

4 2/

Moyens budgetaires - Le Service de Sante du Territoire est un service d'etat qui dispose pour son fonctionnement annuel d'une subvention du Minitere Franyaie de la Sante et de la Famille. Cette subvention couvre l'ensemble des depenses de personnel et de fonctionnement. Toutes les prestations medicales sont fournies gratuitement sans distinction de situation socia1e. Budget total 1980 : 120.948.123 FCFP soit 6.652.146,76 FF •

./ ...

5Qj - Situation sanitaire : - Les dernieres statistiques effectu~e8 montrent que, pour llann4e 1979, le Service de Sant~ assure :

-- .((. ,(,:,1' - 7.861 "I

.,~.

ttl, (

,v- - 55.841 -

362 20

4.534 662

journ~es d'hospitalisaUon pour 981 h08pitalis~s consultations pour 22.384 consultants accouchements grandes interventions chirurcicales examens de laboratoire radiographies

A) ~ Quelques attection! domiRent la pathologie looale : a) - 1a filariose I principale end~mie s~vissant k VALLIS, elle fait l'objet de tous les ettorts du S.H.P.G.E. - Apr~s use enquate h4matologique portant sur presque toute la population adulte, il ressort que 5,~ de personne. sont porteuses de microfilaires et jouent done le r&le d. reservoir de la maladie. - Suivant en cela l'exemple de TAHITI, et ses excellenta resultata, une cam.pacne de chillioprophylasie de l18.ase a ete entreprise. Paralleleaent, est entreprise une lutte anti-aoustiques (lutte anti-larvair8s). 11 est ~ soulicner que ces actions necessitent una prise de conscience de la population qui a le plus gros r&le a jouer. b) - La tUberculose : 18 seul cas ~ bacillosoopie positive en 1979 montre l'efficacit~ de la lutte entreprise depuie ~lusieurs annees. Du point de we -aoyens de depistapllabo-radio), trait.aent et prophTlaxie (vaccinations 818t~aatiques), contrale de l'allergie tuberculinique, tout est en place pour 'liainer d~tinitive..nt cette aaladie de l'tle. c) - Les parasitoses intestinalea : elles restent d'actualit' surtout chez les enfant. et malgr~ les d'paraai taps systeaatiques pratique. dan. tous les etablisseaents scolaires. 11 s'agit de l'ascaridiose et de l'ankflostoaiaae. La construction et l'usage de cabinets suppriaeraient oe. couteuses end~aiea. Leur construction est en oaura (300 environ k ce jour). d) - La pathologie pulmonaire generale est due au cliaat. e) - Les affectiona rhuaatismales : la pathologie rhuaatiamale e.t extr••~aent r'pandue sous forme de R.A.A. avec asses Bouvent atteinte cardiaque precoce chez les jeunes et sous forae de rhumatisme d~g~n~ratit (arthrose, pOly-arthrite chronique, etc ••• ) souvent tree invalidante chez les plus

....)1

19's. 'it

./...

•

f) - C.R.L. : il s'agit surtout d'otite moyenne suppuree et d'otite externe chez les enfants, d'otorrhees chroniques avec sequelles plus ou moins importantes, quelques complications mastotdiennes ont ete constatees. Au point de vue oculaire, les conjonctives virales se presentent sous forme de poussees epidemiques, on rencontre pau de keratites et quelques cataractes. - La

pterygion est asses frequent.

g) - Les dermatoses abondent sur Ie territoire en particulier chez les enfants. - Les mycoses superficielles sont representees par les pytiriasis versicolor et l'herpes circine, affections desesperantes par leur caractere recidivant, et leur extension permanente malgre la tres grande efficacite des medicaments modernes dont on peut disposer. ·.L

h) - Endocrinologie : son incidence est deja elevee et Ie processus progressif d'adoption d'un regime alimentaire de type europeen ne pourra sans doute qu'aggraver ce probleme. Mais il semblerait que les polynesiens de ce territoire aient une predisposition genetique au diabete. L'alimentation traditionnelle est hyperglucidique. II semblerait qu'un regime calorique eleve, ajoute a une absence quasi totale d'exercice surtout chez les femmes, engendre l'obesite qui a son tour est un facteur primordial dans l l etiologie diabetique de ces inaulaires. Une enquBte de la CPS a ete faite en juin 1980. Le8 resultats sont attendus. - La chimiotherapie a base d'hypo-glycemiant administree par voie buccale est generalement suffisante et Ie recours a l'insuline est exceptionnel. - Enfin, ce diabete ne parait pas avoir d'incidence important sur les autres maladies en dehors des affections arteritiquee et leur cortege de complications classiques. i) - La dengue: maladie epidemique, Ie territoire nlen a pas souffert en 1979. Tout est prevu pour faire face efficacement a une eventuelle epidemie et l'enrayer rapidement: pulverisations intra et peri-domiciliaires d'insecticides. La desinsectisation des aeroplanes se posant a WALLIS doit en outre contribuer efficacement a maintenir Ie territoire indemne de cette maladie. La lutte anti-moustiques entre egalement dans Ie cadre de la prophylaxie de cette maladi••

B) - Hxgiene generale : - L'eau destinee a la consommation est distribuee dans presque taus· les villages. Sa salubrite pourra 8tre contr&lee bacteriologiquement. Elle remplacera favorablement l'sau des puits et des'~urgences dont la salubrite est plus que douteuse c~ certainement polluee par les eaux de ruissellement et d'infiltration chargees de microbes et d'oeufs de parasites.

, • :i

- Le seul probleme de l'eau a WALLIS dans Ie domaine de l'hYgiene est et sera dans l'avenir celui de l'evacuation des . eaux usees dont Ie volume augmentera. - Le peril fecal: reste d'actualite avec le nombre toujours important des maladies qui lui sont liees (contaminations du sol et des eaux) ankylostomiase, gastro-enterites, affections cutanees. Les matieres fecales encore trop souvent deposees au hasard des plantations entrainent une contamination permanente du sol et des eaux en geraes et en parasites. La mise en place dans chaque fale d'un cabinet a chasse d'eau est un des objectifs actuel du S.H.P.G.E. - Les matieres usees encombrent encore trop souvent les abords immediats non debrousses des habitations. Le S.H.P.G.E. s'attache actuellement h faire nettoyer et debrousser autour des fale. Un service de ramassage des orduresfonctionne mals "l'evacuation sanitaire" de celles-ci n'est pas organisee de faQon rationnelle. c) - Byglene allmentaire :

- Le S.H.P.G.E. a deja eu a se pencher sur la proprete et la qualite des aliments proposes aux consommateurs. Le laboratoire d'analyses bacteriologiques sera bient&t en me sure d'effectuer des analyses de l'eau et des aliments.

- Du point de vue nutritionnel, l'alimentation des wallisiens reste tres traditionnelle, essentiellement basee sur l'apport glucidique (taro, 19names, bananes, fruits de l'arbre a pain). - Une place particuliere est faite a l'alcoolisme qui touche deja une proportion elevee de jeunes. D) - Elements demographigues : Au dernier recensement, on notait un taux de natalite de 4~ pour un taux de mortalite en decroisaance a ~. - De nos jours, l'exode vera la Nouvelle-Caledonie est plus limitee et nombre de wallisiens commencent a rentrer au pays. - Au recenaement de 1976, la repartition par Age de la population faisait apparaitre une pyramide avec une base tree large, signe d'une jeunesse exceptlonnelle de la population.

**********

Informations clés

Organisation Organisation mondiale de la santé (OMS)

Type de document Technical Documents

Date d'adoption 31 décembre 1980

Source Organisation mondiale de la santé