BRIEF REPORTS RECEIVED FROM GOVERNMENTS ON THE PROGRESS OF THEIR HEPLTH ACTIVITIES Attached are brief reports received from governments on the progress of their health activities in the following countries or areas: American Samoa Australia China* Hong Kong Japan* Macao Malaysia* New Zealand Republic of Korea Samoa* Singapore Viet Nam
*Issued in English only.
ORIGINAL: ENGLISH
AMERICAN SAMOA
Report on progress of health activities!
1.
Health status trends
Three-year averages for the years 1969-1971 and 1979-1981 are presented hereunder:
Indicator Crude birth rate * Crude death rate * Infant mortality rate ** Neonatal mortality rate **
1969-1971 mean 38.3
1979-1981 mean 33.6 4.4 14.7 7.7
percentage change - 12.3% - 17.0% -41.2% - 40.3%
5.3 25.0 12.9
*per 1000 population **per I 000 live births 2. Organization and operation of the Government's health system
The first American Samoan Chief Health Official was appointed on 1 May 1981. As former Public Health Officer of the Department of Health, the new Director, Dr Nofo Siliga, has placed high priority on health promotion and disease prevention. After several unsuccessful attempts to pass legislation making childhood immunizations mandatory for school enrolment, the Department of Health was successful in getting the law enacted this year. Responsibility for immunizations has thus been shifted from the Department of Health to the parents. Ninety per cent. immunization levels are expected soon after the opening of the 1982 fall school year. Health education, long neglected, is again being given great emphasis as part of the total effort to promote health and the maintenance of wellness, as well as health risk reduction. Chronic diseases, largely preventable, are the leading causes of mortality, morbidity and disability. Control of hypertension and reduction in the number of cigarette smokers are targets for high priority programmes this year.
1Submitted by Development Agency.
the
Director,
American
Samoa
Health
Planning
and
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A major Department pf Health initiative is the move to expand the number and scope of services provided' through district primary health centres. Two new sites have been identified for primary health centres, and one of these is scheduled to open immediately. In addition to the increased emphasis on disease prevention and health promotion, the Department of Health has taken significant steps to improve the quality of medical care at the L.B.J. Tropical Medical Center and to put the Department on a more solid financial footing. The goal is to achieve a ratio of not less than one primary care physician per 2000 population and to significantly increase the ratio of registered nurses to licensed practical nurses. Despite severe budget constraints this year, additional physicians and registered nurses are being hired. A new preventive maintenance programme has been initiated, which will ensure that essential medical equipment is in good operating condition when needed. This has been a longstanding problem, which should now be largely resolved. Attempts to fluoridate the government water systems have not progressed further because of insufficient funds, and the dental health of children in the territory remains a worrisome problem. Additional dental resources are being sought to address this need.
ORIGINAL: ENGLISH
AUSTRALIA Report on progress of national health activities! Introduction Australia faces many challenges as health care planners direct their attention to the goal of health for all by the year 2000. For Australia, the problem is perhaps not scarcity of resources but their equitable distribution and efficient, effective use. There is a growing feeling throughout the community that the share of national resources committed to health care is already large enough and that what is needed is a systematic reassessment, nationally, of the way in which these resources are used. As limits are placed on available resources, this task is being undertaken largely by the governments of the Australian States and the Territories, which are responsible for the direct provision of health services. Fundamental to such an assessment is the difficult philosophical question of whether the Australian health care system, with its large body of private medical practice substantially supported by public funds, is able to meet the needs of the whole community at a cost that the community can afford. Health indicator statistics WHO's strategy for health for all - both global and regional -has been brought to the attention of the health authorities of the States and Territories. The Australian Commonwealth Department of Health is seeking their cooperation in the collection of health indicator statistics which will assist Australia in monitoring national progress towards health for all. There are critical areas not reflected by the WHO indicators which must receive more attention in the coming years, such as the need for more emphasis on preventive medicine; health education and promotion, particularly in the workplace; rehabilitation; better health care for our growing number of aged, for our Aboriginal population and for our migrants; manpower planning and the responsible use of high cost technology. International Code of Marketing of Breast-milk Substitutes In anticipation of the matters to be discussed at the thirty-third session of the WHO Regional Committee for the Western Pacific, there are three specific areas of cooperation between Australia and WHO on which progress comments are appropriate. The first of these concerns progress in the implementation of the International Code of Marketing of Breast-milk Substitutes. Since the adoption of the International Code by the Thirty-fourth World Health Assembly, a number of initiatives have been taken for its implementation in Australia and for improving infant and young child feeding. This action has been directed to two main areas: promotion of breast-feeding and nutritionally desirable weaning practices in the community, and regulation of industry practices for the marketing of infant formulas and the manufacture of foods for infants and young children.
1Submitted by the Director-General of Health, Australia.
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Programmes to increase the prevalence of oceast-feeding and to promote desirable weaning patterns are being undertaken at federal, state and territorial levels. All State and Territory health authorities have policies to promote and support breast-feeding. The Commonwealth Department of Health is giving priority to the importance of breast-feeding in its national guidelines to improve the nutritional status of the community. The first of its Dietary Guidelines for Australians is to 'promote breast-feeding'. These Guidelines, now published in a 20-page booklet, have been widely distributed and accepted throughout Australia and were endorsed by the National Health and Medical Research Council at its ninety-third session in June 1982. Another Department of Health publication, Baby's First Food, now in press, emphasizes the importance of breast-feeding as the preferred method of meeting the nutritional, psychological and immunological requirements of infants. Recent data show that approximately 80 per cent. of Australian women are now breast-feeding their infants at the time of discharge from hospital, and more than 50 per cent. of women are still breast-feeding when their infants are three months of · age. This encouraging increase in the number of mothers breast-feeding is considered to be the result of education, the activities of women's self-help groups, and changing community attitudes. As regards the matter of industry practices for marketing breast-milk substitutes, consultations are taking place between Government officials and the relevant companies to develop a voluntary Australian code of practice for the marketing of infant formula. This code is now nearing finalization. The National Health and Medical Research Council is developing a standard for foods for infants and young children, which, inter alia, defines minimum quality standards for such foods. Clauses of the International Code of Marketing of Breast-milk Substitutes, which relate to the labelling of breast-milk substitutes, have been incorporated into this food standard. Biomedical information The second matter concerns regional cooperation in the provision of biomedical information. A memorandum of understanding between WHO and the Government of Australia for the supply of MEDLARS services to the developing countries of the Western Pacific Region was signed in August 1981, and the provision of services was to commence three months later. However, there were delays in the preparation and distribution of promotional material. It was therefore agreed at a meeting in Manila in December 1981 that the service would begin when the national focal points for the implementation of the service in participating countries had been designated. This is expected to be in the latter part of 1982. The two-year term of the Memorandum of Understanding will date from the official commencement of provision' of services.
Since late in 1981 however, both the National Library of Australia and the Commonwealth Department of Health have been offering some services to countries in the Western Pacific Region. During the first six months of 1982, seven countries requested 227 Medlars searches -(China 72, Fiji 6, Malaysia 32, Papua New Guinea 20, Philippines 5, Republic of Korea 56, Singapore 36). In addition, the National Library of Australia supplied 11 searches to India and 21 to Indonesia. Requests for photocopied articles numbered 1469 and most have been met. The majority of these requests (13&lf) were from the Republic of Korea, with only 3 from the People's Republic of China, 29 from Malaysia, 19 from Papua New Guinea and 9 from Singapore.
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An application from Singapore University for direct on-line access to the Australian Medline Service has also been received and is currently under consideraJon. International airports The third and final matter which should be mentioned is the sanitary conditions at international airports throughout Australia. There has been significant progress during the past 12 months in the establishment and maintenance of sanitary conditions as defined in Article 20 of the International Health Regulations at international airports in Australia. Townsville airport achieved international status with the construction of a new international terminal and the establishment of scheduled international traffic. Inse.ct vectors have been controlled within 400 metres of the terminal building by eliminating breeding sites, and an insect vector monitoring scheme is in operation. All international passengers undergo their on-arrival health clearances in vector-proof accommodation. Insect vector monitoring continues at all international airports within Australia. Treatment is undertaken as necessary. Quarantine staff have been trained in the techniques to be employed at mosquito vector control courses run by the Commonwealth Department of Health. Adelaide airport is expected to handle international traffic at the end of 1982. A new international terminal is under construction. A survey has been undertaken to establish the degree of risk and the necessary works to comply with the requirements of Article 20. A survey has also been undertaken at Port Hedland in Western Australia, which has recently started a weekly DC9 service to Bali. A survey was also undertaken at Hobart airport, which operates scheduled services to New Zealand. All future international airport developments will bear regard to Article 20, while active consideration of these aspects is already under way at Darwin and Perth.
ENGLISH ONLY
PROGRESS REPORT ON HEALTH SERVICES IN THE PEOPLE'S REPUBLIC OF CHINA FOR 1981 AND 19&21
Since the thirty-fir:st session of the WHO Regional Committee for the Western Pacific in 1980, new achievements have been made in the health services in China as a result of further implementation by the health department of the policy of "readjusting, restructuring, consolidating and improving the national economy". In pursuance of the requirement of the Ministry of Public Health, all provinces, municipalities and autonomous regions started in 1980 to implement the programme of reorganizing and consolidating the health services in one third of the counties. Thanks to efforts over the last two years, the health services in the first group of 300-odd counties have been reorganized and reinforced technically, and good results have been achieved in the following areas: First, county-level medical and health institutions have been further strengthened, major commune health centres in the rural areas have been restructured and consolidated, and medical delivery at production brigade level has been diversified, thus further developing the three-level rural medical and health network. Second, technical training has been strengthened. The pilot counties have adopted various forms of training by sending key professionals to medical institutions at the higher level for further training and organizing of training courses for health personnel of various categories. According to incomplete statistics from 177 pilot counties, 8 074 persons have undergone further training and 421 962 persons have received training at various courses, representing 30-50% of all medical and health workers. Third, technical and managerial capabilities have been improved. The hospitals in the pilot counties, after undergoing reorganization and development, are able, by and large, to cope with the diagnosis and treatment of commonly encountered and complicated cases in their respective localities as well as provide emergency care. In many of these counties, the epidemic prevention stations are able to perform local epidemiological surveys, planned immunization, infectious diseases control, prevention and treatment of endemic and parasitic diseases and sanitation supervision. Certain county-level maternal and child health centres are already able to provide out-patient consultation and technical guidance in maternal and child care and family planning for the entire county. Three to five major commune health centres below the county level, reinforced with appropriate technical staff, equipment and physical construction facilities, have been generally set up in each county. With a view to meeting the needs of the pilot counties, local governments have given special consideration to the latter in terms of manpower, material and financial resources and increasing funds and capital construction investment in the field of health.
!submitted by the Director, Bureau of Foreign Affairs, Ministry of Public Health.
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Emphasis has also been laid on two tasks, namely, to train and evaluate barefoot doctors and to so_lve thc:ir remunerat_ion problem, thus stabilizing the contingent of barefoot doctors, 1mprovmg. the cap~c1ty of the grassroots level health organization in the treatm~nt and preventiOn of d1seases, and ensuring the steady development of health services at the lowest grassroots level. So far, more than one third of all barefoot doctors have reached the secondary medical school graduate level. In line with the principles put forward by the Government, namely, to raise the educational, scientific, cultural and health standards of the entire nation, foster a high degree of socialist ethics, while at the same time building up a highly developed material civilization, a campaign has been launched since 1981 to promote the "five stresses and four virtues", namely, "conside·rate behaviour, courtesy, cleanliness, order and morality" and to cultivate 11nobility of sentiment, refinement of language, virtuousness in deeds, and beauty of the environment". A "national civic virtues month" has also been designated. During the first national civic virtues month held last March, workers, students, cadres, soldiers and city dwellers by the millions took to the streets to clear away rubbish, dredge sewers, repair roads and plant greenery. As a result, environmental sanitation in some areas has improved. In the last two years, efforts have also focused on intensifying, step by step, the work of prevention and treatment of several diseases which are widely prevalent and present a serious danger to the people's health. This has resulted in a decrease in morbidity. For instance, the number of patients suffering from acute schistosomiasis has decreased by 4-6% compared with 1980. In the case of endemic goitre, about 150 million patients, accounting for 88% of the total population in the endemic area, have taken iodized salt and the number of counties (cities) where endemic goitre is being basically controlled has increased to 319. More than 60% of the patients suffering from prolapse of the uterus and urinary fistula have received proper treatment. Since 1981, the country has made encouraging progress in the field of traditional medicine by further implementing the policy in this area and 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". By the end of 1981, the number of hospitals of tradi tiona! Chinese medicine had increased from 647 to 753; the number of beds had increased from 49 000 to 57 900 and health personnel from 260 000 to 290 000. It is planned to further consolidate experience in the field of traditional Chinese medicine and its integration with western medicine in order to expedite the construction of hospitals and learning institutes of traditional Chinese medicine and departments of traditional Chinese medicine in general hospitals so as to bring into full play the active role of traditional Chinese medicine in promoting the medical sciences. Various forms of training courses have been organized for different categories of administrative personnel, middle-aged key professional staff and new staff by the provinces, prefectures and counties at their respective levels since 1981. Altogether 5 185 personnel have received training in 316 training courses directly sponsored by the Ministry of Public Health. Different kinds of training have been adopte d for this purpose, such as spare-time courses, television university, correspondence courses and
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assignment of health personnel to an institution at a higher level for training. A degree system has also been instituted, which has not only raised the professional and managerial standards of health workers but also stimulated the great majority of intellectuals in the medical and health fields to take the initiative in the "four modernizations" drive. Since 1981, the country has actively conducted international exchange and technical cooperation with the World Health Organization and other international organizations and with many foreign countrie$. By the end of 1981, more than 211 doctors from some 60 countries had attended twelve international training courses on acupuncture and moxibustion held in China and by the same date more than 110 doctors from 42 countries or regions had attended six international workshops on primary health care in Yexian, Conghua and Jiading Collaborating Centres, thus exchanging experiences and enhancing friendly relations. Twenty-five medical research institutions in China have been designated as WHO collaborating centres in accordance with the Memorandum between the Ministry of Public Health and the World Health Organization governing Technical Cooperation in Health Activities. With the full support of the Ministry of Public Health, the Interregional Seminar on Primary Health Care, jointly organized by WHO, UNDP, UNICEF and the World Bank, was held in China last June, at which experiences in the three-level network of the health care system, the people's involvement in management of health care, health manpower development and financing of health care were shared. In the meantime, due attention has been paid to developing bilateral relations and cooperation with technically advanced countries. It is the aim of the health services to work in the interest of the people's health, protection of productivity, development of the economy and building up of material civilization. The health services should therefore be further reinforced, even during the period of economic readjustment. At present, there are still a number of difficulties, and much remains to be done. However, the country will continue to follow resolutely the line and policy laid down by the Government for health work, and unite and work hard to further develop the health services.
ORIGINAL: ENGLISH
COUNTRY REPORT FOR HONG KONG, 19811
1.
Health of the community
Despite heavy pressure on the medical and health services as a result of population increase and the rising expectations of the public, the standard of delivery of the services continues to be satisfactorily maintained. The general level of health of the population remains good, as evidenced by further improvements in the already good health indices, and the absence of quarantinable diseases or epidemics. The infant mortality rate has fallen further to 9.7 per thousand live births and the maternity mortality rate remains very low at 0.08 per thousand total births. The life expectancy has increased to 70 for males, and 77 for females. 2. Communicable diseases
Hong Kong continues to remain free from any quarantinable diseases. Although three imported cases of cholera were reported during the year, there were no secondary cases as a result of the application of effective control measures. The common childhood communicable diseases such as diphtheria, measles, pertussis and poliomyelitis have been either virtually eradicated or brought well under control. The rubella vaccination programme for girls aged 11-14 years was started in 1978. The programme also provides immunization for non-immune women of childbearing age. · An outbreak of rabies, the first in 25 years, was reported in October 1980. The infection was introduced from outside Hong Kong. Vigorous rabies control measures, including mass vaccination of dogs and destruction of stray dogs, were introduced. Since the occurrence of the last case in October 1981, no further cases have been reported. In all, 3 human cases, 16 cases in dogs and 1 in a cat were confirmed. 3. Health services Tuberculosis and chest services A total of 7729 cases of tuberculosis were notified representing a rate of 150 per 100 000 population compared with 160 for 1980. The mortality rate was 9. 5 per 100 000 compared with 10. 9 in 19 80. Tuberculosis deaths accounted for about 2 per cent. of total registered deaths in the year. The BCG vaccination rate remains very high, covering over 99 per cent. of all newborn. Family health services The family health services provide a comprehensive health care programme for women of childbearing age and children from birth to five years of age. The department runs a total of 40 maternal and child care centres, and 41 family planning clinics. During the year, about 90 per cent. of the newborns attended the family health centres. A comprehensive observation scheme was introduced to screen, detect and assess early development anomalies, and to initiate appropriate remedial therapy as early as possible.
1Submitted by the Director of Medical and Health Services.
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Health education The Central Health Education Unit of the Medical and Health Department, since its establishment in 1978, has continued to play an active role in promoting health educational activities, coordinating various departments and voluntary organizations, and ~lso serves as an advisory and resource centre on health educational matters. Major programmes in the year included an anti-cancer campaign, and an anti-smoking campaign. In response to the International Year of Disabled .Persons, a major mental health campaign was organized with various organizations. Events included exhibitions, public lectures, seminars, workshops and radio programmes. Social hygiene services The incidence of venereal diseases recorded in 19 81 was 7601 compared with 5513 in 1980. About 5.17 per cent. of these occurred in the teenage (under 15) group. The common sexually transmitted diseases were gonorrhoea (45 per cent.), syphilis 02 per cent.) and non-gonococcal urethritis (13 per cent.). · School dental service A school dental service was introduced in 1980, which provides regular dental examinations and simple dental treatment to primary schoolchildren. The response from parents to this preventive dentistry has been very encouraging. At the end of its second year of operation, the number of participants from primary I and II schoolchildren has reached some 75 500. The participation rate has increased to 41 per cent. as compared with 28.9 per cent. in the first year of the service. To enable the scheme to cover eventually all primary schoolchildren, six more school dental clinics will be built in addition to the existing two school dental clinics now in operation. 4. Hospital and clinic services
Pressure on the service was experienced on all fronts as reflected in the increase in attendance at outpatient clinics, casualty departments and hospital admissions. To ensure optimum utilization of the resources in the district, the medical and health services have been reorganized on a regional basis since 1977. This has improved the bed occupancy rates of some supported hospitals and to some extent . relieved the pressure on government hospitals. There was a total of 21 586 beds in 43 hospitals and some government and private maternity homes, representing 4-.2 beds per thousand of the population. Hospital services are supported by specialist clinics and general outpatient clinics. Additional sessions have been provided in evening and Sunday /public holiday clinics in order to cope with the increase in demand for the service. 5.
Medical development
Three new clinics were opened during the year. The Lek Yuen Health Centre at Shatin provides a range of primary health care services, including general outpatient, family health, health education and public health laboratory. The newly completed 1300-bed Kwai Chung Hospital for the mentally ill, with all its modern facilities, began its phased operation during the year.
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~
The Prince of Wales Hospital with its 1500 beds is scheduled to open early in 1983. It will serve as the regional hospital for the East New Territories Region and the teaching hospital for the medical school of the Chinese University of Hong Kong. Another four major hospitals of over 1200 beds each and more than 20 clinics and polyclinics will be established in the coming decade. Other facilities planned include the establishment of six multidisciplinary child assessment centres, five new medical rehabilitation centres and three major infirmaries. A total of 15 312 additional hospital beds will be established by 1991. In support of this ambitious medical development programme, additional training facilities are being developed for the training of doctors, nurses and paramedical staff. Apart from the University of Hong Kong, which produces 150 doctors a year, the medical school in the Chinese University of Hong Kong commenced its first intake of 60 students in September 1981. With the opening of the Prince Philip Dental Hospital, the dental school made its first intake of 60 students in September 1980. Dental therapists are being trained in the MacLehose Dental Centre for staffing the school dental service. There are at present three Government hospital schools of nursing for general registered nurses. Two additional nurses training schools will be established in the next few years. In addition, the two psychiatric nurse training schools will expand their intake capacity as from 1982. An Institute of Medical and Health Care at the Hong Kong Polytechnic provides training for paramedical staff, including radiographers, physiotherapists, occupational therapists, medical laboratory technicians. Training facilities for these staff are also being expanded.
ENGLISH ONLY
JAPAN Report on the progress of health activities, 19811
The health situation in Japan has greatly improved recently concurrently with its social and economic development. In this report, some basic health statistics will be presented to show the health situation in Japan, while recent topics in the field of health and medical services will be highlighted. 1. Vital statistics (Table 1) (a) Population
The total population of Japan, according to the last national census on 1 October 1981, was 117 884 000, showing that the population has more than doubled since 1920 when a population of 55 960 000 was recorded by the first national census. This national census of 1981 showed an average annual increase of 0.7 per cent. or 824 000 over a one-year period. This increase was equivalent to the ones recorded between the period 1956-1960, but showed a decline compared with the rate recorded during the period 1970-197 5, which was 1.4 per cent. The higher rate recorded during the period 1970-1975 can be attributed to the second wave of the so-called "baby boom" for that period, the women born during the period of the first ''baby boom", i.e. around 1947 to 1949, reaching child-bearing age. The phenomenon seems to have ended in 1976. In terms of age composition of the population in 1981, the younger age group (0-14 years) accounted for 23.4 per cent., the working age group (15-64 years) 67.2 per cent. and the older age group (65 years or more) 9.3 per cent. (b) Live birth rate
The live birth rate stayed at a level of around 30 per thousand population through the Meiji Era (1868-1912) and the Taisho Era (1912-1926) up to the post-war period around 1949, placing Japan in the category of countries with a high live birth rate at that time. Since then, the rate has continued to decrease sharply, reaching a low of 16.9- in 1961, which is almost as low as those of the European countries. In 1962, the rate showed a slight upturn as a result of the so-called "second baby boom"; however, the rate has begun to decrease since 1974 and the decline still continues. (c) Death rate (Table 2)
The number of deaths in 1981 was 720 142; the death rate was 6.1 per thousand population. The leading causes of death were in order malignant neoplasms, cerebrovascular diseases, and heart diseases. Tuberculosis is no longer among the top ten causes and the emphasis of national health activities is now placed on chronic degenerative diseases.
1Submitted by the Director, International Secretariat, Ministry of Health and Welfare.
Affairs
Division,
Minister's
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(d)
Infant mortality rate
The infant mortality rate stayed at a level of more than 150 per thousand births until the end of the 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 7.1 in 1981. This was much higher than the rates of European countries before the Second World War, but it decreased very sharply after the war at the speed never attained by other countries. Japan now has one of the lowest infant mortality rates in the world. 2. Life expectancy (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 line with the overall development of medical and public health activities. The life expectancy was 50 years in 1947 (50.06 years for male and 53.96 years for females) and reached 60 years for females in 19 50 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 1.52 years for females. In 1981, average life expectancy was 73.79 years for males and 79.13 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 reached the same levels of some Scandinavian countries. This rapid improvement is largely due to the decrease in infant mortality rates and mortality rates from tuberculosis in youth. 3. Measures for health promotion
Cerebra-cardiovascular 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 are being established in the regions as the local centres to carry out health promotion measures since 1972. If health is to be maintained and promoted, daily activities must provide for a proper balance of physical exercise, nutrition and rest. It is difficult for most people, however, to judge correctly 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: (1) examination and judgement of health aspects of individual lives, (2) prescriptions on changing lifestyles, and (3) provision of actual guidance.
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4.
Degenerative diseases contro.l (a) Cerebro-cardiovascular disease control
To prevent cerebro-cardiovascular diseases, continuous control is indispensable in accordance with the results of medical examinations. Mass medical examinations for cerebro-cardiovascular diseases are carried out throughout the country to prevent apoplexy and heart disease. 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 from cancer accounted for 23.1 per cent. of total deaths in 1981. In terms of sites of cancer, both male and female suffer mainly from stomach cancer, which is a characteristic of this disease in Japan. Cancer control measures consist of (1) health education, (2) medical examination, (3) completion of medical institutions specializing in cancer, (4-) training of cancer experts and (5) development of research. There is one national cancer centre in Tokyo and nine regional cancer centres in nine areas, serving the entire country. These regional centres function as centres for cancer diagnosis and treatment in the respective regions. 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 vaccination for diphtheria, pertussis, 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 health hazards due to serious side-effects 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 1981 was 65 86 7 (morbidity was 56.7 per 100 000 population) which was less than one third the morbidity rate in 1968 (morbidity, 225.0). The main emphasis has been on preventive measures, and extensive mass health examinations have been maintained.
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6.
Maternal and child health
Pregnancy and births are required to be registered with local health authorities by the Maternal and Child Health Law, and maternal and child health programmes are focused upon the care and protection of pregnant women and infants. Since the materna! 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 giving priority to the following programmes: (1) 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 were 6744 food sanitation inspectors, as of 31 December 1981, mainly stationed at health centres, who carry out food sanitation inspection. In order to improve the efficiency of the inspection programme aiming at ensuring the safety of food, an active training programme has been conducted for those inspectors. In addition, food sanitation inspectors stationed at 13 major ports and 3 airports are engaged 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. (b) Water supply
The population served with water supply systems, as of 31 March 1980, was approximately 105 563 000, which was equivalent to 91 per cent. of the total population. About 13 800 million m3 of water was supplied during the year 1979, which will be increased to about 21 000 million m3 or more by 1985. 8. Health manpower and medica! facilities (Table 4)
The number of physicians, who form the core of the health manpower, was estimated at about 156 235 as of the end of 1980 (133.6 per 100 000 population). The number of medical schools is 80 at present and the total number of students admitted to these schools was about 8360 in 1982. It is estimated that the physician-population ratio will be 160 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.
TABLE 1.
VITAL STATISTICS 1980 Number Rate Number 117 204 000 13.6 6.2 7.3 7.5 4.9 46.8 11.7 6.7 1.22 1 529 492 720 142 809 350 10 890 7 188 79 205 16 533 776 557 154 235 13.0 6.1 6.9 7.1 4.7 49.2 10.8 6.6 1.32 V1
1981 Rate
Population (estimated) Live births (per 1000 population) Deaths (per 1000 population) Natural increase (per 1000 population) Infant deaths (per 1000 live births) Neonatal deaths (per 1000 live births) Still births (per 1000 births) Perinatal deaths (per 1000 live births) Marriage (per 1000 population) Divorce (per 1000 population)
116 211 800 1 576 889 722 801 854 088 11 841 7 796 77 446 18 385 774 702
141 689
TABLE 2.
DEATHS BY LEADING CAUSES 1980 Number Rate (per 100 000 population) 139.2 139.7 106.3 33.8 27.7 25.1 17.7 14.2 13.7 8.8 Number 1981 Rate (per 100 000 population) 141.9 134.2 107.5 33.6 25.5 24.6 17.1 14.2 13.0 9.1 0\
1.
Malignant neoplasms Cerebrovascular diseases Heart diseases Pneumonia and bronchitis Senility without mention of psychosis Accidents Suicide Cirrhosis of the liver Hypertensive diseases Diabetes mellitus
161 764 162 317 123 505 39 241 32 154 29 217 20 542 16 490 15 911 10 180
166 319 157 320 125 948 39 438 29 865 28 860 20 052 16 630 15 289 10 679
2. 3. 4.
5. 6. 7. 8. 9.
10.
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TABLE 3.
AVERAGE LIFE EXP,ECTANCY AT BIRTH Sex Sex Female 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 Year 1959 1959 1960 1961 1962 1963 1964 1965* 1966 1967 1968 1969 1970* 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 Male 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 76.69 72.97 73.46 73.32 73.79 Female 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 78.72 79.13
Year 1891 - 1898* 1899 - 1903* 1909 - 1913* 1921 - 1925* 1926 - 1930* 1935 - 1936* 1945 1946 1947* 1948 1949 1950 - 1952* 1950 1951 1952 1953 1954 1955* 1955 1956 1957 1958
Male 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
*Complete life tables.
- 8 -
TABLE 4.
NUMBER OF MEDICAL CARE PERSONNEL
1980 Total number Physicians Dentists Pharmacists Public health nurses Midwives Clinical nurses 156 235
Rate
(per 100 000 population) 133.6
53 602 116 056
45.8 99.3
17 957 27 388
15.4 23.4 443.8
518 832
ORIGINAL: ENGLISH
MACAO Report on progress of health activities, 19811
Specialist services The specialization of doctors has been encouraged in order to fill vacant positions for specialists in Macao's health services. In this perspective, an agreement was signed in Lisbon on 26 November 1981, between the Governor of Macao and the Secretary of State for Health. It should thus be possible to promptly satisfy the needs for specialists indicated by the Macao Government. It is expected in the near future that the services of two surgeons, two paediatricians, one internal medicine specialist, one resuscitation specialist and one anaesthesiologist will be available. Communicable diseases The fight against communicable diseases has been intensified. During the year, almost all schoolchildren were inoculated against poliomyelitis. An extensive campaign has been conducted against tuberculosis, the main health problem, detection and treatment services being provided free of charge. It should be noted, that doctors in private practice have also been given the possibility of obtaining chest X-rays and sputum tests free of charge for their patients. Consultant services With the support of the World Health Organization, consultant services were provided during the year in the areas of occupational health, industrial health, malaria, cancer and animal health. Training The World Health Organization also extended its collaboration and support in the training of health personnel as follows: the doctor in charge of the tuberculosis department, in Japan; the doctor in charge of the Hansen's disease department, in Japan; a nurse from the Hansen's disease department, in Spain; a technician for medical equipment, in New Zealand; The Government of Macao supported the participation in congresses held in Portugal and abroad of four doctors and four nurses.
1Submitted
by
the
Director
of
Medical
and
Health
Services,
Macao.
-2-
Sports and school health The Department of Sports Health has been inaugurated. Although it is still in its early stages, it has already served hundreds of athletes from Macao. A special clinic for children up to 5 years of age has opened in "Bairro Tamagnini Barbosa", where all care is given free of charge. The Department of School Health has initiated a mass campaign to detect ophthalmology problems among the entire school population of Macao. The regulations for Sports Health and School Health have also beeri published. Nursing In Central Conde de S. Januario Hospital, intensive courses in Portuguese are being conducted for nursing personnel. These courses have generally speaking had good results. Malaria A programme has been introduced in collaboration with the health authorities of Guangzhou and a delegation from Macao visited that city in the beginning of the year. Two malaria specialists from Guangzhou visited Macao, and promised to look into the possibility of intensifying anti-mosquito measures in the border area with Macao in order to keep this territory free from malaria. Other activities In September 1981, Macao hosted a symposium on transcultural psychiatry. The Director of Macao's health services was elected Vice-Chairman of the WHO Regional Committee. Cooperation was established between Macao's health services and the College of France in the area of research on hypertension and cancer of the nasopharynx. In December 1981 7 a symposium on nasopharyngeal carcinoma was held in Guangzhou, China, in which the Director of Macao's health services participated as a guest of honour. A delegation made up of one doctor from the Central Conde de S. Januario Hospital and one doctor from Kiang Wu Hospital also participated in the symposium. Finally, it should be noted that the Macao Government spent approximately 1 400 000 patacas on equipment for the Central Conde de S. Januario Hospital, which is considered to be a well equipped unit by international authorities who have visited it.
ENGLISH ONLY
HEALTH FOR ALL DEVELOPMENT OF HEALTH PROGRAMME IN MALAYSIA
1.
INTRODUCTION MALAYSIA is a federation of 13 States and a Federal Territory. Eleven of the States and the Federal Territory are in Peninsular Malaysia and the remaining two States, Sabah and Sarawak, are in the Island of Borneo. The population and population density are as follows:1980 Census Population ·(Million)
Density/ Sq.Km. 85 13
Peninsular Malaysia
Sabah Sarawak
.. ~
11.138 1.002 1.295 13.435
.
10 41
MALAYSIA
2.
HEALW STATUS The general health status of the population continues to improve as shown by the various health indicators which have steadily declined. Some Vital Indicators 1957 1980 27.6 5.76 15.60 24.70 2.04 0.63 65.97 (1979 70.92 (1979 % Decline
Crude Birth Rate Crude Death Rate Neonatal Mortality Rate Infant Mortality Rate Toddler Mortality Rate Maternal Mortality Rate
46.2 12.40 29.60 75.50 10,65 2.82
40,25 53.54 47.29 67,28 80,84 77,65
Life Expectancy at Birth ... Male 56.0 .-Female 58.0
-
-
% Increase "" 17.8) % Increase 22. 3)
... 2/-
2
3.
HEALTH BUDGET
The Ministry of Health (MOH) budget for 1982 is M$1,184,172,130 (M$1 ,050 ,676, 700 for Operating Expenditure and M$ 133,495,430 :for Development Expenditure). The operating budget for health is 6.1% of the overall appropriation for the operating budget whilst the development budget is 0.9% of the total allocation for development. The Ministry of Health's appropriation is equivalent to about 4.1% of the Gross National Product, The above does not include the appropriation for health and health related :purposes for other Ministries and agencies. The per capita health allocation is about M$ 80 .1 or about US$ 33,9. 4. THE NEW ECONOMIC . POLICY . (_NEP)
The NEP which is a 20 year perspective socio-economic plan w.hich !;>tarted in 1971, commits the nation to reduce and eventually eradicate poverty by raising income levels and increasing employment opportunities for all Malaysians , It would also accelerate the process of re ... structuring society so as to reduce and eventually eliminate the identification of groups with economic functions. 5, FOURTH .MALAYSIA .PLAN (FMP} ·t981 ~ · 1985
In planning its FMP the MOH took note of the NEP and the need to provide basic health care for the total population . The MOH accords pd.ority to population groups living in economically depressed areas as well as areas which are unserved or underserved by essential health s:ervices·, The §eneral objective of the MOH, in line with the NEP is to facilitate the attainment and maintenance by the individual of a standard of health which will enable him to lead an economically and socially productive life, Based on this general objective, the MOH had identified problem priorities, programme specific objectives, and appropriate broad and specific strategies after examining various options through the application of the following criteria: availability, feasibility and effectiveness of technology; the extent the technology can be used by low category staff, and be widely applied; •• . 3 /-
3 multiple effects on a number of health problems; manpower implication; cost factor.
The overall allocation for the FMP for infrastructure development is M$558.44 million for the construction of 3,123 projects. These projects range from small rural clinics and rural water supply systems to 1000 bedded modern hospitals distributed throughout the country. To date 497 projects had been completed and 486 under construction. The rest are in various stages of planning.
6.
PROGRESS-IN INFRASTRUCTURE-DEVELOPMENT 1956, Malaysia is in its sixth Five Year Plan which started in Throughout, the development of health programmes had formed
an integral component of the Plan. with emphasis on equity of resource allocation, disadvantaged areas and groups as well as balance between the preventive and curative sectors. Special attention continues to be given to the provision of basic medical care, maternal and child health, communicable diseases especially preventable ones, nutrition, sanitation, and health education. The country had embarked on an extensive programme of infrastructure development, In 1980, there were 1,353 outpatient services outlets, giving a facility/populatton ratio of 1:8232. With regard to maternal and child health service, the facility/population ratio was 1:5628 T There were 1_,539 dental chairs fo'l' adults and children throughout the country. At the end of 1980, there were 88 acute hospitals with a total of 23,522 beds, To increase the accessibility of the services to the pub lie, mobile clinics by road~ river or sea and by air operate to remote areas or areas as yet not served by permanent facilities.
A survey carried out in Peninsular Malaysia in 1977/78 showed that .12% of the rural population were underserved by health services, In Sabah and Sarawak, the proportion of underserved population is greater, To rectify this imbalance, relatively underdeveloped areas or states will continue to get a larger share of capital investment for infrastructure development and operating allocation,
4
7.
SOME IMPACT INDICATORS Maternal and Child Health A greater number of registered births is handled by trained personnel. Over the past twenty years hospital deliveries and increased by 100%. Dormiciliary deliveries by public health personnel had similarly increased by more than 100%. Deliveries conducted by tradi tiona! birth attendants accoliDted for only 15% of registered births in 1980 compared with 38% in 1965. The incidence of diptheria had decreased from 3.78 per 100,000 population in 1972 to 0,97 in 1980, Similar figures for poliomyelitis are 8,31 and 0,03 respectively. There has been a progressive decline in the tuberculosis of the meninges and of the more severe form of childhood tuberculosis. With regard to school health service, due to shortage of personnel, priority had been given to pupils in standard 1 and 6 and in Form 3. About 92% of standard 1 and 6 pupils were examined by nurses 1 wh:Ust 62 9o of secondary schools were visited, Started as a pilot project in 1969, the applied food and nutrition programme was expanded to districts with high toddler mortality rates. An evaluation of the programme in 1979 shows improvement in terms of weight at birth, overall weight gain, breast feeding~ use of maternal and child health services, and environmental sanitation. Communicable Diseases ~~---------------~-·-
Control of communicable diseases is carried out through specific or integrated programmes, Diseases associa.ted ·with poor .sanitation and hygiene 01olera, typhoid, paratyphoid and other food/water borne diseases continue to be endemic in the coliDtry. Local outbreaks occur from time to time . Irtfectious ·disea.se.s of childhood See above under Maternal and Child Health. There had also been a gradual decline in the number of cases of whooping cough and tetanus neonatorum,
5
Measles immunisation had been made available in Sarawak since 1976. Nationwide expansion of measles immunisation is being considered. Tuberculosis The BCG coverage among population aged 0-19 years in 1980 is about 89.9%.
Disease specific death rate from tuberculosis in 1976 is estimated to be about 18-20 per 100,000 population. Prior to 1960, the prevalence rate of infectious pulmonary tuberculosis was estimated to be 8-lQ per 1,000 adult population. Bacteriologically positive pulmonary tuberculosis among population aged 15 years and above in 1970 was about 5,7 per 1,000 population. Malaria Before 1967 ~ it was estimated that there were about 300,000 cases of malaria in Peninsular Malaysia. reported. In 1980, 9110 cases were By 1980, about 75% of the population in Peninsular Malaysia
were living in areas under consolidation or pre-maintenance phase of the malaria eradication programme, Dengue · fever · (DF} ·& Dengue ·ha.emorrhagic fever · (DHF) DF &DHF are endemic in the country. In 1980, 373 cases of DF and 300 cases of DHF were reported, DHF is essentially an urban problem, about 89% of the cases coming from urban areas. Children aged S-9 years appear to be particularly at risk. This year, a total of .1845 DF and 793 DHF cases with 33 deaths had been reported to date, Appropriate control measures are being taken, Rural ·santtation ·Programme The rural sanitation programme, aimed at improving water suppltes, excreta and refuse d:tsvosal and general cleanliness of compounds and houses, is an integral component of the rural health service, Community participation, health education and appropriate technology are emphasised, Between 1970 and 1980 a total of about 14,640 small rural water supnly systems and 413,910 sanitary latrines were constructed, benefiting about 1,067,000 and 2,069,600 persons respectively •
... 6/-
6
8•
CHANGING ·. NEEDS AND DEMANDS
Malays·ia is passing through a period of rapid change in its s<:>cto~economic
development, which is reflected in changing Whilst many of the traditional health and
needs and demands.
celated problems are still prevailing in certain areas and among certain population groups. such diseases as heart and cardiovascular diseases, cancer,diseases of metabolism, accidents and similar diseases- of- "affluence" axe on the increase, demand for spec:talist careT In addition there is also a higher level of expectat:i;on from the public and a greater To maintain a proper balance in health
programme development is the continuing concern of the Ministry of Health and others responsible for health and related issue~.
ORIGINAL: ENGLISH
NEW ZEALAND Report on the progress of health activities!
1.
General
In 1976, the Special Advisory Committee on Health Services Organization (SACHSO) was set up by the Government to consider and make recommendations on the future organization and coordination of the health services. The Committee produced proposals which were to be tested in two pilot areas (one urban and one predominantly rural) before a national extension was to be considered. Both areas have reported to the Minister of Health on the feasibility of these proposals and the Government has recently endorsed the concept involved, i.e. the establishment of area health boards. There is a lot of work still to be done before legislation is introduced and before any individual area health board is created. The health services have continued to participate in regional planning under the Town and Country Planning Act, 1977. This allows health services at the regional level to identify regional health needs, influence the planning of organizations whose activities have health implications, and contribute to regional planning schemes. Progress is being made in ·some parts of New Zealand towards the preparation of health plans as part of the regional planning schemes. The regional planning process, and these health plans, are seen as the means of reaching an agreement between the central Government and a region as to priorities for the allocation of resources in each region. 2. Health promotion activities (I)
Family health
Priority continues to be given to the early detection and better management of . deafness by improvement of screening programmes, with attention to risk factors and Auditory Brain Stem Response. The introduction of the health and development record book to be used for children up to the age of 16 years is an important landmark in attempts to improve child health. A copy is issued to every mother before she is discharged from the maternity hospital. The book is colourfully . illustrated and provides parents with information on children's health, behaviour problems, accident prevention and how to make the best use of health services. Space is provided for all health professionals who see the child to record their comments for the benefit of the parents and others concerned with aspects of the child's health. Although it is too early to gauge the benefit of the introduction of the record book, there has been a very favourable response from both parents and professionals. The development of improved services for parent health education is continuing and, so far, fifteen regional committees on health education for parenthood have been established.
1Submitted by the Director-General of Health.
-2-
(2)
Disease prevention
A further significant fall in the reported incidence of tuberculosis occurred for the third year in succession with 346 cases notified, 31 cases being diagnosed among immigrants from South-East Asia. Viral hepatitis notifications, although by no means complete, showed a marked decline, with recorded cases falling below those recorded in the late 1950s. The importance of attempting to identify cases of hepatitis B by available laboratory testing needs to be encouraged, especially in view of the possible introduction of the vaccine. The pandemic of rubella, which was observed in New Zealand in 1979-1980, resulted in 45 cases of laboratory-confirmed congenital rubella, although half of these have shown no detectable abnormalities, and the immunization of 11-year old girls is proceeding well, with 98 per cent. protected in 1981. The programme in which young women of child-bearing age are encouraged to have a serological test, with immunization if found to be susceptible, requires better implementation. The virological test is now advised as a routine procedure for pregnant women, with immunization post-partum if required. The programme to eradicate measles epidemics by December 1983 continues, with an increased level of immunization of between 80-94 per cent. in children aged one to seven. The noncommunicable disease prevention programme continues, with emphasis on encouraging responsibility and moderation in the use of alcohol and on the danger of smoking. Information from serial census figures shows that, with the exception of women under 24 years of age, fewer people smoked in 1981 than in 1976. (3)
Health protection
Over the last decade, the stimulus to local authorities to provide improved water and sewerage systems, given by the Government subsidy scheme, has been highly successful. The total amount available annually has now been reduced; however, to assist the smaller authorities where the need for improvement tends to be greater, a sliding scale has been drawn up, providing for a subsidy of 40-10 per cent. according to size. :".lso in the environmental area, the legislation to provide immediate abatement of neighbourhood noise and the adoption of an overall policy on environmental noise control are both making progress. The Toxic Substances Regulations have still to be promulgated but are at an advanced drafting stage. An appropriate software package for a chemical substance index (registry) is available. With these developments, considerable progress in the control of toxic substances should be made. The new Food Act completed its legislative passage in 1981 and will come into force with the promulgation of the new regulations in a few months' time. There is more involvement with exported food, while the new regulations will extend to the certification of imported foods.
-3-
In the occupational health area, programmes based on the results of the farm worker survey are being developed. A trial of an animal vaccine against l~ptosrirosis has rc<;ulted in a significant reduction in human cases. Guidelines have occn prf'pilred on the use of lead, isocyanates and electroplating. 3. Clinical services (1)
Medicines and medical devices (a) {b) Total expenditure on pharmaceutical benefits increased by 18 per cent. during the year 1981-1982, to NZ$17 4.04 million. Heroin has remained in short supply as a drug of abuse, causing a continued seeking of prescription medicines through thefts from pharmacies or through inappropriate prescribing by medical practitioners. Surveillance of all barbiturate prescriptions has reduced the amount prescribed as medical practitioners change to prescribing more appropriate therapy. Most bandages and wound dressings imported into New Zealand are being sterilized on importation because of proved contamination by clostridial bacteria. The situation is to be reviewed during 1982.
(c)
(2)
Primary medical services
The Government has established a committee to inquire into the adequacy and funding of primary medical services, which is to report by 31 August 1982. Topics to be covered include: modes of practice and methods of payment for general practitioner services; support services, including the practice nurse scheme; alternative methods of funding primary medical services; incentives; problems of minority ethnic groups; organizational problems. The family medicine training programme, whereby young doctors receive vocational training before entering general practice, has also been the subject of a comprehensive review. A report has been submitted to the Government. 4. Dental health
Oral health targets for children were developed in New Zealand in 1976, and adopted at a dental health workshop in Rotorua in 1978. Targets for other age groups were also set.
- 4-
The concept has since been developed by WHO and the International Dental Federation. WHO, at the 1981 World Health Assembly, adopted as the first glol,al indicator of oral health status, an average of not more than three decayed, missing and filled permanent teeth by the year 2000. During 1981, with some knowledge of the WHO proposal, the New Zealand target for 12- 13 year olds was revised, the target for this age group being to achieve the global indicator, i.e. not more than three permanent teeth affected by dental caries by I 988. 5. Hospitals ( 1) Funding for hospital boards
Increasing emphasis is being placed on the control of allocations for hospital board operating expenditure, which absorb more than 70 per cent. of the Government's appropriations for health services in New Zealand. Restraints have been imposed on growth during the past four years and have revealed more clearly the considerable maldistribution of funds between boards and the need for a new basis for making annual allocations. Work undertaken during the last 2-1/2 years has shown that a population-based formula, adjusted for such factors as patient category, age, sex, mortality and fertility ratios, movement of patients between board districts and into private hospitals, long-stay psychiatric patients, and the service costs of teaching health professionals, will result in a more equitable allocation of finance. (2) Service planning guidelines
The development of the new population-based funding formula also drew attention to the value of service planning guidelines for hospital boards. This is being followed through with the preparation of a format for such guidelines which is closely related to the varied sizes and responsibilities of hospital boards. Work on draft guidelines for paediatric services is well advanced. The draft will be circulated to all hospital boards for comment before it is accepted as a firm basis for planning hospital board services. (3) Review of community care projects
In 1977, the duty on alcohol and tobacco was increased and the additional finance available from this source was used to fund a variety of community health care projects through the hospital boards. Machinery has now been set up, at the Minister's request, to review these projects in the light of five years' experience. The general review is intended to improve the overall effectiveness of the community care programme and will be relevant to the development of service planning guidelines for community care.
- 5-
(4)
Hospital manpower
There are persistent manpower shortages in some medical specialities, but increasing numbers of medical graduates are beginning to have an impact on the recruitment difficulties experienced in more remote areas and in some specialities. Some hospital boards are experiencing difficulties in maintaining adequate numbers of qualified nurses. Extensive nursing manpower planning is under way to ensure that appropriate training programmes are available to maintain numbers and standards. Most technological groups have adequate training programmes and are not expected to experience substantial manpower shortages.
ORIGINAL: ENGLISH
REPUBLIC OF KOREA Progress report on the national health situation!
The following is an outline of the national health situation which has developed as a result of the Government's policies and successive five-year economic development plans. The Government is addressing itself with determination to achieving the goal of establishing a democratic welfare state in the 1980s. Medical security plan The medical security plan is being implemented mainly through two schemes: the medicaid programme, which covers 3.7 million or 9.6% of the total population, and the medical insurance scheme, which covers 12.2 million or 31% of the population, in June 1982. With regard to the medicaid programme, the Government introduced the Medicaid Act in 1977 in order to provide adequate medical benefits for indigent and low-income households. The Government also introduced the medical insurance scheme in 1977 for workers in firms with more than 500 employees, and their dependants. This scheme has been successfully developed during last the five years and now covers 7.9 million workers, 3.8 million civil servants and private school teachers, and 0.5 million residents in cities, islands, and in rural counties. According to the long-term medical security plan, the number of medicaid beneficiaries will remain at 3.7 million until 1988, but the coverage of the medical insurance scheme will be extended to 86% of the total population by the same date. This means that almost the entire population will be covered by the medical security system in 1988. Health care network To ensure maximum utilization of the health services, a study on reorganization of the health care network at national level is being carried out. To provide effective health care services in underserved rural areas, a special Act on health care for rural areas was enacted in December 1980.
This Act, which is concerned particularly with the operation of the community health practitioner system, in intended to implement the nationwide primary health care programme. In accordance with the national plan, the Government intends to train over 2000 community health practitioners over a four-year period or 500 each year. The first 392 practitioners have already been trained and assigned to underserved areas since October 1981, and 400 more are under training now.
1Prepared by the Ministry of Health and Social Affairs.
-2-
As a result of the alleviation of economic constraints on medical care utilization through the expansion of health security coverage, the demand for medical services has gradually increased. The Government is therefore substantially renovating existing public medical facilities and medical equipment, such as national provincial hospitals, health centres, sub-health centres and community health posts, which play a key role in providing primary health care. Meanwhile, to ensure the expansion of private medical facilities, the Government has been providing financial support for the construction of hospitals, especially in rural areas and industrial complexes where adequate facilities have been lacking. There is now a total of 65 000 clinic beds in al1 hospitals, equivalent to one bed per 587 persons, which is on the way to covering 94% of the required demand by 1986. Family health services The Government is planning to reduce the rate of population growth to 1.67% by 1986, and has strengthened its family planning campaign for low-income people in urban areas and residents of remote areas. In parallel VJith the family planning project, it has already commenced a project to build a total of 91 large-scale maternity health clinics, mostly in rural and fishery areas, by 1983, of which 53 clinics are now under construction and will be completed this year. Expectant mothers and infants, especially those in needy families, will be able to receive better health services, including nutrition, from these clinics. Preventive medicine activities To prevent acute communicable diseases, early case-finding and detection programmes have been undertaken through the health network system, in parallel with health education through the mass media, to enhance people's knowledge by all possible means. Vaccination against acute communicable diseases has been stepped up under yearly programme activities. To control chronic communicable diseases such as tuberculosis, leprosy and parasitic diseases, the Government is also making efforts to promote early detection and treatment at the institutional level. Mental disorders have become a major health problem, which requires the enactment of a law of wide scope providing for effective control. Some other chronic diseases such as cancer have also been included in measures for research to find effective control methods. Safe water supply To supply safe water to residents in rural and fishery areas, the Government constructed 29 145 simple piped-water supply systems during the period 1967-1981, covering 53% of the total rural and fishery population in the country. It will construct a further 17 679 systems during the period 1982-1986, which will increase water supply coverage from 53% to 92% of the total rural and fishery population by the end of the project. Food and drug control Quality checks on products from food and drug makers have been continued in order to prevent dangerous or sub-standard items from reaching consumers. With a view to making government quality control agencies efficient and reliable the Government plans to set up an institute to conduct research on safe food and medical supplies. T" strengthen narcotics control, the Government will intensify its publicity campaign against the use of habit-forming drugs, including methamphetamine.
-3-
Environmental pollution control With the inauguration of the Office of Environment in 1980 and reinforcement of the National Environment Protection Institute, the Government has placed a high priority on the preservation of a sound environment, and is taking all possible measures to improve national health through the prevention of hazards due to air pollution, water pollution, noise, vibration and offensive odours. Six regional offices have been playing a key role in monitoring environment pollution and surveillance, particularly in large citie~ and industrial complexes where pollution levels are high. Elderly and disabled persons Within the framework of the 1981 International Year of Disabled Persons, the Government has carried out various commemorative programmes and enacted a law in June 1981 for the welfare of physically and mentally disabled persons. This law provides for the promotion of medical rehabilitation, including disability prevention and vocational training. The Government also enacted a law for the welfare of the aged in June 1981, which includes provisions for improving health and social activities for the elderly.
ENGLISH ONLY
STATUS OF HEALTH AND HEALTH SERVICES IN SAMOA 1
The health of the people of Samoa is generally good, and there are no major epidemic diseases prevailing at the moment in the country. With regard to the strengthening of the National Health Administration, it has been decided to reorganize the entire Health Department, both administratively and technically. The World Health Organization has been requested to collaborate in this reorganization programme. This is not an easy task; in fact it is a revolutionary task, and it is not expected that it can be immediately accomplished. It will be satisfactory, however, if the reorganization of the Health Administration can be completed by the early part of next year. It is intended to formulate new national health policies that will suit the needs of the Samoan people. Priorities and goals will be determined that are reasonable and obtainable with the country's meager resources, and aligned with the Government's policies. Once the policies are formulated, a planning programme on broad programming will be carried out. Strategies will be developed and objectives and specific targets stated. Detailed programming will be conducted. At this stage, all heads of units and sections of the Department will be involved. The detailed programmes will specify objectives, the resources needed (men, money, materials - the 3 Ms) and dates and targets will be set to achieve the specific objectives. A study is being conducted of the means to adopt programme budgeting and t) delegate authority and responsibility to each section head. Each responsible official will be held accountable for his or her action, once the resources are provided for these programmes and the budget allocated to them. As mentioned, WHO has been requested to collaborate in this re-organization programme, not only for the technical aspects, but also the administrative aspects, for without the proper logistic and administrative support, no technical programme can be conducted efficiently and its target and goals achieved. By this complete reorganization and planning, it is hoped to prepare a master plan of action, to be implemented probably by early next year. As programmes are implemented, they will be continuously monitored so that policies and strategies can be eventually evaluated. From the outcome of the monitoring and evaluation process, it will be seen whether policies and strategies are on the right course, and if not, it will be necessary to go back to the drawing board, and carry out the process of reprogramming to improve the master plan of action.
1Submitted by the Director-General of Health.
- 2To carry out the constant monitoring process and final evaluation, two elements need to be improved: (I)
the information system, both in the administrative and technical areas, and communication of the information receive<!, in both directions, from the grassroot level to the managerial level and vice-versa, along the chain of command.
(2)
These are areas where there are definite deficiencies, which it has been discovered, have caused a lot of unnecessary problems in the past. The deficiencies in these two areas have diminished capabilities as managers of the Department, reduced efficiency within the Department, and led to wastage of resources, which are sorely needed. In formulating its health policies, the Department will be guided by the primary health care approach to the conduct of programmes. The Department is in the stage of outlining strategies to achieve health for all by the year 2000. The strategies will be based on the fourth Four-Year development plan, 1980-1984. However, the new Government is also reviewing and monitoring this plan, and some changes may have to be made to be more realistic and in harmony with the present-day economy of Samoa. The main problem now is lack of adequate health manpower in certain essential fields, particularly doctors. About 40% of the doctors have passed legal retiring age and are being re-employed. Doctors cannot be trained overnight. There are some United Nations Volunteers and bilateral aid doctors, but they are not permanent staff and cannot be depended upon to meet future needs. This is the area of greatest weakness.
ORIGINAL: ENGLISH
SINGAPORE Brief report on the progress of health activities, 19811 Singapore, an island Republic with an estimated population of 2 443 300 has continued to be free of any serious health problems during 1981. The health status of the Singapore population has been maintained at a high level as is reflected in its low infant mortality of 10.8 per thousand. There were no significant changes in the crude birth rate and crude death rate with the rates remaining at 17 and 5.3 per thousand respectively. The annual rate of population growth remained low at 1.2 per cent. Ministry of Health The responsibility for curative, preventive, promotive and rehabilitative health service rests with the Ministry of Health, which is organized into the following main operational divisions: Primary Health Care and Health Education Division Hospital Division Other Medical and Supporting Division, and Dental Division The Primary Health Care and Health Education Division continued to provide outpatient preventive and curative health care and health care education through the Maternal and Child Health Services, School Health Services, Outpatient Services, Department of Tuberculosis Control and the Training and Health Education Department. During the year further steps were undertaken to improve the services of the division. Curative outpatient services were provided at 12 polyclinics, 13 outpatient dispensaries and 5 staff dispensaries. There were 2 833 394 attendances, a decrease of 2. 9 per cent. compared with 1980. Treatment for pulmonary tuberculosis was provided at eight selected polyclinics and outpatient dispensaries. The total number of new active tuberculosis cases dropped from 2710 in 1980 to 2325. The incidence of 99 per 100 000 population in 1981 was the lowest in the past ten years. Case-finding through routine X-ray examination was confined mainly to people aged 40 years and above. Altogether, 57 958 persons were screened and a pick-up rate was found of 11.3 cases of active tuberculosis per I 000 persons examined. Preventive health care services for mothers, infants and pre-school children were provided by the Maternal and Child Health Services at 12 polyclinics, 12 full-time and 5 part-time Maternal and Child Health Centres, while the School Health Services attended to the health screening of school children. Domiciliary after care was extended to all classes of patients and home nursing care for non-ambulant chronic sick patients referred to the Home Nursing Foundation was also provided by the Maternal and Child Health Services. 476 996 school children were screened and the commonest defects detected were myopia and dental caries.
l Prepared by Dr Lau Buong Yan, Director, Toa Payoh Hospital.
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The Training and Health Education Department continues to provide health education to the general public and specific target groups. The major emphasis was on activities to discourage smoking, especially in the young. Hospital Division There are 13 government hospitals with a total of 8365 beds. Seven acute hospitals offer multidisciplinary services, whereas the remaining six are specialized hospitals providing treatment for psychiatry, leprosy, and skin and infectious diseases. The new Singapore General Hospital, comprising ten blocks with a built-up area of 158 377 square metres, has the latest medical equipment. The hospital is the only one providing tertiary specialist services of radiotherapy, plastic surgery, nephrology, cardiovascular and thoracic surgery and paediatric surgery. Dental Division Dental treatment for members of the public and preventive dental care for school children are provided at 8 hospital dental clinics, 13 outpatient dental clinics, 11 school dental clinics and the Institute of Dental Health. Supportive Services These include the Biomedical Engineering, Blood Transfusion, Diagnostic Radiology, Nuclear Medicine, Pathology, Pharmaceutical, Radiotherapy, Research and Evaluation, and Scientific Services. The Blood Transfusion Department offers a new service for hepatitis B antigen screening. An automatic blood grouping system which can process 80 blood samples an hour was installed. A new cobalt unit and three linear accelerators and supportive equipment were installed at the Department of Radiotherapy. The department treated 2533 cancer patients as compared with 2324 ln 1980. The main conditions treated were cancer of the bronchus (436), nasopharynx (301), breast (275), cervix (227) and colon (66). Under the Health Manpower Development Plan instituted in 1980, a total of 61 doctors were sponsored for training locally and abroad. Four experts were invited to conduct teaching and training sessions. Ministry of Environment The Ministry of Environment deals with environmental health and pollution control. Work on the cleaning of rivers and all unprotected water catchments programme continued throughout the year. · Water pollution control of 1087 factories and industries with effluent discharges was stepped up. A total of 9639 inspections were made as against 7175 in 1980. The number of trade effluent treatment plants increased from 553 to 611 in 1981. Two new sewage treatment works at Seletar and Jurong capable of treating 57 000 and 82 000 cubic sewage per day were commissioned.
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The infectious diseases situation in 1981 was satisfactory. The incidence of the majority of communicable diseases declined in 1981. There were fewer cases of dengue fever, dengue haemorrhagic, viral encephalitis, enteric fever and viral hepatitis. 261 cases of malaria were detected as compared with 200 cases in 1980. 244 were imported and 17 introduced cases. There was no outbreak of malaria of local origin. 68.5 per cent. of infections were caused by Plasmodium vivax. 34 cholera cases were diagnosed, including two cases of imported cases of El Tor cholera. All cases were of serotype Ogawa, except for one case of serotype Inaba. Six carriers of El Tor cholera serotype Ogawa were detected. 2578 public food handlers who were not covered in the last screening exercise were screened for .typhoid, cholera and other food poisoning organisms. They were also vaccinated against typhoid.
ORIGINAL: FRENCH
MINISTRY OF PUBLIC HEALTH
SOCIALIST REPUBLIC OF VIETNAM
BRIEF REPORT ON HEALTH ACTIVITIES DURING THE FIRST HALF OF 1982
1982 is the second year of the third five-year socioeconomic development plan (1981-1985) of the Socialist Republic of Viet Nam. In 1982, in addition to its normal activities, the Health Department of Viet Nam is focusing efforts in the following five major areas in order to achieve the established goals and to implement the programme for "health for all by the year 2000": - Sanitation and epidemic prevention; - Improving the quality of clinical management and treatment, promoting the prevention and control of social diseases; - Protection of maternal and child health; - Provision of adequate supplies of drugs for prevention and treatment of diseases; - Training, refresher courses and improving the scientific and technical levels of health personne I. 1. SANITATION AND EPIDEMIC PREVENTION
The goal is to gradually ensure clean and healthy living and working environments, to reduce morbidity and mortality due to communicable diseases, and thus prevent the outbreak of epidemics. To achieve these objectives, we are continuing the mass campaign for the construction of sanitary installations in rural areas: latrines, wells, wash rooms. We have developed a number of appropriate latrines adapted to the geographical characteristics of each region and made of local materials that are readily available. The installation of septic or semi-septic tanks is being encouraged in towns and every effort is being made to improve the supply of safe water. Mass campaigns of information, health education and health inspection are being promoted to ensure strict compliance with food safety, school health and occupational health regulations, and immunizations are being performed according to the necessary quality and technical standards in accordance with established goals. The expanded programme on immunization is being organized in the context of the WHO programme on a trial basis in Hanoi, Haiphong, Hai Hung, and Ha Son Binh. A sufficient quantity of cholera, typhoid and poliomyelitis vaccine has been produced to cover the needs of the country but vaccines are still needed against diphtheria, pertussis, tetanus, plague, measles; a small quantity of rabies vaccine has had to be imported or requested from foreign assistance.
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There have been frequent attempts to eradicate disease vectors through the ·use of chemicals or other popular means. As a trial, we have also attempted to exterminate rats carried on passenger /cargo boats in ports. We have also started for provincial health staff special courses in preventive hygiene dealing with early screening techniques for communicable diseases, the expanded programme on immunization, international cooperation in the study of some interesting epidemiological problems, the control of epidemics and optimal use of equipment provided by international agencies and intended for health centres and health and epidemiological posts in the provinces or districts. Thanks to the intensive use of the above-mentioned means, the situation with respect to epidemic diseases in the country was relatively stable in the first six months of 1982. Isolated cases of dangerous communicable diseases like cholera and plague occurred only in former endemic foci in the provinces or cities in the south. 2. IMPROVING THE QUALITY OF CLINICAL MANAGEMENT AND TREATMENT, PROMOTING THE PREVENTION AND CONTROL OF SOCIAL DISEASES
2.1 In the last few months there has been some laxity in hospital management which has adversely affected the quality of clinical management and treatment. This has been corrected through the strengthening of supervision. We have just completed an analysis of the costs of clinical management and treatment, and are endeavouring to resolve some of the practical problems in hospitals in order to maintain and improve the quality of case investigation and treatment. 2.2 Prophylactic activities in respect of social diseases have produced some positive results. Malaria: DDT spraying, control of relapses, blood smears to detect haematozoa are being continued. However, tolerance of anopheles to DDT, resistance of patients to antimalaria drugs, and demographic variations have made the problem of malaria control more complex, especially in endemic areas. The parasite rate in the northern provinces is 0.2% (as against 0.25% in the first six months of 1981); in the southern provinces, 3% (similar to the rate of 1981). - Tuberculosis: Tuberculosis patients have been treated regularly with 1'-JH associated with pirizinamide. Because of various difficulties, BCG vaccinations of newborns could not be carried out according to prescribed norms. - Sexually transmitted diseases; Thanks to the international agencies who have supplied drugs and chemicals, we have had the necessary resources to develop STD control activities. However, because of the lack of specialists, the organization of STD control is still inadequate, and laboratory investigation, treatment and screening of patients are still below the necessary level. STD appears to be increasing in the cities in the south. The control of trachoma, leprosy, mental disorders and goitre continues to rnake progress.
- 33. MATERNAL AND CHILD HEALTH PROTECTION
We intend to extend systematic health care to pregnant women in order to reduce rnorbidi ty due to gynaecological affections, to lower the birth rate and to limit communicable disease among children. Thanks to the network of health stations in rural areas during past years, we were able to carry out 2 to 3 prenatal consultations for each pregnant woman but recently, owing to the insufficient training of midwives, the health facilities responsible have only been able to provide prenatal care for 80% of the pregnant women. The rate of post-partum accidents has thus increased. We are presently dealing with this problem. Treatment is being provided for one million women every year suffering from common gynaecological affections. The rate for these diseases has been reduced from 40% to 25- 30%, depending on the region. A strong impetus has been given to family planning. During the first six months of 1982, an additional 230 000 women started to use IUD; more than 500 000 other women are using other contraceptive means. A number of symposia have been conducted, and several groups of health personnel have been sent abroad to study the problem in order to reduce the rate of population increase to a reasonable level. We have also organized the provision of health care for children in day-nurseries and kindergartens (1 to 5 years), including prevention of communicable children•s disease, such as measles, pertussis, diphtheria, tetanus, and an epidemiological survey of nutrition with a view to early detection of cases of child malnutrition. 4. PROVISION OF ADEQUATE SUPPLIES OF DRUGS FOR PREVENTION AND TREATMENT OF DISEASE
Our main objective in 1982 is to increase the quantity of raw materials for the production of drugs. With this in view, the growing of medicinal plants is being encouraged, prescription (non-proprietary) preparations are being developed and the production of medicines from regional drugs is being fostered. In each village, the agricultural cooperative provides the health post with one or two hectares to grow 35 medicinal plants. The health post uses these in simple preparations for the treatment of common diseases (influenza, fever, cough, diarrhoea, dysentery, rheumatism, skin diseases); part of the plants collected will be exchanged for medicines prepared in the district. In the provinces, lands provided to the health services are reserved in priority for the production of a few valuable medicinal plants which are likely to adapt well to the regional climate and develop into a staple commodity used in industrial pharmaceutical production. Measures have been taken to protect and develop high value medicinal herbs, growing in a wild state over large areas, to allow for long-term cultivation. The State is also developing a few kolkhozes for medicinal plants to meet domestic or export needs.
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Prescription (non-proprietary) preparations are dispensed in city or hospital pharmacies. Pharmaceutical industries have continued to increase production of drugs, especially those prepared from local raw materials. In addition to the above-mentioned activities, we are making every effort to increase the export of drugs and proprietary medicines and are cooperating with a certain number of foreign countries in pharmaceutical production. 5.
TRAINING, REFRESHER COURSES, AND IMPROVING THE SCIENTIFIC AND TECHNICAL LEVELS OF HEALTH PERSOI'' '\IEL
In the course of the 1981-1982 academic year, 2200 students were admitted to faculties of medicine, pharmacy and stomatology, 1500 students from secondary and technical schools. We have just enrolled sixty students for higher medical studies (4 years) on a trial basis. The enrolment of pupils for secondary medical studies is left to the regional sectors who undertake the assignment of graduate medical students in the best possible way. Special attehtion is being given to refresher courses for health personnel. A total of 40 short training courses lasting from 1 to 3 months were given to technical and administrative staff. Post-graduate teaching is provided both at Hanoi and Ho Chi Minh City. WHO has helped us start courses on cellular regeneration (ICRO), diarrhoea, and the expanded programme on immunization. These are some of the major activities. carried out as usual. Routine health activities are being
In response to the appeal from the United Nations concerning the "Water Decade" and the "International Year of the Elderly", we are developing facilities to increase the supply of safe water to villagers and town dwellers, and have established a research unit on ''health and diseases of the elderly"; geriatric services have been introduced in a number of hospitals as well as an "open air health club" for retired staff to stimulate the interest and well-being of elderly citizens. A meeting of health ministers of three countries: Lao People's Democratic Republic, Kampuchea, and Viet Nam was held in Vientiane on 26-28 July 1982 to strengthen health cooperation among the three countries. The meeting was very successful and contributed to the stabilization of the situation in the region. Health cooperation with the socialist countries is increasing and becoming stronger. The USSR and the socialist countries have extended their assistance on numerous occasions. Health cooperation with other countries in the region and with international agencies has also steadily developed. In 1981, we received through the assistance of international agencies and particularly through the efficient and invaluable support of WHO, a large quantity of equipment, appliances, drugs and raw materials for the preparation of drugs.
-5In the first half of 1981, we received visits from thirty-two missions of WHO specialists to discuss the implementation of signed projects and to work out new projects for the future. We were in particular very honoured to receive the Regional Director of WHO on an official working visit.